Clinical Experience With Image-Guided Radiotherapy in an Accelerated Partial Breast Intensity-Modulated Radiotherapy Protocol

Leonard, Charles E.; Tallhamer, Michael; Johnson, Timothy K.; Hunter, K.U.; Howell, Kathryn; Kercher, Jane M.; Widener, Jodi; Kaske, Terese I.; Paul, Devchand; Sedlacek, Scot; Carter, Dennis L.

doi:10.1016/j.ijrobp.2009.02.001

Cited by 39 publications

(31 citation statements)

References 28 publications

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“…They have shown huge success in breast radiotherapy, allowing for reduced margins, partial breast treatments and dose escalation [9,10]. In prostate radiotherapy, they are used routinely for image guidance in many institutions leading to increased setup accuracy, reduced target margins and dose escalation [11][12][13].…”

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confidence: 99%

A review of the use of fiducial markers for image-guided bladder radiotherapy

Nolan

Forde

2015

Acta Oncologica

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Background: Enhancing target visualization and reducing set-up errors in image-guided radiotherapy (IGRT) are issues faced when trying to implement more conformal and partial bladder techniques. This review examines the evidence available pertaining to the clinical use of Lipiodol and gold fiducials for IGRT for bladder cancer. Material and methods: Nine published articles relating to the feasibility of using Lipiodol injections or gold fiducial markers in IGRT for bladder patients were recruited from a database search strategy. Set-up errors were evaluated in addition to the stability and visibility of each on verification imaging. Adverse reactions from the insertion of each method were also assessed. Results: Both Lipiodol and gold fiducials have the potential to remain stable and visible in the bladder, however, fading, washout and seed loss was also reported. Set-up errors can be reduced by using Lipiodol or fiducial registration when compared to other registration techniques. Adverse reactions reported were minimal for each. Conclusion: Current evidence suggests that Lipiodol injections and gold fiducial markers present as promising and highly accurate methods of overcoming interfraction bladder motion in IGRT.

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confidence: 99%

A review of the use of fiducial markers for image-guided bladder radiotherapy

Nolan

Forde

2015

Acta Oncologica

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“…Using the Pearson chi-square test with 5 degree of freedom, the χ 2 was 0.053 (p=0.95) for the LKB model and χ 2 was 0.058 (p=0. 95) for the Niemierko model suggesting a good fit for both models. Alexander et al 79 reported that the volume parameter exhibited a strong effect on breast fibrosis.…”

Section: Resultsmentioning

confidence: 80%

“…Each patient underwent two planning CT scans on separate It is now known that surgical clips are a better surrogate of the surgical cavity (tumour bed), as compared to bony anatomy. A number of studies have evaluated the feasibility of using these surgical clips for image guided breast radiotherapy [94][95][96] .…”

Section: Central Lung Distance (Cld)mentioning

confidence: 99%

A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Harris

Mukesh

Jena

et al. 2014

Efficacy and Mechanism Evaluation

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Background Whole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT). Objectives Primary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken. Design Multicentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT. Setting Five radiotherapy departments, participating in IMPORT-HIGH. Participants Two-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH. Interventions There was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images. Main outcome measures Difference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging. Results The primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3 (range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is ...

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“…Gold fiducial markers were implanted near the seroma cavity as a surrogate for its position on orthogonal MV portal imaging. 17 However, the issue of MV exit dose to structures such as the contralateral breast remains because of the use of orthogonal beam projections. The study did not determine whether fiducial markers implanted under ultrasound guidance maintained their relationship with the seroma cavity in the manner Weed et al demonstrated for clips implanted at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%