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Set-up uncertainty during breast radiotherapy

Image-guided radiotherapy for patients with initial extensive variation

Set-up-Unsicherheit während der Brustbestrahlung

Bildgesteuerte Strahlentherapie für Patienten mit initial umfangreichen Abweichungen

Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

The aim of this work was to establish a customized strategy for image-guided radiotherapy during whole breast irradiation. Risk factors associated with extensive errors were assessed.

Methods and materials

A series of 176 consecutive breasts in 174 patients were retrospectively assessed. Electronic portal images from 914 medial and 807 lateral directions were reviewed. On the basis of the chest wall, the deviations between the simulation and each treatment were measured. The systematic (Σ) and random error (σ) of population, and the planning target volume (PTV) margin (2 Σ + 0.7σ) were calculated for each direction. Extensive set-up errors were defined as the fraction over the PTV margins in any direction. For extensive set-up errors, χ2 tests and logistic regression analyses were conducted.

Results

The medial and lateral PTV margins for the right–left, superior–inferior, and anterior–posterior axes and the rotation of collimator were 2.6 and 2.4 mm, 4.6 and 4.6 mm, and 3.1 and 3.3 mm and 2.8 and 2.9 ° and cut-off values for extensive errors were 3, 5, and 4 mm and 3 °, respectively. In χ2 tests, tumor in upper outer quadrant (p = 0.012) and chest wall thickness ≥ 2.0 cm (p = 0.003) for medial portals and age group (p = 0.036) for lateral portals were associated with extensive errors. In multivariate tests, the extensive error on the initial fraction had a high probability of extensive set-up errors in both medial (OR = 4.26, p < 0.001) and lateral portals (OR = 3.07, p < 0.001).

Conclusion

In terms of the set-up uncertainty during breast irradiation, patients with extensive error in the initial treatment should be closely observed with serial image-guided radiotherapy.

Zusammenfassung

Ziel

Das Ziel der Studie war es, eine kundenspezifische Strategie für die bildgesteuerte Radiotherapie während der Bestrahlung der gesamten Brust zu entwickeln. Risikofaktoren und damit assoziierte weitreichende Fehler wurden ermittelt.

Patienten und Methoden

Eine Serie von 176 Brüsten von insgesamt 174 Patienten wurde retrospektiv bewertet. Elektronische Portalbilder aus 914 medialen und 807 lateralen Richtungen wurden geprüft. Basierend auf der Brustwand wurden die Abweichungen zwischen der Simulation und jeder Behandlung gemessen. Für jede Richtung wurde der systematische (Σ) und der zufällige Fehler (σ) der Bevölkerungsgruppe sowie die Grenze (2Σ + 0,7σ) des geplanten Zielvolumens (PTV) berechnet. Umfangreiche Set-up-Fehler wurden als Fraktion definiert, welche die PTV-Grenzen in jede Richtung überschreitet. Für weitreichende Set-up-Fehler wurden χ2-Tests und logistische Regressionsanalysen durchgeführt.

Ergebnisse

Die medialen und lateralen PTV-Grenzen für die rechten-linken, superioren-inferioren und anterioren-posterioren Achsen und die Rotation des Kollimators waren jeweils 2,6 und 2,4 mm, 4,6 und 4,6 mm, 3,1 und 3,3 mm sowie 2,8 und 2,9 °. Cut-off-Werte für weitreichende Fehler waren jeweils 3, 5 und 4 mm bzw. 3 °. In den χ2-Tests waren für mediale Portale ein Tumor am oberen äußeren Quadranten (p = 0,012) und die Brustwanddicke ≥ 2,0 cm (p = 0,003) sowie für laterale Portale die Altersgruppe (p = 0,036) mit den weitreichenden Fehlern verbunden. In den multivariaten Tests war ein weitreichender Fehler bei der anfänglichen Fraktion mit einer hohen Wahrscheinlichkeit für umfangreiche Set-up-Fehler in beiden medialen (OR = 4,26; p < 0,001) und lateralen Portalen (OR = 3,07; p < 0,001) verbunden.

Schlussfolerung

Im Hinblick auf die Set-up-Unsicherheit bei der Brustbestrahlung sollten Patienten mit weitreichenden Fehlern während der anfänglichen Behandlung durch serielle bildgesteuerte Radiotherapie genauer beobachtet werden.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Ansan Hospital, Korea University Medical Center, Jukgeum 123, 425–707, Ansan, Gyeonggi-do, Republic of Korea

    D.S. Yang, W.S. Yoon M.D., Ph.D., S.Y. Chung, J.A. Lee, S. Lee, Y.J. Park & C.Y. Kim

  2. Department of Surgery, Ansan Hospital, Korea University Medical Center, Jukgeum 123, 425–707, Ansan, Gyeonggi-do, Republic of Korea

    G.S. Son

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  1. D.S. Yang
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  2. W.S. Yoon M.D., Ph.D.
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Correspondence to W.S. Yoon M.D., Ph.D..

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Yang, D., Yoon, W., Chung, S. et al. Set-up uncertainty during breast radiotherapy. Strahlenther Onkol 189, 315–320 (2013). https://doi.org/10.1007/s00066-012-0271-4

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  • DOI: https://doi.org/10.1007/s00066-012-0271-4

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