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

M Mankinen; T Virén; J Seppälä; T Koivumäki

doi:10.1186/s13014-024-02418-5

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

Radiat Oncol. 2024 Feb 13;19(1):21. doi: 10.1186/s13014-024-02418-5.

Authors

M Mankinen^{1

2}, T Virén³, J Seppälä³, T Koivumäki^{4

5}

Affiliations

¹ Deparment of Physics, University of Jyväskylä (JYU), Survontie 9 C, 40014, Jyväskylä, Finland. mikko.m.mankinen@student.jyu.fi.
² Deparment of Medical Physics, Hospital Nova of Central Finland, Wellbeing Services County of Central Finland, Jyväskylä, Finland. mikko.m.mankinen@student.jyu.fi.
³ Center of Oncology, Kuopio University Hospital (KUH), The Wellbeing Services Country of North Savo, Kuopio, Finland.
⁴ Deparment of Physics, University of Jyväskylä (JYU), Survontie 9 C, 40014, Jyväskylä, Finland.
⁵ Deparment of Medical Physics, Hospital Nova of Central Finland, Wellbeing Services County of Central Finland, Jyväskylä, Finland.

Abstract

Background: The dosimetric effect of setup uncertainty and tissue deformations in left-sided whole-breast irradiation with complementary surface-guided radiotherapy (SGRT) and cone-beam computed tomography (CBCT) setup was evaluated.

Method: Treatment courses of 40.05 Gy prescribed dose in 15 fractions were simulated for 29 patients by calculating the dose on deformed CT images, that were based on daily CBCT images, and deforming and accumulating the dose onto the planning CT image. Variability in clinical target volume (CTV) position and shape was assessed as the 95% Hausdorff distance (HD95) between the planning CTV and deformed CTV structures. DVH metrics were evaluated between the planned and simulated cumulative dose distributions using two treatment techniques: tangential volumetric modulated arc therapy (tVMAT) and conventional 3D-conformal radiotherapy (3D-CRT).

Results: Based on the HD95 values, the variations in CTV shape and position were enclosed by the 5 mm CTV-PTV margin in 85% of treatment fractions using complementary CBCT and SGRT setup. A residual error of 8.6 mm was observed between the initial SGRT setup and CBCT setup. The median CTV V95% coverage was 98.1% (range 93.1-99.8%) with tVMAT and 98.2% (range 84.5-99.7%) with 3D-CRT techniques with CBCT setup. With the initial SGRT-only setup, the corresponding coverages were 96.3% (range 92.6-99.4%) and 96.6% (range 84.2-99.4%), respectively. However, a considerable bias in vertical residual error between initial SGRT setup and CBCT setup was observed. Clinically relevant changes between the planned and cumulative doses to organs-at-risk (OARs) were not observed.

Conclusions: The CTV-to-PTV margin should not be reduced below 5 mm even with daily CBCT setup. Both tVMAT and 3D-CRT techniques were robust in terms of dose coverage to the target and OARs. Based on the shifts between setup methods, CBCT setup is recommended as a complementary method with SGRT.

Keywords: CBCT; Setup margin; Setup uncertainty; Tissue deformations; VMAT.

MeSH terms

Cone-Beam Computed Tomography / methods
Humans
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted / methods
Radiotherapy, Conformal*
Radiotherapy, Image-Guided* / methods
Radiotherapy, Intensity-Modulated* / methods
Spiral Cone-Beam Computed Tomography*