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Assessment of Motion Effects on the Dosimetry of Breast Irradiation Using SAVI Applicator
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Abstracts / Brachytherapy 13 (2014) S15eS126
twice a day at least 6 hours apart. The treatment planning system is OncentraÔ Brachy (Nucletron, An ElektaCompany, version up to 4.3). Inverse Planning Simulated Annealing (IPSA) optimization was used to achieve radiation therapy oncology group (RTOG) 0413 goals. The patients had multiple followups at 6 months, 1 year, 2 years and 3 years and completed a questionnaire regarding their experience. Informed consent was obtained prior to the completion of the questionnaire. The Institutional Review Board (IRB) approved this study. Results: 120 patients completed the study with a median followup period of 36 months. Based on the Harvard Breast Cosmesis Scale, 95.00% of patients described their cosmetic evaluation as the treated breast essentially the same as the opposite side (excellent), or minimal but identifiable effects were noticed from radiation (good). After a median followup of 36 months, our study concluded a local recurrence rate of .083% and a disease free survival of 97.5%. Adverse events were calculated from the patient’s questionnaire and the medical doctor’s evaluation for which 35.00% (or 42) of patients reported an adverse event. The most common adverse events recorded were fibrosis: 24.70%, hyperpigmentation: 20.00%, radiation skin reaction: 7.05%, seroma: 7.05%, breast pain: 7.05%, erythema: 5.88% and other events were less than 5%. Each adverse event was also recorded using the Common Terminology Criteria for Adverse Events (CTCAE). Of the total 85 adverse events recorded, Grade 1 events totaled 95.29%, Grade 2 events: 2.35%, Grade 3 events: 2.35% and there were no Grade 4 or 5 events recorded. Conclusions: Our study has shown promising results for delivering radiation with either MammoSiteÔ, single or multi-lumen balloon, or ConturaÔ multi-lumen balloon and has been successful in achieving local control in patients with early stage breast cancer. The study has also shown comparable to even better results to other studies in cosmetic outcome, adverse events, disease free survival, and local recurrence rate.
two fractions that used the original plan had rotation angles greater than 10 degrees in the Lateral scout compared to planning. The decrease of V95% and V100% in these fractions was about 5.6% and 7%, respectively. In the three re-planned fractions the average difference of applicator rotation compared to original as measured on the AP and Lateral scouts was 56.3 and 33.5 degrees, respectively. If treated by the original, V95% and V100% would have decreased by 6.9% and 8.8%, respectively. For the fraction that was treated with the third plan, the AP and the Lateral scouts showed rotational deviation of -27 and 21.5 degrees, respectively. Using the original plan would have decreased V95% and V100% by 9.1% and 10%, respectively; the largest changes of all the fractions. In five fractions the D125 for the chest wall exceeded the volume of 1 cc with the maximum of 1.2 cc corresponding to the Lateral scout rotation difference larger than 15 degrees. The D125 for the volume 3 mm below the skin didn’t exceed 1 cc in all fractions. Conclusion: The AP and Lateral CT scouts can be used as predictors of the SAVI applicator rotational stability. Due to the positioning of the device during implant, the Lateral scouts were a better indicator of rotation than the AP scouts. However, a decision should be made during the planning stage on how to examine them before each fraction, depending on the SAVI applicator orientation during implant.
GYNECOLOGY POSTERS Wednesday - Friday PO08
Assessment of Motion Effects on the Dosimetry of Breast Irradiation Using SAVI Applicator Michael Derr, MS, Praveen Dalmia, MS, MBA, Stephen Franklin, MD, Arthur Frazier, MD, Mark Yudelev, PhD. McLaren-Macomb, Mt. Clemens, MI.
