Markerless Image Guidance Using Intrafraction Kilovoltage X-ray Imaging

Inclusion criteria

• Is willing to comply with all trial procedures and intends to provide written Informed Consent for participation in this trial.
• Patients undergoing external beam radiotherapy.
• Histologically proven Stage I NSCLC or oligometastatic lung metastases (3 or less).
• MRI/4D-CT prior to insertion of fiducial markers.
• Patient must be able to have fiducial markers placed in the lung (if on anticoagulants, must be cleared by LMO or cardiologist).
• ECOG performance status 0-2.
• A maximum of three metastases to the lung from any non-haematological malignancy. Multiple metastases will be treated separately.
• 1 cm ≤ Tumour diameter in any dimension ≤ = 5 cm.
• The distance between the tumour centroid and the top end of the diaphragm is \<=10 cm.

Exclusion criteria

• Patient has low respiratory performance as evaluated by the physicians.
• Previous high-dose thoracic radiotherapy.
• Less than one fiducial marker implanted in the lung.
• Fiducial markers are too far from the tumour centroid (\>9 cm).
• Cytotoxic chemotherapy within 3 weeks of commencement of treatment, or concurrently with treatment. Hormonal manipulation agents are allowable (e.g. aromatase inhibitors, selective oestrogen receptor modulators, and gonadotropin releasing hormone receptor modulators).
• Targeted agents (such as sunitinib, bevacizumab and tarceva) within 7 days of commencement of treatment, or concurrently with treatment.
• Women who are pregnant or lactating.
• Unwilling or unable to complete quality of life questionnaires.