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Seth L, Makram O, Essa A, Patel V, Jiang S, Bhave A, Yerraguntla S, Gopu G, Malik S, Swaby J, Rast J, Padgett CA, Shetewi A, Nain P, Weintraub N, Miller ED, Dent S, Barac A, Shiradkar R, Madabhushi A, Ferguson C, Guha A. Laterality of Radiation Therapy in Breast Cancer is Not Associated With Increased Risk of Coronary Artery Disease in the Contemporary Era. Adv Radiat Oncol 2024; 9:101583. [PMID: 39258143 PMCID: PMC11385753 DOI: 10.1016/j.adro.2024.101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/02/2024] [Indexed: 09/12/2024] Open
Abstract
Purpose External beam radiation therapy (EBRT) is a critical component of breast cancer (BC) therapy. Given the improvement in technology in the contemporary era, we hypothesized that there is no difference in the development of or worsening of existing coronary artery disease (CAD) in patients with BC receiving left versus right-sided radiation. Methods and Materials For the meta-analysis portion of our study, we searched PubMed, Web of Science, and Scopus and included studies from January 1999 to September 2022. CAD was identified using a homogenous metric across multiple studies included. We computed the risk ratio (RR) for included studies using a random effects model. For the institutional cohort portion of our study, we selected high cardiovascular-risk patients who received diagnoses of BC between 2010 and 2022 if they met our inclusion criteria. We performed a Cox proportional hazards model with stepwise adjustment. Results A pooled random effects model with 9 studies showed that patients with left-sided BC receiving EBRT had a 10% increased risk of CAD when compared with patients with right-sided BC receiving EBRT (RR, 1.10; 95% CI, 1.02-1.18; P = .01). However, subgroup analysis of 6 studies that included patients diagnosed after 1980 did not show a significant difference in CAD based on BC laterality (RR, 1.07; 95% CI, 0.95-1.20; P = .27). For the institutional cohort portion of the study, we found that patients with left-sided BC who received EBRT did not have a significantly higher risk of CAD when compared with their right-sided counterparts (hazard ratios [HR], 0.73; 95% CI, 0.34-1.54; P = .402). Conclusions Our study suggests a historical trend of increased CAD in BC patients receiving left-sided EBRT. Data from patients diagnosed after 2010 in our institutional cohort did not show a significant difference, emphasizing that modern EBRT regimens are safe, and laterality of BC does not affect CAD outcomes in the short term after a BC diagnosis.
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Affiliation(s)
- Lakshya Seth
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Omar Makram
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Amr Essa
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Vraj Patel
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Stephanie Jiang
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Aditya Bhave
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | | | - Gaurav Gopu
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Sarah Malik
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Justin Swaby
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Johnathon Rast
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Caleb A Padgett
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Ahmed Shetewi
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Priyanshu Nain
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Neal Weintraub
- Department of Medicine, Medical College of Georgia, Augusta, Georgia
| | - Eric D Miller
- Department of Radiation Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Susan Dent
- Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Ana Barac
- Division of Cardio-Oncology, Inova Schar Cancer Institute and Inova Heart and Vascular Institute, Fairfax, Virginia
| | - Rakesh Shiradkar
- Wallace H Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia
| | - Anant Madabhushi
- Wallace H Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia
| | - Catherine Ferguson
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Avirup Guha
- Cardio-Oncology Program, Medical College of Georgia, Augusta, Georgia
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Oki Y, Akasaka H, Uehara K, Mizonobe K, Sawada M, Nagata J, Harada A, Mayahara H. Evaluation of robustness of optimization methods in breast intensity-modulated radiation therapy using TomoTherapy. Phys Eng Sci Med 2024; 47:465-475. [PMID: 38265521 DOI: 10.1007/s13246-023-01377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Intensity-modulated radiation therapy (IMRT) has become a popular choice for breast cancer treatment. We aimed to evaluate and compare the robustness of each optimization method used for breast IMRT using TomoTherapy. A retrospective analysis was performed on 10 patients with left breast cancer. For each optimization method (clipping, virtual bolus, and skin flash), a corresponding 50 Gy/25 fr plan was created in the helical and direct TomoTherapy modes. The dose-volume histogram parameters were compared after shifting the patients anteriorly and posteriorly. In the helical mode, when the patient was not shifted, the median D1cc (minimum dose delivered to 1 cc of the organ volume) of the breast skin for the clipping and virtual bolus plans was 52.2 (interquartile range: 51.9-52.6) and 50.4 (50.1-50.8) Gy, respectively. After an anterior shift, D1cc of the breast skin for the clipping and virtual bolus plans was 56.0 (55.6-56.8) and 50.9 (50.5-51.3) Gy, respectively. When the direct mode was used without shifting the patient, D1cc of the breast skin for the clipping, virtual bolus, and skin flash plans was 52.6 (51.9-53.1), 53.4 (52.6-53.9), and 52.3 (51.7-53.0) Gy, respectively. After shifting anteriorly, D1cc of the breast skin for the clipping, virtual bolus, and skin flash plans was 55.6 (54.1-56.4), 52.4 (52.0-53.0), and 53.6 (52.6-54.6) Gy, respectively. The clipping method is not sufficient for breast IMRT. The virtual bolus and skin flash methods were more robust optimization methods according to our analyses.
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Affiliation(s)
- Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan.
| | - Hiroaki Akasaka
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, Australia
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Masanobu Sawada
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
- Division of Radiological Technology, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo, 669-1321, Japan
| | - Junya Nagata
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
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3
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Madias JE. Right versus left breast radiation and coronary artery disease: is there a differential? Acta Cardiol 2023; 78:5-12. [PMID: 36378524 DOI: 10.1080/00015385.2022.2141431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is literature supporting the view that chest radiation (CR) for the management of primary or metastatic cancer of the mediastinum and chest, including breast cancer is associated with all types of heart disease, including coronary artery disease (CAD), manifesting during long-term follow-up. This review explores the literature about the association of CR for the management of cancer and CAD, particularly focussing on breast cancer, and further on the differential between CR for right versus left breast cancer. The balk of the literature suggests that there is higher incidence of CAD in patients undergoing left versus right-CR for breast cancer, and that cardiologists and oncologists need to become involved systematically in their assessment prior to CR and at subsequent follow-up.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA
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He Y, Chen S, Gao X, Fu L, Kang Z, Liu J, Shi L, Li Y. Robustness of VMAT to setup errors in postmastectomy radiotherapy of left-sided breast cancer: Impact of bolus thickness. PLoS One 2023; 18:e0280456. [PMID: 36693073 PMCID: PMC9873183 DOI: 10.1371/journal.pone.0280456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Volumetric modulated arc therapy (VMAT) with varied bolus thicknesses has been employed in postmastectomy radiotherapy (PMRT) of breast cancer to improve superficial target coverage. However, impact of bolus thickness on plan robustness remains unclear. METHODS The study enrolled ten patients with left-sided breast cancer who received radiotherapy using VMAT with 5 mm and 10 mm bolus (VMAT-5B and VMAT-10B). Inter-fractional setup errors were simulated by introducing a 3 mm shift to isocenter of the original plans in the anterior-posterior, left-right, and inferior-superior directions. The plans (perturbed plans) were recalculated without changing other parameters. Dose volume histograms (DVH) were collected for plan evaluation. Absolute dose differences in DVH endpoints for the clinical target volume (CTV), heart, and left lung between the perturbed plans and the original ones were used for robustness analysis. RESULTS VMAT-10B showed better target coverage, while VMAT-5B was superior in organs-at-risk (OARs) sparing. As expected, small setup errors of 3 mm could induce dose fluctuations in CTV and OARs. The differences in CTV were small in VMAT-5B, with a maximum difference of -1.05 Gy for the posterior shifts. For VMAT-10B, isocenter shifts in the posterior and right directions significantly decreased CTV coverage. The differences were -1.69 Gy, -1.48 Gy and -1.99 Gy, -1.69 Gy for ΔD95% and ΔD98%, respectively. Regarding the OARs, only isocenter shifts in the posterior, right, and inferior directions increased dose to the left lung and the heart. Differences in VMAT-10B were milder than those in VMAT-5B. Specifically, mean heart dose were increased by 0.42 Gy (range 0.10 ~ 0.95 Gy) and 0.20 Gy (range -0.11 ~ 0.72 Gy), and mean dose for the left lung were increased by 1.02 Gy (range 0.79 ~ 1.18 Gy) and 0.68 Gy (range 0.47 ~ 0.84 Gy) in VMAT-5B and VMAT-10B, respectively. High-dose volumes in the organs were increased by approximate 0 ~ 2 and 1 ~ 3 percentage points, respectively. Nevertheless, most of the dosimetric parameters in the perturbed plans were still clinically acceptable. CONCLUSIONS VMAT-5B appears to be more robust to 3 mm setup errors than VMAT-10B. VMAT-5B also resulted in better OARs sparing with acceptable target coverage and dose homogeneity. Therefore 5 mm bolus is recommended for PMRT of left-sided breast cancer using VMAT.
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Affiliation(s)
- Yipeng He
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Sijia Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiang Gao
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Lirong Fu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zheng Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jun Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Liwan Shi
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yimin Li
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- * E-mail:
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5
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Bicakci BC, Demircioglu F, Can SSN, Demircioglu O. Optimal plan target in cases with locally advanced nasopharyngeal cancer: Comparison of VMAT, IMRT, hybrid, and tomotherapy results. J Cancer Res Ther 2023; 19:S731-S736. [PMID: 38384047 DOI: 10.4103/jcrt.jcrt_298_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/06/2022] [Indexed: 02/23/2024]
Abstract
PURPOSE In locally advanced nasopharyngeal cancer (NC), the spread of the disease, proximity to critical structures, and high dose requirement for tumor control may complicate the treatment plan. In this study, VMAT/IMRT/hybrid/tomotherapy plans were made to reach the safest and most effective dose distribution for each of the patients and the results were compared. METHODS Double volumetric-modulated arc therapy (VMAT) and 7- and 9-field intensity-modulated radiation therapy (IMRT) plans were made to 21 locally advanced NCs with Varian Trilogy System. It was observed that appropriate dose distributions could not be achieved with IMRT or VMAT, and hybrid IMRT-VMAT plans were made. All cases were also planned with Tomotherapy Precision System, and the data of four different techniques were compared retrospectively. RESULTS For normal tissue tolerances in 73 structures could not be obtained with VMAT and 38 structures with IMRT whereas the desired tolerance was provided with the hybrid plan. Hybrid plans were made with an average of 14 VMATs and 20 IMRTs. The maximum brainstem and spinal cord doses were found significantly lower in hybrid and tomotherapy techniques. Homogeneity index (HI) and conformity index (CI) values were the best in hybrid plans. No statistically significant difference between the hybrid plan and tomotherapy in terms of normal tissue tolerance doses and HI whereas a significant difference was found in the hybrid plan for CI. CONCLUSION It was observed that the most ideal plans for the locally advanced NC could be obtained with tomotherapy and hybrid plan techniques that the better protection in critical structures and desired dose distribution at target volumes.
