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A multicentre study of the evidence for customized margins in photon breast boost radiotherapy.

Harris, EJ, Mukesh, MB, Donovan, EM, Kirby, AM, Haviland, JS, Jena, R, Yarnold, J, Baker, A, Dean, J, Eagle, S, Mayles, H, Griffin, C, Perry, R, Poynter, A, Coles, CE, Evans, PM and IMPORT high trialists, (2016) A multicentre study of the evidence for customized margins in photon breast boost radiotherapy. Br J Radiol, 89 (1058).

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Abstract

OBJECTIVE: To determine if subsets of patients may benefit from smaller or larger margins when using laser setup and bony anatomy verification of breast tumour bed (TB) boost radiotherapy (RT). METHODS: Verification imaging data acquired using cone-beam CT, megavoltage CT or two-dimensional kilovoltage imaging on 218 patients were used (1574 images). TB setup errors for laser-only setup (dlaser) and for bony anatomy verification (dbone) were determined using clips implanted into the TB as a gold standard for the TB position. Cases were grouped by centre-, patient- and treatment-related factors, including breast volume, TB position, seroma visibility and surgical technique. Systematic (Σ) and random (σ) TB setup errors were compared between groups, and TB planning target volume margins (MTB) were calculated. RESULTS: For the study population, Σlaser was between 2.8 and 3.4 mm, and Σbone was between 2.2 and 2.6 mm, respectively. Females with larger breasts (p = 0.03), easily visible seroma (p ≤ 0.02) and open surgical technique (p ≤ 0.04) had larger Σlaser. Σbone was larger for females with larger breasts (p = 0.02) and lateral tumours (p = 0.04). Females with medial tumours (p < 0.01) had smaller Σbone. CONCLUSION: If clips are not used, margins should be 8 and 10 mm for bony anatomy verification and laser setup, respectively. Individualization of TB margins may be considered based on breast volume, TB and seroma visibility. Advances in knowledge: Setup accuracy using lasers and bony anatomy is influenced by patient and treatment factors. Some patients may benefit from clip-based image guidance more than others.

Item Type: Article
Subjects : CVSSP
Divisions : Faculty of Engineering and Physical Sciences > Electronic Engineering > Centre for Vision Speech and Signal Processing
Authors :
AuthorsEmailORCID
Harris, EJUNSPECIFIEDUNSPECIFIED
Mukesh, MBUNSPECIFIEDUNSPECIFIED
Donovan, EMUNSPECIFIEDUNSPECIFIED
Kirby, AMUNSPECIFIEDUNSPECIFIED
Haviland, JSUNSPECIFIEDUNSPECIFIED
Jena, RUNSPECIFIEDUNSPECIFIED
Yarnold, JUNSPECIFIEDUNSPECIFIED
Baker, AUNSPECIFIEDUNSPECIFIED
Dean, JUNSPECIFIEDUNSPECIFIED
Eagle, SUNSPECIFIEDUNSPECIFIED
Mayles, HUNSPECIFIEDUNSPECIFIED
Griffin, CUNSPECIFIEDUNSPECIFIED
Perry, RUNSPECIFIEDUNSPECIFIED
Poynter, AUNSPECIFIEDUNSPECIFIED
Coles, CEUNSPECIFIEDUNSPECIFIED
Evans, PMUNSPECIFIEDUNSPECIFIED
IMPORT high trialists, UNSPECIFIEDUNSPECIFIED
Date : 5 January 2016
Identification Number : 10.1259/bjr.20150603
Related URLs :
Additional Information : This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License http://creativecommons.org/licenses/by/4.0/ The published version can be viewed here: http://dx.doi.org/10.1259/bjr.20150603
Depositing User : Symplectic Elements
Date Deposited : 29 Jan 2016 10:01
Last Modified : 09 Feb 2016 09:13
URI: http://epubs.surrey.ac.uk/id/eprint/809812

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