Should we customize PTV expansions for BMI? Daily cone beam computerized tomography to assess organ motion in postoperative endometrial and cervical cancer patients

Abstract

Aim

A single-institution review assessing patient characteristics contributing to daily organ motion in postoperative endometrial and cervical cancer patients treated with intensity-modulated radiotherapy (IMRT).

Background

The Radiation Therapy Oncology Group has established consensus guidelines for postoperative pelvic IMRT, recommending a 7[[ce:hsp sp="0.25"/]]mm margin on all three axes of the target volume.

Materials and methods

Daily shifts on 457 radiation setups for 18 patients were recorded in the x axis (lateral), y axis (superior–inferior) and z axis (anterior–posterior); daily positions of the planning tumor volume were referenced with the initial planning scan to quantify variations.

Results

Of the 457 sessions, 85 (18.6%) had plan shifts of at least 7[[ce:hsp sp="0.25"/]]mm in one of the three dimensions. For obese patients (body mass index [BMI][[ce:hsp sp="0.25"/]]≥[[ce:hsp sp="0.25"/]]30), 75/306 (24.5%) sessions had plan shifts ≥7[[ce:hsp sp="0.25"/]]mm. Odds of having a shift ≥7[[ce:hsp sp="0.25"/]]mm in any direction was greater for obese patients under both univariate (OR 4.227, 95% CI 1.235–14.466, p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.021) and multivariate (OR 5.000, 95% CI 1.341–18.646, p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.016) analyses (MVA). Under MVA, having a BMI[[ce:hsp sp="0.25"/]]≥[[ce:hsp sp="0.25"/]]30 was associated with increased odds of shifts in the anterior–posterior (1.173[[ce:hsp sp="0.25"/]]mm, 95% CI 0.281–2.065, p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.001) and lateral (2.074[[ce:hsp sp="0.25"/]]mm, 95% CI 1.284–2.864, p[[ce:hsp sp="0.25"/]]<[[ce:hsp sp="0.25"/]]0.000) directions but not in the superior–inferior axis (0.298[[ce:hsp sp="0.25"/]]mm, 95% CI −0.880 to 1.475, p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.619) exceeding 7[[ce:hsp sp="0.25"/]]mm.

Conclusions

Based on these findings, the standard planned tumor volume expansion of 7[[ce:hsp sp="0.25"/]]mm is less likely to account for daily treatment changes in obese patients.