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Huijskens S, Granton P, Fremeijer K, van Wanrooij C, Offereins-van Harten K, Schouwenaars-van den Beemd S, Hoogeman MS, Sattler MGA, Penninkhof J. Clinical practicality and patient performance for surface-guided automated VMAT gating for DIBH breast cancer radiotherapy. Radiother Oncol 2024; 195:110229. [PMID: 38492672 DOI: 10.1016/j.radonc.2024.110229] [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: 12/22/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND AND PURPOSE To evaluate the performance of automated surface-guided gating for left-sided breast cancer with DIBH and VMAT. MATERIALS AND METHODS Patients treated in the first year after introduction of DIBH with VMAT were retrospectively considered for analysis. With automated surface-guided gating the beam automatically switches on/off, if the surface region of interest moved in/out the gating tolerance (±3 mm, ±3°). Patients were coached to hold their breath as long as comfortably possible. Depending on the patient's preference, patients received audio instructions during treatment delivery. Real-time positional variations of the breast/chest wall surface with respect to the reference surface were collected, for all three orthogonal directions. The durations and number of DIBHs needed to complete dose delivery, and DIBH position variations were determined. To evaluate an optimal gating window threshold, smaller tolerances of ±2.5 mm, ±2.0 mm, and ±1.5 mm were simulated. RESULTS 525 fractions from 33 patients showed that median DIBH duration was 51 s (range: 30-121 s), and median 4 DIBHs per fraction were needed to complete VMAT dose delivery. Median intra-DIBH stability and intrafractional DIBH reproducibility approximated 1.0 mm in each direction. No large differences were found between patients who preferred to perform the DIBH procedure with (n = 21) and without audio-coaching (n = 12). Simulations demonstrated that gating window tolerances could be reduced from ±3.0 mm to ±2.0 mm, without affecting beam-on status. CONCLUSION Independent of the use of audio-coaching, this study demonstrates that automated surface-guided gating with DIBH and VMAT proved highly efficient. Patients' DIBH performance far exceeded our expectations compared to earlier experiences and literature. Furthermore, gating window tolerances could be reduced.
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Affiliation(s)
- Sophie Huijskens
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands.
| | - Patrick Granton
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Kimm Fremeijer
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Cynthia van Wanrooij
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Kirsten Offereins-van Harten
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | | | - Mischa S Hoogeman
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Margriet G A Sattler
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
| | - Joan Penninkhof
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, the Netherlands
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Herr DJ, Moncion A, Griffith KA, Marsh R, Grubb M, Bhatt A, Dominello M, Walker EM, Narayana V, Abu-Isa E, Vicini FA, Hayman JA, Pierce LJ. Factors Associated With Cardiac Radiation Dose Reduction After Hypofractionated Radiation Therapy for Localized, Left-Sided Breast Cancer in a Large Statewide Quality Consortium. Int J Radiat Oncol Biol Phys 2024; 118:632-638. [PMID: 37797748 DOI: 10.1016/j.ijrobp.2023.09.013] [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: 05/16/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Limiting cardiac radiation dose is important for minimizing long-term cardiac toxicity in patients with left-sided early-stage breast cancer. METHODS AND MATERIALS Prospectively collected dosimetric data were analyzed for patients undergoing moderately hypofractionated radiation therapy to the left breast within the Michigan Radiation Oncology Quality Consortium from 2016 to 2022. The mean heart dose (MHD) goal was progressively tightened from ≤2 Gy in 2016 to MHD ≤ 1.2 Gy in 2018. In 2021, a planning target volume (PTV) coverage goal was added, and the goal MHD was reduced to ≤1 Gy. Multivariate logistic regression models were developed to assess for covariates associated with meeting the MHD goals in 2016 to 2020 and the combined MHD/PTV coverage goal in 2021 to 2022. RESULTS In total, 4165 patients were analyzed with a median age of 64 years. Overall average cardiac metric compliance was 91.7%. Utilization of motion management increased from 41.8% in 2016 to 2020 to 46.5% in 2021 to 2022. Similarly, use of prone positioning increased from 12.2% to 22.2% in these periods. On multivariate analysis in the 2016 to 2020 cohort, treatment with motion management (odds ratio [OR], 5.20; 95% CI, 3.59-7.54; P < .0001) or prone positioning (OR, 3.21; 95% CI, 1.85-5.57; P < .0001) was associated with meeting the MHD goal, while receipt of boost (OR, 0.25; 95% CI, 0.17-0.39; P < .0001) and omission of hormone therapy (OR, 0.65; 95% CI, 0.49-0.88; P = .0047) were associated with not meeting the MHD goal. From 2021 to 2022, treatment with motion management (OR, 1.89; 95% CI, 1.12-3.21; P = .018) or prone positioning (OR, 3.71; 95% CI, 1.73-7.95; P = .0008) was associated with meeting the combined MHD/PTV goal, while larger breast volume (≥1440 cc; OR, 0.34; 95% CI, 0.13-0.91; P = .031) was associated with not meeting the combined goal. CONCLUSIONS In our statewide consortium, high rates of compliance with aggressive targets for limiting cardiac dose were achievable without sacrificing target coverage.
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Affiliation(s)
| | | | - Kent A Griffith
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | - Amit Bhatt
- Department of Radiation Oncology, Karmanos Cancer Institute at McLaren Greater Lansing, Lansing, Michigan
| | - Michael Dominello
- Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, Michigan
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Vrinda Narayana
- Department of Radiation Oncology, Ascension Providence Hospital, Southfield, Michigan
| | - Eyad Abu-Isa
- Department of Radiation Oncology, Ascension Providence Hospital, Southfield, Michigan
| | - Frank A Vicini
- MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, Michigan
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Ferrer C, Huertas C, Ocanto A, García D, Plaza R, Mínguez C, de la Monja P, Escribano A, Pérez A, Sáez M. Evolution of dosimetric treatment planning for pediatric total lymphoid irradiation (TLI): a single-institution experience. Rep Pract Oncol Radiother 2024; 28:772-783. [PMID: 38515822 PMCID: PMC10954272 DOI: 10.5603/rpor.98734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/20/2023] [Indexed: 03/23/2024] Open
Abstract
Background Total lymphoid irradiation (TLI) is a conditioning regimen in allogeneic hematopoietic stem cell transplantation (allo-HSCT) which may reduce long-term toxicities attributed to other techniques, such as total body irradiation (TBI). At our institution, TLI treatments were first planned with the three-dimensional conformal radiation therapy (3D-CRT) technique and later with volumetric modulated arc therapy (VMAT). With the recent availability of a basic helical tomotherapy (HT), the possible dosimetric gain of the latter for TLI is studied. Materials and methods 22 pediatric patients were planned for VMAT and HT, prescribed to 8 Gy in 4 fractions. VMAT was planned with template based on a single cost function, using the Monaco treatment planning system (TPS). HT plans were planned using Accuray Precision TPS for a basic HT without the dynamic jaws feature or VOLO-Ultra algorithm. Plan quality was analyzed based on four quality indices, mean and maximum doses to planning target volume (PTV) and organs at risk (OARs), dose gradient and integral doses. Differences were analyzed with Wilcoxon signed-rank test. Results HT plans resulted in improved conformity (CI) and homogeneity indices (HI) (p < 0.05) but less steep dose gradient (p = 0.181). VMAT plans created larger areas with high doses within the PTV, while comparable doses to OARs, except mainly for the spinal marrow, for which a reduction of 37.7% in D2% was obtained (p < 0.05). Integral dose for non-tumor tissue was 11.3% lower with the VMAT template (p < 0.05). Conclusion HT achieves better conformity and homogeneity even without its more advanced features. Nevertheless, the VMAT template achieves dosimetric results close to those of HT, both with similar clinical outcome.
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Affiliation(s)
- Carlos Ferrer
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | - Concepción Huertas
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | | | - David García
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | - Rodrigo Plaza
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | - Cristina Mínguez
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
| | | | - Anne Escribano
- Radiation Oncology Department, H.U. La Paz, Madrid, Spain
| | - Antonio Pérez
- Pediatric Hemato-Oncology Department, H.U. La Paz, Madrid, Spain
| | - Moisés Sáez
- Medical Physics and Radiation Protection Department, H.U. La Paz, Madrid, Spain
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Wang J, Xiang ZZ, Tan CF, Zeng YY, Yang T, Wei XY, Yu ST, Dai ZL, Xu NY, Liu L. Individualized 3D-printed bolus promotes precise postmastectomy radiotherapy in patients receiving breast reconstruction. Front Oncol 2023; 13:1239636. [PMID: 38152364 PMCID: PMC10751906 DOI: 10.3389/fonc.2023.1239636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of 3D-printed tissue compensations in breast cancer patients receiving breast reconstruction and postmastectomy radiotherapy (PMRT). Methods and materials We enrolled patients with breast cancer receiving breast reconstruction and PMRT. The dose distribution of target and skin, conformability, and dose limit of organs at risk (OARs) were collected to evaluate the efficacy of the 3D-printed bolus. Radiation Therapy Oncology Group (RTOG) radiation injury classification was used to evaluated the skin toxicities. Results A total of 30 patients diagnosed between October 2019 to July 2021 were included for analysis. Among all the patients, the 3D-printed bolus could ensure the dose coverage of planning target volume (PTV) [homogeneity index (HI) 0.12 (range: 0.08-0.18)], and the mean doses of D99%, D98%, D95%, D50%, D2% and Dmean were 4606.29cGy, 4797.04cGy, 4943.32cGy, 5216.07cGy, 5236.10cGy, 5440.28cGy and 5462.10cGy, respectively. The bolus demonstrated an excellent conformability, and the mean air gaps between the bolus and the chest wall in five quadrants were 0.04cm, 0.18cm, 0.04cm, 0.04cm and 0.07cm, respectively. In addition, the bolus had acceptable dosage limit of OARs [ipsilateral lung: Dmean 1198.68 cGy, V5 46.10%, V20 21.66%, V30 16.31%); heart: Dmean 395.40 cGy, V30 1.02%, V40 0.22%; spinal cord planning risk volume (PRV): Dmax 1634 cGy] and skin toxicity (grade 1, 76.0%; grade 2, 21.0%; grade 3, 3.3%). Conclusion The 3D-printed bolus offers advantages in terms of dose uniformity and controllable skin toxicities in patients receiving breast reconstruction and PMRT. Further research is needed to comprehensively evaluate the effectiveness of the 3Dprinted bolus in this patient subset.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Lei Liu
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West, China Hospital, Sichuan University, Chengdu, Sichuan, China
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Guo Y, Zhong Y, Yu L, Zhang K, Wang J, Hu W. Implementation and evaluation of an iterative-based algorithm for automatic beam angle optimization in breast cancer treatment planning. Med Dosim 2023; 49:127-138. [PMID: 37925299 DOI: 10.1016/j.meddos.2023.10.002] [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: 07/28/2023] [Revised: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION A beam angle optimization (BAO) algorithm was developed to evaluate its clinical feasibility and investigate the impact of varying BAO constraints on breast cancer treatment plans. MATERIALS AND METHODS A two-part study was designed. In part 1, we retrospectively selected 20 patients treated with radiotherapy after breast-conserving surgery. For each patient, BAO plans were designed using beam angles optimized by the BAO algorithm and the same optimization constraints as manual plans. Dosimetric indices were compared between BAO and manual plans. In part 2, fifteen patients with left breast cancer were included. For each patient, three distinct cardiac constraints (mean heart dose < 5 Gy, 3 Gy or 1 Gy) were established during the BAO process to obtain three optimized beam sets which were marked as BAO_H1, BAO_H3, BAO_H5, respectively. These sets of beams were then utilized under identical IMRT constraints for planning. Comparative analysis was conducted among the three groups of plans. RESULTS For part 1, no significant differences were observed between BAO plans and manual plans in all dosimetric indices, except for ipsilateral lung V5, where BAO plans performed slightly better than manual plans (35.5% ± 5.6% vs 36.9% ± 4.3%, p = 0.034). For part 2, Stricter BAO heart constraints resulted in more perpendicular beams. However, there was no significant difference between BAO_H1, BAO_H3 and BAO_H5 with the same IMRT constraint in the heart dose. Meanwhile, the left lung dose was increased while the right breast and lung doses were decreased with stricter heart constraints in BAO. When mean heart dose < 5 Gy in IMRT constraint, the mean dose to the right lung was decreased from 0.46 Gy for BAO_H5 to 0.33 Gy for BAO_H1 (p = 0.027). CONCLUSIONS The BAO algorithm can achieve quality plans comparable to manual plans. IMRT constraints dominate the final plan dose, while varying BAO constraints alter the trade-off among structures, providing an additional degree of freedom in planning design.
