AlignRT®, Catalyst™ and RPM™ in locoregional radiotherapy of breast cancer with DIBH. Is IGRT still needed?

Abstract

background:In locoregional radiotherapy of breast cancer with deep inspiration breath hold (DIBh), setup accuracy may depend on hospital protocol. At present, comparison between different positioning devices is challenging due to differing hospital protocols. The aim of this study was to evaluate the setup accuracy obtained with surface-guided radiation therapy (sGrT; AlignrT®, Catalyst™) or with lasers and real-time position management (rpM™) in DIBh. Materials and methods:A total of 1692 image pairs were analyzed in three groups: positioning using AlignrT® surface guidance system (Group A, n = 45), Catalyst™ (Group C, n = 50) and conventional lasers and tattoos (Group L, n = 46). We evaluated residual errors for the bony chest wall, th1 and humeral head in kV images with laser-or sGrT-based setup with and without daily image-guided radiation therapy (IGrT). results: Less isocenter variance was found in Group A than in Group L or C (p ≤ 0.05) and in Group C than in L (p = 0.02-0.6). With sGrT only, the smallest random rotation error was found in Group A (p = 0.01). With daily IGrT, only a small difference was found for residual errors between the groups. conclusion: setup with sGrT improves the isocenter reproducibility compared to lasers and rpM™. Only small differences were found in setup accuracy between the sGrT devices. Due to improved isocenter accuracy, daily orthogonal IGrT is suggested in all the groups.

Surface-guided radiotherapy systems in locoregional deep inspiration breath hold radiotherapy for breast cancer — a multicenter study on the setup accuracy

“…Locoregional and whole breast RT groups can be combined [26,27], although PTV delineations and, thus, accuracy requirements are different between groups. Typically, in the publications the results are also combined between the mastectomy and whole breast + lymph nodes groups [21,[28][29]. This study included only locoregional patients.…”

“…All sites defined SGRT protocols at least one year earlier, and the radiotherapy technologists were experienced in SGRT at the time of data collection. The setup protocol of Site 1 has been described earlier in [21]. During the first fractions, FB setup surfaces were captured with optimal overall accuracy with SGRT cameras after kV/kV images (Sites 1 and 3).…”

Current Cardioprotective Strategies for the Prevention of Radiation-Induced Cardiotoxicity in Left-Sided Breast Cancer Patients

“…Left BC patient setup with Surface-Guided Radiation Therapy (SGRT) may improve the isocenter reproducibility in comparison to three or four tattoos [85]. The main SGRT advantage is that it utilizes thousands of points on a patient's body and does not prolong the treatment time or clinical workflow [86].…”

“…The main SGRT advantage is that it utilizes thousands of points on a patient's body and does not prolong the treatment time or clinical workflow [86]. Therefore, more accurate patient positioning and intrafractional monitoring is possible with the use of SGRT rather than lasers and the heart position deviations are smaller [85][86][87][88].…”

Surface-guided radiotherapy improves rotational accuracy in gynecological cancer patients

“…In recent years, surface imaging (SI) has emerged as an accurate and effective alternative [ 1 – 5 ]. SI is most commonly used to position breast cancer patients [ 6 – 11 ]. SI has also been explored for other treatment sites, such as the lungs and prostate, with regard to set-up time and translational precision of patient positioning [ 12 – 15 ].…”