Study of setup error in cone beam CT for whole breast intensity-modulated radiotherapy with breast board immobilization
Yu Shufei1,2, Wang Shulian1, Tang Yu1, Song Yongwen1, Chen Siye1, Li Minghui1, Jin Jing1, Liu Yueping1, Fang Hui1, Chen Bo1, Qi Shunan1, Li Ning1, Tang Yuan1, Lu Ningning1, Li Yexiong1
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences ( CAMS ) and Peking Union Medical College ( PUMC),Beijing 100021,China; 2Department of Oncology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China
Abstract：Objective To investigate the setup errors and influencing factors of the whole breast intensity-modulated radiotherapy (IMRT) after breast-conserving surgery, and to identify the margins from clinical target volume (CTV) to planning target volume (PTV). Methods Thirty patients with left-sided (n=15) or right-sided breast cancer (n=15) receiving whole breast hypofractionated IMRT with breast board immobilization after breast-conserving surgery in Cancer Hospital from 2016 to 2017 were enrolled. The kilo-voltage cone-beam computed tomography (CBCT) was used to compare the errors of planning CT and treatment unit and determine the setup errors. The margins from CTV to PTV were calculated. The setup errors under different conditions were statistically compared by t-test. Results A total of 151 sets of CBCT images were taken in the whole cohort,(5.0±1.3) sets per patient on average. The setup errors in the x-axis (left-right direction), y-axis (cranial-caudal direction) and z-axis (anterior-posterior direction) were (2.2±1.7) mm,(3.1±2.5) mm and (3.3±2.3) mm, respectively. The margins from CTV to PTV were 6.39 mm, 10.00 mm and 8.57 mm, respectively. The setup error in anterior-posterior direction in the first week was (3.7±2.5) mm, significantly larger than (2.6±1.6) mm in the following week (P=0.002). The setup error of the patients with overweight or obesity was (3.9±2.6) mm, significantly higher than (2.9±2.0) mm in those with normal weight in the z-axis direction (P=0.033). Conclusion The margins from CTV to PTV are recommended to be ranged from 6 to 10 mm during hypofractionated whole breast IMRT with breast board immobilization after breast-conserving surgery. More frequent imaging verification should be applied in the first week of IMRT.
Yu Shufei,Wang Shulian,Tang Yu et al. Study of setup error in cone beam CT for whole breast intensity-modulated radiotherapy with breast board immobilization[J]. Chinese Journal of Radiation Oncology, 2019, 28(7): 532-535.
[1]Bartelink H,Horiot J,Poortmans P,et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation[J]. N Engl J Med,2001,345(19):1378-1387. DOI:10.1056/NEJMoa010874. [2]Yarnold J,Ashton A,Bliss J,et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer:long-term results of a randomised trial[J]. Radiother Oncol,2005,75(1):9-17. DOI:10.1016/j.radonc.2005.01.005. [3]Bartelink H,Maingon P,Poortmans P,el al. Whole-breast irradiation with or without a boost for patients treated with breast·conserving surgery for early breast cancer:20-year follow-up of a randomised phase 3 trial[J]. Lancet Oncol,2015,16(1):47-56. DOI:10.1016/S1470-2045(14)71156-8. [4]van der Laan HP,Dolsma WV,Schilstra C,et alLimited benefit of inversely optimised intensity modulation in breast conserving radiotherapy with simultaneously integrated boost[J]. Radiother Oncol,2010,94(3):307-312. DOI:10.1016/j.radonc.2010.01.024. [5]Singla R,King S,Albuquerque K,et al. Simultaneous-integrated boost intensity-modulated radiation therapy (SIB-IMRT) in the treatment of early-stage left-sided breast carcinoma[J]. Med Dosim,2006,31(3):190-196. DOI:10.1016/j.meddos.2005.11.001. [6]彭冉,王淑莲,任雯廷,等,乳腺癌保乳术后同步加量IMRT前瞻性研究[J]. 