3/Evaluation of set-up deviations during the irradiation of patients suffering from breast cancer treated with two different techniques

PurposeTo present results of patient positioning during routine radiotherapy for patients treated after mastectomy and to compare the inaccuracies in patient set-up for this group of patients and for the patients treated after breast conserving therapy with tangential fields.Methods and materialsIn total, the analysis comprised 56 pairs of portal and simulator films for 14 consecutive patients treated following breast conserving therapy and 98 pairs of portal and simulator films for 20 consecutive patients treated after mastectomy. For the first group the tangential field technique (TF technique) was used, for the second the inverse hockey stick technique (IHS technique). The comparison of the treatment reproducibility obtained for both groups of patients was performed in terms of systematic and random error calculated for the whole groups and by the comparison of cumulative distribution of the length of the displacement vector.ResultsIn the IHS and TF techniques for medial and lateral fields, displacement larger than 5 mm occurred in 28.3%, 15.8% and 25.4% respectively. For the IHS technique, the systematic errors for lateral and cranial-caudal direction were 1.9 and 1.7 mm respectively (1 standard deviation – SD), the random errors for lateral and cranial-caudal direction were 2.0 and 2.5 mm. For the TF technique, the systematic errors for lateral and cranial-caudal direction were 2.6 and 1.3 mm for medial field and 3.7 and 0.7 mm for lateral fields respectively, the random errors for lateral and cranial-caudal direction were 2.2 and 1.0 mm for medial field and 2.9 and 1.1 for lateral field respectively. Rotations were negligible in the HIS technique. For the TF technique the systematic component and random component amounted to about 2.0 degrees (1 SD).ConclusionsBoth the inverse hockey stick and standard tangential techniques showed good reproducibility of patients set-up with respect to cranial-caudal direction. For the TF technique, the accuracy should be improved for the medial field with respect to the ventral-dorsal direction