PMID- 25680602
OWN - NLM
STAT- MEDLINE
DCOM- 20150407
LR  - 20181202
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 91
IP  - 3
DP  - 2015 Mar 1
TI  - Intrafraction variability and deformation quantification in the breast.
PG  - 604-11
LID - S0360-3016(14)04367-3 [pii]
LID - 10.1016/j.ijrobp.2014.11.003 [doi]
AB  - PURPOSE: To evaluate intrafraction variability and deformation of the lumpectomy 
      cavity (LC), breast, and nearby organs. METHODS AND MATERIALS: Sixteen left-sided 
      postlumpectomy and 1 bilateral breast cancer cases underwent free-breathing CT 
      (FBCT) and 10-phase 4-dimensional CT (4DCT). Deformable image registration was 
      used for deformation analysis and contour propagation of breast, heart, lungs, 
      and LC between end-exhale and end-inhale 4DCT phases. Respiration-induced motion 
      was calculated via centroid analysis. Two planning target volumes (PTVs) were 
      compared: PTV(FBCT) from the FBCT volume with an isotropic 10 mm expansion (5 mm 
      excursion and 5 mm setup error) and PTV(4DCT) generated from the union of 4DCT 
      contours with isotropic 5 mm margin for setup error. Volume and geometry were 
      evaluated via percent difference and bounding box analysis, respectively. 
      Deformation correlations between breast/cavity, breast/lung, and breast/heart 
      were evaluated. Associations were tested between cavity deformation and proximity 
      to chest wall and breast surface. RESULTS: Population-based 3-dimensional vector 
      excursions were 2.5 +/- 1.0 mm (range, 0.8-3.8 mm) for the cavity and 2.0 +/- 0.8 mm 
      (range, 0.7-3.0 mm) for the ipsilateral breast. Cavity excursion was 
      predominantly in the anterior and superior directions (1.0 +/- 0.8 mm and -1.8 +/- 
      1.2 mm, respectively). Similarly, for all cases, LCs and ipsilateral breasts 
      yielded median deformation values in the superior direction. For 14 of 17 
      patients, the LCs and breast interquartile ranges tended toward the anterior 
      direction. The PTV(FBCT) was 51.5% +/- 10.8% larger (P<.01) than PTV(4DCT). 
      Bounding box analysis revealed that PTV(FBCT) was 9.8 +/- 1.2 (lateral), 9.0 +/- 2.2 
      (anterior-posterior), and 3.9 +/- 1.8 (superior-inferior) mm larger than PTV(4DCT). 
      Significant associations between breast and cavity deformation were found for 6 
      of 9 axes. No dependency was found between cavity deformation and proximity to 
      chest wall or breast surface. CONCLUSIONS: Lumpectomy cavity and breast 
      deformation and motion demonstrated large variability. A PTV(4DCT) approach 
      showed value in patient-specific margins, particularly if robust interfraction 
      setup analysis can be performed.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Glide-Hurst, Carri K
AU  - Glide-Hurst CK
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan. 
      Electronic address: churst2@hfhs.org.
FAU - Shah, Mira M
AU  - Shah MM
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Price, Ryan G
AU  - Price RG
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan; 
      Department of Radiation Oncology, Wayne State University School of Medicine, 
      Detroit, Michigan.
FAU - Liu, Chang
AU  - Liu C
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Kim, Jinkoo
AU  - Kim J
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Mahan, Meredith
AU  - Mahan M
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Fraser, Correen
AU  - Fraser C
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Chetty, Indrin J
AU  - Chetty IJ
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Aref, Ibrahim
AU  - Aref I
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Movsas, Benjamin
AU  - Movsas B
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
FAU - Walker, Eleanor M
AU  - Walker EM
AD  - Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150130
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Breast
MH  - Breast Neoplasms/*diagnostic imaging/pathology/radiotherapy/surgery
MH  - Dose Fractionation, Radiation
MH  - Female
MH  - Four-Dimensional Computed Tomography/methods
MH  - Heart/diagnostic imaging
MH  - Humans
MH  - Lung/diagnostic imaging
MH  - *Mastectomy, Segmental
MH  - Middle Aged
MH  - *Movement
MH  - Organs at Risk/*diagnostic imaging
MH  - Radiation Injuries/prevention & control
MH  - Radiotherapy Setup Errors
MH  - *Respiration
EDAT- 2015/02/15 06:00
MHDA- 2015/04/08 06:00
CRDT- 2015/02/15 06:00
PHST- 2014/07/07 00:00 [received]
PHST- 2014/10/31 00:00 [revised]
PHST- 2014/11/04 00:00 [accepted]
PHST- 2015/02/15 06:00 [entrez]
PHST- 2015/02/15 06:00 [pubmed]
PHST- 2015/04/08 06:00 [medline]
AID - S0360-3016(14)04367-3 [pii]
AID - 10.1016/j.ijrobp.2014.11.003 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2015 Mar 1;91(3):604-11. doi: 
      10.1016/j.ijrobp.2014.11.003. Epub 2015 Jan 30.