Ahead of print
Research paper
Published online: 2024-03-08
Surface-guided radiotherapy systems in locoregional deep inspiration breath hold radiotherapy for breast cancer — a multicenter study on the setup accuracy
DOI: 10.5603/rpor.99673
Abstract
Background: Daily image-guided radiotherapy (IGRT) and deep inspiration breath hold (DIBH) technique are recommended for locoregional RT of breast cancer. The optimal workflow for a combination of surface-guided RT (SGRT) with DIBH technique is of current clinical interest.
Materials and methods: The setup accuracy at three hospitals was evaluated using different SGRT workflows. A total of 150 patients (2269 image pairs) were analyzed in three groups: patient setup with the AlignRT® SGRT system in Tampere (Site 1, n = 50), the Catalyst™ SGRT system in Turku (Site 2, n = 50) and the Catalyst™ SGRT system in Jönköping (Site 3, n = 50). Each site used their routine workflow with SGRT-based setup and IGRT positioning. Residual errors of the bony chest wall, thoracic vertebra (Th 1) and humeral head were evaluated using IGRT images.
Results: Systematic residual errors in the cranio-caudal (CC) direction and in pitch were generally larger at Site 2 than those at Sites 1 and 3 (p = 0.01–0.7). With daily IGRT, only a small difference (p = 0.01–0.9) was observed in residual random errors of bony structures in other directions between sites.
Conclusion: The introduction of SGRT and the use of daily IGRT lead to small residual errors when combining the best workflow practices from different hospitals. Our multicenter evaluation led to improved workflow by tightening the SGRT tolerances on Site 2 and fixation modification. Because of mainly small random errors, systematic posture errors in the images need to be corrected after posture correction with new setup surfaces. We recommend tight SGRT tolerances, good fixation and correction of systematic errors.
Keywords: breast cancerlocoregional radiotherapysurface-guided radiotherapypatient positioningdeep inspiration breath hold
References
- McGale P, Taylor C, Correa C, et al. EBCTCG (Early Breast Cancer Trialists' Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383(9935): 2127–2135.
- Rong Yi, Walston S, Welliver MXu, et al. Improving intra-fractional target position accuracy using a 3D surface surrogate for left breast irradiation using the respiratory-gated deep-inspiration breath-hold technique. PLoS One. 2014; 9(5): e97933.
- Register S, Takita C, Reis I, et al. Deep inspiration breath-hold technique for left-sided breast cancer: An analysis of predictors for organ-at-risk sparing. Med Dosim. 2015; 40(1): 89–95.
- Duma MN, Baumann R, Budach W, et al. Breast Cancer Expert Panel of the German Society of Radiation Oncology (DEGRO). Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol. 2019; 195(10): 861–871.
- Batista V, Gober M, Moura F, et al. Surface guided radiation therapy: An international survey on current clinical practice. Tech Innov Patient Support Radiat Oncol. 2022; 22: 1–8.
- Peters GW, Gao SJ, Knowlton C, et al. Benefit of Deep Inspiratory Breath Hold for Right Breast Cancer When Regional Lymph Nodes Are Irradiated. Pract Radiat Oncol. 2022; 12(1): e7–ee12.
- Lin A, Sharieff W, Juhasz J, et al. The benefit of deep inspiration breath hold: evaluating cardiac radiation exposure in patients after mastectomy and after breast-conserving surgery. Breast Cancer. 2017; 24(1): 86–91.
- Giantsoudi D, Lalonde A, Barra C, et al. Tattoo-Free Setup for Patients With Breast Cancer Receiving Regional Nodal Irradiation. Pract Radiat Oncol. 2023; 13(1): e20–e27.
- Simonetto C, Eidemüller M, Gaasch A, et al. Does deep inspiration breath-hold prolong life? Individual risk estimates of ischaemic heart disease after breast cancer radiotherapy. Radiother Oncol. 2019; 131: 202–207.
- Vuong W, Garg R, Bourgeois DJ, et al. Dosimetric comparison of deep-inspiration breath-hold and free-breathing treatment delivery techniques for left-sided breast cancer using 3D surface tracking. Med Dosim. 2019; 44(3): 193–198.
- Schönecker S, Walter F, Freislederer P, et al. Treatment planning and evaluation of gated radiotherapy in left-sided breast cancer patients using the Catalyst/Sentinel system for deep inspiration breath-hold (DIBH). Radiat Oncol. 2016; 11(1): 143.
- Steffal C, Schratter-Sehn A, Brinda-Raitmayr K, et al. 5 years of experience with DIBH (Deep inspiration breath-hold) combined with SGRT (Surface-Guided Radiation Therapy) in left-sided breast cancer. Senologie. 2020; 17(01): 14–23.
- Deantonio L, Masini L, Loi G, et al. Detection of setup uncertainties with 3D surface registration system for conformal radiotherapy of breast cancer. Rep Pract Oncol Radiother. 2011; 16(3): 77–81.