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Affiliation(s)
- Ying Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Yang Zhong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Lei Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Kang Zhang
- United Imaging Healthcare, Shanghai, 20032, China
| | - Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China; Shanghai Clinical Research Center for Radiation Oncology; Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032, China.
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Huang Y, Gong C, Luo M, Yuan X, Ding S, Wang X, Zhang Y. Comparative dosimetric and radiobiological assessment of left-sided whole breast and regional nodes with advanced radiotherapy techniques. JOURNAL OF RADIATION RESEARCH 2023:rrad045. [PMID: 37315943 DOI: 10.1093/jrr/rrad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/26/2023] [Indexed: 06/16/2023]
Abstract
The aim of this study was to analyze the dosimetric and radiobiologic differences of the left-sided whole breast and regional nodes in intensity-modulated radiotherapy (IMRT), volume-modulated arc therapy (VMAT), and helical tomotherapy (HT). The IMRT, VMAT, and HT plans in this study were generated for thirty-five left-sided breast cancer patients after breast-conserving surgery (BCS). The planning target volume (PTV) included the whole breast and supraclavicular nodes. PTV coverage, homogeneity index (HI), conformity index (CI), dose to organs at risk (OARs), secondary cancer complication probability (SCCP), and excess absolute risk (EAR) were used to evaluate the plans. Compared to IMRT, the VMAT and HT plans resulted in higher PTV coverage and homogeneity. The VMAT and HT plans also delivered a lower mean dose to the ipsilateral lung (9.19 ± 1.36 Gy, 9.48 ± 1.17 Gy vs. 11.31 ± 1.42 Gy) and heart (3.99 ± 0.86 Gy, 4.48 ± 0.62 Gy vs. 5.53 ± 1.02 Gy) and reduced the V5Gy, V10Gy, V20Gy, V30Gy, and V40Gy of the ipsilateral lung and heart. The SCCP and EAR for the ipsilateral lung were reduced by 3.67%, 3.09% in VMAT, and 22.18%, 19.21% in HT, respectively. While were increased for the contralateral lung and breast. This study showed that VMAT plans provide a more homogeneous dose distribution to the PTV, minimizing exposure to ipsilateral structures and significantly reducing SCCP and EAR, and slightly increasing dose to contralateral structures. Overall, the VMAT plan can be considered a beneficial technique for BCS patients whose PTV includes the whole breast and regional nodes.
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Affiliation(s)
- Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Changfei Gong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Mingming Luo
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Xingxing Yuan
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Xiaoping Wang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
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Abdollahi S, Hadizadeh Yazdi MH, Mowlavi AA, Ceberg S, Aznar MC, Tabrizi FV, Salek R, Ghodsi A, Shams A. A dose planning study for cardiac and lung dose sparing techniques in left breast cancer radiotherapy: Can free breathing helical tomotherapy be considered as an alternative for deep inspiration breath hold? Tech Innov Patient Support Radiat Oncol 2023; 25:100201. [PMID: 36798947 PMCID: PMC9926227 DOI: 10.1016/j.tipsro.2023.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/29/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Purpose To investigate the possibility to be able to offer left sided breast cancer patients, not suitable for DIBH, an organ at risk saving treatment. Materials and Methods Twenty patients receiving radiotherapy for left breast cancer in DIBH were enrolled in the study. Planning CT scans were acquired in the same supine treatment position in FB and DIBH. 3DCRT_DIBH plans were designed and optimized using two parallel opposed tangent beams (with some additional segments) for the breast and chest wall and anterior-posterior fields for regional lymph nodes irradiation. Additionally, FB helical tomotherapy plans were optimized to minimize heart and lung dose. All forty plans were optimized with at least 95% of the total CTV covered by the 95% of prescribed dose of 50 Gy in 25 fractions. Results HT_FB plans showed significantly better dose homogeneity and conformity compared to the 3DCRT_DIBH specially for regional nodal irradiation. The heart mean dose was almost comparable in 3DCRT_DIBH and HT_FB while the volume (%) of the heart receiving 25 Gy had a statistically significant reduction from 7.90 ± 3.33 in 3DCRT_DIBH to 0.88 ± 0.66 in HT_FB. HT_FB was also more effective in left descending artery (LAD) mean dose reduction about 100% from 30.83 ± 9.2 Gy to 9.7 ± 3.1. The ipsilateral lung volume receiving 20 Gy has a further reduction of 43 % in HT_FB compared with 3DCRT_DIBH. For low dose comparison, 3DCRT_DIBH was superior for contralateral organ sparing compared to the HT_FB due to the limited angle for dose delivery. Conclusion For patients who cannot be a candidate for DIBH for any reason, HT in free breathing may be a good alternative and provides heart and ipsilateral lung dose sparing, however with the cost of increased dose to contralateral breast and lung.
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Affiliation(s)
- Sara Abdollahi
- Physics Department, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran,Medical Physics Department, Reza Radiotherapy and Oncology Center, Mashhad, Iran
| | | | - Ali Asghar Mowlavi
- Physics Department, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran,Corresponding author at: Physics Department, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Sofie Ceberg
- Medical Radiation Physics, Lund University, Lund, Sweden
| | - Marianne Camille Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Roham Salek
- Radiotherapy and Oncology Department, Reza Radiotherapy and Oncology Center, Mashhad, Iran,Radiotherapy and Oncology Department, Mashhad University of Medical Science, Mashhad, Iran
| | - Alireza Ghodsi
- Department of Statistics, Hakim Sabzevari University, Sabzevar, Iran
| | - Ali Shams
- Medical Physics Department, Seyed-al-Shohada Hospital, Isfahan, Iran
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İnan GA, Aral IP, Arslan A, Celik TO, Ozturk HF, Arslan SA, Tezcan Y. Helical tomotherapy experience in breast cancer adjuvant radiotherapy and acute toxicity results. Rep Pract Oncol Radiother 2022; 27:973-981. [PMID: 36632291 PMCID: PMC9826657 DOI: 10.5603/rpor.a2022.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to evaluate acute toxicity and oncological outcomes of breast cancer patients who underwent adjuvant radiotherapy (RT) with tomotherapy. Materials and methods The results of 114 patients who underwent adjuvant RT with Tomotherapy device between 17.08.10-12.06.2021 in Ankara Atatürk Training and Research Hospital and Ankara City Hospital were evaluated retrospectively. The primary endpoint of the study was acute adverse events, and the secondary endpoints were overall survival (OS) and disease-free survival (DFS). Results The results of 103 patients who met the inclusion criteria were analyzed. The median follow-up was 21 (range 1-125.8) months. Grade +3 esophagitis was not observed in any patient; no esophagitis was observed in 60 (58.3%) patients. Grade 3 dermatitis was observed in 3 (2.9%) patients. In addition, dermatitis was not observed in 47 (45.6%) patients. The relationship between chest wall volume and esophagitis development was statistically significant (p = 0.006; Z score: -2769). The median OS was 24.1 (range 1-128.5) and median disease-free survival was 21.1 (range 1-125.8) months. Five patients (4.9%) died and 9 patients (8.7%) relapsed. Local recurrence was observed in only 1 (1%) patient. There was a statistically significant correlation between OS and contralateral lung V20 dose [p < 0.001; Spearman Correlation Coefficient (SCC) -406) and heart mean dose (p < 0.001; SCC -370)]. There was a statically significant correlation between DFS and cN (p < 0.001); pN (p < 0.001); heart mean dose (p < 0.001; SCC -351); contralateral lung V5 dose (p = 0.041; SCC -213); contralateral lung V20 dose (p < 0.001; SCC -434). Conclusion Acute toxicity results show improvement in breast cancer adjuvant radiotherapy with helical tomotherapy.
