Comparing treatment uncertainty for ultra- vs. standard-hypofractionated breast radiation therapy based on in-vivo dosimetry

Yawo A C Fiagan; Evy Bossuyt; Melanie Machiels; Daan Nevens; Charlotte Billiet; Philip Poortmans; Thierry Gevaert; Dirk Verellen

doi:10.1016/j.phro.2022.05.003

Comparing treatment uncertainty for ultra- vs. standard-hypofractionated breast radiation therapy based on in-vivo dosimetry

Yawo A C Fiagan, Evy Bossuyt, Melanie Machiels, Daan Nevens, Charlotte Billiet, Philip Poortmans, Thierry Gevaert, Dirk Verellen

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Abstract

Background and purpose: Postoperative ultrahypofractionated radiation therapy (UHFRT) in 5 fractions (fx) for breast cancer patients is as effective and safe as conventionally hypofractionated RT (HFRT) in 15 fx, liberating time for higher-level daily online Image-Guided Radiation Therapy (IGRT) corrections. In this retrospective study, treatment uncertainties occurring in patients treated with 5fx (5fx-group) were evaluated using electronic portal imaging device (EPID)-based in-vivo dosimetry (EIVD) and compared with the results from patients treated with conventionally HFRT (15fx-group) to validate the new technique and to evaluate if the shorter treatment schedule could have a positive effect on the treatment uncertainties.

Materials and methods: EPID-based integrated transit dose images were acquired for each treatment fraction in the 5fx-group (203 patients) and on the first 3 days of treatment and weekly thereafter in the 15fx-group (203 patients). A total of 1015 EIVD measurements in the 5fx-group and 1144 in the 15fx-group were acquired. Of the latter group, 755 had been treated with online IGRT correction (i.e., Online-IGRT 15fx-group).

Results: In the 15fx-group 12.0% of fractions failed (FFs) compared to 3.8% in the 5fx-group and 6.9% in the online-IGRT 15fx-group. Causes for FFs in the 15fx-group compared with the 5fx-group were patient positioning (7.4% vs. 2.2%), technical issues (3.1% vs. 1.2%) and breast swelling (1.4% vs. 0.5%). In the online-IGRT 15fx-group, 2.5% were attributed to patient positioning, 3.8% to technical issues and 0.5% to breast swelling.

Conclusions: EIVD demonstrated that UHFRT for breast cancer results in less FFs compared to standard HFRT. A large proportion of this decrease could be explained by using daily online IGRT.

Original language	English
Pages (from-to)	85-90
Number of pages	6
Journal	Physics and imaging in radiation oncology
Volume	22
DOIs	https://doi.org/10.1016/j.phro.2022.05.003
Publication status	Published - Apr 2022

Bibliographical note

Funding Information:
The research is supported by the Islamic Development Bank (IsDB) as the primary funder, the Iridium Netwerk and VUB. The authors would like to acknowledge the radiation oncologists, radiation therapists, and medical physicists of Iridium Netwerk and VUB for their cooperation.

Publisher Copyright:
© 2022 The Author(s)

Copyright:
Copyright 2022 Elsevier B.V., All rights reserved.

Keywords

Automated treatment delivery verification
Early breast cancer
In-vivo dosimetry
Ultrahypofractionated radiation therapy

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@article{bed026fc677d4343a1d2d0e425c58b9a,

title = "Comparing treatment uncertainty for ultra- vs. standard-hypofractionated breast radiation therapy based on in-vivo dosimetry",

abstract = "Background and purpose: Postoperative ultrahypofractionated radiation therapy (UHFRT) in 5 fractions (fx) for breast cancer patients is as effective and safe as conventionally hypofractionated RT (HFRT) in 15 fx, liberating time for higher-level daily online Image-Guided Radiation Therapy (IGRT) corrections. In this retrospective study, treatment uncertainties occurring in patients treated with 5fx (5fx-group) were evaluated using electronic portal imaging device (EPID)-based in-vivo dosimetry (EIVD) and compared with the results from patients treated with conventionally HFRT (15fx-group) to validate the new technique and to evaluate if the shorter treatment schedule could have a positive effect on the treatment uncertainties.Materials and methods: EPID-based integrated transit dose images were acquired for each treatment fraction in the 5fx-group (203 patients) and on the first 3 days of treatment and weekly thereafter in the 15fx-group (203 patients). A total of 1015 EIVD measurements in the 5fx-group and 1144 in the 15fx-group were acquired. Of the latter group, 755 had been treated with online IGRT correction (i.e., Online-IGRT 15fx-group).Results: In the 15fx-group 12.0% of fractions failed (FFs) compared to 3.8% in the 5fx-group and 6.9% in the online-IGRT 15fx-group. Causes for FFs in the 15fx-group compared with the 5fx-group were patient positioning (7.4% vs. 2.2%), technical issues (3.1% vs. 1.2%) and breast swelling (1.4% vs. 0.5%). In the online-IGRT 15fx-group, 2.5% were attributed to patient positioning, 3.8% to technical issues and 0.5% to breast swelling.Conclusions: EIVD demonstrated that UHFRT for breast cancer results in less FFs compared to standard HFRT. A large proportion of this decrease could be explained by using daily online IGRT.",

keywords = "Automated treatment delivery verification, Early breast cancer, In-vivo dosimetry, Ultrahypofractionated radiation therapy",

author = "Fiagan, {Yawo A C} and Evy Bossuyt and Melanie Machiels and Daan Nevens and Charlotte Billiet and Philip Poortmans and Thierry Gevaert and Dirk Verellen",

note = "Funding Information: The research is supported by the Islamic Development Bank (IsDB) as the primary funder, the Iridium Netwerk and VUB. The authors would like to acknowledge the radiation oncologists, radiation therapists, and medical physicists of Iridium Netwerk and VUB for their cooperation. Publisher Copyright: {\textcopyright} 2022 The Author(s) Copyright: Copyright 2022 Elsevier B.V., All rights reserved.",

year = "2022",

month = apr,

doi = "10.1016/j.phro.2022.05.003",

language = "English",

volume = "22",

pages = "85--90",

journal = "Physics and imaging in radiation oncology",

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T1 - Comparing treatment uncertainty for ultra- vs. standard-hypofractionated breast radiation therapy based on in-vivo dosimetry

