Respiratory Gating Techniques for Optimization of Lung Cancer Radiotherapy Philippe Giraud, MD, PhD, Esra Morvan, PhD, Line Claude, MD, Françoise Mornex,

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Respiratory Gating Techniques for Optimization of Lung Cancer Radiotherapy Philippe Giraud, MD, PhD, Esra Morvan, PhD, Line Claude, MD, Françoise Mornex, MD, PhD, Cécile Le Pechoux, MD, Jean-Marc Bachaud, MD, Pierre Boisselier, MD, Véronique Beckendorf, MD, Magali Morelle, MD, Marie-Odile Carrère, MD, PhD Journal of Thoracic Oncology Volume 6, Issue 12, Pages 2058-2068 (December 2011) DOI: 10.1097/JTO.0b013e3182307ec2 Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1. Patient in the treatment position with the SDX spirometric device and diagram of the breathing curve (red) visualized by the patient with the video glasses and by the operator. The patient visualizes the time course of lung volume (red) and the degree of breath-hold (green zone) determined during a training session. After three FB cycles, the patient is asked to achieve and maintain this DIBH level (plateau phase of the red curve). CT acquisition or irradiation is performed during this phase. Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2. The RPM system. An infrared camera illuminates a marker placed on the patient's abdomen, onto which two reflectors are fixed. Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3. Target volumes in axial (A), coronal (B), sagittal (C), and 3D views defined according to the protocol recommendations: GTV (red), CTV (blue), ITV (green), and set-up margin (yellow). Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4. Correlation curves between two consecutive respiratory-gated CT acquisitions with (A) all respiratory gating devices and (B) for the three devices separately analyzed for CTV and TLV. Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 5. Comparison of TLV distribution and of the lung volume receiving a dose of at least 25 Gy (V25) according to the respiratory gating technique: with (RGRT) or without (CRT) respiratory gating. Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 6. Comparison of distributions of the Cardiac Dmax and V40 between a radiotherapy technique with (RGRT) or without (CRT) respiratory gating. Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 7. Overall (A) and disease-free (B) survival (log-rank test) according to the radiotherapy technique with (RGRT) or without (FB) respiratory gating. Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 8. Comparison of TLV distribution according to three devices (ABC, SDX, and RPM) separately analyzed. Journal of Thoracic Oncology 2011 6, 2058-2068DOI: (10.1097/JTO.0b013e3182307ec2) Copyright © 2011 International Association for the Study of Lung Cancer Terms and Conditions