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Chua JZ, Lim LH, Pang EPP, Kusumawidjaja G. Use of immobilisation bra for daily setup of patients with pendulous breasts undergoing radiotherapy. Strahlenther Onkol 2024; 200:287-295. [PMID: 37658923 DOI: 10.1007/s00066-023-02131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/16/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE A feasibility study to evaluate the Chabner XRT® Radiation Bra (CIVCO Radiotherapy & Qfix, Coralville, IA, USA) as a customised immobilisation device for patients with pendulous breasts undergoing radiotherapy was conducted. METHODS A total of 34 patients with large pendulous breasts were fitted with the Chabner XRT® Radiation Bra during RT. A mixed-method questionnaire was administered to both radiation therapists (RTTs) and patients. RTTs evaluated the effectiveness of the bra in setup. Patients appraised its comfort level and ease of wearing. Setup reproducibility was evaluated based on a departmental imaging protocol. Acute skin side effects were documented with photos and assessed using the Radiation Therapy Oncology Group (RTOG) classification. RESULTS Of the patients, 27 (79.4%) completed the questionnaire. 23 patients felt comfortable wearing the bra while 20 felt less exposed during treatment. Reproducibility was acceptable, with a median (range) setup error (isocentre) of 0.0 cm (-0.6 to 0.7 cm; left/right), -0.1 cm (-0.5 to 1.2 cm; posterior) and 0.2 cm (-0.5 to 0.9 cm; inferior) achieved based on matched field borders on skin. However, repeated setups and imaging were required for 3 patients due to large breast size (cups D-G; size 4-5). Minimal skin toxicity (grade 0-1) was observed. No grade ≥ 2 was reported. 10 RTTs completed the survey. Male RTTs (n = 4) were not confident in assisting patients with bra fitting. 8 RTTs agreed that although it was difficult to reproduce the breast tissue for treatment, it helped patients to maintain the treatment position. CONCLUSION Our study demonstrated the feasibility of using a customised bra which provided optimal setup reproducibility while maintaining minimal skin toxicity and patient comfort, especially the value-added modesty felt among Asian women during their breast cancer radiotherapy.
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Affiliation(s)
- J Z Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, 168583, Singapore, Singapore
| | - L H Lim
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, 168583, Singapore, Singapore
| | - E P P Pang
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, 168583, Singapore, Singapore
- Duke-NUS Graduate Medical School, 8 College Road, 169857, Singapore, Singapore
| | - G Kusumawidjaja
- Division of Radiation Oncology, National Cancer Centre Singapore, 30 Hospital Boulevard, 168583, Singapore, Singapore.
- Duke-NUS Graduate Medical School, 8 College Road, 169857, Singapore, Singapore.
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Mast M, Leong A, Korreman S, Lee G, Probst H, Scherer P, Tsang Y. ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation. Tech Innov Patient Support Radiat Oncol 2023; 28:100219. [PMID: 37745181 PMCID: PMC10511493 DOI: 10.1016/j.tipsro.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- M.E. Mast
- Department of Radiation Oncology, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - A. Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
- Bowen Icon Cancer Centre, Wellington, New Zealand
| | - S.S. Korreman
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Oncology, Aarhus University Hospital, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - G. Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - H. Probst
- Sheffield Hallam University, Sheffield, United Kingdom
| | - P. Scherer
- Department of Radiotherapy and Radio-Oncology, LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - Y. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Costin IC, Marcu LG. Factors impacting on patient setup analysis and error management during breast cancer radiotherapy. Crit Rev Oncol Hematol 2022; 178:103798. [PMID: 36031175 DOI: 10.1016/j.critrevonc.2022.103798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy is required to deliver an accurate dose to the tumor while protecting surrounding normal tissues. Breast cancer radiotherapy involves a number of factors that can influence patient setup and error management, including the immobilization device used, the verification system and the patient's treatment position. The aim of this review is to compile and discuss the setup errors that occur due to the above-mentioned factors. In view of this, a systematic search of the scientific literature in the Medline/PubMed databases was performed over the 1990-2021 time period, with 93 articles found to be relevant for the study. To be accessible to all, this study not only aims to identify factors impacting on patient setup analysis, but also seeks to evaluate the role of each verification device, board immobilization and position in influencing these errors.
