A Prospective Study to Investigate the Placement of Setup Skin Markings for Larger Breasted Women Undergoing External Beam Radiotherapy (RT) for Breast Cancer

Author:

Doudoo Chris Osam1,Roberts Neill1,Amankwaa Frempong Emmanuel1,Edusa Clement1,Beecham Kwamena1,Agyiri Kofi1,Ahiagbenyo Promise1,Acquah George Felix1,Eric Abakuri Dominic Gadeka1,Mordey Michael1,Maria Anim Anna1,Djan Bismark1

Affiliation:

1. Department of Radiation Oncology, Sweden Ghana Medical Centre, East- Legon Hills, Accra- Ghana

Abstract

Background: The technique of placing all three skin marks (reference skin marks) on a single position during CT simulation for setup of patients undergoing conventional breast radiotherapy becomes a challenge when presented with larger breasted women (bra cup size ≥ D). A new way of using skin marks in setting these patients up has been developed where three skin marks are made on the patient (one on the sternum and two lateral skin marks more inferiorly beneath the breasts) for setup as against the departmental standard of using only a single skin mark on the sternum, and employing an SSD (Source to Skin Distance) technique. This study therefore reviewed the placement of the skin markings for larger breasted women undergoing external beam radiotherapy for breast cancer by quantifying treatment field alignment errors and setup errors between the two different setup techniques. Method: 36 patients were used in this study. Out of this number, 18 were setup using three reference skin marks and the remaining 18 were setup using one reference anterior skin mark. With an acceptable patient treatment field alignment error of 2 degrees, portal images (AP and lateral) of the different skin mark techniques were analysed for field alignment errors using an Iview GT system. More so, portal images (AP and lateral) of setup for both techniques were analysed for systematic (Σ) and random (σ) errors. Results:The AP images of the single skin mark setup and the three skin mark setup yielded no significant difference as they recorded a p- value (p<0.05) of 0.089 and 0.110 respectively when compared to the treatment field alignment threshold error of 2 degrees. The lateral images of the three skin mark also yielded no significant difference as a p- value (p<0.05) of 0.091 was recorded. The lateral images of the single skin mark yielded a significant difference with a p- value (p<0.05) of 0.026. Secondly, mean comparisons of the field alignment errors between the two setup techniques yielded no significant difference in the AP images as a p- value (p<0.05) of 0.089 was detected. On the contrary, a p- value (p<0.05) of 0.026 was recorded in the field alignment errors of the lateral images. This difference is significant. Lastly, random errors were reduced in all directions (AP- anterior-posterior, SI- superior-inferior and LR- Left-right) in the three skin mark setup (4.5mm AP, 4.9mm SI and 2.4mm LR) as compared to the single skin mark setup (4.7mm AP, 5.2mm SI and 2.6mm LR). Systematic errors were also reduced in the three skin mark setup (1.7mm AP and 1.8mm SI) compared to the single skin mark setup (2.0mm AP, 2.1mm SI). Systematic errors in the LR direction on the other hand increased from 2.0mm in the single skin mark to 2.2mm in the three skin marks. Conclusion For setup of larger breasted women undergoing external beam radiotherapy for breast cancer, the three skin mark setup technique is superior to the single skin mark setup technique.

Publisher

Technoscience Academy

Subject

General Medicine

Reference83 articles.

1. Acquah, G.F., Kyeremeh, P.O., Doudoo, C.O., Ahiagbenyo, P., Edusa, C. & Beecham, K. (2017). Breast Dosimetry: A Phantom study between Tangential Wedge Fields and Multiple Open field-in-field 3D Conformal Forward Planning. International Journal of Scientific Research in Science and Technology, 3 (6), 239-6011. Retrieved from https://www.researchgate.net/profile/George_Acquah/publication/318878230_Breast_Dosimetry_A_Phantom_study_between_Tangential_Wedge_Fields_and_Multiple_Open_field-in-field_3D_Conformal_Forward_Planning/links/59830ac8a6fdccc3f53b1c56/Breast-Dosimetry-A-Phantom-study-between-Tangential-Wedge-Fields-and-Multiple-Open-field-in-field-3D-Conformal-Forward-Planning.pdf

2. Adamczyk, M., Piotrowski, T. & Adamiak, E. (2012). Evaluation of combining bony anatomy and soft tissue position correction strategies for IMRT prostate cancer patients. Reports of practical oncology and radiotherapy: journal of Polish Society of Radiation Oncology, 17(2), 104-9. doi:10.1016/j.rpor.2012.01.005

3. Alderliesten, T., Sonke, J., Betgen, A., Honnef, J., Van Vliet-Vroegindeweij, C. & Remeijer, P. (2012). Application of 3D surface imaging in breast cancer radiotherapy. Journal of the International Society for Optical Engineering, 8316 (9). doi: 10.1117/12.911242

4. American Cancer society. (2018). Retrieved from: https://www.cancer.org/cancer/cancer-causes/diet-physical-activity/body-weight-and-cancer-risk/adult-bmi.html

5. Beltran C, Krasin, M. J, Merchant, T. E. (2011) Inter- and intra- fractional positional uncertainties in pediatric radiotherapy patients with brain and head and neck tumors. . International Journal of Radiation Oncology, Biology, Physics 79(4): 1266-1274. doi: 10.1016/j.ijrobp.2009.12.057.

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