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The impact of inter-fraction set-up errors on the probability of pulmonary and cardiac complication in left-sided breast cancer patients

Published online by Cambridge University Press:  17 February 2014

Crispen Chamunyonga
Crispen Chamunyonga*
Affiliation:
The Cancer Centre, Nassau, Bahamas
*
Correspondence to: Crispen Chamunyonga, The Cancer Centre Bahamas, 72 Collins Avenue, Nassau, Bahamas. Tel: +1242 5029610. Fax: +1242 5029619. E-mail: crischams@yahoo.com
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Abstract

Purpose

This study evaluated the impact of patient set-up errors on the probability of pulmonary and cardiac complications in the irradiation of left-sided breast cancer.

Methods and materials

Using the CMS XiO Version 4·6 radiotherapy planning system's normal tissue complication probability (NTCP) algorithm and the Lyman–Kutcher–Burman model, we calculated the dose–volume histograms (DVH) indices for the ipsilateral lung and heart and the resultant NTCP for radiation-induced pneumonitis and excess cardiac mortality in 12 left-sided breast cancer patients.

Results

Isocentric shifts in the posterior direction had the greatest effect on the lung V20, heart V25, and mean and maximum doses to the lung and the heart. DVH results show that the ipsilateral lung V20 tolerance was exceeded in 58% of the patients after 1 cm posterior shifts. Similarly, the heart V25 tolerance was exceeded after 1 cm antero-posterior and left–right isocentric shifts in 70% of the patients. The baseline NTCPs for radiation-induced pneumonitis ranged from 0·73% to 3·4%, with a mean value of 1·7%. The maximum reported NTCP for radiation-induced pneumonitis was 5·8% (mean 2·6%) after 1 cm posterior isocentric shift. The NTCP for excess cardiac mortality were 0% in 100% of the patients (n = 12) before and after set-up error simulations.

Conclusions

Set-up errors in left-sided breast cancer patients have a statistically significant impact on the Lung NTCPs and DVH indices. However, with a central lung distance of 3 cm or less (CLD < 3 cm), and a maximum heart distance of 1·5 cm or less (MHD < 1·5 cm), the treatment plans could tolerate set-up errors of up to 1 cm without any change in the NTCP to the heart.

Keywords

breast cancer radiotherapyexcess cardiac mortalityNTCPradiation pneumonitis
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 4 , December 2014 , pp. 393 - 402
Copyright
Copyright © Cambridge University Press 2014 

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