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Setup margins and geometric uncertainties in intensity-modulated radiation therapy in treating pituitary adenomas: the experience of Lyon Sud Hospital

Margini di setup e incertezze geometriche nella radioterapia ad intensità modulata degli adenomi ipofisiari: l’esperienza dell’ospedale Lyon Sud

  • Radiotherapy / Radioterapia
  • Published:
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Abstract

Purpose

The authors retrospectively evaluated the setup uncertainties in Intensity-Modulated Radiation Therapy (IMRT) for pituitary adenomas and verified the margins used in daily practice (3 mm).

Materials and methods

Craniocaudal (CC), anteroposterior (AP) and laterolateral (LL) displacements were measured during the first 3 days of treatment and then weekly by comparing two orthogonal images obtained by an electronic system of portal imaging with Digitally Reconstructed Radiographs (DRRs). Setup Margins (SM) were defined according to the International Commission on Radiation Units (ICRU)-62 formula, the Stroom equation and the van Herk equation. The systematic (Σ) and random (σ) errors of the population were calculated as standard deviation (SD) of the population mean and the mean of SDs for every patient, respectively.

Results

Twenty patients were treated by IMRT for pituitary adenomas, and a total of 231 measurements were obtained. Σ and σ were 0.6 and 1.3 mm, 0.8 and 1 mm, 1.2 and 1.5 mm in the AP, LL and CC direction, respectively. Larger setup margin was 2.4, 2.7 and 4 mm in the AP, LL and CC direction, respectively (van Herk formula).

Conclusions

IMRT is a highly sophisticated treatment technique that requires precise definition and optimisation of local setup errors and, finally, of the irradiated volumes. The role of image-guided RT in these kinds of treatments should be prospectively evaluated.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare retrospettivamente le incertezze di setup nella Radioterapia ad Intensità Modulata (IMRT) degli adenomi ipofisiari e verificare i margini usati nella nostra pratica quotidiana (3 mm).

Materiali e metodi

Gli spostamenti cranio-caudali (CC), antero-posteriori (AP) e latero-laterali (LL) sono stati misurati durante i primi 3 giorni di trattamento e poi settimanalmente comparando due immagini ortogonali ottenute da un sistema elettronico di portal imaging e le Digitally Reconstructed Radiographs (DRRs). I margini di setup sono stati definiti secondo la formula dell’International Commission on Radiation Units (ICRU)-62, l’equazione di Stroom e l’equazione di Van-Herk. L’errore sistematico (Σ) e random (σ) della popolazione sono stati calcolati rispettivamente come deviazione standard della media della popolazione e come media delle deviazioni standard per ogni paziente.

Risultati

Venti pazienti sono stati trattati con IMRT per adenoma ipofisiario ed un totale di 231 misure sono state ottenute. L’errore sistematico (Σ) e random (σ) sono stati rispettivamente di 0,6 e 1,3 mm, 0,8 e 1 mm, 1,2 e 1,5 mm, rispettivamente nelle direzioni AP, LL e CC. Il maggiore setup margin calcolato è stato di 2,4, 2,7 e 4 mm rispettivamente nella direzione AP, LL and CC (formula di van Herk).

Conclusioni

La IMRT è una tecnica di trattamento altamente sofisticata che necessita di una definizione precisa ed ottimizzata degli errori di setup locali e, quindi, dei volumi da irradiare. Il ruolo dell’image guided radiation therapy in questo tipo di trattamenti deve essere valutato prospetticamente.

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Authors and Affiliations

  1. Service de Radiothérapie Oncologi, Centre Hospitalier Lyon-Sud, Chemin du Grand-Revoye, 69495, Pierre Benite Cedex, France, EA 3738

    B. De Bari, I. Shakir Shakir, T. Chekrine, L. Lestrade & V. Favrel

  2. Istituto del Radio “O. Alberti”, AO Spedali Civili, Università degli Studi di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy

    B. De Bari

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  1. B. De Bari
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  2. I. Shakir Shakir
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  3. T. Chekrine
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  4. L. Lestrade
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  5. V. Favrel
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Correspondence to B. De Bari.

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De Bari, B., Shakir, I.S., Chekrine, T. et al. Setup margins and geometric uncertainties in intensity-modulated radiation therapy in treating pituitary adenomas: the experience of Lyon Sud Hospital. Radiol med 118, 863–869 (2013). https://doi.org/10.1007/s11547-012-0883-9

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  • DOI: https://doi.org/10.1007/s11547-012-0883-9

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