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Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors.

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  • 1Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia. Faculty of Health Arts and Design, Swinburne University of Technology, Melbourne, Australia.

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Patient variability in radiotherapy displacement requires updated margin calculations. An inverse gamma distribution model for random errors suggests increasing clinical target volume to planning target volume margins by a median of 10% to ensure adequate dose coverage.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Biostatistics

Background:

  • External beam radiotherapy (EBRT) margin calculations traditionally assume constant patient random errors.
  • Real-world data reveal significant inter-patient variability in clinical target volume (CTV) displacement during EBRT.
  • This variability challenges the accuracy of existing margin estimation methods.

Purpose of the Study:

  • To develop and evaluate statistical models of CTV displacements incorporating patient-specific random error variability.
  • To assess the impact of this variability on planning target volume (PTV) margin widths using an inverse gamma (IG) distribution.
  • To compare the proposed IG-based margin model against traditional methods across diverse patient cohorts and malignancy sites.

Main Methods:

  • Collected real-life CTV displacement data from eight patient cohorts (874 patients, 27,391 sessions) across four institutions.
  • Developed statistical models characterizing random errors using an inverse gamma (IG) distribution.
  • Analyzed the effect of IG-based margins on CTV coverage under various clinical requirements and penumbral widths.

Main Results:

  • The IG-based margin model mandates a median increase of 10% in CTV-to-PTV margins compared to traditional models for a 4mm penumbra.
  • This adjustment is necessary to meet the clinical requirement of 95% dose coverage to the CTV for 90% of patients.
  • The range of margin adjustments varied from -19% to +35% across the eight cohorts, highlighting significant patient-specific differences.

Conclusions:

  • Patient-specific random error variability significantly impacts EBRT margin requirements.
  • The proposed IG-based margin model provides a more accurate and robust approach to margin estimation than traditional methods.
  • Implementing this model can reduce the proportion of patients receiving insufficient radiation dose due to inadequate margins.