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Impact of body-mass factors on setup displacement during pelvic irradiation in patients with lower abdominal cancer

Wei-Chieh Wu
Wei-Chieh Wu
, 
Yi-Ru Chang
Yi-Ru Chang
, 
Yo-Liang Lai
Yo-Liang Lai
, 
An-Cheng Shiau
An-Cheng Shiau
, 
Ji-An Liang
Ji-An Liang
, 
Chun-Ru Chien
Chun-Ru Chien
, 
Yu-Cheng Kuo
Yu-Cheng Kuo
 and 
Shang-Wen Chen
Shang-Wen Chen
   | Apr 05, 2019
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Article Category: Research Article
Published Online: Apr 05, 2019
Page range: 256 - 264
Received: Sep 04, 2018
Accepted: Mar 03, 2019
DOI: https://doi.org/10.2478/raon-2019-0017
© 2019 Wei-Chieh Wu, Yi-Ru Chang, Yo-Liang Lai, An-Cheng Shiau, Ji-An Liang, Chun-Ru Chien, Yu-Cheng Kuo, Shang-Wen Chen, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

An example of body-mass factor measurement in a patient with rectal cancer. (A) umbilical circumference, umbilical anterior-posterior (AP) diameter, umbilical lateral diameter; (B) hip circumference, hip AP diameter, hip Lateral diameter; (C) clinical target volume (CTV) circumference, CTV AP diameter, CTV lateral diameter; (D) level of CTV center.
An example of body-mass factor measurement in a patient with rectal cancer. (A) umbilical circumference, umbilical anterior-posterior (AP) diameter, umbilical lateral diameter; (B) hip circumference, hip AP diameter, hip Lateral diameter; (C) clinical target volume (CTV) circumference, CTV AP diameter, CTV lateral diameter; (D) level of CTV center.

Figure 2

A linear relationship between individual setup errors and body-mass factors. (A) SI-SE and hip lateral diameter; (B) SIRE and hip circumference; (C) AP-SE and hip lateral diameter; (D) ML-SE and umbilical AP diameter; (E) ML-RE and umbilical AP diameter.AP-SE = systemic error of anterior-posterior direction; ML-RE = random error of medial-lateral direction; ML-SE = systemic error of medial-lateral direction; SI-RE = random error of superior-inferior direction; SI-SE = systemic error of superior-inferior direction
A linear relationship between individual setup errors and body-mass factors. (A) SI-SE and hip lateral diameter; (B) SIRE and hip circumference; (C) AP-SE and hip lateral diameter; (D) ML-SE and umbilical AP diameter; (E) ML-RE and umbilical AP diameter.AP-SE = systemic error of anterior-posterior direction; ML-RE = random error of medial-lateral direction; ML-SE = systemic error of medial-lateral direction; SI-RE = random error of superior-inferior direction; SI-SE = systemic error of superior-inferior direction

Figure 3

Receiver operating characteristic curves for assessing the optimal cutoffs of body-mass factors. (A) systemic errors of superior-inferior direction, AUC 0.638; (B) random errors of superior-inferior direction, AUC 0.644; (C) systemic errors of anterior-posterior direction, AUC 0.617; (D) systemic errors of medial-lateral direction, AUC 0.701; (E) systemic errors of medial-lateral direction, AUC 0.746.
Receiver operating characteristic curves for assessing the optimal cutoffs of body-mass factors. (A) systemic errors of superior-inferior direction, AUC 0.638; (B) random errors of superior-inferior direction, AUC 0.644; (C) systemic errors of anterior-posterior direction, AUC 0.617; (D) systemic errors of medial-lateral direction, AUC 0.701; (E) systemic errors of medial-lateral direction, AUC 0.746.