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Affiliation(s)
- Beyhan C Bicakci
- Radiation Oncology Clinic, University of Health Sciences Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Fatih Demircioglu
- Radiation Oncology Clinic, University of Health Sciences Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Sevecen S N Can
- Radiation Oncology Clinic, University of Health Sciences Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Ozlem Demircioglu
- Department of Radiology, Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
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Dosimetric Comparison and TCP-NTCP Modeling for Lung, Heart, Left Anterior Descending, and Right Coronary Artery in Left-sided Breast Cancer Conventional and Hypofractionated Radiotherapy. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm.117987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of this study was to evaluate the dose distribution, as well as tumor control probability (TCP) and normal tissue complications probability (NTCP) models for females with left-sided breast cancer for 3D-CRT, 6, and 9 fields intensity modulated radiotherapy (IMRT) and hypofractionated tangential plans. Methods: Eighty females with left-sided breast cancer (N1T1 – N3T3) were included in this study. The patients were divided into breast conserving surgery (BCS) (n= 50) and mastectomy (n=30) patients. CT simulation images of the patients were imported on the treatment planning software (TiGRT, LinaTech, China) and the tangential treatment plans of the mentioned methods were done, using TPS. Dose assessments were performed, employing the TPS, and TCP-NTCP models of stated modalities were done, using Poisson linear-quadatric (PLQ) and Lyman-Kutcher-Burman (LKB) models on MATLAB and R software. Results: For the BCS and post-mastectomy patients, 6FIMRT imposed lower doses to ipsilateral lung, heart, LAD, RCA, and contralateral breast compared to 9FIMRT, hypofractionated RT, and 3D-CRT (P < 0.005). Also, the NTCPs of the mentioned normal tissues for 6FIMRT were lower than other methods for both BCS and post-mastectomy groups. Moreover, it was found that the V20Gy for Ipsilateral lung and the V25Gy for heart, LAD, and RCA of 6FIMRT, 9FIMRT, and hypofractionated RT was significantly lower compared to 3D-CRT (P < 0.005) for both BCS and mastectomy groups, while there were no significant differences among them for the 6FIMRT and 9FIMRT with hypofractionated RT (P > 0.005). The TCP values of 9FIMRT, 6FIMRT, and hypofractionated RT were not considerably different; however, the TCP values of 3D-CRT were lower compared to other stated methods. Conclusions: 6FIMRT is a suitable choice for RT of patients with left-sided breast cancer compared to other mentioned modalities, as a result of providing adequate PTV dose coverage and TCPs. Also, it may impose lower doses and NTCPs for OARs. Hypofractionated RT is a good alternative to reduce treatment time for patients with breast cancer.
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Jung S, Kim JI, Park JM, Shin KH, Kim JH, Choi CH. Comparison of treatment plans between static jaw and jaw tracking techniques in postmastectomy intensity-modulated radiation therapy. Phys Eng Sci Med 2022; 45:181-187. [PMID: 35041187 DOI: 10.1007/s13246-022-01100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
This study reports a dosimetric comparison between treatment plans using static jaw and jaw tracking techniques in intensity-modulated radiation therapy (IMRT) for postmastectomy radiation therapy (PMRT). Seventeen patients treated for left-sided breast cancer with implant-based reconstruction were subjected to IMRT plans. Another group of 22 patients treated for left-sided breast cancer without reconstruction was also subjected to IMRT plans. The plans were generated using the Eclipse treatment planning system with static jaw and jaw tracking techniques. The dose-volume histograms and dosimetric indices, such as mean dose (Dmean), V20 Gy, V10 Gy, and V5 Gy (volumes receiving 20, 10, and 5 Gy at the least, respectively), and generalized equivalent uniform dose for organs at risk (OARs) were analyzed. A significant difference in the value of the dosimetric indices between the static jaw and jaw tracking plans was observed. For jaw tracking plans, the Dmean of the heart for the patients with implant-based reconstruction reduced from 11.6 ± 1.1 Gy to 10.0 ± 1.8 Gy, whereas the V5 Gy reduced from 92.0 ± 4.5% to 85.1 ± 8.4%. The Dmean of the heart for patients without reconstruction reduced from 11.0 ± 2.3 Gy to 9.8 ± 2.6 Gy, whereas the V5 Gy reduced from 81.4 ± 13.6% to 66.7 ± 17.4%. The dosimetric indices of OARs in the jaw tracking plans were significantly lower than those of the OARs in the static jaw plans. The jaw tracking technique was more effective for patients without reconstruction than for those with implant-based reconstruction.
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Affiliation(s)
- Seongmoon Jung
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, 03080, Republic of Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, 03080, Republic of Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea.
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Salvestrini V, Iorio GC, Borghetti P, De Felice F, Greco C, Nardone V, Fiorentino A, Gregucci F, Desideri I. The impact of modern radiotherapy on long-term cardiac sequelae in breast cancer survivor: a focus on deep inspiration breath-hold (DIBH) technique. J Cancer Res Clin Oncol 2021; 148:409-417. [PMID: 34853887 DOI: 10.1007/s00432-021-03875-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION One of the most feared side effects of radiotherapy (RT) in the setting of breast cancer (BC) patients is cardiac toxicity. This side effect can jeopardize the quality of life (QoL) of long-term survivors. The impact of modern techniques of RT such as deep inspiration breath hold (DIBH) have dramatically changed this setting. We report and discuss the results of the literature overview of this paper. MATERIALS AND METHODS Literature references were obtained with a PubMed query, hand searching, and clinicaltrials.gov. RESULTS We reported and discussed the toxicity of RT and the improvements due to the modern techniques in the setting of BC patients. CONCLUSIONS BC patients often have a long life expectancy, thus the RT should aim at limiting toxicities and at the same time maintaining the same high cure rates. Further studies are needed to evaluate the risk-benefit ratio to identify patients at higher risk and to tailor the treatment choices.
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Affiliation(s)
- V Salvestrini
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - G C Iorio
- Radiation Oncology, University of Turin, Turin, Italy
| | - P Borghetti
- Radiation Oncology, University and SpedaliCivili, Brescia, Italy
| | - F De Felice
- Radiation Oncology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - C Greco
- Radiation Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Nardone
- RadiationOncology, Ospedale del Mare, Viale della Metamorfosi, Naples, Italy
| | - A Fiorentino
- Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - F Gregucci
- Radiation Oncology, General Regional Hospital "F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - I Desideri
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Milligan MG, Zieminski S, Johnson A, Depauw N, Rosado N, Specht MC, Liao EC, Jimenez RB. Target coverage and cardiopulmonary sparing with the updated ESTRO-ACROP contouring guidelines for postmastectomy radiation therapy after breast reconstruction: a treatment planning study using VMAT and proton PBS techniques. Acta Oncol 2021; 60:1440-1451. [PMID: 34313520 DOI: 10.1080/0284186x.2021.1957499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The European Society for Therapeutic Radiology and Oncology Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) recently released new contouring guidelines for postmastectomy radiation therapy (PMRT) after implant-based reconstruction (IBR). As compared to prior ESTRO guidelines, the new guidelines primarily redefined the chest wall (CW) target to exclude the breast prosthesis. In this study, we assessed the impact of these changes on treatment planning and dosimetric outcomes using volumetric-modulated arc therapy (VMAT) and proton pencil-beam scanning (PBS) therapy. METHODS We performed a treatment planning study of 10 women with left-sided breast cancer who underwent PMRT after IBR. All target structures were delineated first using standard (ESTRO) breast contouring guidelines and then separately using the new (ESTRO-ACROP) guidelines. Standard organs-at-risk (OARs) and cardiac substructures were contoured. Four sets of plans were generated: (1) VMAT using standard ESTRO contours, (2) VMAT using new ESTRO-ACROP contours, (3) PBS using standard contours, and (4) PBS using new contours. RESULTS VMAT plans using the new ESTRO-ACROP guidelines resulted in modest sparing of the left anterior descending coronary artery (LAD) (mean dose: 6.99 Gy standard ESTRO vs. 6.08 Gy new ESTRO-ACROP, p = 0.010) and ipsilateral lung (V20: 21.66% vs 19.45%, p = 0.017), but similar exposure to the heart (mean dose: 4.6 Gy vs. 4.3 Gy, p = 0.513), with a trend toward higher contralateral lung (V5: 31.0% vs 35.3%, p = 0.331) and CW doses (V5: 31.9% vs 35.4%, p = 0.599). PBS plans using the new guidelines resulted in further sparing of the heart (mean dose: 1.05 Gy(RBE) vs. 0.54 Gy(RBE), p < 0.001), nearly all cardiac substructures (LAD mean dose: 2.01 Gy(RBE) vs. 0.66 Gy(RBE), p < 0.001), and ipsilateral lung (V20: 16.22% vs 6.02%, p < 0.001). CONCLUSIONS PMRT after IBR using the new ESTRO-ACROP contouring guidelines with both VMAT and PBS therapy is associated with significant changes in exposure to several cardiopulmonary structures.
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Affiliation(s)
- Michael G. Milligan
- Harvard Radiation Oncology Program, Boston, MA, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen Zieminski
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Johnson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nicolas Depauw
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Nikki Rosado
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle C. Specht
- Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Eric C. Liao
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel B. Jimenez
- Harvard Radiation Oncology Program, Boston, MA, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
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Zhang Y, Huang Y, Ding S, Yuan X, Shu Y, Liang J, Mao Q, Jiang C, Li J. A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer. Radiat Oncol 2021; 16:171. [PMID: 34488817 PMCID: PMC8422660 DOI: 10.1186/s13014-021-01895-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background To compare the dosimetric, normal tissue complication probability (NTCP), secondary cancer complication probabilities (SCCP), and excess absolute risk (EAR) differences of volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for left-sided breast cancer after mastectomy. Methods and materials Thirty patients with left-sided breast cancer treated with post-mastectomy radiation therapy (PMRT) were randomly enrolled in this study. Both IMRT and VMAT treatment plans were created for each patient. Planning target volume (PTV) doses for the chest wall and internal mammary nodes, PTV1, and PTV of the supraclavicular nodes, PTV2, of 50 Gy were prescribed in 25 fractions. The plans were evaluated based on PTV1 and PTV2 coverage, homogeneity index (HI), conformity index, conformity number (CN), dose to organs at risk, NTCP, SCCP, EAR, number of monitors units, and beam delivery time. Results VMAT resulted in more homogeneous chest wall coverage than did IMRT. The percent volume of PTV1 that received the prescribed dose of VMRT and IMRT was 95.9 ± 1.2% and 94.5 ± 1.6%, respectively (p < 0.001). The HI was 0.11 ± 0.01 for VMAT and 0.12 ± 0.02 for IMRT, respectively (p = 0.001). The VMAT plan had better conformity (CN: 0.84 ± 0.02 vs. 0.78 ± 0.04, p < 0.001) in PTV compared with IMRT. As opposed to IMRT plans, VMAT delivered a lower mean dose to the ipsilateral lung (11.5 Gy vs 12.6 Gy) and heart (5.2 Gy vs 6.0 Gy) and significantly reduced the V5, V10, V20, V30, and V40 of the ipsilateral lung and heart; only the differences in V5 of the ipsilateral lung did not reach statistical significance (p = 0.409). Although the volume of the ipsilateral lung and heart encompassed by the 2.5 Gy isodose line (V2.5) was increased by 6.7% and 7.7% (p < 0.001, p = 0.002), the NTCP was decreased by 0.8% and 0.6%, and SCCP and EAR were decreased by 1.9% and 0.1% for the ipsilateral lung. No significant differences were observed in the contralateral lung/breast V2.5, V5, V10, V20, mean dose, SCCP, and EAR. Finally, VMAT reduced the number of monitor units by 31.5% and the treatment time by 71.4%, as compared with IMRT. Conclusions Compared with IMRT, VMAT is the optimal technique for PMRT patients with left-sided breast cancer due to better target coverage, a lower dose delivered, NTCP, SCCP, and EAR to the ipsilateral lung and heart, similar doses delivered to the contralateral lung and breast, fewer monitor units and a shorter delivery time.
