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Uncertainty in the Esophagus Dose in Retrospective Epidemiological Study of Breast Cancer Radiotherapy Patients

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S Kim

E Mosher1 , S Kim1*, C Lee2 , C Pelletier3 , J Jung3 , E Jones4 , C Lee1 , (1) Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, (2) Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, (3) Department of Physics, East Carolina University Greenville, NC, (4) Radiology and Imaging Sciences Clinical Center, National Institutes of Health, Bethesda, MD


SU-F-T-115 (Sunday, July 31, 2016) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: Epidemiological studies of second cancer risks in breast cancer radiotherapy patients often use generic patient anatomy to reconstruct normal tissue doses when CT images of patients are not available. To evaluate the uncertainty involved in the dosimetry approach, we evaluated the esophagus dose in five sample patients by simulating breast cancer treatments.

Methods: We obtained the diagnostic CT images of five anonymized adult female patients in different Body Mass Index (BMI) categories (16 – 36 kg/m2) from National Institutes of Health Clinical Center. We contoured the esophagus on the CT images and imported them into a Treatment Planning System (TPS) to create treatment plans and calculate esophagus doses. Esophagus dose was calculated once again via experimentally-validated Monte Carlo (MC) transport code, XVMC under the same geometries. We compared the esophagus doses from TPS and the MC method. We also investigated the degree of variation in the esophagus dose across the five patients and also the relationship between the patient characteristics and the esophagus doses.

Results: Eclipse TPS using Analytical Anisotropic Algorithm (AAA) significantly underestimates the esophagus dose in breast cancer radiotherapy compared to MC. In the worst case, the esophagus dose from AAA was only 40% of the MC dose. The Coefficient of Variation across the patients was 48%. We found that the maximum esophagus dose was up to 2.7 times greater than the minimum. We finally observed linear relationship (Dose = 0.0218 x BMI – 0.1, R2=0.54) between patient’s BMI and the esophagus doses.

Conclusion: We quantified the degree of uncertainty in the esophagus dose in five sample breast radiotherapy patients. The results of the study underscore the importance of individualized dose reconstruction for the study cohort to avoid misclassification in the risk analysis of second cancer. We are currently extending the number of patients up to 30.

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