Setup Variations in Radiotherapy of Esophageal Cancer: Evaluation by Daily Megavoltage Computed Tomographic Localization

Yi Jen Chen, Chunhui Han, An Liu, Timothy E. Schultheiss, Kemp H. Kernstine, Stephen Shibata, Nayana L. Vora, Richard D. Pezner, Jeffrey Y C Wong

Research output: Contribution to journalArticle

42 Scopus citations

Abstract

Purpose: To use pretreatment megavoltage computed tomography (MVCT) scans to evaluate setup variations in anterior-posterior (AP), lateral, and superior-inferior (SI) directions and rotational variations, including pitch, roll, and yaw, for esophageal cancer patients treated with helical tomotherapy. Methods and Materials: Ten patients with locally advanced esophageal cancer treated by combined chemoradiation using helical tomotherapy were selected. After patients were positioned using their skin tattoos/marks, MVCT scans were performed before every treatment and automatically registered to planning kilovoltage CT scans according to bony landmarks. Image registration data were used to adjust patient setups before treatment. A total of 250 MVCT scans were analyzed. Correlations between setup variations and body habitus, including height, weight, relative weight change, body surface area, and patient age, were evaluated. Results: The standard deviations for systematic setup corrections in AP, lateral, and SI directions and pitch, roll, and yaw rotations were 1.5, 3.7, and 4.8 mm and 0.5°, 1.2°, and 0.8°, respectively. The appropriate averages of random setup variations in AP, lateral, and SI directions and pitch, roll, and yaw rotations were 2.9, 5.2, and 4.4 mm, and 1.0°, 1.2°, and 1.1°, respectively. Setup variations were stable throughout the entire course of radiotherapy in all three translational and three rotational displacements, with little change in magnitude. No significant correlations were found between setup variations and body habitus variables. Conclusions: Daily MVCT scans before each treatment can effectively detect setup errors and thereby reduce planning target volume (PTV) margins. This will reduce radiation dose to critical organs and may translate into lower treatment-related toxicities.

Original languageEnglish (US)
Pages (from-to)1537-1545
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume68
Issue number5
DOIs
StatePublished - Aug 1 2007

Keywords

  • Esophageal cancer
  • Helical tomotherapy
  • MVCT
  • Radiotherapy
  • Setup variation

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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