A feasibility trial of skin surface motion-gated stereotactic body radiotherapy for treatment of upper abdominal or lower thoracic targets using a novel O-ring gantry

•A new O-ring gantry gates SBRT by surface monitoring, but needs clinical validation.•In this feasibility trial, surface-guided gating at breath-hold was feasible.•During gated breath-hold, tumor residual motion averaged 2 mm.•Online plan adaptation was feasible and usually dosimetrically superior.•After three months, no patient suffered local progression or a grade 3 toxicity. A novel O-ring gantry can deliver stereotactic body radiation therapy (SBRT) with artificial intelligence-facilitated, CT-guided online plan adaptation. It gates mobile targets by optically monitoring skin surface motion. However, this gating solution has not been clinically validated. We conducted a trial to evaluate the feasibility of optical skin surface-guided gating for patients with mobile upper abdominal or lower thoracic malignancies treated with SBRT on this platform (NCT05030454). Ten patients who were prescribed SBRT to a thoracic or abdominal target and were capable of breath-hold for at least 17 s enrolled. They received SBRT in five fractions with breath-hold technique and optical skin surface motion monitored-gating with a ± 2 mm tolerance. Online plan adaptation was left to the discretion of the daily treating physician. The primary endpoint was defined as successful completion of > 75 % of attempted fractions. Exploratory endpoints included local control and acute grade ≥ 3 toxicity rates after three months. For adapted fractions the contouring, planning, quality assurance, and treatment delivery times were recorded. Forty-seven of 51 SBRT fractions (92 %) were successfully gated at breath-hold by optical skin surface motion monitoring. The tumor centroid position during breath-hold varied by a mean of approximately 2 mm. Sixty-three percent of fractions were adapted online with a median total treatment time of 78.5 min. After three months no local recurrences or acute grade ≥ 3 toxicities were observed. SBRT treatment to mobile targets with surface-monitored gating on a novel O-ring gantry was prospectively validated.