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[Assessments setup errors and target margin by 6D couch for primary cervical cancer].

Qianqian Cao1, Lihong Zhu2, Junjie Wang1

  • 1Cancer Center, Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China.

Zhonghua Yi Xue Za Zhi
|May 16, 2015
PubMed
Summary

Kilovoltage cone-beam computed tomography (CBCT) and a 6-degree-of-freedom (6D) couch significantly reduce setup variations in cervical cancer radiotherapy. This allows for smaller planning target volume (PTV) margins, better protecting normal tissues.

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Area of Science:

  • Radiation oncology
  • Medical physics
  • Oncologic imaging

Background:

  • Accurate patient setup is critical in radiotherapy for cervical cancer.
  • Image-guided radiation therapy (IGRT) aims to minimize setup errors.
  • The HexaPOD evo RT 6D couch and kilovoltage cone-beam computed tomography (KV CBCT) are advanced IGRT tools.

Purpose of the Study:

  • To assess inter- and intra-fraction setup variations using the HexaPOD evo RT 6D couch and KV CBCT in cervical cancer patients.
  • To determine appropriate clinical target volume (CTV) margins based on these variations.

Main Methods:

  • 16 patients with primary cervical cancer were treated using IGRT with a vacuum pad in the prone position.
  • Daily KV CBCT scans were acquired before treatment, after 6D couch correction, and post-treatment.
  • Translational (X, Y, Z) and rotational (Rx, Ry, Rz) shifts were analyzed after automatic registration to the planning CT.

Main Results:

  • The combination of KV CBCT and the 6D couch significantly reduced inter-fraction errors in X, Z, Rx, and Ry (P < 0.003).
  • Significant differences in Ry were observed between pre- and post-treatment scans (P = 0.002).
  • Intra-fraction CTV margins were calculated as 2.74 mm (X), 3.9 mm (Y), and 2.87 mm (Z).

Conclusions:

  • KV CBCT with the HexaPOD evo RT 6D couch effectively minimizes translational and rotational setup variations.
  • Reduced setup variations enable smaller planning target volume (PTV) margins.
  • This approach enhances treatment accuracy and improves normal tissue sparing in cervical cancer radiotherapy.