Population SE/RE and adequate PTV margins according to scoring system by significant associated factors in three translational directions in training cohort

DirectionPopulation SE (cm)Population RE (cm)PTV margin (cm)
High risk (1-2)0.120.330.54
SIp=0.016*p=0.016*
Low risk (0)0.090.200.38
High risk0.100.200.40
APp=0.044*p=0.236
Low risk0.100.180.38
High risk0.230.340.82
MLp=0.004*p=0.005*
Low risk0.110.190.42

Univariate and multivariate of patient related parameters and BMFs for setup displacement

SI-SESI-REAP-SEAP-REML-SEML-RECR-SECR-RE
UVMVUVMVUVMVUVMVUVMVUVMVUVMVUVMV
BMFs
BW0.2840.7480.6980.7340.027*0.016*0.9110.85
BH0.4770.130.1410.5140.1680.5270.430.914
BMI0.1320.2160.1960.4560.1040.006*0.7520.909
UC0.2570.2160.4470.4990.043*0.003*0.1290.45
UAPD0.3970.4370.9080.8760.019*0.021*0.001*0.001*0.1760.819
ULD0.2140.3210.1840.2690.050.017*0.4670.348
HC0.0660.041*0.008*0.1710.2980.044*0.015*0.5940.374
HAPD0.0660.1220.3260.3340.042*0.002*0.3510.746
HLD0.036*0.036*0.0550.044*0.044*0.2080.370.2480.2710.971
CTVC0.0880.0590.5540.7380.049*0.013*0.540.363
CTVAPD0.110.1340.4570.5560.041*0.002*0.4090.725
CTVLD0.2370.220.0750.1640.047*0.1240.8150.544
Patient-related parameters
CancerRectum
Prostate0.7490.7490.3440.7490.5080.7440.7521
Gynecology0.1140.1140.3440.2090.0610.20910.209
Age0.039*0.1620.8580.7250.034*0.4460.1570.785
Sex0.1260.1260.7960.5990.021*0.5860.7820.192
Married0.5990.5240.5610.5240.9990.4530.9990.488
Education0.4480.7820.6050.7820.6290.024*0.1140.285
ECOG PS0.042*0.042*0.1990.2990.8090.6220.0750.809
Surgery0.640.8871.00.8870.3720.6680.1380.003*0.003*
CCRT0.1290.1290.7930.9650.3830.8950.2230.485
Cast0.5990.5990.9990.9990.6390.5960.9990.999

The patient-related parameters and body-mass factors of the training cohort

ParametersNumberMedianRange
Age (y/o)64.538-90
BW (kg)6145.4-99.3
BH (cm)160.6142.2-177.3
BMI (kg/m2)23.717.99-35.69
Umbilical circumference (UC, cm)87.863.4-120.3
Umbilical AP diameter (UAPD, cm)19.2513.4-28.6
Umbilical lateral diameter (ULD, cm)32.625-46.4
Hip circumference (HC, cm)94.775-117.8
Hip AP diameter (HAPD, cm)20.6517.1-26.8
Hip Lateral diameter (HLD, cm)35.4530.6-46.4
CTV circumference (CTVC, cm)93.4572.8-118.3
CTV AP diameter (CTVAPD, cm)20.4515.1-27.9
CTV lateral diameter (CTVLD, cm)35.4527.2-46.5
Rectum20
CancerProstate20
Gynecology20
Female31
SexMale29
ECOG PS029
1-231
-46
Surgery+14
-25
CCRT+35

The Population SE/RE and adequate PTV margins according to scoring system in validation cohort

DirectionPopulation SE (cm)Population RE (cm)PTV margin (cm)
High risk (1-2)0.130.170.44
SIp=0.358p=0.225
Low risk (0)0.070.140.27
High risk0.120.260.48
APp=0.213p=0.054
Low risk0.120.180.42
High risk0.230.450.90
MLp=0.195p=0.004*
Low risk0.110.200.41

The population SE/RE and calculated PTV margins of training cohort

DirectionPopulation SEPopulation REPTV margin (cm)
Superior-Inferior (cm)0.110.260.45
Anterior-Posterior (cm)0.110.200.40
Medial-Lateral (cm)0.190.500.81
Couch rotation (degree)0.230.44
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