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Affiliation(s)
- Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Xingxing Yuan
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Yuxian Shu
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Jinhui Liang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Qingfeng Mao
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Chunling Jiang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China. .,Medical College of Nanchang University, Nanchang, Jangxi, 330031, People's Republic of China. .,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Jiangxi, 330029, People's Republic of China.
| | - Jingao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China.,Medical College of Nanchang University, Nanchang, Jangxi, 330031, People's Republic of China.,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Jiangxi, 330029, People's Republic of China
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Arslan A, Aktas E, Sengul B, Tekin B. Dosimetric evaluation of left ventricle and left anterior descending artery in left breast radiotherapy. Radiol Med 2020; 126:14-21. [PMID: 32356249 DOI: 10.1007/s11547-020-01201-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We evaluated the dosimetric results of the identification of the left ventricle (LV) and left anterior descending artery (LAD) as organs at risk (OARs) in adjuvant radiotherapy (RT) after breast-conserving surgery (BCS). MATERIALS AND METHODS Twenty-two patients who had previously received RT in our center were evaluated retrospectively. All patients had undergone BCS operation for left breast cancer. LV and LAD were contoured as OARs on the same simulation CTs for these patients whose treatment was previously completed in which LV and LAD were not defined as OARs. Complying with the initial plans, intensity-modulated RT plans with 7-9 fields were made on the computer. Planning target volume (PTV), homogeneity index (HI), conformity index (CI), monitor unit (MU) values, and doses of OARs were compared using the Wilcoxon signed-rank test (p < 0.05). RESULTS There were no significant differences in PTV 50 (D 50% and D 98%), PTV 60 (D 2% and D 50%), HI, CI, and MU values when treatment plans and control plans were compared (p > 0.05). While it was possible to protect the heart, LAD, and LV better, LAD and LV were not contoured in the treatment plans, and they received higher doses compared to the control plans (p < 0.05). There was no significant difference in the other OARs. CONCLUSION In conclusion, it is essential to define the lower anatomical regions of the heart as OARs. Otherwise, the doses taken by these regions are ignored and may be maintained less than possible. In our study, it was shown that LV and LAD doses were significantly reduced even in the same center and planning by the same team.
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Affiliation(s)
- Alaettin Arslan
- Clinic of Radiation Oncology, Kayseri City Hospital, Turkey, Kayseri, Turkey.
| | - Elif Aktas
- Clinic of Radiology, Kayseri City Hospital, Turkey, Kayseri, Turkey
| | - Burak Sengul
- Clinic of Radiation Oncology, Kayseri City Hospital, Turkey, Kayseri, Turkey
| | - Burcu Tekin
- Clinic of Radiation Oncology, Kayseri City Hospital, Turkey, Kayseri, Turkey
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Jo IY, Kim ES, Kim WC, Min CK, Yeo S. Dosimetric comparison of incidental axillary irradiation between three‑dimensional conformal and volumetric modulated arc techniques for breast cancer. Mol Clin Oncol 2020; 12:551-556. [DOI: 10.3892/mco.2020.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 02/04/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Eun Seog Kim
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Woo Chul Kim
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Chul Kee Min
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
| | - Seung‑Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Chungnam 31151, Republic of Korea
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Karpf D, Sakka M, Metzger M, Grabenbauer GG. Left breast irradiation with tangential intensity modulated radiotherapy (t-IMRT) versus tangential volumetric modulated arc therapy (t-VMAT): trade-offs between secondary cancer induction risk and optimal target coverage. Radiat Oncol 2019; 14:156. [PMID: 31477165 PMCID: PMC6721379 DOI: 10.1186/s13014-019-1363-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background Adjuvant radiotherapy is the standard treatment after breast-conserving surgery. According to meta-analyses, adjuvant 3d-conventional irradiation reduces the risk of local recurrence and thereby improves long-term survival by 5–10%. However, there is an unintended exposure of organs such as the heart, lungs and contralateral breast. Irradiation of the left breast has been related to long-term effects like increased rates of coronary events as well as second cancer induction. Modern radiotherapy techniques such as tangential intensity modulated radiotherapy (t-IMRT) and tangential volumetric modulated arc therapy (t-VMAT) and particularly deep inspiration breath hold (DIBH) technique have been developed in order to improve coverage of target volume and to reduce dose to normal tissue. The aim of this study was to compare t-IMRT-plans with t-VMAT-plans in DIBH position for left-sided breast irradiation in terms of normal tissue exposure, i.e. of lungs, heart, left anterior descending coronary artery (LADCA), as well as homogeneity (HI) and conformity index (CI) and excess absolute risk (EAR) for second cancer induction for organs at risk (OAR) after irradiation. Methods Twenty patients, diagnosed with left-sided breast cancer and treated with breast-preserving surgery, were included in this planning study. For each patient DIBH-t-IMRT plan using 5 to 7 beams and t-VMAT plan using four rotations were generated to achieve 95% dose coverage to 95% of the volume. Data were evaluated on the basis of dose-volume histograms: Cardiac dose and LADCA (mean and maximum dose, D25% and D45%), dose to ipsilateral and contralateral lung (mean, D20%, D30%), dose to contralateral breast (mean dose), total monitor units, V5% of total body and normal tissue integral dose (NTID). In addition, homogeneity index and conformity index, as well as the excess absolute risk (EAR) to estimate the risk of second malignancy were calculated. Results T-IMRT showed a significant reduction in mean cardiac dose of 26% (p = 0.002) compared to t-VMAT, as well as a significant reduction in the mean dose to LADCA of 20% (p = 0.03). Following t-IMRT, mean dose to the left lung was increased by 5% (p = 0.006), whereas no significant difference was found in the mean dose to the right lung and contralateral breast between the two procedures. Monitor units were 31% (p = 0.000004) lower for t-IMRT than for t-VMAT. T-IMRT technique significantly reduced normal tissue integral dose (NTID) by 19% (p = 0.000005) and the V5% of total body by 24% (p = 0.0007). In contrast, t-VMAT improved CI and HI by 2% (p = 0.001) and 0.4% (p = 0.00001), respectively. EAR with t-IMRT was significantly lower, especially for contralateral lung and contralateral breast (2–5/10,000 person years) but not for ipsilateral lung. Conclusion Compared to t-VMAT, t-IMRT in left-sided breast irradiation significantly reduced dose to organs at risk as well as normal tissue integral dose, and V5% total body. EAR with t-IMRT was significantly lower for contralateral lung and contralateral breast. T-VMAT, however, achieved better homogeneity and conformity. This may be relevant in individual cases where sufficient coverage of medial lymphatic target volumes is warranted.
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Affiliation(s)
- Daniel Karpf
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany.,Medical Faculty of the Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mazen Sakka
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany
| | - Martin Metzger
- Division of Radiation Physics, Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany
| | - Gerhard G Grabenbauer
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany. .,Medical Faculty of the Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.
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Kim J, Chang JS, Choi SH, Kim YB, Keum KC, Suh CO, Yang G, Cho Y, Kim JW, Lee IJ. Radiotherapy for initial clinically positive internal mammary nodes in breast cancer. Radiat Oncol J 2019; 37:91-100. [PMID: 31266290 PMCID: PMC6610003 DOI: 10.3857/roj.2018.00451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/20/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. Materials and Methods We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. Results The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. Conclusion RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.
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Affiliation(s)
- Jina Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Gowoon Yang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeona Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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15
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Postmastectomy radiotherapy for left-sided breast cancer patients: Comparison of advanced techniques. Med Dosim 2019; 45:34-40. [PMID: 31129035 DOI: 10.1016/j.meddos.2019.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 12/25/2022]
Abstract
Postmastectomy radiotherapy (PMRT) has been shown to improve the overall survival for invasive breast cancer patients, and many advanced radiotherapy technologies were adopted for PMRT. The purpose of our study is to compare various advanced PMRT techniques including fixed-beam intensity-modulated radiotherapy (IMRT), non-coplanar volumetric modulated arc therapy (NC-VMAT), multiple arc VMAT (MA-VMAT), and tomotherapy (TOMO). Results of standard VMAT and mixed beam therapy that were published by our group previously were also included in the plan comparisons. Treatment plans were produced for nine PMRT patients previously treated in our clinic. The plans were evaluated based on planning target volume (PTV) coverage, dose homogeneity index (DHI), conformity index (CI), dose to organs at risk (OARs), normal tissue complication probability (NTCP) of pneumonitis, lifetime attributable risk (LAR) of second cancers, and risk of coronary events (RCE). All techniques produced clinically acceptable PMRT plans. Overall, fixed-beam IMRT delivered the lowest mean dose to contralateral breast (1.56 ± 0.4 Gy) and exhibited lowest LAR (0.6 ± 0.2%) of secondary contralateral breast cancer; NC-VMAT delivered the lowest mean dose to lungs (7.5 ± 0.8 Gy), exhibited lowest LAR (5.4 ± 2.8%) of secondary lung cancer and lowest NTCP (2.1 ± 0.4%) of pneumonitis; mixed beam therapy delivered the lowest mean dose to heart (7.1 ± 1.3 Gy) and exhibited lowest RCE (8.6 ± 7.1%); TOMO plans provided the most optimal target coverage while delivering higher dose to OARs than other techniques. Both NC-VMAT and MA-VMAT exhibited lower values of all OARs evaluation metrics compare to standard VMAT. Fixed-beam IMRT, NC-VMAT, and mixed beam therapy could be the optimal radiation technique for certain breast cancer patients after mastectomy.
