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

40 Citations (Scopus)

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

Fingerprint

Esophageal Neoplasms
radiation therapy
Yaws
Radiotherapy
cancer
Tomography
evaluation
Intensity-Modulated Radiotherapy
yaw
tomography
Weights and Measures
Body Surface Area
planning
Therapeutics
landmarks
Radiation
Skin
toxicity
organs
pretreatment

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Setup Variations in Radiotherapy of Esophageal Cancer : Evaluation by Daily Megavoltage Computed Tomographic Localization. / Chen, Yi Jen; Han, Chunhui; Liu, An; Schultheiss, Timothy E.; Kernstine, Kemp H.; Shibata, Stephen; Vora, Nayana L.; Pezner, Richard D.; Wong, Jeffrey Y C.

In: International Journal of Radiation Oncology Biology Physics, Vol. 68, No. 5, 01.08.2007, p. 1537-1545.

Research output: Contribution to journalArticle

Chen, Yi Jen ; Han, Chunhui ; Liu, An ; Schultheiss, Timothy E. ; Kernstine, Kemp H. ; Shibata, Stephen ; Vora, Nayana L. ; Pezner, Richard D. ; Wong, Jeffrey Y C. / Setup Variations in Radiotherapy of Esophageal Cancer : Evaluation by Daily Megavoltage Computed Tomographic Localization. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 68, No. 5. pp. 1537-1545.
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T2 - Evaluation by Daily Megavoltage Computed Tomographic Localization

AU - Chen, Yi Jen

AU - Han, Chunhui

AU - Liu, An

AU - Schultheiss, Timothy E.

AU - Kernstine, Kemp H.

AU - Shibata, Stephen

AU - Vora, Nayana L.

AU - Pezner, Richard D.

AU - Wong, Jeffrey Y C

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AB - 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.

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KW - Helical tomotherapy

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