Set-up uncertainty during postmastectomy radiotherapy with Segmented Photon Beams Technique.

AIM: To verify the reproducibility of patients irradiated after mastectomy on the immobilization system designed and manufactured for our hospital and to compare the Internal Protocol (IP) with the modified-No Action Level Protocol.
BACKGROUND: Application of forward IMRT techniques requires a good reproducibility of patient positioning. To minimize the set-up error, an effective immobilization system is important.
MATERIALS AND METHODS: The study was performed for two groups of 65 each. In the first group, portal images for anterior field were taken in 1-3 fractions and, subsequently, three times a week. In this group, the mNAL protocol was used. In the second group, the IP was used. The portal images from the anterior field and from the gantry 0 were taken during the 1-3 and 10 fractions. In both groups, image registration was performed off-line. For each group the systematic and random errors and PTV margin were calculated.
RESULTS: In the first group the value of the population systematic errors and random errors were 1.6 ± 1.6 mm for the left-right, and 1.5 ± 1.7 mm for the cranial-caudal directions, respectively, 1.7 ± 1.3 mm, and 1.9 ± 1.3 mm for the second group. The PTV margins for the left-right and cranial-caudal directions were 5.1 and 4.9 mm for the first group and 5.4 and 6.4 mm for the second group.
CONCLUSIONS: For patients immobilized with our support device treated according to the mNAL protocol or IP, a good set-up reproducibility was obtained. Implementation of IP limits the number of required images.