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16
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Complications cardiaques de la radiothérapie mammaire. Bull Cancer 2019; 106:379-388. [DOI: 10.1016/j.bulcan.2019.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/24/2018] [Accepted: 01/30/2019] [Indexed: 11/21/2022]
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Xiang Q, Jie W, Zhu K, Wang Q, Cheng J. Which technique of positioning and immobilization is better for breast cancer patients in postmastectomy IMRT, single-pole or double-pole immobilization? J Appl Clin Med Phys 2018; 20:168-174. [PMID: 30512231 PMCID: PMC6333128 DOI: 10.1002/acm2.12506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/24/2018] [Accepted: 10/26/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose Our purpose was to explore which immobilization is more suitable for clinical practice in postmastectomy intensity modulation radiotherapy, the single‐pole position or the double‐pole position? Methods Patients treated with postmastectomy intensity modulation radiotherapy were eligible. They were selected randomly for single‐pole position or double‐pole position. Dose–volume histogram (DVH) was used to evaluate plans. After their first radiotherapy, the physicians asked a question about the comfort level of their position. The dosimetric parameters, comfort levels, and reproducibility of the two immobilization techniques were collected and analyzed after all patients had finished the whole radiotherapy. Results Totally, 94 patients were enrolled. Of these, 54 patients were treated with the single‐pole position, 28 (51.9%)had left‐sided lesions. While 40 patients were treated with the double‐pole position, 20 (50%) had left‐sided lesions. Patients’ characteristics in two groups were comparable. The single‐pole and double‐pole immobilizations had similar conformity (0.60 ± 0.05 vs 0.60 ± 0.06, P = 0.887) and homogeneity index (0.14 ± 0.03 vs 0.13 ± 0.03, P = 0.407). Compared to single‐pole position, double‐pole position typically increased the mean dose, V20, and V30 of heart (P < 0.05). Moreover, patients in the single‐pole group felt more comfortable than another group (P < 0.05). There was no difference in reproducibility between the two groups (P > 0.05). Conclusions Single‐pole position seems to be more comfortable and can reduce dose coverage to heart. Both devices allow for reproducible setup and acceptable dosimetry.
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Affiliation(s)
- Qun Xiang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wuyun Jie
- Affiliated Tumor Hospital of Xinjiang Medical University, Urumuqi, China
| | - KuiKui Zhu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Li WH, Zhang ZG, Huang ZR, Zhang W, Li ZB, Qi ZQ. No association between tumor laterality and cardiac-related mortality in breast cancer patients after radiotherapy: a population-based study. Cancer Manag Res 2018; 10:3649-3656. [PMID: 30271213 PMCID: PMC6152604 DOI: 10.2147/cmar.s172595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction To assess the effect of tumor laterality to cardiac-related deaths of breast cancer in the current radiation practices using a large modern population-based study. Methods Women diagnosed with breast cancer from 2000 to 2008 were included using the current Surveillance, Epidemiology, and End Results database. The primary outcome of this study was the cardiac-related mortality. Multivariate analysis was performed using the Cox proportional hazards model to analyze the cardiac-related mortality including demographic, clinicopathologic, and treatment factors. Results We identified 168,761 breast cancer patients, including 85,006 (50.4%) patients with left-sided tumors and 83,755 (49.6%) patients with right-sided tumors. The median follow-up period was 8.8 years. The 10-year cardiac-related mortality was 2.3% and 2.3% in left- and right-sided tumors, respectively (P=0.685). The results indicated that patients with older age, non-Hispanic Black, receipt of mastectomy, and married status were the independent adverse factors for cardiac-related mortality. However, left-sided tumors were not associated to a higher risk of cardiac-related mortality than right-sided tumors following postoperative radiotherapy (right vs left, hazard ratios 1.025, 95% CI 0.856–1.099, P=0.484). The risk of cardiac-related mortality in the entire cohort was increased with the extension of follow-up time. However, there was still not significantly different between left- and right-sided tumors. Subgroup analysis also found no association between tumor laterality and cardiac-related mortality after postoperative radiotherapy based on various demographics and treatment factors. Conclusion With a median follow-up of 8.8 years, no significant differences were found in cardiac-related mortality between left- and right-sided tumors under current radiation practices of breast cancer patients.
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Affiliation(s)
- Wei-Hua Li
- Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Zi-Guan Zhang
- Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Zheng-Rong Huang
- Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Wei Zhang
- Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Zhi-Bin Li
- Epidemiology Research Unit, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China,
| | - Zhong-Quan Qi
- Organ Transplantation Institute, Medical College, Xiamen University, Xiamen 361005, People's Republic of China,
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Balaji K, Yadav P, BalajiSubramanian S, Anu Radha C, Ramasubramanian V. Hybrid volumetric modulated arc therapy for chest wall irradiation: For a good plan, get the right mixture. Phys Med 2018; 52:86-92. [PMID: 30139614 DOI: 10.1016/j.ejmp.2018.06.641] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To find the optimal dose weighting for hybrid volumetric modulated arc therapy (H-VMAT), a combination of conventional 3DCRT and VMAT plans for left sided chest wall and supraclavicular radiation therapy. METHODS & MATERIALS 20 left-sided breast cancer patients who received adjuvant radiotherapy were considered for this study. To find the optimal weighting, 5 H-VMAT plans were generated for each study case by combining different dose proportions of 3DCRT and VMAT plans including: 90% 3DCRT/10% VMAT, 80% 3DCRT/20% VMAT, 70% 3DCRT/30% VMAT, 60% 3DCRT/40% VMAT, 50% 3DCRT/50% VMAT. Further field-in-field, optimal H-VMAT and VMAT alone plans were compared. RESULTS All H-VMAT plans achieved the expected target coverage. A higher conformity index was achieved for 50% 3DCRT/50% VMAT plan, while better homogeneity index was achieved for 80% 3DCRT/20% VMAT plan. Mean and low doses were less in 90% 3DCRT/10% VMAT plan. Compared with other proportions, 80% 3DCRT/20% VMAT and 70% 3DCRT/30% VMAT weighted H-VMAT plans achieved balanced results for PTVs and OARs. CONCLUSION The optimal dose mixture for H-VMAT technique is 70% to 80% for 3DCRT and 20% to 30% for VMAT. The optimal H-VMAT achieved balanced results for the PTVs and OARs compared with field-in-field and VMAT alone plans.
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Affiliation(s)
- Karunakaran Balaji
- Department of Radiation Oncology, Gleneagles Global Hospitals, Chennai, India; School of Advanced Sciences, Vellore Institute of Technology, Vellore, India.
| | - Poonam Yadav
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Rastogi K, Sharma S, Gupta S, Agarwal N, Bhaskar S, Jain S. Dosimetric comparison of IMRT versus 3DCRT for post-mastectomy chest wall irradiation. Radiat Oncol J 2018; 36:71-78. [PMID: 29621872 PMCID: PMC5903359 DOI: 10.3857/roj.2017.00381] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/18/2017] [Accepted: 10/18/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. Materials and Methods One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters—Dnear-max (D2), Dnear-min (D98), Dmean, V95, and V107—homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V5), 20 Gy (V20), and 55 Gy (V55) and that of heart receiving 5 Gy (V5), 25 Gy (V25), and 45 Gy (V45) were extracted from dose-volume histograms and compared. Results PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V20, 22.09% vs. 30.16%; V55, 5.16% vs. 10.27%; p < 0.001) and heart (V25, 4.59% vs. 9.19%; V45, 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume (V5 lung, 61.48% vs. 51.05%; V5 heart, 31.02% vs. 23.27%; p < 0.001). conclusions For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.
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Affiliation(s)
- Kartick Rastogi
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Shantanu Sharma
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Shivani Gupta
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Nikesh Agarwal
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Sandeep Bhaskar
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
| | - Sandeep Jain
- Department of Radiotherapy, Sawai Man Singh Medical College and Attached Group of Hospitals, Jaipur, India
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Zhang HW, Hu B, Xie C, Wang YL. Dosimetric comparison of three intensity-modulated radiation therapies for left breast cancer after breast-conserving surgery. J Appl Clin Med Phys 2018. [PMID: 29524290 PMCID: PMC5978563 DOI: 10.1002/acm2.12287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE This study aimed to evaluate dosimetric differences of intensity-modulated radiation therapy (IMRT) in target and normal tissues after breast-conserving surgery. METHODS IMRT five-field plan I, IMRT six-field plan II, and field-in-field-direct machine parameter optimization-IMRT plan III were designed for each of the 50 patients. One-way analysis of variance was performed to compare differences, and P < 0.05 was considered statistically significant. RESULTS Homogeneity index of plan III is lower than those of plans I and II. No difference was identified in conformity index of targets. Plan I exhibited difference in mean dose (Dmean ) for the heart (P < 0.05). Plan I featured smaller irradiation dose volumes in V5 , V20 (P < 0.05) of the left lung than II. Plan I exhibited significantly higher V5 in the right lung than plans II and III (P < 0.05). Under plan I, irradiation dose at V5 in the right breast is higher than that in plans II and III. Patients in plan III presented less total monitor unit and total treatment time than those in plans I and II (P < 0.05). CONCLUSION IMRT six-field plans II, and field-in-field-direct machine parameter optimization-IMRT plans III can reduce doses and volumes to the lungs and heart better while maintaining satisfying conformity index and homogeneity index of target. Nevertheless, plan II neglects target movements caused by respiration. In the same manner, plan III can substantially reduce MU and shorten patient treatment time. Therefore, plan III, which considers target movement caused by respiration, is a more practical radiation mode.
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Affiliation(s)
- Huai-Wen Zhang
- Department of Radiotherapy, Jiang-Xi Cancer Hospital, Nanchang, China
| | - Bo Hu
- Key Laboratory of Nondestructive Testing (Ministry of Education), Nanchang Hang Kong University, Nanchang, China
| | - Chen Xie
- Department of Radiotherapy, Jiang-Xi Cancer Hospital, Nanchang, China
| | - Yun-Lai Wang
- Department of Radiation Oncology, PLA General Hospital, Beijing, China
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Khullar P, Garg C, Sinha SN, Kaur I, Datta NR. An in silico comparative dosimetric study of postmastectomy locoregional irradiation using intensity-modulated vs 3-dimensional conventional radiotherapy. Med Dosim 2018; 43:370-376. [PMID: 29352629 DOI: 10.1016/j.meddos.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/27/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022]
Abstract
An in silico dosimetric evaluation of intensity-modulated radiation therapy (IMRT) vs 3-dimensional conventional radiation therapy (3D-CRT) treatment plans in postmastectomy radiation therapy (PMRT) to the chest wall and regional lymphatics was conducted. Twenty-five consecutive patients with breast cancer referred for locoregional PMRT, stages T2-4 with N1-3, were planned to receive 50 Gy in 25 fractions with IMRT. Additionally, a 3D-CRT plan was generated using identical contours for the clinical target volumes (CTV), planning target volumes (PTV), and organs at risk (OAR). Treatment plans were assessed using dose-volume histogram (DVH) parameters of D98, D95, D50, D2, and homogeneity index for individual CTVs and PTVs. OARs evaluated were ipsilateral and contralateral lungs, heart, spinal cord, and opposite breast. Most DVH parameters pertaining to CTVs and PTVs significantly favored IMRT. V20 for ipsilateral and contralateral lungs, D33 of heart and maximum dose to spinal cord favored IMRT (all p < 0.001). The mean dose to the opposite breast was significantly lesser with 3D-CRT (5.8 ± 1.8 Gy vs 2.0 ± 1.0 Gy, p < 0.001). Thus, except for the mean dose to the opposite breast, the compliance to DVH constraints applied to PTV and OARs were significantly better with IMRT. At a median follow-up of 76 months (7-91), none had locoregional failure or pulmonary or cardiac morbidity. For PMRT, requiring comprehensive irradiation to both chest wall and regional lymphatics, IMRT offers superior dosimetric advantages over 3D-CRT. This was also corroborated by long-term outcomes in these patients treated with IMRT.