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Affiliation(s)
- Ioana-Claudia Costin
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; "Dr. Gavril Curteanu" County Hospital, Oradea 410469, Romania
| | - Loredana G Marcu
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia.
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Dong F, Weng X, Deng X, Yang Y, Xu B, Li X. Clinical utility of a new immobilization method in image-guided intensity-modulated radiotherapy for breast cancer patients after radical mastectomy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:641-655. [PMID: 35367978 DOI: 10.3233/xst-221127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate clinical utility of a new immobilization method in image-guided intensity-modulated radiotherapy (IMRT) for breast cancer patients after radical mastectomy. MATERIALS AND METHODS Forty patients with breast cancer who underwent radical mastectomy and postoperative IMRT were prospectively enrolled. The patients were randomly and equally divided into two groups using both a carbon-fiber support board and a hollowed-out cervicothoracic thermoplastic mask (Group A) and using only the board (Group B). An iSCOUT image-guided system was used for acquiring and correcting pretreatment setup errors for each treatment fraction. Initial setup errors and residual errors were obtained by aligning iSCOUT images with digitally reconstructed radiograph (DRR) images generated from planning CT. Totally 600 initial and residual errors were compared and analyzed between two groups, and the planning target volume (PTV) margins before and after the image-guided correction were calculated. RESULTS The initial setup errors of Group A and Group B were (3.14±3.07), (2.21±1.92), (2.45±1.92) mm and (3.14±2.97), (2.94±3.35), (2.80±2.47) mm in the left-right (LAT), superior-inferior (LONG), anterior-posterior (VERT) directions, respectively. The initial errors in Group A were smaller than those in Group B in the LONG direction (P < 0.05). No significant difference was found in the distribution of three initial error ranges (≤3 mm, 3-5 mm and > 5 mm) in each of the three translational directions for the two groups (P > 0.05). The residual errors of Group A and Group B were (1.74±1.03), (1.62±0.92), (1.66±0.91) mm and (1.70±0.97), (1.68±1.18), (1.58±0.98) mm in the three translational directions, respectively. No significant difference was found in the residual errors between two groups (P > 0.05). With the image-guided correction, PTV margins were reduced from 8.01, 5.44, 5.45 mm to 3.54, 2.99, 2.89 mm in three translational directions of Group A, respectively, and from 8.14, 10.89, 6.29 mm to 2.67, 3.64, 2.74 mm in those of Group B, respectively. CONCLUSION The use of hollowed-out cervicothoracic thermoplastic masks combined with a carbon-fiber support board showed better inter-fraction immobilization than the single use of the board in reducing longitudinal setup errors for breast cancer patients after radical mastectomy during IMRT treatment course, which has potential to reduce setup errors and improve the pretreatment immobilization accuracy for breast cancer IMRT after radical mastectomy.
