RESUMO
Historically, respiratory induced motion has made renal radiotherapy difficult due to the potential risk of additional toxicities to the patient due to tumor movement. The use of deep inspiration breath holds (DIBH) in congruence with magnetic resonance guided radiotherapy (MRgRT) may be an effective method to manage tumor and organ at risk (OAR) motion and deliver radiation safer and more effectively. The purpose of this case study was to evaluate the effectiveness of DIBH in sparing radiation dose to colon and small bowel during MRgRT of right sided renal cell carcinoma (RCC). The goals were to reduce radiation dose to colon and small bowel during RCC treatment with these motion management techniques. A retrospective case study of a patient with oligoprogression in the postoperative renal fossa was found to be a candidate for DIBH using MRgRT. Treatment planning called for motion management and real-time imaging in order to safely treat the tumor volume. Results were evaluated by the achievement of specific dosimetric criteria and tolerances and the regression of disease in the renal fossa. The use of real-time imaging and simultaneous motion management proved to be effective tools for the treatment of RCC. This radiation therapy treatment resulted in the elimination of malignancy at the primary site of disease.