AI Article Synopsis
- The study investigated how respiratory movement affects the planned radiation dose in patients receiving whole-breast irradiation (WBI) using hypofractionated techniques, specifically comparing the impact of different fractionation schedules.
- Ten patients were analyzed using phase-triggered 4D-CT images to create VMAT treatment plans, assessing variations in dose resulting from respiratory motion, while 3D-CRT plans served as a reference.
- Findings indicated that respiratory motion caused minor reductions in target volume coverage and dose uniformity, but these changes were not clinically significant, with margins of up to 5 mm deemed adequate to compensate for breathing movements.
Article Abstract
Background And Purpose: The interplay effect of respiratory motion on the planned dose in free-breathing right-sided whole-breast irradiation (WBI) were studied by simulating hypofractionated VMAT treatment courses.
Materials And Methods: Ten patients with phase-triggered 4D-CT images were included in the study. VMAT plans targeting the right breast were created retrospectively with moderately hypofractionated (40.05 Gy in 15 fractions of 2.67 Gy) and ultra-hypofractionated (26 Gy 5 fractions of 5.2 Gy) schemes. 3D-CRT plans were generated as a reference. All plans were divided into respiratory phase-specific plans and calculated in the corresponding phase images. Fraction-specific dose was formed by deforming and summing the phase-specific doses in the planning image for each fraction. The fraction-specific dose distributions were deformed and superimposed onto the planning image, forming the course-specific respiratory motion perturbed dose distribution. Planned and respiratory motion perturbed doses were compared and changes due to respiratory motion and choice of fractionation were evaluated.
Results: The respiratory motion perturbed PTV coverage (V95%) decreased by 1.7% and the homogeneity index increased by 0.02 for VMAT techniques, compared to the planned values. Highest decrease in CTV coverage was 0.7%. The largest dose differences were located in the areas of steep dose gradients parallel to respiratory motion. The largest difference in DVH parameters between fractionation schemes was 0.4% of the prescribed dose. Clinically relevant changes to the doses of organs at risk were not observed. One patient was excluded from the analysis due to large respiratory amplitude.
Conclusion: Respiratory motion of less than 5 mm in magnitude did not result in clinically significant changes in the planned free-breathing WBI dose. The 5 mm margins were sufficient to account for the respiratory motion in terms of CTV dose homogeneity and coverage for VMAT techniques. Steep dose gradients near the PTV edges might decrease the CTV coverage. No clinical significance was found due to the choice of fractionation.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8898500 | PMC |
| http://dx.doi.org/10.1186/s13014-022-02014-5 | DOI Listing |
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