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Affiliation(s)
- Gonca Altınışık İnan
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ipek Pinar Aral
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Aliye Arslan
- Radiation Oncology, Ankara City Hospital, Cankaya, Turkey
| | | | - Huseyin Furkan Ozturk
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Suheyla Aytac Arslan
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Yilmaz Tezcan
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
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Göksel EO, Tezcanli E, Arifoğlu A, Küçücük H, Şenkesen Ö, Abacıoğlu U, Aslay I, Şengöz M. Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines. Radiat Oncol 2022; 17:168. [PMID: 36271401 PMCID: PMC9587659 DOI: 10.1186/s13014-022-02134-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background The ESTRO-ACROP Consensus Guideline (EACG) recommends implant excluded clinical target volume (CTVp) definitions for post-mastectomy radiation therapy after implant-based immediate breast reconstruction (IBR). The purpose of this study is to investigate the effectiveness of Helical Tomotherapy (HTp) and Volumetric Modulated Arc Therapy (VMATp) treatment techniques in terms of CTVp coverage and reduced organ at risk (OAR), normal tissue and implant doses when CTVp was used for treatment planning as the target structure instead of conventional CTV. Methods Eight left-sided and eight right-sided breast cancer patients who underwent IBR after mastectomy were included in this study. Planning CT data sets were acquired during free breathing and patients were treated with HT technique targeted to conventional CTV. Retrospectively, CTVp was delineated based on EACG by the same radiation oncologist, and treatment plans with HTp and VMATp techniques were generated based on CTVp. For each patient, relevant dosimetric parameters were obtained from three different treatment plans. Results There was no statistically significant difference on target coverage in terms of, PTVp-D95, PTVp-Vpres, homogeneity index (p > 0.05) between HTp and VMATp plans. But, the conformity numbers were significantly higher (HTp vs VMATp, 0.69 ± 0.15 vs 0.79 ± 0.12) for VMATp (Z = − 2.17, p = 0.030). While HTp significantly lowered Dmax and Dmean for LAD (LAD-Dmax: χ2 = 12.25, p = 0.002 and LAD-Dmean: χ2 = 12.30, p = 0.002), neither HTp nor VMATp could reduce maximum and mean dose to heart (p > 0.05). Furthermore, heart volume receiving 5 Gy was significantly higher for VMATp when compared to HTp (21.2 ± 9.8 vs 42.7 ± 24.8, p: 0.004). Both techniques succeeded in reducing the mean dose to implant (HTp vs HT, p < 0.001; VMATp vs HT, p < 0.001; VMATp vs HTp, p = 0.005). Conclusion Both HTp and VMATp techniques succeeded to obtain conformal and homogeneous dose distributions within CTVp while reducing the mean implant dose. HTp was found to be superior to VMATp with regards to lowering all OAR doses except for CB.
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Affiliation(s)
- Evren Ozan Göksel
- Radiotherapy Program, Vocational School of Health Services, Acibadem MAA University, Istanbul, Turkey
| | - Evrim Tezcanli
- General Senology Department, Research Institute of Senology, Acibadem MAA University, Istanbul, Turkey. .,Department of Radiation Oncology, Acibadem Altunizade Hospital, 34662, Uskudar, Istanbul, Turkey.
| | - Alptekin Arifoğlu
- Department of Radiation Oncology, Acibadem Altunizade Hospital, 34662, Uskudar, Istanbul, Turkey
| | - Halil Küçücük
- Department of Radiation Oncology, Acibadem Altunizade Hospital, 34662, Uskudar, Istanbul, Turkey
| | - Öznur Şenkesen
- Radiotherapy Program, Vocational School of Health Services, Acibadem MAA University, Istanbul, Turkey
| | - Ufuk Abacıoğlu
- Department of Radiation Oncology, Acibadem MAA University, Istanbul, Turkey
| | - Işık Aslay
- Department of Radiation Oncology, Acibadem Altunizade Hospital, 34662, Uskudar, Istanbul, Turkey
| | - Meriç Şengöz
- Department of Radiation Oncology, Acibadem MAA University, Istanbul, Turkey
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10
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Chang JS, Chang JH, Kim N, Kim YB, Shin KH, Kim K. Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy in the Treatment of Breast Cancer: An Updated Review. J Breast Cancer 2022; 25:349-365. [DOI: 10.4048/jbc.2022.25.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/16/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Nalee Kim
- Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
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11
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Nichol A, Narinesingh D, Wade L, Raman S, Gondara L, Speers C, Tran E, Chan EK, Lohrisch CA, Truong P. Breast Tangent Beam Energy, Surgical Bed-to-Skin Distance and Local Recurrence after Breast-Conserving Treatment. Int J Radiat Oncol Biol Phys 2021; 112:671-680. [PMID: 34699929 DOI: 10.1016/j.ijrobp.2021.10.014] [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: 07/09/2021] [Revised: 10/09/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Higher energy (>6 MV) photons reduce dose inhomogeneity with breast tangent beams, thereby reducing late breast toxicity, but skin and superficial tissue sparing by higher energy beams raises concerns about local recurrence (LR) risk. This study aimed to determine whether beam energy and surgical bed-to-skin distance affect LR. METHODS AND MATERIALS This population-based study included newly diagnosed invasive breast cancers without skin involvement (pT1-4a, any-N, M0) treated with breast-conserving surgery and adjuvant whole breast radiotherapy without bolus or beam spoilers. The primary endpoint was the cumulative incidence of LR (CILR). A multivariable analysis (MVA) included mean beam energy, age, T-stage, nodal status, overall stage, lymphovascular invasion (LVI), grade, margin status, extensive intraductal component (EIC), breast cancer subtype, hormone therapy and chemotherapy. In a subgroup with contoured surgical beds, another MVA included surgical bed-to-skin distance. RESULTS The cohort consisted of 10,083 women treated from 2002 to 2011, 327 with 4MV, 6,006 with 6 MV, 2,083 with >6-10 MV and 1,667 with >10 MV tangents. The median follow-up time was 11.1 years. The 10-year CILR was 3.1% [95% confidence interval 1.6,5.4] with 4 MV, 2.8% [2.4,3.3] with 6 MV, 4.2% [3.4,5.3] with >6-10 MV and 2.6% [1.9,3.5] with >10 MV. On MVA of the entire cohort, LR risk was increased with positive margins, LVI, EIC, and lack of hormone therapy, but was not associated with beam energy (HR = 1.01 [0.96,1.05], p = 0.8). On MVA of 3,359 patients with contoured surgical beds, LR risk was not associated with surgical bed-to-skin distance (HR = 1.00 [0.99,1.02], p = 0.8). CONCLUSIONS Use of higher breast tangent beam energies is not associated with increased risk of local recurrence, including in cases with surgical beds that are close to the skin.
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Affiliation(s)
- Alan Nichol
- Departments of Radiation Oncology, BC Cancer-Vancouver, Vancouver, Canada.
| | - Dylan Narinesingh
- Departments of Radiation Oncology, BC Cancer-Vancouver, Vancouver, Canada
| | - Louise Wade
- Departments of Radiation Oncology, BC Cancer-Vancouver, Vancouver, Canada
| | - Srinivas Raman
- Departments of Radiation Oncology, BC Cancer-Vancouver, Vancouver, Canada
| | - Lovedeep Gondara
- Departments of Cancer Surveillance and Outcomes, BC Cancer-Vancouver, Vancouver, Canada
| | - Caroline Speers
- Departments of Cancer Surveillance and Outcomes, BC Cancer-Vancouver, Vancouver, Canada
| | - Eric Tran
- Departments of Radiation Oncology, BC Cancer-Vancouver, Vancouver, Canada
| | - Elisa K Chan
- Departments of Radiation Oncology, BC Cancer-Vancouver, Vancouver, Canada
| | | | - Pauline Truong
- Department of Radiation Oncology, BC Cancer-Victoria, Victoria, Canada
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12
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Ahrouch I, Van Gestel D, Koshariuk O, Kirkove C, Desmet A, Philippson C, Reynaert N, De Caluwe A. Unintended dose to the lower axilla in adjuvant radiotherapy for breast cancer: Differences between tangential beam and VMAT. Radiother Oncol 2021; 164:282-288. [PMID: 34648872 DOI: 10.1016/j.radonc.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate dosimetric differences in unintended dose to the lower axilla between 3D-standard (3DCRT), tangential beam forward intensity modulated radiotherapy (F-IMRT) and volumetric modulated arc therapy (VMAT). The objective is to evaluate whether results of clinical trials, such as the ACOSOG-Z011 trial, that evaluated omission of axillary clearance can be extrapolated towards more conformal techniques like VMAT. MATERIALS AND METHODS Twenty-five consecutive patients treated with whole breast radiotherapy alone (WBRT) using a F-IMRT technique were identified. Three additional plans were created for every patient: one plan using a single 270° arc (VMAT 1x270°), another using two small ≤90° opposing arcs (VMAT 2x < 90°) and thirdly a 3DCRT plan without F-IMRT. Axillary levels I-II were contoured after the treatment plans were made. RESULTS The volume of the axilla level I that was covered by the 50% isodose (V50%) was significantly higher for VMAT 2x < 90° (71.3 cm3, 84% of structure volume, p < 0.001) and VMAT 1x270° (68.8 cm3, 81%, p < 0.01) compared to 3DCRT (60.3 cm3, 71%) and F-IMRT (60.8 cm3, 72%). The V50% to the axilla level II, however, was low for all techniques: 12.3 cm3 (12%); 8.9 cm3 (9%); 4.3 cm3 (4%); 4.4 cm3 (4%) for VMAT 2x < 90°, VMAT 1x270°, 3DCRT, F-IMRT, respectively. For the higher doses (V90% and above), no clinically relevant differences were seen between the different modalities. CONCLUSION WBRT treatments with VMAT do not lead to a significant reduction of the unintended axillary dose in comparison with a tangential beam setup. Hence, concerning tumor control, VMAT can be applied to clinical situations similar to the Z0011 trial. The intermediate axillary dose is higher with VMAT, but the clinical consequence of this difference on toxicity is unknown.
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Affiliation(s)
- Imane Ahrouch
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Olga Koshariuk
- Department of Radiation Oncology, Clinique St Elisabeth, Namur, Belgium
| | - Carine Kirkove
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Antoine Desmet
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Catherine Philippson
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Nick Reynaert
- Department of Medical Physics, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Alex De Caluwe
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium.
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13
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Evaluation on dosimetric plan quality and treatment delivery time of dynamic jaw mode in TomoTherapy® for left-side breast cancer patients. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
Few studies claimed that dynamic jaw (DJ) mode in Helical TomoTherapy® (HT) could improve the cranio-caudal dose distribution without prolonging the treatment time in treating different types of cancer. Also, studies suggested that DJ with a wider 5 cm field width (FW) could replace fixed jaws (FJ) with 2.5 cm FW to reduce the delivery time with the sustainable plan quality. Yet, the study on breast cancer with supraclavicular fossa (SCF) nodal involvement using DJ mode in HT is limited. This study aims to evaluate the DJ mode retrospectively by comparing their dosimetric quality with normal tissue complication probability (NTCP) of organs at risk and treatment delivery time with FJ mode on treating left-side breast with SCF nodal involvement.
Materials and methods:
All post-mastectomy patients, who had been irradiated for left-side breast with SCF nodal involvement were selected retrospectively in this study. With the same dose constraint and prescription as the treated DJ2.5 plan, two extra plans using DJ mode with 5 cm FW(DJ5.0) and FJ mode with 2.5 cm FW (FJ2.5) were computed for plan comparison.