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Affiliation(s)
- Pooja Khullar
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Charu Garg
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sujit Nath Sinha
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Inderjit Kaur
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Niloy Ranjan Datta
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
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Li J, Wang X, Ma J, Yu X, Guo X, Zhang Z. Prospective evaluation of skin toxicities in patients receiving post-mastectomy irradiation of chest wall, supra/infraclavicular and internal mammary nodes delivered by conventional versus intensity-modulated radiotherapy technique. Oncotarget 2017; 8:80012-80019. [PMID: 29108383 PMCID: PMC5668116 DOI: 10.18632/oncotarget.20820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background To determine whether IMRT could decrease skin toxicities in patients undergoing PMRT of chest wall, supra/infraclavicular (SCV), and internal mammary nodes (IMN) as compared to conventional technique. Materials and Methods Between 2009 and 2013, 106 patients treated with IMRT and 138 treated with conventional technique were followed up regularly. The skin toxicities were graded according to the CTCAE v4.0 issued by the NCI, and compared between groups. Results Grade 3 radiation dermatitis occurred in 49 patients (35.5%) in the conventional group and 14 (13.2%) in the IMRT group, and the difference was statistically significant (p < 0.001), favoring IMRT. Moist desquamation at the area associated with adjacent fields’ junctions or overlaps was observed in 35 patients (71.4%) in the conventional group and none in the IMRT group (p = 0.023). Grade 2 telangiectasia occurred in 32 patients (23.1%) in the conventional group and 9 (8.5%) in the IMRT group; this difference was statistically significant (p = 0.002), in favor of IMRT as well. Telangiectasias at the sub-sites associated with adjacent fields’ junctions or overlaps were observed in 26 patients (81.2%) in the conventional group and none in the IMRT group (p < 0.001). Further, 21 in the conventional group, who had initial moist desquamation at the sub-sites associated with adjacent fields’ overlaps or junctions, subsequently developed skin telangiectasias at the identical sub-sites. Conclusions IMRT-based post-mastectomy irradiation of chest wall, SCV and IMN might decrease the occurrence of initial moist desquamation as well as subsequent telangiectasia at the subsites associated with adjacent fields’ junctions or overlaps as compared to conventional technique.
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Affiliation(s)
- Juan Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaofang Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinli Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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The feasibility of a heart block with an electron compensation as an alternative whole breast radiotherapy technique in patients with underlying cardiac or pulmonary disease. PLoS One 2017; 12:e0184137. [PMID: 28863179 PMCID: PMC5580979 DOI: 10.1371/journal.pone.0184137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 08/18/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We aimed to evaluate the feasibility of the heart block with electron compensation (HBE) technique, based on three-dimensional conformal radiotherapy (3D-CRT) in left-sided breast cancer patients with underlying cardiac or pulmonary disease. METHODS Twenty patients with left-sided breast cancer who were treated with whole breast radiotherapy (WBRT) were included in this study. Intensity-modulated radiotherapy (IMRT), 3D-CRT, and HBE treatment plans were generated for each patient. Based on the 3D-CRT plan, the HBE plan included a heart block from the medial tangential field to shield the heart and added an electron beam to compensate for the loss in target volume coverage. The dosimetric parameters for the heart and lung and the target volume between the three treatment types were compared. RESULTS Of the three plans, the HBE plan yielded the most significant reduction in the doses received by the heart and lung (heart Dmean: 5.1 Gy vs. 12.9 Gy vs. 4.0 Gy and lung Dmean: 11.4 Gy vs. 13.2 Gy vs. 10.5 Gy, for 3D-CRT, IMRT, and HBE, respectively). Target coverage with all three techniques was within the acceptable range (Dmean 51.0 Gy vs. 51.2 Gy vs. 50.6 Gy, for 3D-CRT, IMRT, and HBE, respectively). CONCLUSIONS The HBE plan effectively reduced the amount of radiation exposure to the heart and lung. It could be beneficial for patients who are vulnerable to radiation-related cardiac or pulmonary toxicities.
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[Technique of complex mammary irradiation: Mono-isocentric 3D conformational radiotherapy and helical tomotherapy]. Cancer Radiother 2017; 21:741-748. [PMID: 28693911 DOI: 10.1016/j.canrad.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/15/2017] [Accepted: 03/22/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the dosimetric contribution of helical tomotherapy for breast cancers compared with conformal radiotherapy in mono-isocentric technique. PATIENTS AND METHOD For 23 patients, the dosimetric results in mono-isocentric 3D conformational radiotherapy did not satisfy the constraints either of target volumes nor organs at risk. A prospective dosimetric comparison between mono-isocentric 3D conformational radiotherapy and helical tomotherapy was therefore carried out. RESULTS The use of helical tomotherapy showed a benefit in these 23 patients, with either an improvement in the conformity index or homogeneity, but with an increase in low doses. Of the 23 patients, two had pectus excavatum, five had past thoracic irradiation and two required bilateral irradiation. The other 14 patients had a combination of morphology and/or indication of lymph node irradiation. For these patients, helical tomotherapy was therefore preferred to mono-isocentric 3D conformational radiotherapy. CONCLUSIONS Tomotherapy appears to provide better homogeneity and tumour coverage. This technique of irradiation may be justified in the case of morphological situations such as pectus exavatum and in complex clinical situations. In other cases, conformal radiotherapy in mono-isocentric technique remains to be favoured.
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Rahimy E, Hong JC, Gross CP, Hu X, Soulos PR, Shafman T, Connor HJ, Ross R, Yu JB, Dosoretz A, Evans SB. Increased Number of Beam Angles Is Associated With Higher Cardiac Dose in Adjuvant Fixed Gantry Intensity Modulated Radiation Therapy of Left-Sided Breast Cancer. Int J Radiat Oncol Biol Phys 2017; 99:1137-1145. [PMID: 28864402 DOI: 10.1016/j.ijrobp.2017.06.2451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE To analyze the relationship between angle number and mean heart dose (MHD) in adjuvant fixed gantry intensity modulated radiation therapy (FG-IMRT) treatment of left-sided breast cancer as is currently practiced in the community. METHODS AND MATERIALS We performed a retrospective, multi-institutional review of women with left-sided breast cancer receiving adjuvant FG-IMRT between 2012 and 2014, encompassing 85 centers in 15 states. Bivariate and multivariate regression analyses were done to identify factors associated with MHD. Long-term cardiac risk was estimated according to a previously published model. RESULTS Of the 538 women included, 284 had >2 gantry angle treatment plans (multi-angle), and 254 had 2 gantry angle (standard) plans. Median MHD was higher in patients with multi-angle plans compared with standard (median 475 vs 203 cGy). Number of gantry angles was significantly associated with MHD, with multi-angle plans independently increasing MHD by 229 cGy. Absolute risk of acute coronary events 20 years after treatment was estimated as 7 excess events per 1000 women for standard plans, compared with 12 excess events for multi-angle plans. CONCLUSIONS Fixed gantry IMRT breast treatment plans with >2 gantry angles were associated with increased MHD, which translated to an increased cardiac risk. Clinicians should account for this potential drawback in treatment technique when assessing overall plan quality.
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Affiliation(s)
- Elham Rahimy
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
| | - Julian C Hong
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut; Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xin Hu
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Timothy Shafman
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut; 21st Century Oncology, Fort Myers, Florida
| | - Henry J Connor
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut; Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rudi Ross
- 21st Century Oncology, Fort Myers, Florida
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Arie Dosoretz
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; 21st Century Oncology, Fort Myers, Florida
| | - Suzanne B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
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Rudat V, Nour A, Hammoud M, Abou Ghaida S. Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy : Results of a single, institutional, retrospective study. Strahlenther Onkol 2017; 193:375-384. [PMID: 28233048 PMCID: PMC5405099 DOI: 10.1007/s00066-017-1115-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy. PATIENTS AND METHODS Patients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction. RESULTS In all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3-4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF. CONCLUSION HF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
| | - Alaa Nour
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
| | - Mohamed Hammoud
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
| | - Salam Abou Ghaida
- Department of Radiation Oncology, Saad Specialist Hospital, 31952 Al Khobar, Saudi Arabia
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Zahnreich S, Ebersberger A, Karle H, Kaina B, Schmidberger H. Quantification of Radiation Biomarkers in Leukocytes of Breast Cancer Patients Treated with Different Modalities of 3D-CRT or IMRT. Radiat Res 2016; 186:508-519. [DOI: 10.1667/rr14475.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Heiko Karle
- Radiation Oncology and Radiation Therapy and
| | - Bernd Kaina
- Toxicology, University Medical Center Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Techniques d’irradiation du cancer du sein en 2016 : intérêt et indications de la radiothérapie conformationnelle avec modulation d’intensité. Cancer Radiother 2016; 20:572-5. [DOI: 10.1016/j.canrad.2016.07.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022]
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Mondal D, Sharma DN. External beam radiation techniques for breast cancer in the new millennium: New challenging perspectives. J Egypt Natl Canc Inst 2016; 28:211-218. [PMID: 27595191 DOI: 10.1016/j.jnci.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022] Open
Abstract
Radiation therapy in breast cancer has evolved dramatically over the past century. It has traveled a long path touching different milestones and taking unprecedented turns. At the end, a fine tune of clinical understanding, skill, technological advancement and translation of radiobiological understanding to clinical outcome has taken place. What all these have given is better survival with quality survivorship. It is thus prudent to understand breast irradiation in a new perspective suitable for the current millennium.
