Published online Jun 10, 2017. doi: 10.5306/wjco.v8.i3.300
Peer-review started: December 5, 2016
First decision: February 21, 2017
Revised: March 3, 2017
Accepted: April 18, 2017
Article in press: April 20, 2017
Published online: June 10, 2017
Processing time: 179 Days and 19.8 Hours
Stereotactic body radiotherapy (SBRT) is a widely accepted option for the treatment of medically inoperable early-stage non-small cell lung cancer (NSCLC). Herein, we highlight the importance of interfraction image guidance during SBRT. We describe a case of early-stage NSCLC associated with segmental atelectasis that translocated 15 mm anteroinferiorly due to re-expansion of the adjacent segmental atelectasis following the first fraction. The case exemplifies the importance of cross-sectional image-guided radiotherapy that shows the intended target, as opposed to aligning based on rigid anatomy alone, especially in cases associated with potentially “volatile” anatomic areas.
Core tip: This is a case of early-stage non-small cell lung cancer associated with segmental atelectasis that translocated owing to re-expansion of the adjacent segmental atelectasis following the first fraction. There are image-guidance systems that register solely based on rigid (bony) anatomy and others that also show soft tissue; if the former would have been used, the translocated target would have been missed. The case exemplifies the importance of cross-sectional image-guided radiotherapy that shows the intended target, as opposed to aligning based on rigid anatomy alone, in cases associated with potentially “volatile” anatomic areas.