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Interfraction and intrafraction setup variability for prone breast radiation therapy.

James Mitchell1, Silvia C Formenti, J Keith DeWyngaert

  • 1Department of Radiation Oncology, New York University School of Medicine, New York, NY 10016, USA.

International Journal of Radiation Oncology, Biology, Physics
|November 14, 2009
PubMed
Summary

This study quantifies setup variations in prone breast radiotherapy, establishing a 1.4 cm clinical tumor volume (CTV) to planning target volume (PTV) margin for accurate treatment delivery.

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Prone breast radiotherapy is utilized to minimize dose to organs at risk.
  • Accurate patient setup and motion management are crucial for effective radiotherapy.
  • Establishing appropriate margins between clinical tumor volume (CTV) and planning target volume (PTV) is essential to account for uncertainties.

Purpose of the Study:

  • To quantify interfraction and intrafraction setup variations in patients undergoing prone breast radiotherapy.
  • To determine an optimal clinical tumor volume (CTV) to planning target volume (PTV) margin that accounts for setup and motion uncertainties.

Main Methods:

  • Ten patients undergoing accelerated, hypofractionated prone breast irradiation were prospectively studied.
  • Electronic portal imaging device in cine mode was used to acquire portal images.

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  • Interfraction setup error was assessed by comparing daily fractions to a reference image; intrafraction motion was evaluated by measuring displacements of external fiducials and breast surface throughout each fraction.
  • Main Results:

    • Mean interfraction setup variability for fiducials was 0.08 cm (AP) and -0.04 cm (SI).
    • Mean interfraction breast surface variability was -0.14 cm (AP).
    • Mean intrafraction displacements for fiducials and breast surface were 0.13 cm and 0.15 cm, respectively. A CTV to PTV expansion of 1.4 cm was calculated.

    Conclusions:

    • Interfraction and intrafraction setup variations in prone breast radiotherapy were found to be acceptable.
    • A clinical tumor volume (CTV) to planning target volume (PTV) expansion of 1.4 cm is recommended based on the observed setup uncertainties.