The heterogeneous CTV-PTV margins should be given for different parts of tumors during tomotherapy

Objective The purpose of this study was to evaluate CTV-PTV margins of tumors for tomotherapy. Methods Setup errors were analyzed for 151 patients receiving helical tomotherapy treatment. 53 patients had head and neck tumors, 45 had thoracic tumors, 20 had abdominal tumors, and 33 had pelvic tumors. The setup errors were calculated in six directions, i.e. +X (left), -X (right), +Y (head), -Y (foot), +Z (ventral), and -Z (dorsal), after Megavoltage CT (MVCT) images were registered to simulation CT images. And then the CTV-PTV margins were calculated. Results The setup errors along the +Z direction were significantly higher than that along the -Z direction (p<0.05). The CTV-PTV margins on +X, -X, +Y, -Y, +Z, and -Z directions were asymmetric for all tumors, and the heterogeneity were more remarkable on the +Z and -Z directions. The CTV-PTV margins on +Z and -Z were 4.1 mm, 4.6 mm, 5.2 mm, and 8.4 mm; and 3.9 mm, 7.7 mm, 3.3 mm, and 7.7 mm for head and neck tumors, thoracic tumors, abdominal tumors, and pelvic tumors, respectively. Conclusions The CTV-PTV margins for patients with different types of tumors were heterogeneous during tomotherapy. The individual margins of six directions should be given for those patients who accept tomotherapy.