AU - Fiagan, Yawo A C

AU - Bossuyt, Evy

AU - Machiels, Melanie

AU - Nevens, Daan

AU - Billiet, Charlotte

AU - Poortmans, Philip

AU - Gevaert, Thierry

AU - Verellen, Dirk

N1 - Funding Information: The research is supported by the Islamic Development Bank (IsDB) as the primary funder, the Iridium Netwerk and VUB. The authors would like to acknowledge the radiation oncologists, radiation therapists, and medical physicists of Iridium Netwerk and VUB for their cooperation. Publisher Copyright: © 2022 The Author(s) Copyright: Copyright 2022 Elsevier B.V., All rights reserved.

PY - 2022/4

Y1 - 2022/4

N2 - Background and purpose: Postoperative ultrahypofractionated radiation therapy (UHFRT) in 5 fractions (fx) for breast cancer patients is as effective and safe as conventionally hypofractionated RT (HFRT) in 15 fx, liberating time for higher-level daily online Image-Guided Radiation Therapy (IGRT) corrections. In this retrospective study, treatment uncertainties occurring in patients treated with 5fx (5fx-group) were evaluated using electronic portal imaging device (EPID)-based in-vivo dosimetry (EIVD) and compared with the results from patients treated with conventionally HFRT (15fx-group) to validate the new technique and to evaluate if the shorter treatment schedule could have a positive effect on the treatment uncertainties.Materials and methods: EPID-based integrated transit dose images were acquired for each treatment fraction in the 5fx-group (203 patients) and on the first 3 days of treatment and weekly thereafter in the 15fx-group (203 patients). A total of 1015 EIVD measurements in the 5fx-group and 1144 in the 15fx-group were acquired. Of the latter group, 755 had been treated with online IGRT correction (i.e., Online-IGRT 15fx-group).Results: In the 15fx-group 12.0% of fractions failed (FFs) compared to 3.8% in the 5fx-group and 6.9% in the online-IGRT 15fx-group. Causes for FFs in the 15fx-group compared with the 5fx-group were patient positioning (7.4% vs. 2.2%), technical issues (3.1% vs. 1.2%) and breast swelling (1.4% vs. 0.5%). In the online-IGRT 15fx-group, 2.5% were attributed to patient positioning, 3.8% to technical issues and 0.5% to breast swelling.Conclusions: EIVD demonstrated that UHFRT for breast cancer results in less FFs compared to standard HFRT. A large proportion of this decrease could be explained by using daily online IGRT.

AB - Background and purpose: Postoperative ultrahypofractionated radiation therapy (UHFRT) in 5 fractions (fx) for breast cancer patients is as effective and safe as conventionally hypofractionated RT (HFRT) in 15 fx, liberating time for higher-level daily online Image-Guided Radiation Therapy (IGRT) corrections. In this retrospective study, treatment uncertainties occurring in patients treated with 5fx (5fx-group) were evaluated using electronic portal imaging device (EPID)-based in-vivo dosimetry (EIVD) and compared with the results from patients treated with conventionally HFRT (15fx-group) to validate the new technique and to evaluate if the shorter treatment schedule could have a positive effect on the treatment uncertainties.Materials and methods: EPID-based integrated transit dose images were acquired for each treatment fraction in the 5fx-group (203 patients) and on the first 3 days of treatment and weekly thereafter in the 15fx-group (203 patients). A total of 1015 EIVD measurements in the 5fx-group and 1144 in the 15fx-group were acquired. Of the latter group, 755 had been treated with online IGRT correction (i.e., Online-IGRT 15fx-group).Results: In the 15fx-group 12.0% of fractions failed (FFs) compared to 3.8% in the 5fx-group and 6.9% in the online-IGRT 15fx-group. Causes for FFs in the 15fx-group compared with the 5fx-group were patient positioning (7.4% vs. 2.2%), technical issues (3.1% vs. 1.2%) and breast swelling (1.4% vs. 0.5%). In the online-IGRT 15fx-group, 2.5% were attributed to patient positioning, 3.8% to technical issues and 0.5% to breast swelling.Conclusions: EIVD demonstrated that UHFRT for breast cancer results in less FFs compared to standard HFRT. A large proportion of this decrease could be explained by using daily online IGRT.

KW - Automated treatment delivery verification

KW - Early breast cancer

KW - In-vivo dosimetry

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DO - 10.1016/j.phro.2022.05.003

M3 - Article

C2 - 35602547

SN - 2405-6316

VL - 22

SP - 85

EP - 90

JO - Physics and imaging in radiation oncology

JF - Physics and imaging in radiation oncology

ER -

Comparing treatment uncertainty for ultra- vs. standard-hypofractionated breast radiation therapy based on in-vivo dosimetry

Abstract

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Keywords

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