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Affiliation(s)
- Fangfen Dong
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xing Weng
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xianzhi Deng
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Yong Yang
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Benhua Xu
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xiaobo Li
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
- Department of Engineering Physics, Tsinghua University, Beijing, China
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Mulla Z, Iskanderani O, Weber A, AlMohamad A, Al-Amoodi MS, Soaida S. Comparing Accuracy of Thermoplastic Mask versus Commercial Bra for the Immobilization of Pendulous Breast During Radiation Therapy Treatment: A Retrospective Cohort Study. Adv Radiat Oncol 2021; 6:100592. [PMID: 33665487 PMCID: PMC7897755 DOI: 10.1016/j.adro.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/11/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose This study aimed to compare thermoplastic mask with bra in terms of setup reproducibility and immobilization of pendulous breasts during radiation therapy (RT). Methods and materials Forty-two female patients with breast cancer treated with either intensity modulated RT or 3-dimensional conformal RT were retrospectively reviewed. Of these, 21 benefited from thermoplastic mask immobilization and 21 used a bra. Setup accuracy was evaluated using consecutive cone beam computed tomography/electronic portal imaging device sessions over the first 3 days before treatment (systematic setting), followed by weekly cone beam computed tomography/electronic portal imaging device (random settings), and compared with the reference image to calculate the corresponding translational shift (setup error) in the 3 planes. Average absolute shift values in both systematic and random settings were compared between the 2 groups. Accuracy was analyzed by comparing the percentage of pooled settings within ±0.05 and ±0.1 cm of the reference image. Results Compared with a bra, use of the mask was associated with a smaller longitudinal shift in systematic settings (difference in mean: 0.27 cm; P = .027; Mann-Whitney U test) and a lesser lateral shift in random setting (difference in mean: 0.19 cm; P = .005; Mann-Whitney U test). In the pooled systematic settings, the mask performed relatively better than the bra in the lateral and longitudinal planes, with no statistical significance. In pooled random settings, mask showed greater accuracy than bra in the lateral plane with 86.0% versus 58.9% accuracy at ±0.5 cm (P < .001) and 48.8% versus 21.7% accuracy at ±0.1 cm (P < .001), respectively. There was no significant difference in the incidence of radiodermatitis between the 2 groups. However, a hypofractionation regimen was associated with a lower incidence of radiodermatitis, and the severity of skin reactions was positively correlated with treatment dose (unstandardized regression coefficient: B = .001; correlation coefficient: r = .571; P < .001). Conclusions Masks provide superior reproducibility compared with commercially available bras.
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Affiliation(s)
- Zaheeda Mulla
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Corresponding author: Zaheeda Mulla
| | - Omar Iskanderani
- Department of Oncology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amina Weber
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdullah AlMohamad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Shamel Soaida
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Stewart D, Ambat J, Wallis S, Gurram M, Martin R. Breast Radiation Therapy Using a Breast Cup: Moving the Target, Not the Patient. Pract Radiat Oncol 2020; 10:e238-e243. [DOI: 10.1016/j.prro.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/22/2019] [Accepted: 10/20/2019] [Indexed: 11/26/2022]
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Han MC, Hong CS, Chang KH, Kim J, Han SC, Kim DW, Park K, Kim MJ, Shin HB, Lee SH, Kim JS. TomoMQA: Automated analysis program for MVCT quality assurance of helical tomotherapy. J Appl Clin Med Phys 2020; 21:151-157. [PMID: 32268003 PMCID: PMC7324692 DOI: 10.1002/acm2.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose In this study, we developed a simple but useful computer program, called TomoMQA, to offer an automated quality assurance for mega‐voltage computed tomography (MVCT) images generated via helical tomotherapy. Methods TomoMQA is written in MATLAB and contains three steps for analysis: (a) open the DICOM dataset folder generated via helical tomotherapy (i.e., TomoTherapy® and Radixact™), (b) call the baseline data for the consistency test and click the “Analysis” button (or click the “Analysis” button without the baseline data and export the results as the baseline data), and (c) print an analyzed report. The overall procedure for the QA analysis included in TomoMQA is referred from the TG‐148 recommendation. Here, the tolerances for MVCT QA were implemented from TG‐148 recommended values as default; however, it can be modified by a user manually. Results To test the performance of the TomoMQA program, 15 MVCTs were prepared from five helical tomotherapy machines (1 of TomoTherapy® HD, 2 of TomoTherapy® HDA, and 2 of Radixact™) in 3 months and the QA procedures were performed using TomoMQA. From our results, the evaluation revealed that the developed program can successfully perform the MVCT QA analysis irrespective of the type of helical tomotherapy equipment. Conclusion We successfully developed a new automated analysis program for MVCT QA of a helical tomotherapy platform, called TomoMQA. The developed program will be made freely downloadable from the TomoMQA‐dedicated website.
