{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:29:59Z","timestamp":1780068599775,"version":"3.54.0"},"reference-count":39,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The aim of this retrospective study was to investigate the impact of setup errors on the dosimetry and radiobiology of left\u2010sided breast cancer (BC) patients with different breast sizes undergoing conventionally fractionated volumetric modulated arc therapy (VMAT) radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 36 BC patients who underwent breast\u2010conserving surgery were enrolled in the study. Setup errors were simulated through isocenter shifts in six directions. Differences in dosimetric and radiobiological parameter variations between the large breast group (volume\u00a0&gt;\u00a0975\u00a0cm\n                      <jats:sup>3<\/jats:sup>\n                      ) and the small breast group were compared under the same setup errors, relative to the original plan for the planning target volume (PTV) and organs at risk (OARs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>When the isocenter error reached 2.5\u00a0mm, notable dosimetric deviations were observed, except for the PTV in the right direction and the heart in the superior direction, which remained stable. At a 5\u00a0mm isocenter error, the small breast group demonstrated greater dosimetric variability in the PTV compared to the large breast group. However, the heart showed less variation in the small breast group. Additionally, for both 2.5 and 5\u00a0mm isocenter errors, the small breast group had smaller changes in the NTCP for the heart than the large breast group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conventionally fractionated VMAT radiotherapy for left\u2010sided breast cancer, isocenter setup errors affect the dosimetric and radiobiological outcomes of the PTV and OARs to varying degrees, depending on setup errors and breast size. When the setup error exceeds 2.5\u00a0mm, patients with larger breasts experience more pronounced increases in heart dose and Normal Tissue Complication Probability (NTCP) than those with smaller breasts, particularly in the right and posterior directions. Therefore, stricter setup error thresholds (e.g., \u22642.5\u00a0mm) and more frequent imaging guidance (e.g., \u22652 cone\u2010beam computed tomography (CBCT) verifications per week) are recommended for this patient group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70151","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T06:27:17Z","timestamp":1752474437000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of breast size on dosimetry and radiobiology of VMAT left\u2010sided breast\u2010conserving conventional fractionation radiotherapy under setup errors"],"prefix":"10.1002","volume":"26","author":[{"given":"Chao","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Radiology Zhujiang Hospital Southern Medical University  Guangzhou Guangdong People's Republic of 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