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(1) Background: the aims of this study were to determine the total extent of pancreatic cancer's internal motions, using Calypso ® extracranial tracking, and to indicate possible clinical advantages of continuous intrafractional fiducial-based tumor motion tracking during SABR. (2) Methods: thirty-four patients were treated with SABR for LAPC using Calypso ® for motion management. Planning MSCTs in FB and DBH, and 4D-CTs were performed. Using data from Calypso ® and 4D-CTs, the movements of the lesions in the CC, AP and LR directions, as well as the volumes of the 4D-CT-based ITV and the volumes of the Calypso ® -based ITV were compared. (3) Results: significantly larger medians of tumor excursions were found with Calypso ® than with 4D-CT: CC: 29 mm ( p &lt; 0.001); AP: 14 mm ( p &lt; 0.001) and LR: 11 mm ( p &lt; 0.039). The median volume of the Calypso ® -based ITV was significantly larger than that of the 4D-CT based ITV ( p &lt; 0.001). (4) Conclusion: beside known respiratory-induced internal motions, pancreatic cancer seems to have significant additional motions which should be considered during respiratory motion management. Only direct and continuous intrafractional fiducial-based motion tracking seems to provide complete coverage of the target lesion with the prescribed isodose, which could allow for safe tumor dose escalation.

current oncology

An Evaluation of Total Internal Motions of Locally Advanced Pancreatic Cancer during SABR Using Calypso® Extracranial Tracking, and Its Possible Clinical Impact on Motion Management