Arms positioning in post-mastectomy proton radiation: Feasibility and development of a new arms down contouring atlas.

Background And Purpose: Breast cancer patients receiving radiation are traditionally positioned with both arms up, but this may not be feasible or comfortable for all patients. We evaluated the treatment planning and positioning reproducibility differences between the arms up and arms down positions for patients receiving post-mastectomy radiation therapy (PMRT) using proton pencil beam scanning (PBS).

Materials And Methods: Ten PMRT patients who were scheduled to receive PBS underwent CT-based treatment planning in both an arms down and a standard arms up position.

Phase II Study of Proton Beam Radiation Therapy for Patients With Breast Cancer Requiring Regional Nodal Irradiation.

Purpose: To evaluate the safety and efficacy of proton beam radiation therapy (RT) for patients with breast cancer who require regional nodal irradiation.

Methods: Patients with nonmetastatic breast cancer who required postoperative RT to the breast/chest wall and regional lymphatics and who were considered suboptimal candidates for conventional RT were eligible. The primary end point was the incidence of grade 3 or higher radiation pneumonitis (RP) or any grade 4 toxicity within 3 months of RT.

Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring.

Purpose: To determine the accuracy of a surface guided radiotherapy (SGRT) system for positioning of breast cancer patients in breath-hold (BH) with respect to cone-beam computed tomography (CBCT). Secondly, to evaluate the thorax position stability during BHs with SGRT, when using an air-volume guidance system.

Methods And Materials: Eighteen left-sided breast cancer patients were monitored with SGRT during CBCT and treatment, both in BH.

Tattoo free setup for partial breast irradiation: A feasibility study.

Purpose: Patients undergoing external beam accelerated partial breast irradiation (APBI) receive permanent tattoos to aid with daily setup alignment and verification. With the advent of three-dimensional (3D) body surface imaging and two-dimensional (2D) x-ray imaging-based matching to surgical clips, tattoos may not be necessary to ensure setup accuracy. We compared the accuracy of conventional tattoo-based setups to a patient setup without tattoos.

Reducing X-ray imaging for proton postmastectomy chest wall patients.

Purpose: Proton postmastectomy radiation therapy (PMRT) patients are positioned daily using surface imaging with additional x-ray imaging for confirmation. This study aims to investigate whether weekly x-ray imaging with daily surface imaging, as performed for photon treatment, is sufficient to maintain PMRT patient positioning fidelity.

Methods And Materials: Calculated radiographic corrections and surface imaging residual setup errors were analyzed at the treatment angle for 28 PMRT patients (with and without breast implant, left and right sided).

Can surface imaging improve the patient setup for proton postmastectomy chest wall irradiation?

Purposes/objectives: For postmastectomy radiation therapy by proton beams, the usual bony landmark based radiograph setup technique is indirect because the target volumes are generally superficial and far away from major bony structures. The surface imaging setup technique of matching chest wall surface directly to treatment planning computed tomography was evaluated and compared to the traditional radiograph-based technique.

Methods And Materials: Fifteen postmastectomy radiation therapy patients were included, with the first 5 patients positioned by standard radiograph-based technique; radiopaque makers, however, were added on the patient's skin surface to improve the relevance of the setup.

A novel approach to postmastectomy radiation therapy using scanned proton beams.

Purpose: Postmastectomy radiation therapy (PMRT), currently offered at Massachusetts General Hospital, uses proton pencil beam scanning (PBS) with intensity modulation, achieving complete target coverage of the chest wall and all nodal regions and reduced dose to the cardiac structures. This work presents the current methodology for such treatment and the ongoing effort for its improvements.

Methods And Materials: A single PBS field is optimized to ensure appropriate target coverage and heart/lung sparing, using an in-house-developed proton planning system with the capability of multicriteria optimization.