Should we customize PTV expansions for BMI? Daily cone beam computerized tomography to assess organ motion in postoperative endometrial and cervical cancer patients.
OBJECTIVE
A single-institution review assessing patient characteristics contributing to daily organ motion in postoperative endometrial and cervical cancer patients treated with intensity-modulated radiotherapy (IMRT).


BACKGROUND
The Radiation Therapy Oncology Group has established consensus guidelines for postoperative pelvic IMRT, recommending a 7 mm margin on all three axes of the target volume.


METHODS
Daily shifts on 457 radiation setups for 18 patients were recorded in the x axis (lateral), y axis (superior-inferior) and z axis (anterior-posterior); daily positions of the planning tumor volume were referenced with the initial planning scan to quantify variations.


RESULTS
Of the 457 sessions, 85 (18.6%) had plan shifts of at least 7 mm in one of the three dimensions. For obese patients (body mass index [BMI] ≥ 30), 75/306 (24.5%) sessions had plan shifts ≥7 mm. Odds of having a shift ≥7 mm in any direction was greater for obese patients under both univariate (OR 4.227, 95% CI 1.235-14.466, p = 0.021) and multivariate (OR 5.000, 95% CI 1.341-18.646, p = 0.016) analyses (MVA). Under MVA, having a BMI ≥ 30 was associated with increased odds of shifts in the anterior-posterior (1.173 mm, 95% CI 0.281-2.065, p = 0.001) and lateral (2.074 mm, 95% CI 1.284-2.864, p < 0.000) directions but not in the superior-inferior axis (0.298 mm, 95% CI -0.880 to 1.475, p = 0.619) exceeding 7 mm.


CONCLUSIONS
Based on these findings, the standard planned tumor volume expansion of 7 mm is less likely to account for daily treatment changes in obese patients.
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Arya
A
Amini
Department of Biostatistics and Informatics, University of Colorado Denver, Aurora, CO, United States.
Peter E
PE
DeWitt
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Yevgeniy
Y
Vinogradskiy
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Chad G
CG
Rusthoven
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Cem
C
Altunbas
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Tracey E
TE
Schefter
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, United States.
Christine M
CM
Fisher
BMI; IGRT; IMRT; Organ motion; Postoperative pelvic radiation