A Retrospective Analysis of Primary Radiation Therapy for Medically Inoperable Stage I-II Endometrial Cancer Adrianna L. Henson, PhD1,2, Alaattin Ozen, MD3,2, Dominic Moore, MS, MPH4, Paola Gehrig, MD5, Mahesh Varia, MD2, Ellen Jones, MD, PhD2. 1 School of Medicine, University of Louisville, Louisville, KY; 2Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; 3 Radiation Oncology, Trakya University Hospital, Edirne, Turkey; 4 Biostatistics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; 5Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Purpose: The purpose of the study is to investigate the inter-fraction variations in dose delivery during Accelerated Partial Breast Irradiation (APBI) using Strut Adjusted Volume Implant (SAVI) applicator in highdose-rate (HDR) brachytherapy. The objective is to assess the effect of the applicator rotational positioning measured from the AP and lateral CT scouts on the dosimetric parameters. Materials and Methods: Series of CT scans utilizing the breath hold were performed during initial CT simulation and prior to each treatment session. Throughout the simulation and treatment patients remained in a VacLoc device, leveling tattoos were applied and the orientation of the applicator ring was marked on the skin. The planning was performed using Oncentra Brachytherapy software and the dwell times were calculated based on IPSA optimization. The calculated dosimetric parameters included V95 and V100 for the PTV Eval, as well as the D125 for chest wall and skin. Prior to each treatment session the position and orientation of the SAVI applicator were compared by measuring the angle between the central lumen and the fourth marker on the AP and Lateral scouts. In addition, the planning and the treatment CT data sets were co-registered and the dosimetric parameters were recalculated using the planning dwell times. Results: Two revision plans were developed during the course of therapy due to observed rotation of the applicator in the lumpectomy cavity. Six out of the ten fractions were delivered with the original plan, three with a second plan, and one with a third plan based on a patient’s scan at the time. In the original plan, V95 and V100 of the PTV Eval measured 55.12cc (98.2%) and 54.02cc (96.2%), respectively. If the original plan was delivered to all the fractions, these parameters would have decreased by about 4.8% and 6%, respectively. In four out of six fractions that used the original plan, the rotation angle in the Lateral scout image were within three degrees of the original scouts, and V95% and V100% decreased on average by about 1.9% and 2.4%, respectively. The other
Purpose: The purpose of this study was to analyze prognostic factors and treatment results of High-dose-rate (HDR) brachytherapy pelvic radiotherapy (RT) for medically inoperable clinical stage I-II endometrial cancer at a single institution. Materials and Methods: After University of North Carolina Institutional Review Board approval, we reviewed the medical records of 652 patients who were treated with HDR brachytherapy between January 2000 and January 2013. We identified 28 medically inoperable endometrial cancer patients treated with primary irradiation at our institution. After 5 tandem and ovoid (T þ O) treatments, tandem alone was used for dose escalation in patients treated with HDR brachytherapy alone. TþO high-dose-rate brachytherapy (HDR) 600 cGy dose was prescribed at Point A corresponding to 1200 cGy at 1 cm depth of myometrium and the tandem only dose of 1200 cGy at 1 cm depth of myometrium. External beam pelvic radiation treatment was delivered with 180 cGy/fraction to 45005040 cGy and sidewall boost to 5400 cGy in some patients. Selected patients with low grade and no myometrial invasion by imaging were treated with HDR brachytherapy only. Patient demographics, pathology, survival, toxicity, and recurrence data were extracted from their charts. Disease specific survival (DSS) and overall survival (OS) were calculated by the Kaplan-Meir survival method. Results: Patient characteristics are presented in Table 1. Twenty (72%) patients were treated with HDR brachytherapy þ pelvic RT and 8 patients (29%) were treated with HDR brachytherapy alone. There was no patient with grade III histology and stage II disease in group treated with HDR brachytherapy alone. Median followup time was 45 (range: 5.3 - 122.1) months. During this followup time locoregional relapse occurred in 9 (32%) patients (4 patients in the HDR brachytherapy and 5 patients in the HDR brachytherapy þ pelvic RT group) and metastases occurred in 3 (11%) of patients (1 patient treated withHDR brachytherapy alone and 2
