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Volume 21, Number 3, 2016

Should we customize PTV expansions for BMI? Daily cone beam computerized tomography to assess organ motion in postoperative endometrial and cervical cancer patients

Arya Amini, Peter E. DeWitt, Yevgeniy Vinogradskiy, Chad G. Rusthoven, Cem Altunbas, Tracey E. Schefter, Christine M. Fisher



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).


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.

Materials and 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.


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.


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.

Signature: Rep Pract Oncol Radiother, 2016; 21(3) : 195-200

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