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Affiliation(s)
- Min Cheol Han
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Su Chul Han
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Min-Joo Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Seoul, Korea.,Department of Biomedical Engineering, Research Institute of Biomedical Engineering, College of Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Han Back Shin
- Department of Radiation Oncology, Yonsei Cancer Center, Seoul, Korea
| | - Se Hyung Lee
- Department of Nuclear Engineering, Hanyang University, Seoul, Korea.,Department of Radiation Oncology, Bundang Jesaeng General Hospital, Gyeonggi-do, Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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Biston MC, Jarril J, Dupuis P, Boisbouvier S, Gassa F, Cervellera M, Chabaud S, Racadot S. Comparison among four immobilization devices for whole breast irradiation with Helical Tomotherapy. Phys Med 2020; 69:205-211. [PMID: 31918372 DOI: 10.1016/j.ejmp.2019.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/30/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the repositioning accuracy of 4 immobilization devices (ID) used for whole breast Helical Tomotherapy treatments: arm float with VacFix® (Par Scientific, Denmark), all-in-one® (AIO®) system (Orfit, Belgium), MacroCast thermoplastic mask (Macromedics, The Netherlands) and BlueBag® system with Arm-Shuttle (Elekta, Sweden). MATERIALS AND METHODS Twenty four women with breast cancer with PTV including the breast/chest wall and lymph nodes were involved in this study (6 women per group). Pretreatment registration results were first collected using automatic bone registration + manual adjustment on the vertebra followed by independent registrations on different ROIs representing each treated area (axillary, mammary chain, clavicular, breast/chest wall). The differences in translations and rotations between reference registration and the above mentionned ROIs were calculated. A total of 120 MVCT images were analyzed. RESULTS Significant differences were found between IDs (p < 0.0001), ROIs (p = 0.0002) and the session number (p < 0.0001) on the observed shifts, when examining 3D translation vectors. 3D-vectors were significantly lower for the BlueBag® than for the VacFix® or for the AIO® (p < 0.0001), but differences were not significant compared to the mask (p = 0.674). Finally, setup margins were overall smaller for the BlueBag® than for other IDs, with values ranging from 1.53 to 1.91 mm on the mammary chain area, 4.52-6.07 mm on the clavicular area, 2.71-4.62 mm on the axillary area, and 3.39-5.10 mm on the breast. CONCLUSION We demonstrated in this study that the BlueBag® combined with arm shuttle is a robust solution for breast and nodes immobilization during HT treatments.
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Affiliation(s)
- Marie-Claude Biston
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France; CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
| | - Jimmy Jarril
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | - Pauline Dupuis
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | | | - Frédéric Gassa
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | | | - Sylvie Chabaud
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
| | - Séverine Racadot
- Centre Léon Bérard, 28, rue Laennec, 69373 Lyon Cedex 08, France
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Tong Y, Gong G, Chen J, Lu J, Liu T, Cheng P, Yin Y. The heterogeneous CTV-PTV margins should be given for different parts of tumors during tomotherapy. Oncotarget 2017; 8:89086-89094. [PMID: 29179501 PMCID: PMC5687671 DOI: 10.18632/oncotarget.21631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to evaluate CTV-PTV margins of tumors for tomotherapy. Methods Setup errors were analyzed for 151 patients receiving helical tomotherapy treatment. 53 patients had head and neck tumors, 45 had thoracic tumors, 20 had abdominal tumors, and 33 had pelvic tumors. The setup errors were calculated in six directions, i.e. +X (left), -X (right), +Y (head), -Y (foot), +Z (ventral), and -Z (dorsal), after Megavoltage CT (MVCT) images were registered to simulation CT images. And then the CTV-PTV margins were calculated. Results The setup errors along the +Z direction were significantly higher than that along the –Z direction (p<0.05). The CTV-PTV margins on +X, -X, +Y, -Y, +Z, and -Z directions were asymmetric for all tumors, and the heterogeneity were more remarkable on the +Z and –Z directions. The CTV-PTV margins on +Z and –Z were 4.1 mm, 4.6 mm, 5.2 mm, and 8.4 mm; and 3.9 mm, 7.7 mm, 3.3 mm, and 7.7 mm for head and neck tumors, thoracic tumors, abdominal tumors, and pelvic tumors, respectively. Conclusions The CTV-PTV margins for patients with different types of tumors were heterogeneous during tomotherapy. The individual margins of six directions should be given for those patients who accept tomotherapy.
