Setup Error and Effectiveness of Weekly Image-Guided Radiation Therapy of TomoDirect for Early Breast Cancer
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Purpose This study investigated setup error and effectiveness of weekly image-guided radiotherapy(IGRT) of TomoDirect for early breast cancer. Materials and MethodsOne hundred and fifty-one breasts of 147 consecutive patients who underwent breastconserving surgery followed by whole breast irradiation using TomoDirect in 2012 and 2013were evaluated. All patients received weekly IGRT. The weekly setup errors from simulationto each treatment in reference to chest wall and surgical clips were measured. Random,systemic, and 3-dimensional setup errors were assessed. Extensive setup error wasdefined as 5 mm above the margin in any directions. ResultsAll mean errors were within 3 mm of all directions. The mean angle of gantry shifts was0.6°. The mean value of absolute 3-dimensional setup error was 4.67 mm. In multivariateanalysis, breast size (odds ratio, 2.82; 95% confidence interval, 1.00 to 7.90) was a significantfactor for extensive error. The largest significant deviation of setup error was observedin the first week of radiotherapy (p < 0.001) and the deviations gradually decreased withtime. The deviation of setup error was 5.68 mm in the first week and within 5 mm after thesecond week. ConclusionIn this study, there was a significant association between breast size and significant setuperror in breast cancer patients who received TomoDirect. The largest deviation occurred inthe first week of treatment. Therefore, patients with large breasts should be closely observedon every fraction and fastidious attention is required in the first fraction of IGRT.
Abstract
Purpose This study investigated setup error and effectiveness of weekly image-guided radiotherapy(IGRT) of TomoDirect for early breast cancer. Materials and MethodsOne hundred and fifty-one breasts of 147 consecutive patients who underwent breastconserving surgery followed by whole breast irradiation using TomoDirect in 2012 and 2013were evaluated. All patients received weekly IGRT. The weekly setup errors from simulationto each treatment in reference to chest wall and surgical clips were measured. Random,systemic, and 3-dimensional setup errors were assessed. Extensive setup error wasdefined as 5 mm above the margin in any directions. ResultsAll mean errors were within 3 mm of all directions. The mean angle of gantry shifts was0.6°. The mean value of absolute 3-dimensional setup error was 4.67 mm. In multivariateanalysis, breast size (odds ratio, 2.82; 95% confidence interval, 1.00 to 7.90) was a significantfactor for extensive error. The largest significant deviation of setup error was observedin the first week of radiotherapy (p < 0.001) and the deviations gradually decreased withtime. The deviation of setup error was 5.68 mm in the first week and within 5 mm after thesecond week. ConclusionIn this study, there was a significant association between breast size and significant setuperror in breast cancer patients who received TomoDirect. The largest deviation occurred inthe first week of treatment. Therefore, patients with large breasts should be closely observedon every fraction and fastidious attention is required in the first fraction of IGRT.
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