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Effect of Breathing Motion in Radiotherapy of Breast Cancer

4D Dose Calculation and Motion Tracking via EPID

Einfluss der Atembewegung auf die strahlentherapeutische Behandlung von Brustkrebs. 4D-Dosisberechnung und Bewegungsverfolgung mit EPID

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Purpose:

To evaluate the influence of breathing motion in postoperative whole-breast radiotherapy.

Patients and Methods:

For ten patients with left-sided breast cancer, radiotherapy treatment plans were generated based on conventional three-dimensional computed tomography (3D CT) studies: two techniques (segmented and wedge-based tangential fields) were compared. The influence of breathing motion on the dose to the target and organs at risk (OARs) was evaluated with four-dimensional (4D) dose calculation based on respiration-correlated CTs. Reproducibility of breathing motion was evaluated with electronic portal images (EPID) acquired in cine mode during treatment.

Results:

Differences in dose distributions were small between segmented and wedge techniques based on 3D studies. Because of small motion amplitude of the chest in the 4D CT studies (1.8 mm ± 0.9 mm), target coverage was reduced by < 5% due to breathing motion. Differences between 3D and 4D dose calculation were similar for segmented and wedge techniques. Blurring of the dose distribution in 4D dose calculation resulted in lower doses to the OARs. Analysis of EPID movies proved good reproducibility of breathing motion observed in the 4D CT study.

Conclusion:

Breathing motion was of minor relevance in postoperative radiotherapy treatment of breast cancer for both segmented and wedge tangential field techniques.

Ziel:

Untersuchung zum Einfluss der Atembewegung auf die postoperative Brustbestrahlung.

Patienten und Methodik:

Die Bestrahlungsplanung von Tangentenfeldern basierte auf dreidimensionalen Computertomographie-( 3D-CT-)Studien von zehn Brustkrebspatientinnen: Zwei Bestrahlungstechniken (Keilfilterfelder und Segmenttechnik) wurden verglichen. Der Einfluss der Atembewegung auf die Dosis im Zielvolumen und in den Risikoorganen wurde über die akkumulierte Dosisverteilung bestimmt, die aus atemgetriggerten CTs (4D CT) berechnet wurde. Die Reproduzierbarkeit der Atembewegung wurde mittels Portal Image Movies analysiert.

Ergebnisse:

In den 3D-Studien wurden nur geringe Unterschiede zwischen segment- und keilbasierter Technik beobachtet. Die kleinen Bewegungsamplituden der Thoraxwand in den 4D CTs (1,8 mm ± 0,9 mm) verschlechterten die Zielvolumenerfassung nur wenig. Die Unterschiede zwischen den 3D- und 4D-Dosisverteilungen waren für segment- und keilbasierte Technik ähnlich. Die mittlere Dosis der Risikoorgane verringerte sich aufgrund der Dosisverschmierung. Die Auswertung der Portal Image Movies zeigte eine gute Reproduzierbarkeit der Bewegungsamplitude im Vergleich mit dem 4D CT.

Schlussfolgerung:

Die Atembewegung beeinflusste die postoperative Bestrahlung von Brustkrebspatientinnen sowohl für die keil- als auch die segmentbasierte Tangententechnik in geringem Maße.

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Authors and Affiliations

  1. University of Würzburg, Department of Radiation Oncology, Würzburg, Germany

    Anne Richter, Reinhard Sweeney, Kurt Baier, Michael Flentje & Matthias Guckenberger

  2. Department of Radiation Oncology, Julius Maximilian University, Josef-Schneider-Straße 11, 97080, Würzburg, Germany

    Anne Richter

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  1. Anne Richter
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  2. Reinhard Sweeney
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  5. Matthias Guckenberger
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Correspondence to Anne Richter.

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Richter, A., Sweeney, R., Baier, K. et al. Effect of Breathing Motion in Radiotherapy of Breast Cancer. Strahlenther Onkol 185, 425–430 (2009). https://doi.org/10.1007/s00066-009-1980-1

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  • DOI: https://doi.org/10.1007/s00066-009-1980-1

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