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Affiliation(s)
- Dodul Mondal
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India
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Rudat V, Nour A, Ghaida SA, Alaradi A. Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy. Radiat Oncol 2016; 11:100. [PMID: 27473272 PMCID: PMC4967307 DOI: 10.1186/s13014-016-0674-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/22/2016] [Indexed: 02/08/2023] Open
Abstract
Background The purpose of the study was to evaluate the impact of multiple prognostic factors on the acute skin reaction in adjuvant breast cancer radiotherapy, in particular the impact of hypofractionation (HF) compared to conventional fractionation (CF) and tangential beam (TB) IMRT compared to three-dimensional conformal radiotherapy (3DCRT). Methods Two-hundred and sixty-six breast cancer patients with postoperative radiotherapy after breast conserving surgery or mastectomy were retrospectively evaluated. Patients were treated with HF (15 fractions of 2.67 Gy; n = 121) or CF (28 fractions of 1.8 Gy or 25 fractions of 2.0 Gy; n = 145) and TB-IMRT (n = 151) or 3DCRT (n = 115). The acute skin reactions were prospectively assessed using the CTCAE v4 grading scale. Ordinal regression analysis was used to assess the impact of possible prognostic factors on the maximal acute skin reaction. Results Grade 2 skin reactions were observed in 19 % of the patients treated with CF compared to 2 % treated with HF. On univariate analysis, the fractionation regimen, the PTV (breast versus chest wall), the volume of the PTV and the body mass index were significant prognostic factors for the maximum acute skin reaction. On multivariate analysis, the fractionation regimen (p < 0.00001) and the volume of the PTV (p = 0.0002) remained as independent significant factors. Conclusions Our data suggest that HF is associated with a significantly reduced maximal acute skin reaction compared to CF.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia.
| | - Alaa Nour
- Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia
| | - Salam Abou Ghaida
- Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia
| | - Aziz Alaradi
- Department of Radiation Oncology, Saad Specialist Hospital, Al Khobar, 31952, Saudi Arabia
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Farrukh S, Ilyas N, Iqbal MJ, Ahmed M, Khan KM, Khan AM. Variations in the Dose Profiles of Physical and Virtual Wedge Filters of ONCOR Linear Accelerator. J Med Imaging Radiat Sci 2015; 46:413-419. [PMID: 31052122 DOI: 10.1016/j.jmir.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE In this study, we measured the dose profiles of physical wedges (PWs) and virtual wedges (VW) for photon energies (6 MV and 15 MV), various field sizes (10 × 10, 15 × 15, and 20 × 20 cm2), depths (dmax, 10 cm, 20 cm), and wedge angles (15°, 30°, 45°, and 60°). This study was performed using a Siemens ONCOR IMRT Plus linear accelerator. The acquired dose profiles of PW and VW were compared and statistically analyzed. MATERIALS AND METHODS The dose profiles were measured using IBA CC13 ion chamber in IBA Blue phantom (a three-dimensional water phantom). The source-to-surface distance was kept 100 cm and measurements were taken for 10 × 10, 15 × 15, and 20 × 20 cm2 field sizes and for 15°, 30°, 45°, and 60° PWs. These measurements were taken for both 6 MV and 15 MV photon energies. VW profiles were obtained using LDA-99 linear detector array (IBA, Germany). The percent off-axis dose difference between PW and VW profiles were calculated, analyzed, and plotted. Statistics on the measured data was applied using SPSS version 13. RESULTS AND CONCLUSION The percent dose difference between PW and VW beam profiles were calculated at different off-axis positions. These dose variations increased in the wedge direction (toe region), but were negligible in the nonwedge direction. The results of one-way analysis of variance show that the dose variation between PW and VW are significant with off-axis positions, wedge angles, and depth, but are statistically nonsignificant with energy and field sizes. These variations could produce abnormal doses, especially in large field sizes and wedge angles in clinical applications, which could be avoided by understanding the behavior of wedge profiles and comparing the calculated (from treatment planning system) and measured (actual) doses.
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Affiliation(s)
| | - Nasir Ilyas
- Institute of Space and Planetary Astrophysics, University of Karachi, Karachi, Pakistan
| | - Muhammad Jawed Iqbal
- Institute of Space and Planetary Astrophysics, University of Karachi, Karachi, Pakistan
| | - Munib Ahmed
- Atomic Energy Medical Centre, JPMC, Karachi, Pakistan
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Dosimetric analysis of intensity-modulated radiotherapy and three-dimensional conformal radiotherapy for chest wall irradiation in breast cancer patients. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackgroundFor chest wall irradiation in breast cancer patients, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) have made tremendous changes in treatment delivery.PurposeThe purpose of this study is to compare the dosimetric parameters in IMRT and 3DCRT plans.Materials and methodsIMRT and 3DCRT plans were generated for 25 randomly selected postmastectomy breast cancer patients. The prescribed dose (PD) was 50 Gray (Gy) in 25 fractions (#) at the rate of 2 Gy/# with 5#/week. Dose volume histogram was evaluated for planning target volume (PTV) coverage and dose to organs at risk (OARs). All the dosimetric parameters were compared using unpaired student’s t-test.ResultsPTV coverage was significantly better in IMRT, although the 90% of PTV was well covered by 90% of PD in all plans by both the techniques. Homogeneity index and conformity index were better in IMRT. V5 Gy and Dmean of contralateral lung, contralateral breast and heart (right side chest wall cases) were found to be lesser in 3DCRT compared with that in IMRT. However, there was no significant difference in V20 Gy of ipsilateral lung and V25 Gy of heart (left side chest wall cases) in all the plans by both the techniques.ConclusionAdequate target coverage was achieved by both the techniques, however, dose to OARs were lesser in 3DCRT plans as compared with that in IMRT plans. Thus, it can be concluded that 3DCRT is as efficient as IMRT for the chest wall irradiation.
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Assessing radiation exposure of the left anterior descending artery, heart and lung in patients with left breast cancer: A dosimetric comparison between multicatheter accelerated partial breast irradiation and whole breast external beam radiotherapy. Radiother Oncol 2015; 117:459-66. [PMID: 26328940 DOI: 10.1016/j.radonc.2015.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/20/2015] [Accepted: 08/09/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE This study aims to quantify dosimetric reduction to the left anterior descending (LAD) artery, heart and lung when comparing whole breast external beam radiotherapy (WBEBRT) with multicatheter accelerated partial breast irradiation (MCABPI) for early stage left breast cancer. MATERIALS AND METHODS Planning CT data sets of 15 patients with left breast cancer receiving multicatheter brachytherapy post breast conserving surgery were used to create two independent treatment plans - WBEBRT prescribed to 50 Gy/25 fractions and MCABPI prescribed to 34 Gy/10 fractions. Dose parameters for (i) LAD artery, (ii) heart, and (iii) ipsilateral lung were calculated and compared between the two treatment modalities. RESULTS After adjusting for Equivalent Dose in 2 Gy fractions(EQD2), and comparing MCAPBI with WBEBRT, the largest dose reduction was for the LAD artery whose mean dose differed by a factor of 7.7, followed by the ipsilateral lung and heart with a factor of 4.6 and 2.6 respectively. Compared to WBEBRT, the mean MCAPBI LAD was significantly lower compared to WBEBRT (6.0 Gy vs 45.9 Gy; p<0.01). Mean MCAPBI heart D(0.1cc) (representing the dose received by the most highly exposed 0.1 cc of the risk organ, i.e. the dose peak) was significantly lower (16.3 Gy vs 50.6 Gy; p<0.01). Likewise, the mean heart dose (MHD) was significantly lower (2.3 Gy vs 6.0 Gy; p<0.01). Peak dose and mean lung dose (MLD) for ipsilateral lung was also lower for MCAPBI compared to WBEBRT (Peak dose: 22.2 Gy vs 52.0 Gy; p<0.01; MLD: 2.3 Gy vs 10.7 Gy; p<0.01). CONCLUSION Compared to WBEBRT, MCAPBI showed a significant reduction in radiation dose for the LAD, heart and lung. This may translate into better cardiac and pulmonary toxicities for patients undergoing MCAPBI.
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Sautter-Bihl ML, Sedlmayer F. Radiotherapy of the Lymphatic Pathways in Early Breast Cancer. Breast Care (Basel) 2015; 10:254-8. [PMID: 26600761 PMCID: PMC4608631 DOI: 10.1159/000438662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
International guidelines reveal substantial differences regarding indications for regional nodal irradiation (RNI). Recently, several randomized studies provided new insights and these are discussed here. Patients with 1-3 positive nodes seem to profit from RNI compared to whole-breast (WBI) or chest-wall irradiation (CWI) alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and 1 meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel nodes or microscopic metastases on prognosis are equivocal. Recent data suggest that the current restrictive use of RNI should be scrutinized, as the hazard-benefit relation appears to shift towards an improvement of outcome.
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Affiliation(s)
| | - Felix Sedlmayer
- Department of Radiotherapy and Radiation Oncology, LKH Salzburg, Paracelsus Medical University Hospital, Salzburg, Austria
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Liu ZM, Ge XL, Chen JY, Wang PP, Zhang C, Yang X, Zhu HC, Liu J, Qin Q, Xu LP, Lu J, Zhan LL, Cheng HY, Sun XC. Adjuvant Radiotherapy after Breast Conserving Treatment for Breast Cancer: A Dosimetric Comparison between Volumetric Modulated Arc Therapy and Intensity Modulated Radiotherapy. Asian Pac J Cancer Prev 2015; 16:3257-65. [PMID: 25921129 DOI: 10.7314/apjcp.2015.16.8.3257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiotherapy is an important treatment of choice for breast cancer patients after breast- conserving surgery, and we compare the feasibility of using dual arc volumetric modulated arc therapy (VMAT2), single arc volumetric modulated arc therapy (VMAT1) and Multi-beam Intensity Modulated Radiotherapy (M-IMRT) on patients after breast-conserving surgery. MATERIALS AND METHODS Thirty patients with breast cancer (half right-sided and half left-sided) treated by conservative lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned with three different radiotherapy techniques: 1) VMAT1; 2) VMAT2; 3) M-IMRT. The distributions for the planning target volume (PTV) and organs at risk (OARs) were compared. Dosimetries for all the techniques were compared. RESULTS All three techniques satisfied the dose constraint well. VMAT2 showed no obvious difference in the homogeneity index (HI) and conformity index (CI) of the PTV with respect to M-IMRT and VMAT1. VMAT2 clearly improved the treatment efficiency and can also decrease the mean dose and V5Gy of the contralateral lung. The mean dose and maximum dose of the spinal cord and contralateral breast were lower for VMAT2 than the other two techniques. The very low dose distribution (V1Gy) of the contralateral breast also showed great reduction in VMAT2 compared with the other two techniques. For the ipsilateral lung of right-sided breast cancer, the mean dose was decreased significantly in VMAT2 compared with VMAT1 and M-IMRT. The V20Gy and V30Gy of the ipsilateral lung of the left- sided breast cancer for VMAT2 showed obvious reduction compared with the other two techniques. The heart statistics of VMAT2 also decreased considerably compared to VMAT1 and M-IMRT. CONCLUSIONS Compared to the other two techniques, the dual arc volumetric modulated arc therapy technique reduced radiation dose exposure to the organs at risk and maintained a reasonable target dose distribution.
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Affiliation(s)
- Zhe-Ming Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China E-mail : ;
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Dosimetric comparison for volumetric modulated arc therapy and intensity-modulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer. Radiol Oncol 2015; 49:91-8. [PMID: 25810708 PMCID: PMC4362613 DOI: 10.2478/raon-2014-0033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 07/07/2014] [Indexed: 01/22/2023] Open
Abstract
Background The aim of the study was to evaluate the dosimetric benefit of applying volumetric modulated arc therapy (VMAT) on the post-mastectomy left-sided breast cancer patients, with the involvement of internal mammary nodes (IMN). Patients and methods The prescription dose was 50 Gy delivered in 25 fractions, and the clinical target volume included the left chest wall (CW) and IMN. VMAT plans were created and compared with intensity-modulated radiotherapy (IMRT) plans on Pinnacle treatment planning system. Comparative endpoints were dose homogeneity within planning target volume (PTV), target dose coverage, doses to the critical structures including heart, lungs and the contralateral breast, number of monitor units and treatment delivery time. Results VMAT and IMRT plans showed similar PTV dose homogeneity, but, VMAT provided a better dose coverage for IMN than IMRT (p = 0.017). The mean dose (Gy), V30 (%) and V10 (%) for the heart were 13.5 ± 5.0 Gy, 9.9% ± 5.9% and 50.2% ± 29.0% by VMAT, and 14.0 ± 5.4 Gy, 10.6% ± 5.8% and 55.7% ± 29.6% by IMRT, respectively. The left lung mean dose (Gy), V20 (%), V10 (%) and the right lung V5 (%) were significantly reduced from 14.1 ± 2.3 Gy, 24.2% ± 5.9%, 42.4% ± 11.9% and 41.2% ± 12.3% with IMRT to 12.8 ± 1.9 Gy, 21.0% ± 3.8%, 37.1% ± 8.4% and 32.1% ± 18.2% with VMAT, respectively. The mean dose to the contralateral breast was 1.7 ± 1.2 Gy with VMAT and 2.3 ± 1.6 Gy with IMRT. Finally, VMAT reduced the number of monitor units by 24% and the treatment time by 53%, as compared to IMRT. Conclusions Compared to 5-be am step-and-shot IMRT, VMAT achieves similar or superior target coverage and a better normal tissue sparing, with fewer monitor units and shorter delivery time.
