The effects of set-up errors on dose distribution in radiotherapy treatment for lung cancer

Background: Our aim was to analyze the effects of set-up errors on dose distribution in radiotherapy treatment for lung cancer by using kilovoltage cone-beam CT (CBCT). Materials and Methods: In this study, we used a Varian IX linear accelerator system to perform CBCT scans of 30 lung cancer patients before radiotherapy. Subsequently, the image was matched with the planned CT, and the left and right (LR), top and bottom (SI), and front and back (AP) directions were set incorrectly. And in the CMS planning system, the center of the plan has been moved to the center of the actual scan. Finally, the dose distribution before the bed-moving is simulated. We want to explore the impact of the planned target volume setting error (PTV), the total tumor volume (GTV), and radiation of normal tissues. Results: The set-up errors of the LR, SI and AP directions were (-0.20 +/- 2.84), (-1.09 +/- 5.40), and (-2.61 +/- 2.08) mm, respectively. The 5mm error accounted for 97.8%, 73% and 92.6% in the three directions. Statistically significant differences were found in the distribution of 95% PTV dose, the average dose of PTV, 95% GTV dose and the average dose of GTV without bed-moving, compared with the original plan. Conclusions: In clinical lung cancer radiotherapy, the commonly used setting error is usually less than 5mm, most of which are along the AP direction. In this study, we found that the setting error is related to the patient's inherent characteristics and can significantly change the radiation treatment dose in the target area.