Results:
No statistical significance was found in all the parameters of PTV and OARs, except for V20 of whole lung. DJ5.0 received V20 in ipsilateral left lung than FJ2.5 and DJ2.5. However, the average delivery time of DJ5.0 was significantly lower than that of DJ2.5 and FJ2.5 by almost 40%.
Conclusions:
No statistical significance was found in those dosimetric and radiobiological parameters among three modes while the delivery time has greatly reduced by using DJ5.0. A shorter treatment time can minimise intra-fractional error and better the patient’s experience during treatment.
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14
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Meattini I, Poortmans PM, Aznar MC, Becherini C, Bonzano E, Cardinale D, Lenihan DJ, Marrazzo L, Curigliano G, Livi L. Association of Breast Cancer Irradiation With Cardiac Toxic Effects: A Narrative Review. JAMA Oncol 2021; 7:924-932. [PMID: 33662107 DOI: 10.1001/jamaoncol.2020.7468] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE To promptly recognize and manage cardiovascular (CV) risk factors before, during, and after cancer treatment, decreasing the risk of cancer therapy-related cardiac dysfunction is crucial. After recent advances in breast cancer treatment, mortality rates from cancer have decreased, and the prevalence of survivors with a potentially higher CV disease risk has increased. Cardiovascular risks might be associated with the multimodal approach, including systemic therapies and breast radiotherapy (RT). OBSERVATIONS The heart disease risk seems to be higher in patients with tumors in the left breast, when other classic CV risk factors are present, and when adjunctive anthracycline-based chemotherapy is administered, suggesting a synergistic association. Respiratory control as well as modern RT techniques and their possible further refinement may decrease the prevalence and severity of radiation-induced heart disease. Several pharmacological cardioprevention strategies for decreasing cardiac toxic effects have been identified in several guidelines. However, further research is needed to ascertain the feasibility of these strategies in routine practice. CONCLUSIONS AND RELEVANCE This review found that evidence-based recommendations are lacking on the modalities for and intensity of heart disease screening, surveillance of patients after RT, and treatment of these patients. A multidisciplinary and multimodal approach is crucial to guide optimal management.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Philip M Poortmans
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium
- University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - Marianne Camille Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Elisabetta Bonzano
- Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Polyclinic Foundation, Pavia, Italy
- PhD School in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
| | - Daniel J Lenihan
- Cardio-Oncology Center of Excellence, Washington University in St Louis, St Louis, Missouri
| | - Livia Marrazzo
- Medical Physics Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giuseppe Curigliano
- Division of Early Drug Development, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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15
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Inoue E, Doi H, Monzen H, Tamura M, Inada M, Ishikawa K, Nakamatsu K, Nishimura Y. Dose-volume Histogram Analysis of Knowledge-based Volumetric-modulated Arc Therapy Planning in Postoperative Breast Cancer Irradiation. In Vivo 2021; 34:1095-1101. [PMID: 32354897 DOI: 10.21873/invivo.11880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM We evaluated the dosimetric profiles of manually generated volumetric-modulated arc therapy (VMAT) plans and performance of a commercial knowledge-based planning system (KBP) in treating breast cancer. MATERIALS AND METHODS We defined the manually generated VMAT plan as the manual plan (MP). Twenty MPs were generated for left-sided breast cancer patients who underwent breast-conserving surgery and used to develop a KBP training set. The other five patients were used for validation. The dosimetric parameters among MPs, tangential irradiation plans (TPs), and KBP-VMAT plans (KBP-Ps) were compared. RESULTS D95 and homogeneity of the planning target volume (PTV) were significantly higher and greater in MPs and KBP-Ps than in TPs. Lung V20, V40 The Dmean for the left anterior descending artery was lower in MPs and KBP-Ps than in TPs. KBP could save time in generating VMAT plans. CONCLUSION MPs and KBP-Ps could ensure higher dose uniformity of PTV than TPs. KBP could faster generate comparable MPs for breast cancer.
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Affiliation(s)
- Eri Inoue
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Osaka, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuki Ishikawa
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka, Japan
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16
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Bartolucci L, Adrien C, Goudjil F, Amessis M, El Amine W, Fourquet A, Mazal A, Kirova Y. Dosimetric comparison of four high performance techniques for irradiation of breast cancer patients. Cancer Radiother 2021; 25:254-258. [PMID: 33402289 DOI: 10.1016/j.canrad.2020.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The use of IMRT for the treatment of breast cancer has been growing considerably in our institution since 2009. Alternatively, helical tomotherapy (HT) using a field width of 2.5 and 5cm (HT_FW_5), volumetric-modulated arc therapy (VMAT), or proton therapy with pencil-beam scanning (PT-PBS) have also been used to reduce treatment duration or optimize organ-at-risk (OAR) sparing. The purpose of this study was to compare the 4 treatment modalities available at our site. PATIENTS AND METHODS We studied 10 patients treated for breast cancer with lymph node involvement. The prescribed dose was 51.8Gy to the breast with a simultaneous integrated boost up to 63Gy, and 50.4Gy to lymph nodes in 28 fractions. The CTV was delineated according to ESTRO Guidelines. Dosimetric planning in routine clinical practice was performed using HT_FW_2.5. The approved clinical plan was compared to the 3 other plans. Dosimetric goals for PTV coverage were D95%≥95% and D2%≤107% of the prescribed dose. Mean and maximum doses to OAR were recorded. RESULTS HT_FW_5 and VMAT plans ensure equivalent or even better PTV coverage compared to the initial clinically approved plan but at the cost of poorer OAR sparing. PT_PBS plans showed that an excellent PTV coverage can be maintained with significantly lower doses to OAR. CONCLUSION HT_FW_5 and VMAT plans allow a significant reduction of treatment duration and can be a good alternative to HT_FW_2.5 for specific populations. HT_FW_2.5 could be chosen for patients at higher risk of side effects. In addition, PT_PBS should be considered in the near future as it has been shown to have a major potential benefit to lower the risk of side effects with the same level of PTV coverage.
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Affiliation(s)
- L Bartolucci
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - C Adrien
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - F Goudjil
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - M Amessis
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - W El Amine
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - A Fourquet
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - A Mazal
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France
| | - Y Kirova
- Department of radiation oncology, Institut Curie, Paris-Orsay, 26 rue d'Ulm, 75005 Paris, France.
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17
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Liu YC, Chang HM, Lin HH, Lu CC, Lai LH. Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer. J Clin Med 2020; 9:E3884. [PMID: 33260404 PMCID: PMC7760558 DOI: 10.3390/jcm9123884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to compare different types of right breast cancer radiotherapy planning techniques and to estimate the whole-body effective doses and the critical organ absorbed doses. The three planning techniques are intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT; two methods) and hybrid 3D-CRT/IMRT (three-dimensional conformal radiotherapy/intensity-modulated radiotherapy). The VMAT technique includes two methods to deliver a dose: non-continuous partial arc and continuous partial arc. A thermoluminescent dosimeter (TLD) is placed in the RANDO phantom to estimate the organ absorbed dose. Each planning technique applies 50.4 Gy prescription dose and treats critical organs, including the lung and heart. Dose-volume histogram was used to show the planning target volume (V95%), homogeneity index (HI), conformity index (CI), and other optimized indices. The estimation of whole-body effective dose was based on the International Commission on Radiation Protection (ICRP) Publication 60 and 103. The results were as follows: Continuous partial arc and non-continuous partial arc showed the best CI and HI. The heart absorbed doses in the continuous partial arc and hybrid 3D-CRT/IMRT were 0.07 ± 0.01% and 0% (V5% and V10%, respectively). The mean dose of the heart was lowest in hybrid 3D-CRT/IMRT (1.47 Gy ± 0.02). The dose in the left contralateral lung (V5%) was lowest in continuous partial arc (0%). The right ipsilateral lung average dose and V20% are lowest in continuous partial arc. Hybrid 3D-CRT/IMRT has the lowest mean dose to contralateral breast (organs at risk). The whole-body effective doses for ICRP-60 and ICRP-103 were highest in continuous partial arc (2.01 Sv ± 0.23 and 2.89 Sv ± 0.15, respectively). In conclusion, the use of VMAT with continuous arc has a lower risk of radiation pneumonia, while hybrid 3D-CRT/IMRT attain lower secondary malignancy risk and cardiovascular complications.
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Affiliation(s)
- Yi-Chi Liu
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 30015 Taiwan;
- Department of Radiation Oncology, Wei Gong Memorial Hospital, Miaoli 35148, Taiwan
| | - Hung-Ming Chang
- Department of General Surgery, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan;
| | - Hsin-Hon Lin
- Medical Physics Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan;
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Chia-Chun Lu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan;
| | - Lu-Han Lai
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
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18
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Archibald-Heeren B, Byrne M, Hu Y, Liu G, Collett N, Cai M, Wang Y. Single click automated breast planning with iterative optimization. J Appl Clin Med Phys 2020; 21:88-97. [PMID: 33016622 PMCID: PMC7700918 DOI: 10.1002/acm2.13033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 05/26/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose To present the development of an in‐house coded solution for treatment planning of tangential breast radiotherapy that creates single click plans by emulating the iterative optimization process of human dosimetrists. Method One hundred clinical breast cancer patients were retrospectively planned with an automated planning (AP) code incorporating the hybrid intensity‐modulated radiotherapy (IMRT) approach. The code automates all planning processes including plan generation, beam generation, gantry and collimator angle determination, open segments and dynamic IMRT fluence and calculations. Thirty‐nine dose volume histogram (DVH) metrics taken from three international recommendations were compared between the automated and clinical plans (CP), along with median interquartile analysis of the DVH distributions. Total planning time and delivery QA were also compared between the plan sets. Results Of the 39 planning metrics analyzed 23 showed no significant difference between clinical and automated planning techniques. Of the 16 metrics with statistically significant variations, 2 were improved in the clinical plans in comparison to 14 improved in the AP plans. Automated plans produced a greater number of ideal plans against international guidelines as per EviQ (AP:77%, CP:68%), RTOG 1005 (AP:80%, CP:71%), and London Cancer references (AP:80%, CP:75%). Delivery QA results for both techniques were equivalent. Automated planning techniques resulted in an average reduction in planning time from 23 to 5 minutes. Conclusion We have introduced an automated planning code with iterative optimization that produces equivalent quality plans to manual clinical planning. The resultant change in workflow results in a reduction in treatment planning times.
