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Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation.

Xin Zhen1,2, Bo Zhao1, Zhuoyu Wang3

  • 1Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.

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Summary

Stereotactic partial breast irradiation (S-PBI) requires precise dose delivery. This study found non-rigid errors in S-PBI are comparable to rigid errors, necessitating their inclusion in treatment planning margins.

Keywords:
CyberknifeFiducialMarginStereotactic partial breast irradiation

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Breast Cancer Treatment

Background:

  • Stereotactic partial breast irradiation (S-PBI) enables precise, high-dose radiation delivery to breast tumors.
  • Accurate dose delivery is crucial for S-PBI treatment quality and sparing healthy tissue.
  • Understanding geometric errors is key to optimizing S-PBI accuracy.

Purpose of the Study:

  • To investigate rigid and non-rigid geometric errors in S-PBI.
  • To determine corresponding treatment margins for S-PBI.
  • To identify clinical factors associated with target geometric errors.

Main Methods:

  • Analysis of fiducial marker positions from kV images during CyberKnife treatment in 43 early-stage breast cancer patients.
  • Estimation of intra-fraction and composite errors, including both rigid and non-rigid components.
  • Linear regression analysis to correlate clinical factors with observed errors.

Main Results:

  • Composite rigid errors measured at 2.3 ± 0.5 mm and non-rigid errors at 1.3 ± 0.8 mm.
  • Estimated rigid margins ranged from 2.1 to 2.4 mm; the non-rigid margin was 1.7 mm.
  • Outer breast quadrants showed higher susceptibility to errors; target-to-chest wall distance correlated with errors.

Conclusions:

  • This is the first comprehensive analysis of rigid and non-rigid errors in S-PBI.
  • The non-rigid margin is comparable to the rigid margin and should be included in planning target volumes.
  • Treatment margin selection must account for identified clinical factors and non-rigid errors.