Influence of Clinical and Tumor Factors on Interfraction Setup Errors With Rotation Correction for Vacuum Cushion in Lung Stereotactic Body Radiation Therapy.

Hua Chen,Hao Wang,Hengle Gu,Yanhua Duan,Lingxiang Liu,Zhiyong Xu,Ying Huang,Yan Shao,Aihui Feng

doi:10.3389/fonc.2021.734709

Abstract

PurposeTo explore the influence of clinical and tumor factors over interfraction setup errors with rotation correction for non-small cell lung cancer (NSCLC) stereotactic body radiation therapy (SBRT) patients immobilized in vacuum cushion (VC) to better understand whether patient re-setup could further be optimized with these parameters.Materials and MethodsThis retrospective study was conducted on 142 NSCLC patients treated with SBRT between November 2017 to July 2019 in the local institute. Translation and rotation setup errors were analyzed in 732 cone-beam computed tomography (CBCT) scans before treatment. Differences between groups were analyzed using independent sample t-test. Logistic regression test was used to analyze possible correlations between patient re-setup and clinical and tumor factors.ResultsMean setup errors were the largest in anterior–posterior (AP) direction (3.2 ± 2.4 mm) compared with superior–inferior (SI) (2.8 ± 2.1 mm) and left–right (LR) (2.5 ± 2.0 mm) directions. The mean values were similar in pitch, roll, and rtn directions. Of the fractions, 83.7%, 90.3%, and 86.6% satisfied setup error tolerance limits in AP, SI, and LR directions, whereas 95% had rotation setup errors of <2° in the pitch, roll, or rtn directions. Setup errors were significantly different in the LR direction when age, body mass index (BMI), and “right vs. left” location parameters were divided into groups. Both univariate and multivariable model analyses showed that age (p = 0.006) and BMI (p = 0.002) were associated with patient re-setup.ConclusionsAge and BMI, as clinical factors, significantly influenced patient re-setup in the current study, whereas all other clinical and tumor factors were not correlated with patient re-setup. The current study recommends that more attention be paid to setup for elderly patients and patients with larger BMI when immobilized using VC, especially in the left–right direction.

Highlights

Local tumor control rates of stereotactic body radiotherapy (SBRT) in early-stage non-small cell lung cancer (NSCLC) is approximately 90%, with survival rates matching those of surgery in similar patient groups [1, 2]
A total of 732 predelivery cone-beam computed tomography (CBCT) images were collected for 142 patients
The mean setup error was largest in the AP direction (3.2 ± 2.4 mm), and the maximum setup error was larger in this direction

Summary

Introduction

Local tumor control rates of stereotactic body radiotherapy (SBRT) in early-stage non-small cell lung cancer (NSCLC) is approximately 90%, with survival rates matching those of surgery in similar patient groups [1, 2]. Accurate patient positioning for lung SBRT is mainly undertaken using image-guided radiation therapy (IGRT) combined with an immobilization device. Studies have reported more accurate setup comprising cone-beam computed tomography (CBCT) scans compared with electronic portal imaging device [8]. Daily CBCT image guidance with soft-tissue setup is recommended in lung SBRT [12,13,14]. Previous studies indicated that immobilization device is an important strategy to ensure reproducible patient setup. No clear standard approach has been reported so far [16, 18, 19], indicating that each institute needs to select an immobilization approach based on the best available evidence and characteristics of the institute [17]

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Results