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The effect of image guidance on dose distributions in breast boost radiotherapy

Donovan, EM, Brooks, C, Mitchell, RA, Harris, EJ, Mukesh, M, Coles, CE and Evans, PM (2014) The effect of image guidance on dose distributions in breast boost radiotherapy Clinical Oncology, 26 (11). pp. 671-676.

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Aims: To determine the effect of image-guided radiotherapy on the dose distributions in breast boost treatments. Materials and methods: Computed tomography images from a cohort of 60 patients treated within the IMPORT HIGH trial (CRUK/06/003) were used to create sequential and concomitant boost treatment plans (30 cases each). Two treatment plans were created for each case using tumour bed planning target volume (PTV) margins of 5 mm (achieved with image-guided radiotherapy) and 8 mm (required for bony anatomy verification). Dose data were collected for breast, lung and heart; differences with margin size were tested for statistical significance. Results: A median decrease of 29 cm (range 11-193 cm) of breast tissue receiving 95% of the prescribed dose was observed where image-guided radiotherapy margins were used. Decreases in doses to lungs, contralateral breast and heart were modest, but statistically significant (P < 0.01). Plan quality was compromised with the 8 mm PTV margin in one in eight sequential boost plans and one third of concomitant boost plans. Tumour bed PTV coverage was <95% (>91%) of the prescribed dose in 12 cases; in addition, the required partial breast median dose was exceeded in nine concomitant boost cases by 0.5-3.7 Gy. Conclusions: The use of image guidance and, hence, a reduced tumour bed PTV margin, in breast boost radiotherapy resulted in a modest reduction in radiation dose to breast, lung and heart tissues. Reduced margins enabled by image guidance were necessary to discriminate between dose levels to multiple PTVs in the concomitant breast boost plans investigated.

Item Type: Article
Divisions : Faculty of Engineering and Physical Sciences > Electronic Engineering > Centre for Vision Speech and Signal Processing
Authors :
Date : 1 November 2014
Identification Number : 10.1016/j.clon.2014.05.013
Additional Information : NOTICE: this is the author’s version of a work that was accepted for publication in Clinical Oncology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Clinical Oncology, 26(11), November 2014, DOI 10.1016/j.clon.2014.05.013.
Depositing User : Symplectic Elements
Date Deposited : 10 Dec 2014 16:36
Last Modified : 11 Dec 2014 02:33

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