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Review Open Access

Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review)

  • Authors:
    • Kainan Shao
    • Weijun Chen
    • Yaping Xu
    • Shuangyan Yang
  • View Affiliations / Copyright

    Affiliations: Cancer Center, Department of Radiation Oncology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China, Department of Radiation Oncology, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, P.R. China
    Copyright: © Shao et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 415
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    Published online on: June 27, 2025
       https://doi.org/10.3892/ol.2025.15161
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Abstract

Respiratory‑induced tumor motion is a major obstacle in the precise delivery of stereotactic body radiotherapy (SBRT) for lung cancer, often leading to geometric uncertainties, insufficient tumor coverage and increased radiation‑induced toxicity such as pneumonitis, esophagitis and rib fractures. The present review systematically assesses motion management techniques used in lung SBRT, synthesizing evidence from 352 high‑quality clinical studies published between 2000 and 2024. Selected studies included patients with non‑small cell lung cancer treated exclusively with SBRT which incorporated strategies such as deep inspiration breath‑hold, abdominal compression, respiratory gating and real‑time tumor tracking, and often integrated with image guidance technologies such as 4DCT, cone beam CT and MRI. These techniques demonstrated notable reductions in planning target volume margins and normal tissue dose, leading to improved local control and lower toxicity rates, particularly in tumors with large motion amplitudes or proximity to critical structures. Despite these benefits, implementation remains variable due to patient‑specific challenges, technical complexity and institutional resource differences. The present review highlights the clinical applications and limitations of each strategy, and proposes a decision‑making framework to guide clinicians in selecting the most appropriate motion management strategy based on tumor characteristics, motion amplitude and patient‑specific factors. The integration of respiratory motion management with advanced imaging is essential for optimizing therapeutic outcomes and safety in lung SBRT.
View Figures

Figure 1

Schematic illustration of four
respiratory motion management strategies in lung stereotactic body
radiotherapy. (A) Breath-holding (deep inspiration breath-hold):
Patient holds a deep inspiration to stabilize tumor position by
expanding the lungs and lowering the diaphragm. (B) Abdominal
compression: External pressure limits diaphragmatic movement to
reduce tumor motion. (C) Respiratory gating: Radiation is delivered
only during selected phases of the breathing cycle, guided by
internal or external surrogates. (D) Real-time tumor tracking:
Tumor position is continuously monitored and the beam dynamically
follows the moving target.
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Copy and paste a formatted citation
Spandidos Publications style
Shao K, Chen W, Xu Y and Yang S: Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review). Oncol Lett 30: 415, 2025.
APA
Shao, K., Chen, W., Xu, Y., & Yang, S. (2025). Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review). Oncology Letters, 30, 415. https://doi.org/10.3892/ol.2025.15161
MLA
Shao, K., Chen, W., Xu, Y., Yang, S."Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review)". Oncology Letters 30.3 (2025): 415.
Chicago
Shao, K., Chen, W., Xu, Y., Yang, S."Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review)". Oncology Letters 30, no. 3 (2025): 415. https://doi.org/10.3892/ol.2025.15161
Copy and paste a formatted citation
x
Spandidos Publications style
Shao K, Chen W, Xu Y and Yang S: Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review). Oncol Lett 30: 415, 2025.
APA
Shao, K., Chen, W., Xu, Y., & Yang, S. (2025). Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review). Oncology Letters, 30, 415. https://doi.org/10.3892/ol.2025.15161
MLA
Shao, K., Chen, W., Xu, Y., Yang, S."Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review)". Oncology Letters 30.3 (2025): 415.
Chicago
Shao, K., Chen, W., Xu, Y., Yang, S."Application of respiratory motion management technology for patients with lung cancer treated with stereotactic body radiotherapy (Review)". Oncology Letters 30, no. 3 (2025): 415. https://doi.org/10.3892/ol.2025.15161
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