- Rong Yi, Walston S, Welliver MXu, et al. Improving intra-fractional target position accuracy using a 3D surface surrogate for left breast irradiation using the respiratory-gated deep-inspiration breath-hold technique. PLoS One. 2014; 9(5): e97933.
- Neubauer E, Dong L, Followill DS, et al. Assessment of shoulder position variation and its impact on IMRT and VMAT doses for head and neck cancer. Radiat Oncol. 2012; 7: 19.
- Skyttä T, Kapanen M, Laaksomaa M, et al. Improving the reproducibility of voluntary deep inspiration breath hold technique during adjuvant left-sided breast cancer radiotherapy. Acta Oncol. 2016; 55(8): 970–975.
- McIntosh A, Shoushtari AN, Benedict SH, et al. Quantifying the reproducibility of heart position during treatment and corresponding delivered heart dose in voluntary deep inhalation breath hold for left breast cancer patients treated with external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 81(4): e569–e576.
- Koivumäki T, Tujunen J, Virén T, et al. Geometrical uncertainty of heart position in deep-inspiration breath-hold radiotherapy of left-sided breast cancer patients. Acta Oncol. 2017; 56(6): 879–883.
- Mhatre V. Quality assurance for clinical implementation of an Optical Surface monitoring system. IOSR Journal of Applied Physics . 2017; 9(6): 15–22.
- Pallotta S, Marrazzo L, Ceroti M, et al. A phantom evaluation of Sentinel(™), a commercial laser/camera surface imaging system for patient setup verification in radiotherapy. Med Phys. 2012; 39(2): 706–712.
- Laaksomaa M, Ahlroth J, Pynnönen K, et al. AlignRT, Catalyst™ and RPM™ in locoregional radiotherapy of breast cancer with DIBH. Is IGRT still needed? Rep Pract Oncol Radiother. 2022; 27(5): 797–808.
- van Herk M, Remeijer P, Rasch C, et al. The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys. 2000; 47(4): 1121–1135.
- Kügele M, Mannerberg A, Nørring Bekke S, et al. Surface guided radiotherapy (SGRT) improves breast cancer patient setup accuracy. J Appl Clin Med Phys. 2019; 20(9): 61–68.
- Wei X, Liu M, Ding Y, et al. Setup errors and effectiveness of Optical Laser 3D Surface imaging system (Sentinel) in postoperative radiotherapy of breast cancer. Sci Rep. 2018; 8(1): 7270.
- Cravo Sá A, Fermento A, Neves D, et al. Radiotherapy setup displacements in breast cancer patients: 3D surface imaging experience. Rep Pract Oncol Radiother. 2018; 23(1): 61–67.
- Sauer TO, Ott OJ, Lahmer G, et al. Prerequisites for the clinical implementation of a markerless SGRT-only workflow for the treatment of breast cancer patients. Strahlenther Onkol. 2023; 199(1): 22–29.
- Betgen A, Alderliesten T, Sonke JJ, et al. Assessment of set-up variability during deep inspiration breath hold radiotherapy for breast cancer patients by 3D-surface imaging. Radiother Oncol. 2013; 106(2): 225–230.
- Rossi M, Laaksomaa M, Aula A. Patient setup accuracy in DIBH radiotherapy of breast cancer with lymph node inclusion using surface tracking and image guidance. Med Dosim. 2022; 47(2): 146–150.
- Laaksomaa M, Kapanen M, Haltamo M, et al. Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold. Radiat Oncol. 2015; 10: 76.
- Wiant D, Wentworth S, Liu H, et al. How Important Is a Reproducible Breath Hold for Deep Inspiration Breath Hold Breast Radiation Therapy? Int J Radiat Oncol Biol Phys. 2015; 93(4): 901–907.
- Jensen CA, Acosta Roa AM, Lund JÅ, et al. Intrafractional baseline drift during free breathing breast cancer radiation therapy. Acta Oncol. 2017; 56(6): 867–873.
- Laaksomaa M, Sarudis S, Rossi M, et al. AlignRT and Catalyst™ in whole-breast radiotherapy with DIBH: Is IGRT still needed? J Appl Clin Med Phys. 2019; 20(3): 97–104.
- Rossi M, Boman E, Kapanen M. Optimal selection of optimization bolus thickness in planning of VMAT breast radiotherapy treatments. Med Dosim. 2019; 44(3): 266–273.
- Seppälä J, Vuolukka K, Virén T, et al. Breast deformation during the course of radiotherapy: The need for an additional outer margin. Phys Med. 2019; 65: 1–5.
- Laaksomaa M, Moser T, Kritz J, et al. Comparison of three differently shaped ROIs in free breathing breast radiotherapy setup using surface guidance with AlignRT. Rep Pract Oncol Radiother. 2021; 26(4): 545–552.
- Sorgato V, Ghazouani K, Queffelec Y, et al. Benchmarking the AlignRT surface deformation module for the early detection and quantification of oedema in breast cancer radiotherapy. Tech Innov Patient Support Radiat Oncol. 2022; 21: 16–22.