中华放射肿瘤学杂志,2015,24(3):251-255. DOI:10.3760/cma.j.issn.1004-4221.2015.03.006. Peng R,Wang SL,Ren WT,et al. A prospective study of intensity-modulated radiotherapy with integrated boost after breast conservative surgery in breast cancer pafients[J]. Chin J Radiat Oncol,2015,24(3):251-255. DOI:10.3760/cma.j.issn.1004-4221.2015.03.006. [7]van Herk M,Remeijer P,Paseh C,et al. The probability of correct target dosage:dose-population histograms for deriving treatment margins in radiotherapy[J]. Int J Radiat Oncol Biol Phys,2000,47(4):1121-1135. DOI:10.1016/j.ijrobp.2011.09.010. [8]Lirette A,Pouliot J,Aubin M,et alThe role of electronic portal imaging in tangential breast irradiation:a prospective study[J]. Radiother Oncol,1995,37(2):241-245. DOI:10.1016/0167-8140(95)01653-8. [9]Fein DA,McGee KP,Schultbeiss TE,et alIntra-and interfractional reproducibility of tangential breast fields:a prospective on-line portal imaging study[J]. Int J Radiat Oncol Biol Phys.1996,34(4):733-740. DOI:10.1016/0360-3016(95)02037-3. [10]Kim LH,Wong J,Yan D. On-line localization of the lumpectomy cavity using surgical clips[J]. Int J Radiat Oncol Biol Phys,2007,69(4):1305-1309. DOI:10.1016/j.ijrobp.2007.07.2365. [11]Topolnjak R,van Vliet-Vroegindeweij C,Sonke JJ,et al. Breast-conserving therapy:radiotherapy margins for breast tumor bed boost[J]. Int J Radiat Oncol Biol Phys,2008,72(3):941-948. DOI:10.1016/j.ijrobp.2008.06.1924. [12]Topolnjak R,Sonke JJ,Nijkamp J,et alBreast patient setup error assessment:comparison of electronic portal image devices and cone-beam computed tomography matching results[J]. Int J Radiat Oncol Biol Phys,2010,78(4):1235-1243. DOI:10.1016/j.ijrobp.2009.12.021. [13]Joep C,Ben J,Heijmen M. Geometrical uncertainties,radiotherapy planning margins,and the ICRU 62 report[J]. Radiother Oncol,2002,64(1):75-83. DOI:10.1016/S0167-8140(02)00140-8 [14]Green AG,McKenzie AL,Harrisobn AJL,et al. Geometric Uncertainties in rdiotherapy defining the planning target volume[M]. London:The British institute of radiology,2003. [15]王健仰,王淑莲,黄鹏,等. 乳腺托架固定下全乳调强放疗摆位误差兆伏X线验证平片测定分析[J]. 中华放射肿瘤学杂志,2013,22(3):329-342. DOI:10.3760/cma.j.issn.1004-4221.2013.03.020. Wang JY Wang SL,Huang P,et al. Assessment of setup error in orthogonal megavoltage X-ray film for whole breast radiation with breast bracket immobflized[J]. Chin J Radiat Oncol,2013,22(3):329-342. DOI:10.3760/cma.j.issn.1004-4221.2013.03.020. [16]吴志勤,余建义,阎华伟,等,锥形术CT引导下乳腺癌保乳术后调强放疗摆位误差及配准方式的分析[J]. 中国全科医学,2017,20(15):1903-1905. DOI:10.3969/j.issn.1007-9572.2017.15.023. Wu ZQ,Yu JY,Yan HW,et al. Setup errors and registration algorithm of intensity modulated radiation therapy after breast conserving surgery of breast cancer based on cone-beam CT[J]. Chin General Pract,2017,20(15):1903-1905. DOI:10.3969/j.issn.1007-9572.2017.15.023. [17]van Herk M,Bentgen A,Remeijer P,et al. Comparison of setup error determined with EPID and with cone beam CT for lung cancer patients-how accurate is EPID image analysis in clinical practice for a difficult site?[M]. Brighton:International workshop electronic portal imaging,2004. [18]王振立,孙晓东,张耀文,等. 食管癌患者螺旋断层治疗的摆位误差分析[J]. 中华放射肿瘤学杂志,2017,26(4):429-432. DOI:10.3760/cma.j.issn.1004-4221.2017.04.013. Wang LZ,Sun XD,ZHang YW,et al. An analysis of setup errors in hefical tomotherapy for esophageal cancer patients[J]. Chin J Radiat Oncol,2017,26(4):429-432. DOI:10.3760/cma.j.issn.1004-4221.2017.04.013. [19]Kim H, Beriwal S, Huq MS,et al. Evaluation of Set-up Uncertainties with Daily Kilovoltage Image Guidance in External Beam Radiation Therapy for Gynaecological Cancers[J]. Clinical Oncology (2012) e39ee45doi:10.1016/j.clon.2011.09.0 07 [20]Darby SC,Ewertz M,McGale P,et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer[J]. N Engl J Med,2013,368(11):987-998. DOI:10.1056/NEJMoa1209825. [21]Henson KE,McGale P,Taylor C,et al. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer[J]. Br J Cancer,2013,108(1):179-182 DOI:10.1038/bjc.2012.575.
2019, Vol. 28 
