Dosimetric Effects of Anatomical Deformations and Positioning Errors in VMAT Breast Radiotherapy

Overview

Journal J Appl Clin Med Phys

Specialties Biophysics
General Medicine

Date 2018 Jul 7

PMID 29978548

Citations 19

Authors

Maija Rossi

Eeva Boman

Tanja Skytta

Mikko Haltamo

Marko Laaksomaa

Mika Kapanen

Affiliations

Soon will be listed here.

Abstract

Aim: Traditional radiotherapy treatment techniques of the breast are insensitive for deformations and swelling of the soft tissue. The purpose of this study was to evaluate the dose changes seen with tissue deformations using different image matching methods when VMAT technique was used, and compare these with tangential technique.

Methods: The study included 24 patients with breast or chest wall irradiations, nine of whom were bilateral. In addition to planar kV setup imaging, patients underwent weekly cone-beam computed tomography (CBCT) imaging to evaluate soft tissue deformations. The effect of the deformations was evaluated on VMAT plans optimized with 5-mm virtual bolus to create skin flash, and compared to standard tangential plans with 2.5 cm skin flash. Isocenter positioning using 2D imaging and CBCT were compared.

Results: With postural changes and soft tissue deformations, the target coverage decreased more in the VMAT plans than in the tangential plans. The planned V90% coverage was 98.3% and 99.0% in the tangential and VMAT plans, respectively. When tattoo-based setup and online 2D match were used, the coverage decreased to 97.9% in tangential and 96.5% in VMAT plans (P < 0.001). With automatic CBCT-based image match the respective coverages were 98.3% and 98.8%. In the cases of large soft tissue deformations, the replanning was needed for the VMAT plan, whereas the tangential plan still covered the whole target volume.

Conclusions: The skin flash created using an optimization bolus for VMAT plans was in most cases enough to take into account the soft tissue deformations seen in breast VMAT treatments. However, in some cases larger skin flash or replanning were needed. The use of 2D match decreased the target coverage for VMAT plans but not for FinF plans when compared to 3D match. The use of CBCT match is recommended when treating breast/chest wall patients with VMAT technique.

Citing Articles

Interfractional variation in whole-breast VMAT irradiation: a dosimetric study with complementary SGRT and CBCT patient setup.

Mankinen M, Viren T, Seppala J, Koivumaki T Radiat Oncol. 2024; 19(1):21.

PMID: 38347554 PMC: 10863193. DOI: 10.1186/s13014-024-02418-5.

Organ-contour-driven auto-matching algorithm in image-guided radiotherapy.

Kishigami Y, Nakamura M, Okamoto H, Takahashi A, Iramina H, Sasaki M J Appl Clin Med Phys. 2023; 25(1):e14220.

PMID: 37994694 PMC: 10795436. DOI: 10.1002/acm2.14220.

Planning System-dependent Recommendations of Intensity-modulated Technique for Breast Radiotherapy: A Literature Review-based Adaptation and Institutional Dosimetric Experience from a Large-volume Tertiary Cancer Care Hospital.

Sarkar B, Pradhan A J Med Phys. 2023; 48(3):221-229.

PMID: 37969141 PMC: 10642598. DOI: 10.4103/jmp.jmp_51_23.

Dosimetric variation in preoperative partial breast radiosurgery assessed by deformable image registrations.

Yoo S, Blitzblau R, McDuff S, Yin F, Cui Y J Radiosurg SBRT. 2023; 8(3):227-235.

PMID: 36861003 PMC: 9970744.

Robustness of Breast Margins with Volumetric Modulated Arc Therapy without a Six-Degrees-of-Freedom Couch: A Dosimetric Evaluation.

Prunaretty J, Mir N, Tilhac A, Gouillou M, Azria D, Fenoglietto P J Clin Med. 2023; 12(3).

PMID: 36769509 PMC: 9917561. DOI: 10.3390/jcm12030862.

