Assessment of the Residual Error in Soft Tissue Setup in Patients Undergoing Partial Breast Irradiation: Results of a Prospective Study Using Cone-Beam Computed Tomography

Fatunase, T; Wang, Zhiheng; Yoo, Sua; Hubbs, Jessica L.; Prosnitz, Robert G.; Yin, Fang‐Fang; Marks, Lawrence B.

doi:10.1016/j.ijrobp.2007.07.2344

Cited by 66 publications

(54 citation statements)

References 43 publications

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“…The clips implanted in the boundaries of the lumpectomy cavity were prevalently used in guiding target volume delineation and displacement measurement for EB-PBI [8,15,22]. Kim et al [18] analysed 19 studies of respiratory motion in patients treated with accelerated partial breast irradiation.…”

Section: Discussionmentioning

confidence: 99%

“…The target volume was typically defined using surgical clips, the seroma and any post-operative tissue changes when available [9]. The respiratoryinduced displacements and set-up error were important components in EB-PBI planning, and the residual error was not .5 mm after online error correction based on cone-beam CT [15]. Therefore, respiratory-induced TB motion is the major component of the planning target volume for EB-PBI [8].…”

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confidence: 99%

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Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study

Ding¹,

Li²,

Wang³

et al. 2013

BJR

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et al. Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study. Br J Radiol 2013;86:20130416. FULL PAPER Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study Objective: To compare the displacements of the lumpectomy cavity delineated by the surgical clips and the seroma based on four-dimensional CT (4D-CT) for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS). Methods: 14 breast cancer patients after BCS were recruited for EB-PBI and undertook 4D-CT simulation.On the 10 sets of the 4D-CT images, all the surgical clips in the cavity were delineated. The gross tumour volume (GTV) formed by the clips, the seroma, and both the clips and the seroma were defined as GTV c , GTV s and GTV c1s , respectively. The displacements of the centre of mass (COM) of the clips, GTV c , GTV s , GTV c1s and the selected clips in the three-dimensional (3D) directions were recorded and compared.Results: In the left-right, anterior-posterior and superiorinferior directions, the displacements were 2.20, 1.80 and 2.70 mm for the clip COM; 0.90, 1.05 and 1.20 mm for GTV c ; 0.80, 1.05 and 0.80 mm for GTV s ; and 0.90, 1.20 and 1.40 mm for GTV c1s , respectively. In the 3D directions, the displacements of the clip COM were greater than the GTV c , GTV s , GTV c1s , and the displacements of the clip COM, GTV c1s , GTV c and GTV s were significantly greater than the displacements of the selected clips (p,0.05). Conclusion:The displacements of the clip COM were greater than that of the GTV c , GTV s , GTV c1s and the four selected clips. The optimal internal target volume should be defined based on the boundary displacements. Advances in knowledge: When the GTV was delineated using the clips and/or the seroma, there was displacement difference between the lumpectomy cavity centre and the boundary for the EB-PBI. The optimal internal target volume should be defined based on the boundary displacements of the lumpectomy cavity.Previous studies have reported that approximately 70-80% of the in-breast tumour recurrences occurred in the vicinity of the tumour bed (TB) and that the absolute risk of ipsilateral breast recurrence away from the primary tumour site is approximately 1.5-3.5% [1][2][3][4]. Thus, for early-stage breast cancer patients after breast-conserving surgery (BCS), partial breast irradiation (PBI), treating only the lumpectomy cavity with a suitable margin, may achieve a similar local control rate and an overall survival rate to whole-breast irradiation treating the whole breast. Externalbeam partial breast irradiation (EB-PBI) is an important approach in PBI, and clinical research has demonstrated that EB-PBI can achieve excellent results after strict patient selection and accurate target volume delineation [5,6].Accur...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study

Ding¹,

Li²,

Wang³

et al. 2013

BJR

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“…However, the use of immobilization devices and image-guided RT techniques using cone-beam CT (CBCT) has been demonstrated to improve setup reproducibility in RT for breast cancer. 6,9,10 As was demonstrated in various studies, the setup errors were less when CBCT was used (≤5 mm) and was more (>5 mm) with portal images. 9,10 For this reason, we preferred virtual setup errors of 5 and 10 mm at all directions, for both evaluating setup errors observed with simple methods using portal images and more accurate techniques using CBCT.…”

