Case report of visual biofeedback-driven, magnetic resonance-guided single-fraction SABR in breath hold for early stage non-small-cell lung cancer.

Stereotactic ablative body radiation therapy (SABR) is a well-established alternative to surgery for early stage non-small-cell lung cancer (NSCLC). While SABR is typically delivered in 3 to 5 fractions, randomized trials have shown single-fraction SABR to be a reasonable alternative. We present the case of a 66-year-old male with history of cholangiocarcinoma who was subsequently diagnosed with peripheral early stage NSCLC and treated in mid-inspiration breath hold (BH) to 34 Gy in 1 fraction on a magnetic resonance (MR)-guided linear accelerator, with treatment delivery completed in 17 minutes. Visual biofeedback was utilized to maximize patient compliance with appropriate depth of inspiration BH and improve overall treatment delivery time efficiency. The benefits of single- vs multifraction SABR and unique advantages of MR guidance that are particularly well-suited for single-fraction SABR are reviewed.
Competing Interests: Conflicts of Interest MDC reports grants, personal fees, and nonfinancial support from ViewRay; personal fees and nonfinancial support from Sirtex; personal fees and nonfinancial support from Accuray; grants from AstraZeneca, personal fees from Advanced Accelerator Applications, outside the submitted work. RK reports personal fees from Accuray, personal fees and nonfinancial support from Peerview, Inc., personal fees and nonfinancial support from Elsevier, inc., grants, personal fees and non-financial support from ViewRay, grants, personal fees and nonfinancial support from Elekta, grants, personal fees and nonfinancial supportfrom Novocure, outside the submitted work. MM reports personal fees from Mevion, personal fees from Karyopharm, personal fees from Tocagen, personal fees from AstraZeneca, personal fees from Blue Earth Diagnostics, and serves on the Board of Directors of Oncoceutics (with options), outside the submitted work. ANG reports personal fees and nonfinancial support from ViewRay outside the submitted work. FD reports personal fees from Sirtex, outside the submitted work. KM reports personal fees and nonfinancial support from ViewRay, other from MR Guidance, LLC, outside the submitted work.
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