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Feasibility of Supraclavicular Field Treatment by Investigating Variation of Junction Position Between Breast Tangential and Supraclavicular Fields for Deep Inspiration Breath Hold (DIBH) Left Breast Radiation

H Zhao

H Zhao*, V Sarkar , A Paxton , P Rassiah-Szegedi , Y Huang , M Szegedi , L Huang , F Su , B Salter , University Utah, Salt Lake City, UT


SU-F-J-55 (Sunday, July 31, 2016) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose:To explore the feasibility of supraclavicular field treatment by investigating the variation of junction position between tangential and supraclavicular fields during left breast radiation using DIBH technique.

Methods:Six patients with left breast cancer treated using DIBH technique were included in this study. AlignRT system was used to track patient’s breast surface. During daily treatment, when the patient’s DIBH reached preset AlignRT tolerance of ±3mm for all principle directions (vertical, longitudinal, and lateral), the remaining longitudinal offset was recorded. The average with standard-deviation and the range of daily longitudinal offset for the entire treatment course were calculated for all six patients (93 fractions totally). The ranges of average±1σ and 2σ were calculated, and they represent longitudinal field edge error with the confidence level of 68% and 95%. Based on these longitudinal errors, dose at junction between breast tangential and supraclavicular fields with variable gap/overlap sizes was calculated as a percentage of prescription (on a representative patient treatment plan).

Results:The average of longitudinal offset for all patients is 0.16±1.32mm, and the range of longitudinal offset is -2.6 to 2.6mm. The range of longitudinal field edge error at 68% confidence level is -1.48 to 1.16mm, and at 95% confidence level is -2.80 to 2.48mm. With a 5mm and 1mm gap, the junction dose could be as low as 37.5% and 84.9% of prescription dose; with a 5mm and 1mm overlap, the junction dose could be as high as 169.3% and 117.6%.

Conclusion:We observed longitudinal field edge error at 95% confidence level is about ±2.5mm, and the junction dose could reach 70% hot/cold between different DIBH. However, over the entire course of treatment, the average junction variation for all patients is within 0.2mm. The results from our study shows it is potentially feasible to treat supraclavicular field with breast tangents.

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