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Affiliation(s)
| | - Mikel Byrne
- Icon Cancer Centres, Wahroonga, NSW, Australia
| | - Yunfei Hu
- Icon Cancer Centres, Wahroonga, NSW, Australia
| | - Guilin Liu
- Icon Cancer Centres, Wahroonga, NSW, Australia
| | | | - Meng Cai
- Icon Cancer Centres, Wahroonga, NSW, Australia
| | - Yang Wang
- Icon Cancer Centres, Wahroonga, NSW, Australia
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Xie Y, Bourgeois D, Guo B, Zhang R. Comparison of conventional and advanced radiotherapy techniques for left-sided breast cancer after breast conserving surgery. Med Dosim 2020; 45:e9-e16. [PMID: 32646715 DOI: 10.1016/j.meddos.2020.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Whole breast radiotherapy (WBRT) after breast conserving surgery is the standard treatment to prevent recurrence and metastasis of early stage breast cancer. This study aims to compare seven WBRT techniques including conventional tangential, field-in-field (FIF), hybrid intensity-modulated radiotherapy (IMRT), IMRT, standard volumetric modulated arc therapy (STD-VMAT), noncoplanar VMAT (NC-VMAT), and multiple arc VMAT (MA-VMAT). Fifteen patients who were previously diagnosed with left-sided early stage breast cancer and treated in our clinic were selected for this study. WBRT plans were created for these patients and were evaluated based on target coverage and normal tissue toxicities. All techniques produced clinically acceptable WBRT plans. STD-VMAT delivered the lowest mean dose (1.1 ± 0.3 Gy) and the lowest maximum dose (7.3 ± 4.9 Gy) to contralateral breast, and the second lowest lifetime attributable risk (LAR) (4.1 ± 1.4%) of secondary contralateral breast cancer. MA-VMAT delivered the lowest mean dose to lungs (4.9 ± 0.9 Gy) and heart (5.5 ± 1.2 Gy), exhibited the lowest LAR (1.7 ± 0.3%) of secondary lung cancer, normal tissue complication probability (NTCP) (1.2 ± 0.2%) of pneumonitis, risk of coronary events (RCE) (10.3 ± 2.7%), and LAR (3.9 ± 1.3%) of secondary contralateral breast cancer. NC-VMAT plans provided the most conformal target coverage, the lowest maximum lung dose (46.2 ± 4.1 Gy) and heart dose (41.1 ± 5.4 Gy), and the second lowest LAR (1.8 ± 0.4%) of secondary lung cancer and RCE (10.5 ± 2.8%). MA-VMAT and NC-VMAT could be the preferred techniques for early stage breast cancer patients after breast conserving surgery.
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Affiliation(s)
- Yibo Xie
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA
| | - Daniel Bourgeois
- Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA
| | - Beibei Guo
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA, USA
| | - Rui Zhang
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, USA; Department of Radiation Oncology, Mary Bird Perkins Cancer Center, Baton Rouge, LA, USA.
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20
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Wang W, Wang J, Qiu P, Sun T, Zhang Y, Shao Q, Xu M, Liu X, Li J. Factors Influencing the Incidental Dose Distribution in Internal Mammary Nodes: A Comparative Study. Front Oncol 2020; 10:456. [PMID: 32328459 PMCID: PMC7160365 DOI: 10.3389/fonc.2020.00456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/13/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the effect of anatomic and technical parameters on the incidental internal mammary lymph node (IMN) irradiation (IIMNI) dose among postmastectomy patients. Methods: We retrospectively delineated the IMN on planning CT images from 138 patients who had undergone postmastectomy radiotherapy (PMRT). We analyzed the IIMNI dose coverage and its relationship with anatomic and technical parameters. Results: The IIMNI mean dose was 32.85 ± 9.49 Gy, and 10 of 138 patients (7.25%) treated with PMRT received ≥45 Gy. In univariate analysis, the body weight, body mass index, body surface area, thoracic transverse diameter (DT), ratio of DT to the thoracic anteroposterior diameter (DAP)(RT/AP), planning target volume of IMN (PTVIMN) included in PTV (IMNin) and the ratio of IMNin to PTVIMN (RIMNin) and PTV posterior border were the parameters affecting IIMNI dose. In multivariate analysis, body weight, RT/AP, and RIMNin were correlative factors that affected IIMNI dose. Conclusions: For patients who underwent PMRT without IMN irradiation (IMNI), there was a wide variety in IIMNI doses. A minority of patients had adequate IIMNI dose coverage, and the higher IIMNI doses were associated with the less body weights and more RIMNin.
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Affiliation(s)
- Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Pengfei Qiu
- Breast Cancer Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Medical Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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21
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Avanzo M, Pirrone G, Vinante L, Caroli A, Stancanello J, Drigo A, Massarut S, Mileto M, Urbani M, Trovo M, El Naqa I, De Paoli A, Sartor G. Electron Density and Biologically Effective Dose (BED) Radiomics-Based Machine Learning Models to Predict Late Radiation-Induced Subcutaneous Fibrosis. Front Oncol 2020; 10:490. [PMID: 32373520 PMCID: PMC7186445 DOI: 10.3389/fonc.2020.00490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/18/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose: to predict the occurrence of late subcutaneous radiation induced fibrosis (RIF) after partial breast irradiation (PBI) for breast carcinoma by using machine learning (ML) models and radiomic features from 3D Biologically Effective Dose (3D-BED) and Relative Electron Density (3D-RED). Methods: 165 patients underwent external PBI following a hypo-fractionation protocol consisting of 40 Gy/10 fractions, 35 Gy/7 fractions, and 28 Gy/4 fractions, for 73, 60, and 32 patients, respectively. Physicians evaluated toxicity at regular intervals by the Common Terminology Adverse Events (CTAE) version 4.0. RIF was assessed every 3 months after the completion of radiation course and scored prospectively. RIF was experienced by 41 (24.8%) patients after average 5 years of follow up. The Hounsfield Units (HU) of the CT-images were converted into relative electron density (3D-RED) and Dose maps into Biologically Effective Dose (3D-BED), respectively. Shape, first-order and textural features of 3D-RED and 3D-BED were calculated in the planning target volume (PTV) and breast. Clinical and demographic variables were also considered (954 features in total). Imbalance of the dataset was addressed by data augmentation using ADASYN technique. A subset of non-redundant features that best predict the data was identified by sequential feature selection. Support Vector Machines (SVM), ensemble machine learning (EML) using various aggregation algorithms and Naive Bayes (NB) classifiers were trained on patient dataset to predict RIF occurrence. Models were assessed using sensitivity and specificity of the ML classifiers and the area under the receiver operator characteristic curve (AUC) of the score functions in repeated 5-fold cross validation on the augmented dataset. Results: The SVM model with seven features was preferred for RIF prediction and scored sensitivity 0.83 (95% CI 0.80-0.86), specificity 0.75 (95% CI 0.71-0.77) and AUC of the score function 0.86 (0.85-0.88) on cross-validation. The selected features included cluster shade and Run Length Non-uniformity of breast 3D-BED, kurtosis and cluster shade from PTV 3D-RED, and 10th percentile of PTV 3D-BED. Conclusion: Textures extracted from 3D-BED and 3D-RED in the breast and PTV can predict late RIF and may help better select patient candidates to exclusive PBI.
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Affiliation(s)
- Michele Avanzo
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giovanni Pirrone
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Angela Caroli
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Annalisa Drigo
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Samuele Massarut
- Breast Surgery Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Mario Mileto
- Breast Surgery Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Martina Urbani
- Department of Radiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Marco Trovo
- Department of Radiation Oncology, Udine General Hospital, Udine, Italy
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Antonino De Paoli
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giovanna Sartor
- Department of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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22
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Eskandari A, Nasseri S, Gholamhosseinian H, Hosseini S, Farzaneh MJK, Keramati A, Naji M, Rostami A, Momennezhad M. Evaluation of the heart and lung dosimetric parameters in deep inspiration breath hold using 3D Slicer. Radiat Oncol J 2020; 38:68-76. [PMID: 32229811 PMCID: PMC7113148 DOI: 10.3857/roj.2019.00654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/06/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The present study was conducted to compare dosimetric parameters for the heart and left lung between free breathing (FB) and deep inspiration breath hold (DIBH) and determine the most important potential factors associated with increasing the lung dose for left-sided breast radiotherapy using image analysis with 3D Slicer software. Materials and Methods Computed tomography-simulation scans in FB and DIBH were obtained from 17 patients with left-sided breast cancer. After contouring, three-dimensional conformal plans were generated for them. The prescribed dose was 50 Gy to the clinical target volume. In addition to the dosimetric parameters, the irradiated volumes and both displacement magnitudes and vectors for the heart and left lung were assessed using 3D Slicer software. Results The average of the heart mean dose (Dmean) decreased from 5.97 to 3.83 Gy and V25 from 7.60% to 3.29% using DIBH (p < 0.001). Furthermore, the average of Dmean for the left lung was changed from 8.67 to 8.95 Gy (p = 0.389) and V20 from 14.84% to 15.44% (p = 0.387). Both of the absolute and relative irradiated heart volumes decreased from 42.12 to 15.82 mL and 8.16% to 3.17%, respectively (p < 0.001); however, these parameters for the left lung increased from 124.32 to 223.27 mL (p < 0.001) and 13.33% to 13.99% (p = 0.350). In addition, the average of heart and left lung displacement magnitudes were calculated at 7.32 and 20.91 mm, respectively. Conclusion The DIBH is an effective technique in the reduction of the heart dose for tangentially treated left sided-breast cancer patients, without a detrimental effect on the left lung.