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Impact of breathing on post-mastectomy radiotherapy: a dosimetric comparison between intensity-modulated radiotherapy and 3D tangential radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPurposeTo quantify the effect of breathing motion on post-mastectomy radiotherapy with three-dimensional (3D) tangents and intensity-modulated radiotherapy (IMRT)Materials and methodsPatients trained for breath-hold underwent routine free breathing (FB) computed tomography (CT) simulation for radiotherapy as well as additional CT scans with breath held at the end of normal inspiration (NI scan) and expiration (NE scan) for study. The FB scan was used to develop both tangents and IMRT plans. To simulate breathing, each plan was copied and applied on NI and NE scans. The respiratory parameters of the patients as well as the dosimetric data with both the plans were analysed.ResultsBreathing motion resulted in mean fall in target coverage (V95) with IMRT by more than 5% when compared with tangents, and this effect significantly correlated with higher tidal volume. There was also a decrease in the mean target minimal dose by 20–25% with IMRT when compared with 10–12% with tangents, attributable to breathing motion. However, the cardiac dose crossed the limit (V25<10%) with breathing in the 3D tangents plan.ConclusionsDosimetric coverage of the chest wall is sensitive to breathing motion for the IMRT technique when compared with standard tangents, especially in patients with large tidal volume.
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Lin Y, Wang B. Dosimetric absorption of intensity-modulated radiotherapy compared with conventional radiotherapy in breast-conserving surgery. Oncol Lett 2014; 9:9-14. [PMID: 25435927 PMCID: PMC4246647 DOI: 10.3892/ol.2014.2704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to investigate the dosimetric benefits between intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CR) among patients receiving breast-conserving surgery. A dosimetric comparison of IMRT and CR was evaluated in 20 patients with early-stage breast cancer using a three-dimensional treatment planning system. The prescribed mammary gland dose was completed in 25 fractions with a total dose of 5,000 cGy. Homogeneity of the planning target volume (PTV), irradiation dose and volume of organs at risk (OARs) were evaluated through a dose-volume histogram. For the homogeneity of PTV, the average volume receiving 95% of the prescribed dose in the IMRT plan was similar to that in the CR plan (97 vs. 96%, respectively). With regard to normal tissue sparing in OARs, the ipsilateral lung V20 in the IMRT and CR plans was 27.8 and 20.8%, respectively. The mean dose and V30 of the heart for five patients were 598.4 versus 348.3 cGy and 10.06 versus 5.3%, respectively. The mean dose sparing the heart or lung was markedly reduced in the IMRT plan compared with the CR plan. The results of the current study demonstrated that whole breast IMRT improves PTV dose distribution and improves normal tissue sparing in OARs.
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Affiliation(s)
- Yang Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Benzhong Wang
- Department of Breast Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Rudat V, Nour A, Alaradi AA, Mohamed A, Altuwaijri S. In vivo surface dose measurement using GafChromic film dosimetry in breast cancer radiotherapy: comparison of 7-field IMRT, tangential IMRT and tangential 3D-CRT. Radiat Oncol 2014; 9:156. [PMID: 25022449 PMCID: PMC4120005 DOI: 10.1186/1748-717x-9-156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/09/2014] [Indexed: 01/03/2023] Open
Abstract
Purpose The purpose of this study was to compare the surface dose of 7-field IMRT (7 F-IMRT), tangential beam IMRT (TB-IMRT), and tangential beam 3D-CRT (3D-CRT) of breast cancer patients receiving adjuvant radiotherapy by means of in vivo GafChromic film dosimetry. Material and methods Breast cancer patients receiving adjuvant radiotherapy of the whole breast or the chest wall were eligible for the study. Study patients were treated with a treatment plan using two different radiotherapy techniques (first patient series, 3D-CRT followed by TB-IMRT; second patient series, TB-IMRT followed by 7 F-IMRT). The surface dose was evaluated on three consecutive treatment fractions per radiotherapy technique using in vivo GafChromic film dosimetry. The paired t-test was used to assess the difference of in vivo GafChromic film readings or calculated plan parameters of the compared pairs of radiation techniques for statistical significance. Results Forty-five unselected breast cancer patients were analysed in this study. 7 F-IMRT significantly reduced the surface dose compared to TB-IMRT. Differences were greatest in the central and lateral breast or chest wall region and amounted to a dose reduction of -11.8% to -18.8%. No significant difference of the surface dose was observed between TB-IMRT and 3D-CRT. A corresponding observation was obtained for the calculated skin dose derived from dose-volume histograms. Conclusions In adjuvant breast cancer radiotherapy, 7 F-IMRT offers a significantly reduced surface dose compared to TB-IMRT or 3D-CRT.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, P,O, Box 30353, Al Khobar 31952, Saudi Arabia.
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Shah C, Badiyan S, Berry S, Khan AJ, Goyal S, Schulte K, Nanavati A, Lynch M, Vicini FA. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol 2014; 112:9-16. [PMID: 24813095 DOI: 10.1016/j.radonc.2014.04.009] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/06/2014] [Accepted: 04/18/2014] [Indexed: 12/12/2022]
Abstract
Breast cancer radiotherapy represents an essential component in the overall management of both early stage and locally advanced breast cancer. As the number of breast cancer survivors has increased, chronic sequelae of breast cancer radiotherapy become more important. While recently published data suggest a potential for an increase in cardiac events with radiotherapy, these studies do not consider the impact of newer radiotherapy techniques commonly utilized. Therefore, the purpose of this review is to evaluate cardiac dose sparing techniques in breast cancer radiotherapy. Current options for cardiac protection/avoidance include (1) maneuvers that displace the heart from the field such as coordinating the breathing cycle or through prone patient positioning, (2) technological advances such as intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT), and (3) techniques that treat a smaller volume around the lumpectomy cavity such as accelerated partial breast irradiation (APBI), or intraoperative radiotherapy (IORT). While these techniques have shown promise dosimetrically, limited data on late cardiac events exist due to the difficulties of long-term follow up. Future studies are required to validate the efficacy of cardiac dose sparing techniques and may use surrogates for cardiac events such as biomarkers or perfusion imaging.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Shahed Badiyan
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, United States
| | - Sameer Berry
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Atif J Khan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey & Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey & Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Kevin Schulte
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Anish Nanavati
- Department of Oncology, Georgetown University School of Medicine, Washington DC United States
| | - Melanie Lynch
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Frank A Vicini
- Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, United States.
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Rudat V, El-Sweilmeen H, Brune-Erber I, Nour AA, Almasri N, Altuwaijri S, Fadel E. Identification of breast cancer patients with a high risk of developing brain metastases: a single-institutional retrospective analysis. BMC Cancer 2014; 14:289. [PMID: 24761771 PMCID: PMC4006960 DOI: 10.1186/1471-2407-14-289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 04/22/2014] [Indexed: 09/02/2023] Open
Abstract
Background The objective of this study was to identify breast cancer patients with a high risk of developing brain metastases who may benefit from pre-emptive medical intervention. Methods Medical records of 352 breast cancer patients with local or locoregional disease at diagnosis were retrospectively analysed. The brain metastasis-free survival was estimated using the Kaplan-Meier method and patient groups were compared using the log rank test. The simultaneous relationship of multiple prognostic factors was assessed using Cox’s proportional hazard regression analysis. The Fisher exact test was used to test the difference of proportions for statistical significance. Results On univariate analysis, statistically highly significant unfavourable risk factors for the brain metastasis-free survival were negative ER status, negative PR status, and triple negative tumor subtype. Young age at diagnosis (≤35 years) and advanced disease stage were not statistically significant (p = 0.10). On multivariate analysis, the only independent significant factor was the ER status (negative ER status; hazard radio (95% confidence interval), 5.1 (1.8-14.6); p = 0.003). In the subgroup of 168 patients with a minimum follow-up of 24 months, 49 patients developed extracranial metastases as first metastatic event. Of those, 7 of 15 (46.6%) with a negative ER status developed brain metastases compared to 5 of 34 (14.7%) with a positive ER status (Fisher exact test, p = 0.03). The median time interval (minimum-maximum) between the diagnosis of extracranial and brain metastases was 7.5 months (1-30 months). Conclusions Breast cancer patients with extracranial metastasis and negative ER status exhibited an almost 50% risk of developing brain metastasis during their course of disease. Future studies are highly desired to evaluate the efficacy of pre-emptive medical intervention such as prophylactic treatment or diagnostic screening for high risk breast cancer patients.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, P,O, Box 30353, Al Khobar 31952, Saudi Arabia.
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DEGRO practical guidelines: radiotherapy of breast cancer III--radiotherapy of the lymphatic pathways. Strahlenther Onkol 2014; 190:342-51. [PMID: 24638236 DOI: 10.1007/s00066-013-0543-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/12/2013] [Indexed: 01/09/2023]
Abstract
AIM The purpose of this work is to update the practical guidelines for adjuvant radiotherapy of the regional lymphatics of breast cancer published in 2008 by the breast cancer expert panel of the German Society of Radiation Oncology (DEGRO). METHODS A comprehensive survey of the literature concerning regional nodal irradiation (RNI) was performed using the following search terms: "breast cancer", "radiotherapy", "regional node irradiation". Recent randomized trials were analyzed for outcome as well as for differences in target definition. Field arrangements in the different studies were reproduced and superimposed on CT slices with individually contoured node areas. Moreover, data from recently published meta-analyses and guidelines of international breast cancer societies, yielding new aspects compared to 2008, provided the basis for defining recommendations according to the criteria of evidence-based medicine. In addition to the more general statements of the German interdisciplinary S3 guidelines updated in 2012, this paper addresses indications, targeting, and techniques of radiotherapy of the lymphatic pathways after surgery for breast cancer. RESULTS International guidelines reveal substantial differences regarding indications for RNI. Patients with 1-3 positive nodes seem to profit from RNI compared to whole breast (WBI) or chest wall irradiation alone, both with regard to locoregional control and disease-free survival. Irradiation of the regional lymphatics including axillary, supraclavicular, and internal mammary nodes provided a small but significant survival benefit in recent randomized trials and one meta-analysis. Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection (ALND), while reducing the rate of lymph edema. Data concerning the impact of 1-2 macroscopically affected sentinel node (SN) or microscopic metastases on prognosis are conflicting. CONCLUSION Recent data suggest that the current restrictive use of RNI should be scrutinized because the risk-benefit relationship appears to shift towards an improvement of outcome.
