Inter-fraction motion and dosimetric consequences during breast intensity-modulated radiotherapy (IMRT)

Jain, Pooja; Marchant, Tom; Green, Melanie; Watkins, Gillian; Davies, Julie; McCarthy, Claire; Loncaster, Juliette; Stewart, Alan; Magee, Brian; Moore, Christopher; Price, Pat

doi:10.1016/j.radonc.2008.10.010

« Previous Next »Radiotherapy & Oncology
Volume 90, Issue 1 , Pages 93-98, January 2009

Inter-fraction motion and dosimetric consequences during breast intensity-modulated radiotherapy (IMRT)

Pooja Jain
- Academic Department of Radiation Oncology, The University of Manchester, Manchester M20 4BX, UK
Tom Marchant
- North Western Medical Physics, Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
Melanie Green
- Academic Department of Radiation Oncology, The University of Manchester, Manchester M20 4BX, UK
Gillian Watkins
- Academic Department of Radiation Oncology, The University of Manchester, Manchester M20 4BX, UK
Julie Davies
- The Wade Centre for Radiotherapy Research, Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
Claire McCarthy
- The Wade Centre for Radiotherapy Research, Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
Juliette Loncaster
- Department of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
Alan Stewart
- Department of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
Brian Magee
- Department of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
Christopher Moore
- North Western Medical Physics, Christie Hospital NHS Foundation Trust, Manchester M20 4BX, UK
Pat Price
- Academic Department of Radiation Oncology, The University of Manchester, Manchester M20 4BX, UK
- Corresponding author. Address: Academic Department of Radiation Oncology, The University of Manchester, Christie Hospital NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom.

Received 24 July 2008; received in revised form 7 October 2008; accepted 12 October 2008. published online 14 November 2008.

Abstract

Background and purpose

Intensity-modulated radiotherapy (IMRT) can improve dose homogeneity within the breast planned target volume (PTV), but may be more susceptible to patient/organ motion than standard tangential radiotherapy (RT). We used daily cone-beam CT (CBCT) imaging to assess inter-fraction motion during breast IMRT and its subsequent impact on IMRT and standard RT dose homogeneity.

Materials and methods

Ten breast cancer patients selected for IMRT were studied. CBCT images were acquired immediately after daily treatment. Automatic image co-registration was used to determine patient positioning variations. Daily PTV contours were used to calculate PTV variations and daily delivered IMRT and theoretically planned tangential RT dose.

Results

Group systematic (and random) setup errors detected by CBCT were 5.7 (3.9)mm laterally, 2.8 (3.5)mm vertically and 2.3 (3.2)mm longitudinally. Rotations >2° in any axis occurred on 53/106 (50%) occasions. Daily PTV volume varied up to 23%. IMRT dose homogeneity was superior at planning and throughout the treatment compared with standard RT (1.8% vs. 15.8% PTV received >105% planned mean dose), despite increased motion sensitivity.

Conclusions

CBCT revealed inadequacies of current patient positioning and verification procedures during breast RT and confirmed improved dose homogeneity using IMRT for the patients studied.

Keywords: Breast radiotherapy, IMRT, Cone-beam imaging, Inter-fraction motion, Dose homogeneity