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Affiliation(s)
- Azam Eskandari
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahrokh Nasseri
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Gholamhosseinian
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sare Hosseini
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Alireza Keramati
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Naji
- Department of Radiation Oncology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atefeh Rostami
- Department of Medical Physics and Radiological Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mehdi Momennezhad
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Cheng HW, Chang CC, Shiau AC, Wang MH, Tsai JT. Dosimetric comparison of helical tomotherapy, volumetric-modulated arc therapy, intensity-modulated radiotherapy, and field-in-field technique for synchronous bilateral breast cancer. Med Dosim 2020; 45:271-277. [PMID: 32122694 DOI: 10.1016/j.meddos.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 11/25/2019] [Accepted: 01/30/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare the dosimetric characteristics of helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), intensity-modulated radiotherapy (IMRT), and tangential field-in-field technique (FIF) for the treatment of synchronous bilateral breast cancer (SBBC). METHODS AND MATERIALS Ten patients with early-stage unilateral breast cancer were selected for simulating the patients with SBBC in this retrospective analysis. Treatment plans with HT, VMAT, IMRT, and FIF were generated for each patient with a total dose of 50.4 Gy in 28 fractions to the target. Plan quality, namely conformity index (CI), homogeneity index (HI), dose-volume statistics of organs at risk (OARs), and beam-on time (BOT), were evaluated. RESULTS HT plans showed a lower mean heart dose (3.53 ± 0.31Gy) compared with the other plans (VMAT = 5.6 ± 1.36 Gy, IMRT = 3.80 ± 0.76 Gy, and FIF = 4.84 ± 2.13 Gy). Moreover, HT plans showed a significantly lower mean lung dose (p < 0.01) compared with the other plans: mean right lung doses were 6.81 ± 0.67, 10.32 ± 1.04, 9.07 ± 1.21, and 10.03 ± 1.22 Gy and mean left lung doses were 6.33 ± 0.87, 8.82 ± 0.91, 7.84 ± 1.07, and 8.64 ± 0.99 Gy for HT, VMAT, IMRT, and FIF plans, respectively. The mean dose to the left anterior descending artery was significantly lower in HT plans (p < 0.01) than in the other plans: HT = 19.41 ± 0.51 Gy, VMAT = 25.77 ± 7.23 Gy, IMRT = 27.87 ± 6.48 Gy, and FIF = 30.95 ± 10.17 Gy. FIF plans showed a worse CI and HI compared with the other plans. VMAT plans showed shorter BOT (average, 3.9 ± 0.2 minutes) than did HT (average, 11.0 ± 3.0 minutes), IMRT (average, 6.1 ± 0.5 minutes), and FIF (average, 4.6 ± 0.7 minutes) plans. CONCLUSIONS In a dosimetric comparison for SBBC, HT provided the most favorable dose sparing of OARs. However, HT with longer BOT may increase patient discomfort and treatment uncertainty. VMAT enabled shorter BOT with acceptable doses to OARs and had a better CI than did FIF and IMRT.
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Affiliation(s)
- Hao-Wen Cheng
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Chieh Chang
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - An-Cheng Shiau
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan; Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Ming-Hua Wang
- Department of Radiation Oncology, Landseed Hospital, Taoyuan, Taiwan
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Yeh HP, Huang YC, Wang LY, Shueng PW, Tien HJ, Chang CH, Chou SF, Hsieh CH. Helical tomotherapy with a complete-directional-complete block technique effectively reduces cardiac and lung dose for left-sided breast cancer. Br J Radiol 2020; 93:20190792. [PMID: 31939310 PMCID: PMC7362916 DOI: 10.1259/bjr.20190792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: To evaluate the feasibility and optimal restricted angle of the complete-directional-complete block (CDCB) technique in helical tomotherapy (HT) by including regional nodal irradiation (RNI) with the internal mammary node (IMN) in left-sided breast cancer. Methods: Ten left-sided breast cancer patients treated with 50 Gy in 25 fractions were compared with five-field intensity-modulated radiation therapy (5F-IMRT) and six types of HT plans. In the HT plans, complete block (CB), organ-based directional block (OBDB) and CDCB with different restricted angles were used. Results: The conformity index (CI) between the CDCB0,10,15,20 and 5F-IMRT groups was similar. Compared to CB, OBDB and 5F-IMRT, CDCB20 resulted in a decreased ipsilateral mean lung dose. The low-dose region (V5) of the ipsilateral lung in OBDB (84.0%) was the highest among all techniques (p < 0.001). The mean dose of the heart in CB was significantly reduced (by 11.5–22.4%) compared with other techniques. The V30 of the heart in CDCB20 (1.9%) was significantly lower than that of CB, OBDB and 5F-IMRT. Compared to the mean dose of the left anterior descending (LAD) artery of 5F-IMRT (27.0 Gy), CDCB0, CDCB10, CDCB15, CDCB20 and OBDB reduced the mean dose effectively by 31.7%, 38.3%, 39.6%, 42.0 and 56.2%, respectively. Considering the parameters of the organs-at-risk (OARs), CDCB10,15,20 had higher expectative values than the other techniques (p = 0.01). Conclusions: HT with the CDCB technique is feasible for treating left-sided breast cancer patients. The CDCB10-20 techniques not only achieved similar planning target volume coverage, homogeneity and dose conformity but also allowed better sparing of the heart and bilateral lungs. Advances in knowledge: For left-sided breast cancer patients whose RNI field includes the IMN, heart avoidance is an important issue. The CDCB technique achieved good PTV coverage, homogeneity and dose conformity and allowed better sparing of the mean dose of the lung, the LAD artery, and the heart and reduced the V30 of the heart.
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Affiliation(s)
- Hsin-Pei Yeh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China
| | - Yu-Chuen Huang
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, Republic of China.,School of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Li-Ying Wang
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Hui-Ju Tien
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China.,Department of Biomedical Imaging and Radiological Science, National Yang- Ming University, Taipei, Taiwan
| | - Chiu-Han Chang
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China
| | - San-Fang Chou
- Department of Medical Research, Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China
| | - Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, Republic of China.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China.,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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25
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Hybrid planning techniques for hypofractionated whole-breast irradiation using flattening filter-free beams. Strahlenther Onkol 2019; 196:376-385. [PMID: 31863154 DOI: 10.1007/s00066-019-01555-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility of flattening filter-free (FFF) photon beams in hybrid intensity-modulated radiation therapy (H-IMRT) and hybrid volumetric modulated arc therapy (H-VMAT) for left-sided whole-breast radiation therapy with a boost volume (RT) using a hypofractionated dose regimen. PATIENTS AND METHODS RT plans of 25 patients with left-sided early-stage breast cancer were created with H‑IMRT and H‑VMAT techniques under breath-hold conditions using 6‑MV FFF beams. In hybrid techniques, three-dimensional conformal radiotherapy (3DCRT) plans were kept as base-dose plans for the VMAT and IMRT plans. In addition, H‑IMRT in step-and-shoot mode was also calculated to assess its achievability with FFF beams. RESULTS All hybrid plans achieved the expected target coverage. H‑VMAT showed better coverage and homogeneity index results for the boost target (p < 0.002), while H‑IMRT presented better results for the whole-breast target (p < 0.001). Mean doses to normal tissues were comparable between both plans, while H‑IMRT reduced the low-dose levels to heart and ipsilateral lung (p < 0.05). H‑VMAT revealed significantly better results with regard to monitor units (MU) and treatment time (p < 0.001). CONCLUSION The 6‑MV FFF beam technique is feasible for large-field 3DCRT-based hybrid planning in whole-breast and boost planning target volume irradiation. For breath-hold patients, the H‑VMAT plan is superior to H‑IMRT for hypofractionated dose regimens, with reduced MU and treatment delivery time.
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Haciislamoglu E, Cinar Y, Gurcan F, Canyilmaz E, Gungor G, Yoney A. Secondary cancer risk after whole-breast radiation therapy: field-in-field versus intensity modulated radiation therapy versus volumetric modulated arc therapy. Br J Radiol 2019; 92:20190317. [PMID: 31295011 DOI: 10.1259/bjr.20190317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In this study, we used the concept of organ-equivalent dose (OED) to evaluate the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for breast cancer. METHODS Using CT data set of 12 patients, we generated three different whole-breast radiation treatment plans using 50 Gy in 2 Gy fractions: three-dimensional conformal radiotherapy with a field-in-field (FinF) technique, intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). The OEDs were calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models. Secondary cancer risks of the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL) were estimated and compared. RESULTS The lowest EARs for the CB, CL, and IL were achieved with FinF, which reduced the EARs by 77%, 88%, and 56% relative to those with IMRT, and by 77%, 84%, and 58% relative to those with VMAT, respectively. The secondary cancer risk for FinF was significantly lower than those of IMRT and VMAT. OED-based secondary cancer risks for CB and IL were similar when IMRT and VMAT were used, but the risk for CL was statistically lower when VMAT was used. CONCLUSION The overall estimation of EAR indicated that the radiation-induced cancer risk of breast radiation therapy was lower with FinF than with IMRT and VMAT. Therefore, when secondary cancer risk is a major concern, FinF is considered to be the preferred treatment option in irradiation of whole-breast. ADVANCES IN KNOWLEDGE Secondary malignancy estimation after breast radiotherapy is becoming an important subject for comparative treatment planning.When secondary cancer risk a major concern, FinF technique is considered the preferred treatment option in whole breast patients.
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Affiliation(s)
- Emel Haciislamoglu
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yunus Cinar
- Department of Radiation Oncology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Fatih Gurcan
- Department of Computer Engineering, Karadeniz Technical University Faculty of Engineering, Trabzon, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem University, Istanbul, Turkey
| | - Adnan Yoney
- Department of Radiation Oncology, Acibadem University, Istanbul, Turkey
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Flores-Martinez E, Kim GY, Yashar CM, Cerviño LI. Dosimetric study of the plan quality and dose to organs at risk on tangential breast treatments using the Halcyon linac. J Appl Clin Med Phys 2019; 20:58-67. [PMID: 31183967 PMCID: PMC6612683 DOI: 10.1002/acm2.12655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/13/2018] [Accepted: 05/13/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the plan quality and doses to the heart, contralateral breast (CB), ipsilateral lung (IL), and contralateral lung (CL) in tangential breast treatments using the Halcyon linac with megavoltage setup fields. Methods Radiotherapy treatment plans with tangential beams from 25 breast cancer patients previously treated on a C‐arm linac were replanned for Halcyon. Thirteen corresponded to right‐sided breasts and 12 to left‐sided breasts, all with a dose prescription of 50 Gy in 25 fractions. Plans were created with the following setup imaging techniques: low‐dose (LD) MVCBCT, high‐quality (HQ) MVCBCT, LD‐MV and HQ‐MV pairs and the imaging dose was included in the plans. Plan quality metric values for the lumpectomy cavity, whole‐breast and doses to the organs at risk (OARs) were measured and compared with those from the original plans. Results No significant differences in plan quality were observed between the original and Halcyon plans. An increase in the mean dose (Mean) for all the organs was observed for the Halcyon plans. For right‐sided plans, the accumulated Mean over the 25 fractions in the C‐arm plans was 0.4 ± 0.3, 0.2 ± 0.2, 5.4 ± 1.3, and 0.1 ± 0.1 Gy for the heart, CB, IL, and CL, respectively, while values in the MVCBCT‐LD Halcyon plans were 1.2 ± 0.2, 0.6 ± 0.1, 6.5 ± 1.4, and 0.4 ± 0.1 Gy, respectively. For left‐sided treatments, Mean in the original plans was 0.9 ± 0.2, 0.1 ± 0.0, 4.2 ± 1.2, and 0.0 ± 0.0 Gy, while for the MVCBCT‐LD Halcyon plans values were 1.9 ± 0.2, 0.6 ± 0.2, 5.1 ± 1.2, and 0.5 ± 0.2 Gy, respectively. Conclusions Plan quality for breast treatments using Halcyon is similar to the quality for a 6 MV, C‐arm plan. For treatments using megavoltage setup fields, the dose contribution to OARs from the imaging fields can be equal or higher than the dose from treatment fields.