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Mihailidis DN. In Regard to MacDonald et al. Int J Radiat Oncol Biol Phys 2014; 88:754. [DOI: 10.1016/j.ijrobp.2013.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/23/2013] [Indexed: 11/24/2022]
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Kara FG, Haydaroğlu A, Eren H, Kitapçıoğlu G. Comparison of Different Techniques in Breast Cancer Radiotherapy Planning. THE JOURNAL OF BREAST HEALTH 2014; 10:83-87. [PMID: 28331649 DOI: 10.5152/tjbh.2014.1772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/14/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study aimed to minimize the radiation dose to organs other than the target tissue during adjuvant therapy applied for breast cancer, by using different planning methods. MATERIALS AND METHODS 30 women with T1-2 N1-3 M0 breast cancer were included in the study. Planning was performed using four different methods to the supraclavicular area, internal, and external tangential fields. All planning was done in a virtual environment by and the requested data was obtained. All patients were treated by the 1st method. Method 1: Different isocenter, complete supraclavicular area, breast half beam. Method 2: Different isocenter, half supraclavicular area, breast half beam. Method 3: Single isocenter, half supraclavicular area, breast half beam. Method 4: Different isocenter, supraclavicular area full beam, breast full beam. RESULTS Evaluation of PTV values showed a statistically significant reduction in D-max, 110% and 115% values by method III. Lower doses in other parameters were not statistically significant. CONCLUSION Based on these results, the application of single isocenter, 3D radiotherapy in breast cancer provides significant advantages especially in PTV and pulmonary dosages.
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Affiliation(s)
- F Gülşen Kara
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ayfer Haydaroğlu
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hakan Eren
- Department of Radiation Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gül Kitapçıoğlu
- Department of Biostatistics and Health Informatics, Ege University Faculty of Medicine, İzmir, Turkey
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Budach W, Kammers K, Boelke E, Matuschek C. Adjuvant radiotherapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials. Radiat Oncol 2013; 8:267. [PMID: 24225206 PMCID: PMC3842771 DOI: 10.1186/1748-717x-8-267] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/08/2013] [Indexed: 12/21/2022] Open
Abstract
Background Radiotherapy (RT) improves overall survival (OS) of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved lymph nodes (LN). The contribution of RT to the regional LN to this survival benefit was poorly understood. Recently, the results of three large randomized trials addressing this question have become available. Material and methods The published abstracts (full publication pending) of the MA.20 (n=1832) and the EORTC 22922–10925 (EORTC) (n=4004) trial and the full publication of the French trial (n=1334) were basis of the meta-analysis. Main eligibility criteria were positive axillary LN (all trials), LN negative disease with high risk for recurrence (MA.20), and medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial tested the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS). Results Regional RT of the MS-LN and the IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS (Hazard Ratio (HR) 0.85 (95% CL 0.75 - 0.96)). Adding the results of the French trial and using the random effects model to respect the different design of the French trial, the effect on OS of regional radiotherapy was still significant (HR 0.88 (95% CL 0.80 - 0.97)). The absolute benefits in OS were 1.6% in the MA.20 trial at 5 years, 1.6% in the EORTC trial at 10 years, and 3.3% in the French trial at 10 years (not significant in single trials). Regional radiotherapy of the MS-LN and the IM-LN (MA.20 and EORTC) was associated with a significant improvement of DFS (HR 0.85 (95% CL 0.77 - 0.94)) and DMFS (HR 0.82 (95% CL 0.73 - 0.92)). The effect sizes were not significantly different between trials for any end point. Conclusion Additional regional radiotherapy to the internal mammary and medial supraclavicular lymph nodes statistically significantly improves DFS, DMFS, and overall survival in stage I-III breast cancer.
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Affiliation(s)
- Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University of Düsseldorf, Moorenstraße 5, Düsseldorf, D-40225, Germany.
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Mulliez T, Speleers B, Madani I, De Gersem W, Veldeman L, De Neve W. Whole breast radiotherapy in prone and supine position: is there a place for multi-beam IMRT? Radiat Oncol 2013; 8:151. [PMID: 23800109 PMCID: PMC3702403 DOI: 10.1186/1748-717x-8-151] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Early stage breast cancer patients are long-term survivors and finding techniques that may lower acute and late radiotherapy-induced toxicity is crucial. We compared dosimetry of wedged tangential fields (W-TF), tangential field intensity-modulated radiotherapy (TF-IMRT) and multi-beam IMRT (MB-IMRT) in prone and supine positions for whole-breast irradiation (WBI). Methods MB-IMRT, TF-IMRT and W-TF treatment plans in prone and supine positions were generated for 18 unselected breast cancer patients. The median prescription dose to the optimized planning target volume (PTVoptim) was 50 Gy in 25 fractions. Dose-volume parameters and indices of conformity were calculated for the PTVoptim and organs-at-risk. Results Prone MB-IMRT achieved (p<0.01) the best dose homogeneity compared to WTF in the prone position and WTF and MB-IMRT in the supine position. Prone IMRT scored better for all dose indices. MB-IMRT lowered lung and heart dose (p<0.05) in supine position, however the lowest ipsilateral lung doses (p<0.001) were in prone position. In left-sided breast cancer patients population averages for heart sparing by radiation dose was better in prone position; though non-significant. For patients with a PTVoptim volume ≥600 cc heart dose was consistently lower in prone position; while for patients with smaller breasts heart dose metrics were comparable or worse compared to supine MB-IMRT. Doses to the contralateral breast were similar regardless of position or technique. Dosimetry of prone MB-IMRT and prone TF-IMRT differed slightly. Conclusions MB-IMRT is the treatment of choice in supine position. Prone IMRT is superior to any supine treatment for right-sided breast cancer patients and left-sided breast cancer patients with larger breasts by obtaining better conformity indices, target dose distribution and sparing of the organs-at-risk. The influence of treatment techniques in prone position is less pronounced; moreover dosimetric differences between TF-IMRT and MB-IMRT are rather small.
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Affiliation(s)
- Thomas Mulliez
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium.
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48
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Jimenez RB, Goma C, Nyamwanda J, Kooy HM, Halabi T, Napolitano BN, McBride SM, Taghian AG, Lu HM, MacDonald SM. Intensity modulated proton therapy for postmastectomy radiation of bilateral implant reconstructed breasts: a treatment planning study. Radiother Oncol 2013; 107:213-7. [PMID: 23647751 DOI: 10.1016/j.radonc.2013.03.028] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/04/2013] [Accepted: 03/20/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Delivery of post-mastectomy radiation (PMRT) in women with bilateral implants represents a technical challenge, particularly when attempting to cover regional lymph nodes. Intensity modulated proton therapy (IMPT) holds the potential to improve dose delivery and spare non-target tissues. The purpose of this study was to compare IMPT to three-dimensional (3D) conformal radiation following bilateral mastectomy and reconstruction. MATERIALS AND METHODS Ten IMPT, 3D conformal photon/electron (P/E), and 3D photon (wide tangent) plans were created for 5 patients with breast cancer, all of whom had bilateral breast implants. Using RTOG guidelines, a physician delineated contours for both target volumes and organs-at-risk. Plans were designed to achieve 95% coverage of all targets (chest wall, IMN, SCV, axilla) to a dose of 50.4 Gy or Gy (RBE) while maximally sparing organs-at-risk. RESULTS IMPT plans conferred similar target volume coverage with enhanced homogeneity. Both mean heart and lung doses using IMPT were significantly decreased compared to both P/E and wide tangent planning. CONCLUSIONS IMPT provides improved homogeneity to the chest wall and regional lymphatics in the post-mastectomy setting with improved sparing of surrounding normal structures for woman with reconstructed breasts. IMPT may enable women with mastectomy to undergo radiation therapy without the need for delay in breast reconstruction.
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Affiliation(s)
- Rachel B Jimenez
- Harvard Radiation Oncology Program, Brigham & Women's Hospital, Department of Radiation Oncology, 75 Francis Street, Boston, MA 02215, USA.
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Ma J, Li J, Xie J, Chen J, Zhu C, Cai G, Zhang Z, Guo X, Chen J. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities. Radiat Oncol 2013; 8:81. [PMID: 23566488 PMCID: PMC3643842 DOI: 10.1186/1748-717x-8-81] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventional post-mastectomy radiation therapy is delivered with tangential fields for chest wall and separate fields for regional nodes. Although chest wall and regional nodes delineation has been discussed with RTOG contouring atlas, CT-based planning to treat chest wall and regional nodes as a whole target has not been widely accepted. We herein discuss the dosimetric characteristics of a linac IMRT technique for treating chest wall and regional nodes as a whole PTV after modified radical mastectomy, and observe acute toxicities following irradiation. METHODS Patients indicated for PMRT were eligible. Chest wall and supra/infraclavicular region +/-internal mammary nodes were contoured as a whole PTV on planning CT. A simplified linac IMRT plan was designed using either integrated full beams or two segments of half beams split at caudal edge of clavicle head. DVHs were used to evaluate plans. The acute toxicities were followed up regularly. RESULTS Totally, 85 patients were enrolled. Of these, 45 had left-sided lesions, and 35 received IMN irradiation. Planning designs yielded 55 integrated and 30 segmented plans, with median number of beams of 8 (6-12). The integrated and segmented plans had similar conformity (1.41±0.14 vs. 1.47±0.15, p=0.053) and homogeneity indexes (0.13±0.01 vs. 0.14±0.02, p=0.069). The percent volume of PTV receiving >110% prescription dose was <5%. As compared to segmented plans, integrated plans typically increased V5 of ipsilateral lung (p=0.005), and heart (p=0.001) in patients with left-sided lesions. Similarly, integrated plans had higher spinal cord Dmax (p=0.009), ipsilateral humeral head (p<0.001), and contralateral lung Dmean (p=0.019). During follow-up, 36 (42%) were identified to have ≥ grade 2 radiation dermatitis (RD). Of these, 35 developed moist desquamation. The median time to onset of moist desquamation was 6 (4-7) weeks from start of RT. The sites of moist desquamation were most frequently occurred in anterior axillary fold (32/35), and secondly chest wall (12/35). The difference in occurrence of ≥ grade 2 RD between integrated and segmented plans was statistically insignificant (X2=0.35, p=0.55). Only 2 were found to have grade 2 radiation pneumonitis. CONCLUSIONS The linac IMRT technique applied in PMRT with chest wall and regional nodes as a whole PTV was dosimetrically feasible, and the treatment was proved to be well-tolerated by most patients.
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Affiliation(s)
- Jinli Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Cancer Institute of Fudan University, Shanghai, 200032, China
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50
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Evaluation of organ-specific peripheral doses after 2-dimensional, 3-dimensional and hybrid intensity modulated radiation therapy for breast cancer based on Monte Carlo and convolution/superposition algorithms: Implications for secondary cancer risk assessment. Radiother Oncol 2013; 106:33-41. [DOI: 10.1016/j.radonc.2012.11.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 10/10/2012] [Accepted: 11/18/2012] [Indexed: 11/18/2022]
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