Sci—Fri PM: Topics — 02: Evaluation of Dosimetric Variations in Partial Breast Seed Implant (PBSI) due to Patient Arm Position (Up vs. Down)

Authors

  • Watt E,

    1. Department of Physics & Astronomy, University of Calgary, Calgary, AB
    2. Tom Baker Cancer Centre, Calgary, AB
    3. Department of Oncology, University of Calgary, Calgary, AB
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  • Long K,

    1. Department of Physics & Astronomy, University of Calgary, Calgary, AB
    2. Tom Baker Cancer Centre, Calgary, AB
    3. Department of Oncology, University of Calgary, Calgary, AB
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  • Husain S,

    1. Department of Physics & Astronomy, University of Calgary, Calgary, AB
    2. Tom Baker Cancer Centre, Calgary, AB
    3. Department of Oncology, University of Calgary, Calgary, AB
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  • Meyer T

    1. Department of Physics & Astronomy, University of Calgary, Calgary, AB
    2. Tom Baker Cancer Centre, Calgary, AB
    3. Department of Oncology, University of Calgary, Calgary, AB
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Abstract

The planning for PBSI is done with the patient's ipsilateral arm raised, however, anatomical changes and variations are unavoidable as the patient resumes her daily activities, potentially resulting in significant deviations in implant geometry from the treatment plan. This study aims to quantify the impact of the ipsilateral arm position on the geometry and dosimetry of the implant at eight weeks, evaluated on post-plans using the MIM Symphony™ software (MIM Software, Cleveland, OH). The average dose metrics for the three patients treated at the TBCC thus far using rigid fusion and contour transfer for the arms up position were 76% for the CTV V100, 61% for the PTV V100, and 37% for the PTV V200; and for the arms down position 81% for the CTV V100, 64% for the PTV V100, and 42% for the PTV V200. Qualitative analysis of the post-implant CT for one of the three patients showed poor agreement between the seroma contour transferred from the pre-implant CT and the seroma visible on the post-implant CT. To obtain a clinically accurate plan for that patient, contour modifications were used, yielding improved dose metric averages for the arms-up position for all three patients of 87% for the CTV V100, 68% for the PTV V100, and 39% for the PTV V200. Overall, the data available shows that dosimetric parameters increase with the patient's arm down, both in terms of coverage and in terms of the hot spot, and accrual of more patients may confirm this in a larger population.

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