ESTRO 2022

Session Item

Patient preparation, positioning and immobilisation

Session Code: 9000

Session Type: Poster (digital)

Track: RTT

SURFACE GUIDED ADJUVANT RADIOTHERAPY TATTOO-FREE FOR BREAST CANCER

Rosilda Cuscito , Italy

Presentation Number: PO-1845

Abstract

Abstract Title:

SURFACE GUIDED ADJUVANT RADIOTHERAPY TATTOO-FREE FOR BREAST CANCER

Authors:

Rosilda Cuscito¹, Federica Fragnoli¹, Chiara Indelicati¹, Giuseppe Sanfrancesco², Christian De Pascali¹, Marina De Masi¹, Rosalinda Parabita¹, Alberto Aga¹, Francesco Berloco¹, Luciana Brana'¹, Annarita Ciocia¹, Domenico Curci¹, Gianluca Ladisa¹, Mariella Nardiello¹, Daniela Nardelli¹, Valeria De Candia¹, Fabiana Gregucci¹, Alessia Surgo¹, Roberta Carbonara¹, Maria Paola Cliliberti¹, Morena Caliandro¹, Ilaria Bonaparte¹, Alba Fiorentino¹

¹Miulli General Regional Hospital, Radiation Oncology, Acquaviva delle Fonti - Bari, Italy; ²Miulli General Regional Hospital, Radiation Oncology, Miulli General Regional Hospital, Italy

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Purpose or Objective

To test inter-fraction and intra-fraction variability of patients’ position in women with breast cancer (BC) that received radiation therapy (RT) using a tattoo-free treatment approach guided by a system of Surface Guided RT (SGRT).

Material and Methods

Patients with BC received lumpectomy + adjuvant hypofractionated whole breast RT with simultaneous integrated boost on tumor bed for a total dose respectively of 40.5Gy and 48Gy in 15 fractions. During simulation procedures, all patients were immobilized in a supine position and underwent to a planning CT (2 mm slide thickness) without skin tattoo using a system of SGRT (Optical Surface Monitor System AlignRT®) to register and verify patients’ position. An expansion of 6mm in the transverse direction and 8mm in cranial–caudal direction was applied from CTV to PTV. The treatment was delivered using an FFF-VMAT technique. For each treatment session, match values of all 3 translational and 3 rotational axes were recorded. To evaluate inter-fraction variability, daily portal images were performed, revising setup treatment position, and acquiring data. To evaluate intra-fraction variations, SGRT was applied, acquiring data regarding final patient’s position at the end of RT.

Data regarding acute side effects were collected weekly during RT and at the end of treatment according to RTOG radiation morbidity scoring system.

Results

Between 01/2021-04/2021, a total of 375 treatment sessions were analyzed in 25 women. Clinical data were summarized in Table 1. Inter-fraction mean values (±SD) (IC95%) were as follow: longitudinally 2.2mm (±1.6) (2-2.4), laterally 1.4mm (±1.1) (1.2-1.5), vertically 1.8mm (±1.5) (1.6-1,9), roll 0.0° (±0.3) (0.03-0.1), pitch 0.8° (±0.6°) (0.8-0.9), yaw 0.67° (±0.53°) (0.6-0.7). Intra-fraction mean values (±SD) (IC95%) were: longitudinally 0.12mm (±0.11mm) (0.1-0.13), laterally 0.07mm (±0.07mm) (0.06-0.08), vertically 0.12mm (±0.12mm) (0.1-0.13), roll 0.33° (±0.34°) (0.28-0.37), pitch 0.43° (±0.49°) (0.36-0.49), yaw 0.35° (±0.44°) (0.29-0.4). Median and IQR values were showed in Figure 1.

All patients completed their treatment. G0 acute skin toxicity was recorded in 13 (52%) cases and G1 in 12 (48%) cases. No skin toxicity≥2 was observed or other types of side effects.

Conclusion

The analysis shows that the SGRT-guided tattoo-free approach in breast RT is a reproducible and safe treatment suggesting that radiological imaging could be reduced to verify treatment patients’ position.