References

Laaksomaa M, Kapanen M, Haltamo M, Skytta T, Peltola S, Hyodynmaa S . Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold. Radiat Oncol. 2015; 10:76. PMC: 4399145. DOI: 10.1186/s13014-015-0383-y. View

Ding G, Munro P . Radiation exposure to patients from image guidance procedures and techniques to reduce the imaging dose. Radiother Oncol. 2013; 108(1):91-8. DOI: 10.1016/j.radonc.2013.05.034. View

Kapanen M, Laaksomaa M, Skytta T, Haltamo M, Pehkonen J, Lehtonen T . Residual position errors of lymph node surrogates in breast cancer adjuvant radiotherapy: Comparison of two arm fixation devices and the effect of arm position correction. Med Dosim. 2015; 41(1):47-52. DOI: 10.1016/j.meddos.2015.08.001. View

Popescu C, Olivotto I, Beckham W, Ansbacher W, Zavgorodni S, Shaffer R . Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys. 2009; 76(1):287-95. DOI: 10.1016/j.ijrobp.2009.05.038. View

Neubauer E, Dong L, Followill D, Garden A, Court L, White R . Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer. Radiat Oncol. 2012; 7:19. PMC: 3311611. DOI: 10.1186/1748-717X-7-19. View

Boman E, Rossi M, Haltamo M, Skytta T, Kapanen M . A new split arc VMAT technique for lymph node positive breast cancer. Phys Med. 2016; . DOI: 10.1016/j.ejmp.2016.10.012. View

Laaksomaa M, Kapanen M, Skytta T, Peltola S, Hyodynmaa S, Kellokumpu-Lehtinen P . Estimation of optimal matching position for orthogonal kV setup images and minimal setup margins in radiotherapy of whole breast and lymph node areas. Rep Pract Oncol Radiother. 2014; 19(6):369-75. PMC: 4201775. DOI: 10.1016/j.rpor.2014.05.001. View

Kumar A, Singh I, Sharma S, John S, Ravindran B . Radiation dose measurements during kilovoltage-cone beam computed tomography imaging in radiotherapy. J Cancer Res Ther. 2016; 12(2):858-63. DOI: 10.4103/0973-1482.164699. View

Skytta T, Kapanen M, Laaksomaa M, Peltola S, Haltamo M, Boman E . Improving the reproducibility of voluntary deep inspiration breath hold technique during adjuvant left-sided breast cancer radiotherapy. Acta Oncol. 2016; 55(8):970-5. DOI: 10.3109/0284186X.2016.1161823. View

10.

McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M . Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383(9935):2127-35. PMC: 5015598. DOI: 10.1016/S0140-6736(14)60488-8. View

11.

Tournel K, Verellen D, Duchateau M, Fierens Y, Linthout N, Reynders T . An assessment of the use of skin flashes in helical tomotherapy using phantom and in-vivo dosimetry. Radiother Oncol. 2007; 84(1):34-9. DOI: 10.1016/j.radonc.2007.06.003. View

12.

Michalski A, Atyeo J, Cox J, Rinks M . Inter- and intra-fraction motion during radiation therapy to the whole breast in the supine position: a systematic review. J Med Imaging Radiat Oncol. 2012; 56(5):499-509. DOI: 10.1111/j.1754-9485.2012.02434.x. View

13.

Viren T, Heikkila J, Myllyoja K, Koskela K, Lahtinen T, Seppala J . Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiat Oncol. 2015; 10:79. PMC: 4404692. DOI: 10.1186/s13014-015-0392-x. View

14.

Giorgia N, Antonella F, Alessandro C, Eugenio V, Luca C . Planning strategies in volumetric modulated are therapy for breast. Med Phys. 2011; 38(7):4025-31. DOI: 10.1118/1.3598442. View

15.

Fogliata A, Seppala J, Reggiori G, Lobefalo F, Palumbo V, De Rose F . Dosimetric trade-offs in breast treatment with VMAT technique. Br J Radiol. 2016; 90(1070):20160701. PMC: 5685098. DOI: 10.1259/bjr.20160701. View

16.

Alvarado R, Booth J, Bromley R, Gustafsson H . An investigation of image guidance dose for breast radiotherapy. J Appl Clin Med Phys. 2013; 14(3):4085. PMC: 5714412. DOI: 10.1120/jacmp.v14i3.4085. View

17.

Ueltzhoffer S, Zygmanski P, Hesser J, Hogele W, Wong J, R Bellon J . Clinical application of varian OBI CBCT system and dose reduction techniques in breast cancer patients setup. Med Phys. 2010; 37(6):2985-98. DOI: 10.1118/1.3432617. View

18.

Teoh M, Clark C, Wood K, Whitaker S, Nisbet A . Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. 2011; 84(1007):967-96. PMC: 3473700. DOI: 10.1259/bjr/22373346. View