Section: Discussionmentioning

confidence: 76%

“…9 Furthermore, studies evaluating the dose distribution changes originating from setup errors were focused on only target volume dose changes and did not evaluate organs at risk doses and healthy tissues within the irradiated breast. 10 In a study by van Mourik et al 18 , the effects of setup errors and breast changes on dose distribution have been evaluated for wedge, simple IMRT, and full IMRT plans.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Although the FIF technique achieves a more homogenous dose distribution compared with standard tangential field RT, IMRT plans can be more susceptible to set-up errors and breast shape changes because IMRT plans contain nonglancing segments. 8 Both organ motion and patient positioning inaccuracies have been well documented for various breast RT techniques [9][10][11] ; however, the impact of motion on dosimetry for the FIF technique has not yet been well studied. The present study was designed to evaluate the effects of setup errors on dose distribution for both the target volume and healthy tissue within the irradiated volume and also critical surrounding organs for breast RT using the FIF technique.…”

Section: Inroductionmentioning

confidence: 99%

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Effects of Setup Errors on Dose Distribution for Tangential Wedge Field and Field-in-Field Techniques During Breast Irradiation

Önal¹

2014

UHOD

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This study is aimed to evaluate the effects of setup errors on dose distribution for target volume and healthy tissue within the irradiated volume and also critical surrounding organs for breast radiotherapy (RT) using both the tangential field and the field-in-field (FIF) technique. Ten patients with breast cancer were enrolled. For each patients two plans were generated; tangential field plan and FIF-plan. The setup errors were simulated for a series of displacements of ±5 mm and ±10 mm in superior-inferior (x-axis), medial-lateral (y-axis), and anteriorposterior (z-axis) directions and dose volume comparisons were made both between and within groups. The most prominent changes were observed in setup errors at z-axis. In wedge plan, 10-mm setup error at the +z axis caused a significant decrease in tumor coverage compared with the plan with no setup error (96.5% vs. 99.2%; p= 0.01). The 5 and 10 mm setup errors at the +z-axis resulted in significantly higher healthy tissue doses in wedge plans compared with FIF plans. The setup errors along z-axis had a significant effect on the dose distribution for target volume and also to the lungs. The setup error in the isocenter should be kept strictly below 5 mm.Keywords: Breast cancer, Radiotherapy, Field-in-field technique, Setup errors ÖZET Meme Radyoterapisi Sırasında Set-up Hatalarının Tanjansiyel Wedge ve Field-in-field Tekniklerindeki Doz Dağılımına EtkileriBu çalışmanın amacı, meme radyoterapisi (RT) sırasında kullanılan tanjansiyel alan ve 'field-in-field' (FIF) tekniklerindeki set-up hatalarının hedef hacim, ışınlanan hacimdeki sağlıklı doku ve çevre organ dozları üzrindeki etkilerini değerlendirmektir. Meme kanseri tanılı 10 hasta çalışmaya dahil edilmiştir. Her hasta için ikişer plan oluşturulmuştur: tanjansiyel alan ve FIF tekniği. Set-up hataları superior-inferior (x-axis), medial-lateral (y-axis), and anterior-posterior (z-axis) istikamatte ±5 mm ve ±10 mm olarak oluşturulmuş olup, doz volüm karşılaştırmaları hem grup içinde hem de gruplar arasında yapılmıştır. En belirgin değişiklik z-axis de gözlenmiştir. Tanjansiyel planda +z-axis de oluşan 10 mm lik setup hatasındaki hedef hacimi kapsama, set up hatası olmayan plana gore anlamlı düşük bulunmuştur (%96.5 vs. %99.2; p= 0.01). +z-axisteki 5 ve 10 mm'lik setup hataları sonucunda oluşan sağlıklı doku dozları tanjansiyel planda FIF planına gore anlamlı olarak yüksek bulunmuştur. z-axisteki hatalar hem hedef volüm hem de akciğer dozlarında belirgin bir etki yaratmaktadır. İzosentrdaki hataların 5 mm nin altında olması güvenlidir.Anahtar Kelimeler: Meme kanseri, Radyoterapi, Field-in-field tekniği, Setup hataları

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Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?

Batumalai

Quinn

Jameson

et al. 2015

J of Medical Radiation Sci

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IntroductionCorrect target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy.MethodsPlanning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). The mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast.ResultsThe highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI.ConclusionsFor breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account.

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Assessment of the Residual Error in Soft Tissue Setup in Patients Undergoing Partial Breast Irradiation: Results of a Prospective Study Using Cone-Beam Computed Tomography

Cited by 66 publications

References 43 publications

Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study

Displacement of the lumpectomy cavity defined by surgical clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast-conserving surgery: a comparative study

Effects of Setup Errors on Dose Distribution for Tangential Wedge Field and Field-in-Field Techniques During Breast Irradiation

Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?

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