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Clinical Implications of Geometric and Dosimetric Uncertainties of Inter- and Intra-Fractional Movement during Volumetric Modulated Arc Therapy for Breast Cancer Patients

Authors
 Jason Joon Bock Lee  ;  Ik Jae Lee  ;  Yeonho Choi  ;  Mi Jin Jeon  ;  Il Hun Jung  ;  Ho Lee 
Citation
 CANCERS, Vol.13(7) : 1651, 2021-04 
Journal Title
 CANCERS 
Issue Date
2021-04
Keywords
breast cancer ; cone-beam computed tomography ; image-guided radiotherapy ; intrafraction motion ; volumetric modulated arc therapy
Abstract
With the introduction of modern sophisticated radiotherapy (RT) techniques, the significance of accuracy has increased considerably. This study evaluated the necessity of pre-treatment and intra-fractional cone-beam computed tomography (CBCT) by analyzing inter- and intra-fractional CBCT images of breast cancer patients receiving RT. From 57 patients, 1206 pre-treatment CBCT and 1067 intra-fractional CBCT images were collected. Geometric movements of patients were measured quantitively in both inter- and intra-fractional CBCT, and changes in dosimetric parameters were evaluated in selected patients with extreme intra-fractional movement. For right-sided breast cancer patients, left-sided breast cancer patients treated using deep-inspiration breath hold (DIBH), and left-sided breast cancer patients treated using continuous positive airway pressure (CPAP), median inter-fractional deviations were 0.53 (range 0.06-2.98) cm, 0.66 (range 0.08-4.41) cm, and 0.69 (range 0.04-3.80) cm, and median intra-fractional deviations were 0.14 (range 0.00-0.62) cm, 0.23 (range 0.02-0.96) cm, and 0.24 (0.00-1.15) cm, respectively. Modified plans reflecting large changes in intra-fractional position in 10 selected cases revealed insufficient target coverage in seven cases and more than 20-fold increase in the volume of heart receiving at least 25 Gy in two cases. Intra-fractional verification, as well as pre-treatment verification, might be considered in patients using DIBH or CPAP.
Files in This Item:
T202101611.pdf Download
DOI
10.3390/cancers13071651
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Lee, Ho(이호) ORCID logo https://orcid.org/0000-0001-5773-6893
Cho, Yeona(조연아) ORCID logo https://orcid.org/0000-0002-1202-0880
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182936
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