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Affiliation(s)
- Everardo Flores-Martinez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Gwe-Ya Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Catheryn M Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Laura I Cerviño
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
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Arbor N, Gasteuil J, Noblet C, Moreau M, Meyer P. A GATE/Geant4 Monte Carlo toolkit for surface dose calculation in VMAT breast cancer radiotherapy. Phys Med 2019; 61:112-117. [PMID: 31036441 DOI: 10.1016/j.ejmp.2019.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022] Open
Abstract
The accuracy of superficial dose calculations for breast cancer treatments with Volumetric Modulated Arc Therapy (VMAT) is of major importance. For target volumes close to the surface, the inverse dosimetric planning can lead to very high fluences in the build-up region to properly cover the volume to be treated. Various radiotherapy modalities are currently used in parallel with additional protocols to enable a better control on the dose delivery (bolus, target volume margins). One of the difficulties currently facing medical physicists is the lack of available tools to test the impact of these different solutions on the superficial dose distribution. We present a new open source toolkit to assist medical physicists in evaluating the 3D distributions of superficial dose in VMAT breast cancer treatments. This tool is based on the GATE Monte Carlo software, a Geant4 application dedicated to medical physics. A set of macros has been developed to simulate in an easy way a full VMAT plan from the information available in the DICOM-RT files (image, plan, structure and dose). The toolkit has been tested on a 6 MV Varian NovalisTx™ accelerator. The paper presents a precise comparison of 3D surface dose distributions from experimental measurements (EBT3 films), TPS (Varian Eclipse) and Monte Carlo simulation (GATE). The comparison made it possible to highlight both the TPS biases for the surface dose calculation and the good performances of the developed toolkit. The simulation of surface dose distributions on a real patient has also been performed to illustrate the potential clinical applications.
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Affiliation(s)
- Nicolas Arbor
- Université de Strasbourg, IPHC, 23 rue du Loess, 67037 Strasbourg, France; CNRS, UMR7178, 67037 Strasbourg, France.
| | - Jean Gasteuil
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Caroline Noblet
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Matthieu Moreau
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
| | - Philippe Meyer
- Division of Medical Physics, Department of Radiotherapy, Paul Strauss Center, Strasbourg, France
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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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30
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Russo S, Esposito M, Hernandez V, Saez J, Rossi F, Paoletti L, Pini S, Bastiani P, Reggiori G, Nicolini G, Vanetti E, Tomatis S, Scorsetti M, Mancosu P. Does deep inspiration breath hold reduce plan complexity? Multicentric experience of left breast cancer radiotherapy with volumetric modulated arc therapy. Phys Med 2019; 59:79-85. [PMID: 30928069 DOI: 10.1016/j.ejmp.2019.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/14/2019] [Accepted: 02/20/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Volumetric modulated arc therapy (VMAT) for left breast treatments allows heart sparing without compromising PTV coverage. However, this technique may require highly complex plans. Deep Inspiration Breath Hold (DIBH) procedure increases the heart-to-breast distance, facilitating the dose sparing of the heart. The aim of the present work was to investigate if the cardiac-sparing benefits of the DIBH technique were achieved with lower plan modulation and complexity than Free Breathing (FB) treatments. METHODS AND MATERIALS Ten left side breast cases were considered by two centers with different treatment planning systems (TPS) and Linacs. VMAT plans were elaborated in FB and DIBH according to the same protocol. Plan complexity was evaluated by scoring several complexity indices. A new global score index accounting for both plan quality and dosimetric parameters was defined. Pre-treatment QA was performed for all VMAT plans using EPID and Epiqa software. RESULTS DIBH-VMAT plans were associated with significant PTV coverage improvement and mean heart dose reduction (p < 0.003), increasing the resulting global score index. All the evaluated complexity indices showed lower plan complexity for DIBH plans than FB ones, but only in few cases the results were statistically significant. All plans passed the gamma analysis with the selected criteria. CONCLUSIONS The DIBH technique is superior to the FB technique when the heart needs further sparing, allowing a reduction of the doses to OARs with a slightly lower degree of plan complexity and without compromising plan deliverability. These benefits were achieved regardless of the technological scenarios adopted.
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Affiliation(s)
| | - Marco Esposito
- Medical Physics Unit, AUSL Toscana Centro, Florence, Italy
| | - Victor Hernandez
- Department of Medical Physics, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Jordi Saez
- Radiation Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Lisa Paoletti
- Radiotherapy Unit, AUSL Toscana Centro, Florence, Italy
| | - Silvia Pini
- Medical Physics Unit, AUSL Toscana Centro, Florence, Italy
| | | | - Giacomo Reggiori
- Medical Physicist Group of Radiotherapy and Radiosurgery Dept., Humanitas Clinical and Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Giorgia Nicolini
- Medical Physics Team, Radiqa Developments, Bellinzona, Switzerland
| | - Eugenio Vanetti
- Medical Physics Team, Radiqa Developments, Bellinzona, Switzerland
| | - Stefano Tomatis
- Medical Physicist Group of Radiotherapy and Radiosurgery Dept., Humanitas Clinical and Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Hospital IRCCS, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Pietro Mancosu
- Medical Physicist Group of Radiotherapy and Radiosurgery Dept., Humanitas Clinical and Research Hospital IRCCS, Milan-Rozzano, Italy
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31
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Chitapanarux I, Nobnop W, Tippanya D, Sripan P, Chakrabandhu S, Klunklin P, Onchan W, Jia-Mahasap B, Tharavichitkul E. Clinical outcomes and dosimetric study of hypofractionated Helical TomoTherapy in breast cancer patients. PLoS One 2019; 14:e0211578. [PMID: 30703145 PMCID: PMC6355009 DOI: 10.1371/journal.pone.0211578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/16/2019] [Indexed: 11/23/2022] Open
Abstract
We present a single center’s experience of treatment outcomes and dosimetric parameters for breast cancer patients treated with hypofractionated Helical TomoTherapy (HT). This is a retrospective study of one hundred and thirty-six patients with invasive breast cancer treated between March 2012 and October 2016. Dosimetric parameters and 3-year loco-regional failure free survival (LRFFS) were analyzed. Dose to ipsilateral lung, heart and contralateral breast as well as acute and late toxicities were recorded. The median follow-up time is 45 months (range: 5–83). Two patients had loco-regional failure. The 3-year LRFFS was 99%. Acute grade 1 and 2 skin toxicities occurred in 95% and 1%, respectively. Coverage of the target volumes was achieved with the mean ± standard deviation (SD) of homogeneity and conformity index being 0.1 ± 0.04, and 0.8 ± 0.07, respectively. Dose to ipsilateral lung, contralateral breast, and heart was also within the limited constraints regardless of the complexity of target volumes. Only two percent of patients experienced late grade 2 skin toxicity. No late grade 2 subcutaneous tissue toxicity was found. Nine percent of patients developed late grade 1 lung toxicity. Hypofractionated radiotherapy using Helical TomoTherapy in breast irradiation provides excellent 3-year LRFFS and minimal acute and late toxicities. A careful, longer follow-up of healthy tissue effects to lung, heart, and contralateral breast is warranted.
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Affiliation(s)
- Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wannapha Nobnop
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Damrongsak Tippanya
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pitchayaponne Klunklin
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wimrak Onchan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Bongkot Jia-Mahasap
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Chan TY, Tang JI, Tan PW, Roberts N. Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res 2018; 10:4853-4870. [PMID: 30425577 PMCID: PMC6205528 DOI: 10.2147/cmar.s172818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Neill Roberts
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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33
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Zeverino M, Petersson K, Kyroudi A, Jeanneret-Sozzi W, Bourhis J, Bochud F, Moeckli R. A treatment planning comparison of contemporary photon-based radiation techniques for breast cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 7:32-38. [PMID: 33458403 PMCID: PMC7807600 DOI: 10.1016/j.phro.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/24/2018] [Accepted: 08/17/2018] [Indexed: 01/03/2023]
Abstract
Background and purpose Adjuvant radiation therapy (RT) of the whole breast (WB) is still the standard treatment for early breast cancer. A variety of radiation techniques is currently available according to different delivery strategies. This study aims to provide a comparison of six treatment planning strategies commonly adopted for breast-conserving adjuvant RT and to use the Pareto concept in an attempt to assess the degree of plan optimization. Materials and methods Two groups of six left- and five right-sided cases with different dose prescriptions were involved (22 patients in total). Field-in-Field (FiF), two and four Fields static-IMRT (sIMRT-2f and sIMRT-4f), Volumetric-Modulated-Arc-Therapy (VMAT), Helical Tomotherapy (HT) and Static-Angles Tomotherapy (TomoDirect™ – TD) were planned. Dose volume constraints were taken from the RTOG protocol 1005. Pareto fronts were built for a selected case to evaluate the reliability of the plan optimization process. Results The best target dose coverage was observed for TD able to improve significantly (p < 0.01) the V95% in a range varying from 1.2% to 7.5% compared to other techniques. The V105% was significantly reduced up to 2% for HT (p < 0.05) although FiF and VMAT produced similar values. For the ipsilateral lung, V5Gy, V10Gy and Dmean were significantly lower than all other techniques (p < 0.02) for TD while the lowest value of V20Gy was observed for HT. The maximum dose to contralateral breast was significantly lowest for TD (p < 0.02) and for FiF (p < 0.05). Minor differences were observed for the heart in left-sided patients. Plans for all tested techniques were found to lie on their respective Pareto fronts. Conclusions Overall, TD provided significantly better results in terms of target coverage and dose sparing of ipsilateral lung with respect to all other evaluated techniques. It also significantly minimized dose to contralateral breast together with FiF. Pareto front analysis confirmed the reliability of the optimization for a selected case.
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Affiliation(s)
- Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Kristoffer Petersson
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Archonteia Kyroudi
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Wendy Jeanneret-Sozzi
- Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Francois Bochud
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
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Ratosa I, Jenko A, Oblak I. Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning. Radiol Oncol 2018; 52:233-244. [PMID: 30210048 PMCID: PMC6137355 DOI: 10.2478/raon-2018-0026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/12/2018] [Indexed: 02/08/2023] Open
Abstract
Background Breast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size. Conclusions Inhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.