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Abstracts / Brachytherapy 13 (2014) S15eS126
twice a day at least 6 hours apart. The treatment planning system is OncentraÔ Brachy (Nucletron, An ElektaCompany, version up to 4.3). Inverse Planning Simulated Annealing (IPSA) optimization was used to achieve radiation therapy oncology group (RTOG) 0413 goals. The patients had multiple followups at 6 months, 1 year, 2 years and 3 years and completed a questionnaire regarding their experience. Informed consent was obtained prior to the completion of the questionnaire. The Institutional Review Board (IRB) approved this study. Results: 120 patients completed the study with a median followup period of 36 months. Based on the Harvard Breast Cosmesis Scale, 95.00% of patients described their cosmetic evaluation as the treated breast essentially the same as the opposite side (excellent), or minimal but identifiable effects were noticed from radiation (good). After a median followup of 36 months, our study concluded a local recurrence rate of .083% and a disease free survival of 97.5%. Adverse events were calculated from the patient’s questionnaire and the medical doctor’s evaluation for which 35.00% (or 42) of patients reported an adverse event. The most common adverse events recorded were fibrosis: 24.70%, hyperpigmentation: 20.00%, radiation skin reaction: 7.05%, seroma: 7.05%, breast pain: 7.05%, erythema: 5.88% and other events were less than 5%. Each adverse event was also recorded using the Common Terminology Criteria for Adverse Events (CTCAE). Of the total 85 adverse events recorded, Grade 1 events totaled 95.29%, Grade 2 events: 2.35%, Grade 3 events: 2.35% and there were no Grade 4 or 5 events recorded. Conclusions: Our study has shown promising results for delivering radiation with either MammoSiteÔ, single or multi-lumen balloon, or ConturaÔ multi-lumen balloon and has been successful in achieving local control in patients with early stage breast cancer. The study has also shown comparable to even better results to other studies in cosmetic outcome, adverse events, disease free survival, and local recurrence rate.
two fractions that used the original plan had rotation angles greater than 10 degrees in the Lateral scout compared to planning. The decrease of V95% and V100% in these fractions was about 5.6% and 7%, respectively. In the three re-planned fractions the average difference of applicator rotation compared to original as measured on the AP and Lateral scouts was 56.3 and 33.5 degrees, respectively. If treated by the original, V95% and V100% would have decreased by 6.9% and 8.8%, respectively. For the fraction that was treated with the third plan, the AP and the Lateral scouts showed rotational deviation of -27 and 21.5 degrees, respectively. Using the original plan would have decreased V95% and V100% by 9.1% and 10%, respectively; the largest changes of all the fractions. In five fractions the D125 for the chest wall exceeded the volume of 1 cc with the maximum of 1.2 cc corresponding to the Lateral scout rotation difference larger than 15 degrees. The D125 for the volume 3 mm below the skin didn’t exceed 1 cc in all fractions. Conclusion: The AP and Lateral CT scouts can be used as predictors of the SAVI applicator rotational stability. Due to the positioning of the device during implant, the Lateral scouts were a better indicator of rotation than the AP scouts. However, a decision should be made during the planning stage on how to examine them before each fraction, depending on the SAVI applicator orientation during implant.
GYNECOLOGY POSTERS Wednesday - Friday PO08
Assessment of Motion Effects on the Dosimetry of Breast Irradiation Using SAVI Applicator Michael Derr, MS, Praveen Dalmia, MS, MBA, Stephen Franklin, MD, Arthur Frazier, MD, Mark Yudelev, PhD. McLaren-Macomb, Mt. Clemens, MI.