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Affiliation(s)
- Ying Tong
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Guanzhong Gong
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jinhu Chen
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jie Lu
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Tonghai Liu
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Pinjing Cheng
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Yong Yin
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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Joseph K, Warkentin H, Ghosh S, Polkosnik LA, Powell K, Brennan M, Warkentin B, Jacobs J, Alkaabi K, Chafe S, Tankel K, Gabos Z, Liu HW, Tai P. Cardiac-sparing radiation therapy using positioning breast shell for patients with left-sided breast cancer who are ineligible for breath-hold techniques. Adv Radiat Oncol 2017; 2:532-539. [PMID: 29204519 PMCID: PMC5707409 DOI: 10.1016/j.adro.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 12/05/2022] Open
Abstract
Purpose Patients with left-sided breast cancer (LSBC) are at increased risk of cardiac morbidity from adjuvant breast radiation therapy (ABRT). Breath-hold (BH) techniques substantially reduce the radiation received by heart during radiation therapy for LSBC. However, a subset of patients with LSBC are ineligible for BH techniques due to an inability to breath-hold or because of other comorbidities. To reduce radiation to the heart, we routinely use a custom-made breast shell for the treatment of patients with LSBC who are ineligible for BH techniques. This study evaluates the dosimetric impact of using a breast shell for patients with LSBC undergoing ABRT. Methods and materials Sixteen consecutive patients with LSBC who failed BH and underwent ABRT using a breast shell during the period of 2014 to 2016 were identified. Treatment was planned using field-in-field tangents with a prescribed dose of 42.5 Gy in 16 fractions. Comparisons between plans with and without a shell were made for each patient using a paired t test to quantify the sparing of organs at risk (OARs) and target coverage. Results There was no statistically significant difference in the planning target volume of breast coverage. A statistically significant improvement was observed in sparing the heart, left ventricle (LV), and ipsilateral lung (P-value < .001). Plans with the shell spared OARs better than the no-shell plans with a mean dose of 2.15 Gy versus 5.15 Gy (58.2% reduction) to the heart, 3.27 Gy versus 9.00 Gy (63.7% reduction) to the LV, and 5.16 Gy versus 7.95 Gy (35% reduction) to the ipsilateral lung. The irradiated volumes of OARs for plans with and without shell are 13.3 cc versus 59.5 cc (77.6% reduction) for the heart, 6.2 cc versus 33.2 cc (81.2% reduction) for the LV, and 92.8 cc versus 162.5 cc (42.9% reduction) for the ipsilateral lung. Conclusions A positioning breast shell offers significant benefit in terms of sparing the heart for patients with LSBC who are ineligible for BH techniques. It also can be used as a simple cardiac-sparing alternative in centers without BH capability.
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Affiliation(s)
- Kurian Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Heather Warkentin
- Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Lee-Anne Polkosnik
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Kent Powell
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Matthew Brennan
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Brad Warkentin
- Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | - Khalifa Alkaabi
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Susan Chafe
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Zsolt Gabos
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Hong-Wei Liu
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Alberta, Canada
| | - Patricia Tai
- Division of Radiation Oncology, Department of Oncology, University of Saskatchewan & Allan Blair Cancer Center, Regina, Saskatchewan, Canada
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Meyer P, Le Pennec F, Hui SK, Dehaynin N, Jarnet D, Gantier M, Niederst C, Mazzara C, Baudrier E, Noblet V. Megavoltage 2D topographic imaging: An attractive alternative to megavoltage CT for the localization of breast cancer patients treated with TomoDirect. Phys Med 2017; 39:33-38. [DOI: 10.1016/j.ejmp.2017.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022] Open
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Ricotti R, Ciardo D, Fattori G, Leonardi MC, Morra A, Dicuonzo S, Rojas DP, Pansini F, Cambria R, Cattani F, Gianoli C, Spinelli C, Riboldi M, Baroni G, Orecchia R, Jereczek-Fossa BA. Intra-fraction respiratory motion and baseline drift during breast Helical Tomotherapy. Radiother Oncol 2017; 122:79-86. [DOI: 10.1016/j.radonc.2016.07.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/08/2016] [Accepted: 07/09/2016] [Indexed: 11/30/2022]
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