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Rahimi A, Zhang Y, Kim DW, Morgan H, Hossain F, Leitch M, Wooldridge R, Seiler S, Goudreau S, Haley B, Rao R, Rivers A, Spangler A, Ahn C, Stevenson S, Staley J, Albuquerque K, Ding C, Gu X, Zhao B, Timmerman R. Risk Factors for Fat Necrosis After Stereotactic Partial Breast Irradiation for Early-Stage Breast Cancer in a Phase 1 Clinical Trial. Int J Radiat Oncol Biol Phys 2020; 108:697-706. [PMID: 32464155 DOI: 10.1016/j.ijrobp.2020.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study reports predictive dosimetric and physiologic factors for fat necrosis after stereotactic-partial breast irradiation (S-PBI). METHODS AND MATERIALS Seventy-five patients with ductal carcinoma-in situ or invasive nonlobular epithelial histologies stage 0, I, or II, with tumor size <3 cm were enrolled in a dose-escalation, phase I S-PBI trial between January 2011 and July 2015. Fat necrosis was evaluated clinically at each follow-up. Treatment data were extracted from the Multiplan Treatment Planning System (Cyberknife, Accuray). Univariate and stepwise logistic regression analyses were conducted to identify factors associated with palpable fat necrosis. RESULTS With a median follow-up of 61 months (range: 4.3-99.5 months), 11 patients experienced palpable fat necrosis, 5 cases of which were painful. The median time to development of fat necrosis was 12.7 months (range, 3-42 months). On univariate analyses, higher V32.5-47.5 Gy (P < .05) and larger breast volume (P < .01) were predictive of any fat necrosis; higher V35-50 Gy (P < .05), receiving 2 treatments on consecutive days (P = .02), and higher Dmax (P = .01) were predictive of painful fat necrosis. On multivariate analyses, breast volume larger than 1063 cm3 remained a predictive factor for any fat necrosis; receiving 2 treatments on consecutive days and higher V45 Gy were predictive of painful fat necrosis. Breast laterality, planning target volume (PTV), race, body mass index, diabetic status, and tobacco or drug use were not significantly associated with fat necrosis on univariate analysis. CONCLUSIONS Early-stage breast cancer patients treated with breast conserving surgery and S-PBI in our study had a fat necrosis rate comparable to other accelerated partial breast irradiation modalities, but S-PBI is less invasive. To reduce risk of painful fat necrosis, we recommend not delivering fractions on consecutive days; limiting V42.5 < 50 cm3, V45 < 20 cm3, V47.5 < 1 cm3, Dmax ≤ 48 Gy and PTV < 100 cm3 when feasible; and counseling patients about the increased risk for fat necrosis when constraints are not met and for those with breast volume >1000 cm3.
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Affiliation(s)
- Asal Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Yuanyuan Zhang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dong W Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Howard Morgan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ferzana Hossain
- Medical School, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Marilyn Leitch
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rachel Wooldridge
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen Seiler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sally Goudreau
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Barbara Haley
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roshni Rao
- Department of Surgery, Columbia University, New York, New York
| | - Aeisha Rivers
- Department of Surgery, Memorial Health care System, Miramar, Florida
| | - Ann Spangler
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chul Ahn
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stella Stevenson
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jason Staley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chuxiong Ding
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xuejun Gu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bo Zhao
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Iijima K, Okamoto H, Takahashi K, Aikawa A, Wakita A, Nakamura S, Nishioka S, Harada K, Notake R, Sugawara A, Yoshimura R, Kunieda E, Itami J. Inter-fractional variations in the dosimetric parameters of accelerated partial breast irradiation using a strut-adjusted volume implant. JOURNAL OF RADIATION RESEARCH 2020; 61:123-133. [PMID: 31665490 PMCID: PMC7022137 DOI: 10.1093/jrr/rrz061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/23/2019] [Accepted: 04/29/2019] [Indexed: 06/10/2023]
Abstract
The aim of the study was to evaluate inter-fractional dosimetric variations for high-dose rate breast brachytherapy using a strut-adjusted volume implant (SAVI). For the nine patients included, dosimetric constraints for treatment were as follows: for the planning target volume for evaluation (PTV_Eval), the volume receiving 90, 150 and 200% of the prescribed dose (V90%,150%,200%) should be >90%, ≤50 cm3 and ≤20 cm3, respectively; the dose covering 1 cm3 (D1cc) of the organs at risk should be ≤110% of the prescribed dose; and the air volume should be ≤10% of PTV_Eval. Differences in V90%,150%,200%, D1cc and air volume ($\Delta V$ and $\Delta D$) as inter-fractional dosimetric variations and SAVI displacements were measured with pretreatment and planning computed tomography (CT) images. Inter-fractional dosimetric variations were analyzed for correlations with the SAVI displacements. The patients were divided into two groups based on the distance of the SAVI from the surface skin to assess the relationship between the insertion position of the SAVI and dosimetric parameters. The median ΔV90%,150%,200% for the PTV_Eval in all patients was -0.3%, 0.2 cm3 and 0.2 cm3, respectively. The median (range) ΔD1cc for the chest wall and surface skin was -0.8% (-18.9 to 9.4%) and 0.3% (-7.6 to 5.3%), respectively. SAVI displacement did not correlate with inter-fractional dosimetric variations. In conclusion, the dose constraints were satisfied in most cases. However, there were inter-fractional dosimetric changes due to SAVI displacement.
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Affiliation(s)
- Kotaro Iijima
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Ako Aikawa
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Akihisa Wakita
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Satoshi Nakamura
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Shie Nishioka
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Ken Harada
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Ryoichi Notake
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Bunkyo-ku, Ushima 1-5-45, Tokyo, 113-8510, Japan
| | - Akimoto Sugawara
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Bunkyo-ku, Ushima 1-5-45, Tokyo, 113-8510, Japan
| | - Etsuo Kunieda
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Jun Itami
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
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