A Retrospective Analysis of Primary Radiation Therapy for Medically Inoperable Stage I-II Endometrial Cancer Adrianna L. Henson, PhD1,2, Alaattin Ozen, MD3,2, Dominic Moore, MS, MPH4, Paola Gehrig, MD5, Mahesh Varia, MD2, Ellen Jones, MD, PhD2. 1 School of Medicine, University of Louisville, Louisville, KY; 2Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; 3 Radiation Oncology, Trakya University Hospital, Edirne, Turkey; 4 Biostatistics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; 5Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Purpose: The purpose of the study is to investigate the inter-fraction variations in dose delivery during Accelerated Partial Breast Irradiation (APBI) using Strut Adjusted Volume Implant (SAVI) applicator in highdose-rate (HDR) brachytherapy. The objective is to assess the effect of the applicator rotational positioning measured from the AP and lateral CT scouts on the dosimetric parameters. Materials and Methods: Series of CT scans utilizing the breath hold were performed during initial CT simulation and prior to each treatment session. Throughout the simulation and treatment patients remained in a VacLoc device, leveling tattoos were applied and the orientation of the applicator ring was marked on the skin. The planning was performed using Oncentra Brachytherapy software and the dwell times were calculated based on IPSA optimization. The calculated dosimetric parameters included V95 and V100 for the PTV Eval, as well as the D125 for chest wall and skin. Prior to each treatment session the position and orientation of the SAVI applicator were compared by measuring the angle between the central lumen and the fourth marker on the AP and Lateral scouts. In addition, the planning and the treatment CT data sets were co-registered and the dosimetric parameters were recalculated using the planning dwell times. Results: Two revision plans were developed during the course of therapy due to observed rotation of the applicator in the lumpectomy cavity. Six out of the ten fractions were delivered with the original plan, three with a second plan, and one with a third plan based on a patient’s scan at the time. In the original plan, V95 and V100 of the PTV Eval measured 55.12cc (98.2%) and 54.02cc (96.2%), respectively. If the original plan was delivered to all the fractions, these parameters would have decreased by about 4.8% and 6%, respectively. In four out of six fractions that used the original plan, the rotation angle in the Lateral scout image were within three degrees of the original scouts, and V95% and V100% decreased on average by about 1.9% and 2.4%, respectively. The other
Purpose: The purpose of this study was to analyze prognostic factors and treatment results of High-dose-rate (HDR) brachytherapy pelvic radiotherapy (RT) for medically inoperable clinical stage I-II endometrial cancer at a single institution. Materials and Methods: After University of North Carolina Institutional Review Board approval, we reviewed the medical records of 652 patients who were treated with HDR brachytherapy between January 2000 and January 2013. We identified 28 medically inoperable endometrial cancer patients treated with primary irradiation at our institution. After 5 tandem and ovoid (T þ O) treatments, tandem alone was used for dose escalation in patients treated with HDR brachytherapy alone. TþO high-dose-rate brachytherapy (HDR) 600 cGy dose was prescribed at Point A corresponding to 1200 cGy at 1 cm depth of myometrium and the tandem only dose of 1200 cGy at 1 cm depth of myometrium. External beam pelvic radiation treatment was delivered with 180 cGy/fraction to 45005040 cGy and sidewall boost to 5400 cGy in some patients. Selected patients with low grade and no myometrial invasion by imaging were treated with HDR brachytherapy only. Patient demographics, pathology, survival, toxicity, and recurrence data were extracted from their charts. Disease specific survival (DSS) and overall survival (OS) were calculated by the Kaplan-Meir survival method. Results: Patient characteristics are presented in Table 1. Twenty (72%) patients were treated with HDR brachytherapy þ pelvic RT and 8 patients (29%) were treated with HDR brachytherapy alone. There was no patient with grade III histology and stage II disease in group treated with HDR brachytherapy alone. Median followup time was 45 (range: 5.3 - 122.1) months. During this followup time locoregional relapse occurred in 9 (32%) patients (4 patients in the HDR brachytherapy and 5 patients in the HDR brachytherapy þ pelvic RT group) and metastases occurred in 3 (11%) of patients (1 patient treated withHDR brachytherapy alone and 2
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