Faculty Collaboration Database

Intra- and interfractional variations for prone breast irradiation: an indication for image-guided radiotherapy. Int J Radiat Oncol Biol Phys 2007 Nov 01;69(3):910-7

Date

09/25/2007

Pubmed ID

17889272

DOI

10.1016/j.ijrobp.2007.06.056

Scopus ID

2-s2.0-34548699117 (requires institutional sign-in at Scopus site)   61 Citations

Abstract

PURPOSE: Intra- and interfractional errors for breast cancer patients undergoing breast irradiation in the prone position were analyzed.

METHODS AND MATERIALS: To assess intrafractional error resulting from respiratory motion, four-dimensional computed tomography scans were acquired for 3 prone and 3 supine patients, and the respiratory motion was compared for the two positions. To assess the interfractional error caused by daily set-up variations, daily electronic portal images of one of the treatment beams were taken for 15 prone-positioned patients. Portal images were then overlaid with images from the planning system that included the breast contour and the isocenter, treatment beam portal, and isocenter. The shift between the planned and actual isocenter was recorded for each portal image, and descriptive statistics were collected for each patient. The margins were calculated using the 2Sigma + 0.7sigma recipe, as well as 95% confidence interval based on the pooled standard deviation of the datasets.

RESULTS: Respiratory motion of the chest wall is drastically reduced from 2.3 +/- 0.9 mm in supine position to -0.1 +/- 0.4 mm in prone position. The daily set-up errors vary in magnitude from 0.0 cm to 1.65 cm and are patient dependent. The margins were defined by considering only the standard deviation to be 1.1 cm, and 2.0 cm when the systematic errors were considered using the 2Sigma + 0.7sigma recipe.

CONCLUSIONS: Prone positioning of patients for breast irradiation significantly reduces the uncertainty introduced by intrafractional respiratory motion. The presence of large systematic error in the interfractional variations necessitates a large clinical target volume-to-planning target volume margin and indicates the importance of image guidance for partial breast irradiation in the prone position, particularly using imaging modality capable of identifying the lumpectomy cavity.

Author List

Morrow NV, Stepaniak C, White J, Wilson JF, Li XA

Author

Natalya V. Morrow PhD Assistant Professor in the Radiation Oncology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Breast Neoplasms
Confidence Intervals
Humans
Lung
Movement
Prone Position
Respiration
Supine Position
Tomography, X-Ray Computed