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Interfractional target variations for partial breast irradiation.

Ergun E Ahunbay1, Jared Robbins, Robert Christian

  • 1Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA. eahunbay@mcw.edu

International Journal of Radiation Oncology, Biology, Physics
|May 17, 2011
PubMed
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Accurate alignment during partial breast irradiation (PBI) minimizes target margin expansion. Analyzing daily CT scans revealed significant interfractional variations, highlighting the need for adaptive radiotherapy to reduce normal tissue irradiation.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Breast Cancer Treatment

Background:

  • Partial breast irradiation (PBI) is an alternative to whole-breast irradiation for early-stage breast cancer.
  • Accurate patient positioning and target delineation are crucial for effective PBI.
  • Interfractional variations in clinical target volume (CTV) shape can impact treatment accuracy.

Purpose of the Study:

  • To quantify interfractional shape variations of the CTV during CT-guided PBI.
  • To compare the effectiveness of different repositioning and alignment strategies in managing these variations.

Main Methods:

  • Analysis of daily CT data from 13 breast cancer patients undergoing PBI (prone or supine).
  • Deformable image registration used to calculate deformation vectors and distances along surface normals (DSN) for approximately 25 CTV surface points.

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  • Evaluation of seven alignment methods, including volumetric and 2D projection imaging, and skin marks.

    • Main Results:

    • The best alignment method, based on deformation field data, required a margin expansion of 2.7 mm to cover 99% of points.
    • Center-of-mass alignment required 4.0 mm, while 2D projection and skin mark methods necessitated larger margins (7.0-13.9 mm).
    • Significant CTV shrinkage was observed, with DSN values ranging up to 7 mm even with optimal alignment.

    Conclusions:

    • Effective alignment strategies are critical for minimizing margin requirements in PBI due to observed target deformations.
    • Adaptive radiotherapy is recommended to further reduce unnecessary irradiation of normal tissues.
    • The choice of alignment impacts the required safety margin and potential normal tissue complication probability.