Abstract
PurposeIn postoperative breast irradiation, changes in the breast contour and arm positioning can result in patient positioning errors and offline re-planning. This can lead to increased treatment burden, and strain on departmental logistics due to the need for additional cone-beam CT images or even a new radiotherapy treatment plan (TP). Online daily adaptive radiotherapy (oART) could provide a solution to these challenges. We have clinically implemented and evaluated the feasibility of oART for whole breast irradiation. Methods and MaterialsTwenty patients treated with postoperative whole breast right irradiation (5 × 5.2 Gy) were included in BREAST-ART, a prospective single-arm trial. Dosimetry of the reference TP calculated on the daily anatomy and adaptive TP were compared. Duration of the oART workflow, in-house satisfaction questionnaires, and acute toxicity (CTCAE v5.0) was collected. The oART workflow was evaluated by investigating the impact of manual corrections of influencer and target contours on treatment time and quality. ResultsIn the first 17 patients (85 fractions), the on-couch time, i.e. time between the end of CBCT1 and CBCT3, was median 13.8 minutes (range=11–25). Retrospective evaluation of the use of the influencer (i.e. breast) in 4 patients (20 fractions) and manual correction of the most cranial and caudal target contours (i.e. 4 mm) in 10 patients (36 fractions) was done. This resulted in a reduced on-couch time in the last 3 clinical patients to a median of 13.0 minutes (range=11–19). No grade 3 or higher toxicity was observed, and 19/20 patients indicated to prefer the same treatment again. Skin marks for patient positioning during treatment were no longer necessary. ConclusionsThis study showed the feasibility, challenges, and practical solutions for the implementation of oART for breast cancer patients. Future work will focus on more complex breast indications such as whole breast including axillary nodes, to further investigate benefits and challenges of oART in breast cancer.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