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Affiliation(s)
- Ivica Ratosa
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Aljasa Jenko
- Division of Radiotherapy, Department of Medical Physics, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Irena Oblak
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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35
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Lancellotta V, Iacco M, Perrucci E, Falcinelli L, Zucchetti C, de Bari B, Saldi S, Aristei C. Comparing four radiotherapy techniques for treating the chest wall plus levels III-IV draining nodes after breast reconstruction. Br J Radiol 2018; 91:20160874. [PMID: 29474098 DOI: 10.1259/bjr.20160874] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare the dosimetric outcomes of four radiotherapy (RT) techniques for treating the chest wall plus draining nodes after mastectomy and breast reconstruction. METHODS Three-dimensional conformal radiotherapy, linac-based intensity modulated RT, helical tomotherapy (HT) and direct tomotherapy treatments were planned for 40 breast cancer patients. Dose prescription was 50 Gy. Plans were compared in terms of doses to the planning target volume, organs at risk and the homogeneity index. The non-parametric Friedman test for paired data and the Conover post hoc analysis were used for data analysis. RESULTS HT provided the highest D90 and D98% and the lowest HI, V107% and D2%. HT was associated with the lowest D2% and V25 Gy to the heart in left-sided treatments but the mean cardiac dose was highest. HT provided the highest V5 Gy and V20 Gy to the ipsilateral lung, but the V30 Gy was lower. The contralateral breast and lung were more exposed with HT. CONCLUSION The present dosimetric study together with daily use of CT-MV image guided RT have led us to opt for HT after mastectomy and breast reconstruction and to draw up a suitable protocol for treating the chest wall and levels III and IV draining nodes. Advances in knowledge: HT is a suitable for treating the chest wall and levels III and IV draining nodes.
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Affiliation(s)
- Valentina Lancellotta
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
| | - Martina Iacco
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
| | | | - Lorenzo Falcinelli
- 3 Radiation Oncology Division, Perugia General Hospital , Perugia , Italy
| | - Claudio Zucchetti
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
| | - Berardino de Bari
- 4 Department of radiation Oncology, University Bourgogne Franche-Comté, CHRU Besançon, INSERM U1098 EFS/BFC , Besançon , France
| | - Simonetta Saldi
- 5 Radiation Oncology Section, University of Perugia , Perugia , Italy
| | - Cynthia Aristei
- 1 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital , Perugia , Italy.,2 Medical Physics Unit, Perugia General Hospital , Perugia , Italy
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Orecchia R, Rojas DP, Cattani F, Ricotti R, Santoro L, Morra A, Cambria R, Luraschi R, Dicuonzo S, Ronchi S, Surgo A, Dell' Acqua V, Veronesi P, De Lorenzi F, Fodor C, Leonardi MC, Jereczek-Fossa BA. Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation. Med Oncol 2018; 35:39. [PMID: 29442173 DOI: 10.1007/s12032-018-1095-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II-III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy® System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012-2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0-35 months). 70.8% (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7% of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.
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Affiliation(s)
- Roberto Orecchia
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Damaris Patricia Rojas
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosa Luraschi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Samantha Dicuonzo
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Sara Ronchi
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Alessia Surgo
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Veronica Dell' Acqua
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - Francesca De Lorenzi
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Maria Cristina Leonardi
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
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Robustness of VMAT and 3DCRT plans toward setup errors in radiation therapy of locally advanced left-sided breast cancer with DIBH. Phys Med 2018; 45:12-18. [DOI: 10.1016/j.ejmp.2017.11.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 12/25/2022] Open
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Cozzi L, Lohr F, Fogliata A, Franceschini D, De Rose F, Filippi AR, Guidi G, Vanoni V, Scorsetti M. Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer. Radiat Oncol 2017; 12:200. [PMID: 29258539 PMCID: PMC5735809 DOI: 10.1186/s13014-017-0935-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this review is the critical appraisal of the current use of volumetric modulated arc therapy for the radiation therapy management of breast cancer. Both clinical and treatment planning studies were investigated. Material and methods A Pubmed/MEDLINE search of the National Library of Medicine was performed to identify VMAT and breast related articles. After a first order rejection of the irrelevant findings, the remaining articles were grouped according to two main categories: clinical vs. planning studies and to some sub-categories (pointing to significant technical features). Main areas of application, dosimetric and clinical findings as well as areas of innovations were defined. Results A total of 131 articles were identified and of these, 67 passed a first order selection. Six studies reported clinical results while 61 treatment dealed with treatment planning investigations. Among the innovation lines, the use of high intensity photon beams (flattening filter free), altered fractionation schemes (simultaneous integrated boost, accelerated partial breast irradiation, single fraction), prone positioning and modification of standard VMAT (use of dynamic trajectories or hybrid VMAT methods) resulted among the main relevant fields of interest. Approximately 10% of the publications reported upon respiratory gating in conjunction with VMAT. Conclusions The role of VMAT in the radiation treatment of breast cancer seems to be consolidated in the in-silico arena while still limited evidence and only one phase II trial appeared in literature from the clinical viewpoint. More clinical reports are needed to fully proove the expected dosimetric benefits demonstrated in the planning investigations.
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Affiliation(s)
- Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
| | - Frank Lohr
- Radiation Oncology Department, Ospedaliero-Universitaria, Modena, Italy
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy
| | - Fiorenza De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy
| | - A R Filippi
- Department of Radiation Oncology, Osp. S. Luigi Gonzaga University Hospital, Torino, Italy
| | - Gabriele Guidi
- Medical Physics Department, Az. Ospedaliero-Universitaria, Modena, Italy
| | | | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
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Squires M, Hu Y, Byrne M, Archibald‐Heeren B, Cheers S, Bosco B, Teh A, Fong A. Static beam tomotherapy as an optimisation method in whole-breast radiation therapy (WBRT). J Med Radiat Sci 2017; 64:281-289. [PMID: 28580762 PMCID: PMC5715293 DOI: 10.1002/jmrs.232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/10/2017] [Accepted: 04/21/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION TomoTherapy (Accuray, Sunnyvale, CA) has recently introduced a static form of tomotherapy: TomoDirect™ (TD). This study aimed to evaluate TD against a contemporary intensity modulated radiation therapy (IMRT) alternative through comparison of target and organ at risk (OAR) doses in breast cancer cases. A secondary objective was to evaluate planning efficiency by measuring optimisation times. METHODS Treatment plans of 27 whole-breast radiation therapy (WBRT) patients optimised with a tangential hybrid IMRT technique were replanned using TD. Parameters included a dynamic field width of 2.5 cm, a pitch of 0.251 and a modulation factor of 2.000; 50 Gy in 25 fractions was prescribed and planning time recorded. The planning metrics used in analysis were ICRU based, with the mean PTV minimum (D99 ) used as the point of comparison. RESULTS Both modalities met ICRU50 target heterogeneity objectives (TD D99 = 48.0 Gy vs. IMRT = 48.1 Gy, P = 0.26; TD D1 = 53.5 Gy vs. IMRT = 53.0 Gy, P = 0.02; Homogeneity index TD = 0.11 vs. IMRT = 0.10, P = 0.03), with TD plans generating higher median doses (TD D50 = 51.1 Gy vs. IMRT = 50.9 Gy, P = 0.03). No significant difference was found in prescription dose coverage (TD V50 = 85.5% vs. IMRT = 82.0%, P = 0.09). TD plans produced a statistically significant reduction in V5 ipsilateral lung doses (TD V5 = 23.2% vs. IMRT = 27.2%, P = 0.04), while other queried OARs remained comparable (TD ipsilateral lung V20 = 13.2% vs. IMRT = 14.6%, P = 0.30; TD heart V5 = 2.7% vs. IMRT = 2.8%, P = 0.47; TD heart V10 = 1.7% vs. IMRT = 1.8%, P = 0.44). TD reduced planning time considerably (TD = 9.8 m vs. IMRT = 27.6 m, P < 0.01), saving an average planning time of 17.8 min per patient. CONCLUSIONS TD represents a suitable WBRT treatment approach both in terms of plan quality metrics and planning efficiency.
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Affiliation(s)
| | - Yunfei Hu
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Mikel Byrne
- Radiation Oncology CentresWahroongaNew South WalesAustralia
| | | | - Sonja Cheers
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Bruno Bosco
- Precision Cancer CareAustralia
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Amy Teh
- Radiation Oncology CentresGosfordNew South WalesAustralia
- Radiation Oncology CentresWahroongaNew South WalesAustralia
| | - Andrew Fong
- Radiation Oncology CentresWahroongaNew South WalesAustralia
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Xi D, Ding Y, Hu R, Gu W, Mu J, Li Q. Advantages of a technique using two 50 degree arcs in simultaneous integrated boost radiotherapy for left-sidebreast cancer. Sci Rep 2017; 7:14748. [PMID: 29116237 PMCID: PMC5677093 DOI: 10.1038/s41598-017-15307-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/25/2017] [Indexed: 11/26/2022] Open
Abstract
This study evaluated radiotherapy techniques with 15 cases for simultaneous integrated boost to treat whole left breast and tumor bed following breast conserving surgery. Treatment plans were generated using three techniques: volumetric modulated arc therapy (VMAT) with a partial arc of 190° (1ARC), VMAT with two tangential mini-arcs of 50° each (2TARC) and intensity modulated radiation therapy with four fixed angle fields (4IMRT). Dosimetric parameters for the whole breast (Target), the boost tumor bed (Boost), and surrounding normal organs were compared. Chair Index (CHI) was introduced to evaluate the dose homogeneity in Target given the two levels of prescription dose. The dose coverage in Target was better in 1ARC and 2TARC than that in 4IMRT. The mean CHI in 1ARC (2.47) and 2TARC (2.62) were higher than that in 4IMRT (1.71, p < 0.05), and this indicated the dose homogeneity of Target was better in 1ARC and 2TARC than that in 4IMRT. The mean doses to right lung, and contralateral breast in 4IMRT were lower than those in 2TARC but the differences between them were small. 2TARC was better than 4IMRT with respect to the dose to ipsilateral lung and heart. Overall, 2TARC was optimal among three techniques.
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Affiliation(s)
- Dan Xi
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Yun Ding
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Rui Hu
- Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 213003, China
| | - Wendong Gu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Jinming Mu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China
| | - Qilin Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, The First Peoples' Hospital of Changzhou, Changzhou, 213003, China.
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Xu LM, Kang ML, Jiang B, Liu QF, Li YX. A study of the dosimetric characteristics between different fixed-field IMRT and VMAT in early-stage primary mediastinal B-cell lymphoma. Med Dosim 2017; 43:91-99. [PMID: 28935521 DOI: 10.1016/j.meddos.2017.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
This analysis was designed to compare dosimetric parameters among different fixed-field intensity-modulated radiation therapy (IMRT) solutions and volumetric-modulated arc therapy (VMAT) to identify which can achieve the lowest risk of organs at risk (OARs) and treatment delivery efficiently. A total of 16 patients (8 male and 8 female) with early-stage primary mediastinal large B-cell lymphoma (PMBCL) were enrolled with planned gross tumor volume (PGTV) 45 Gy and planning target volume (PTV) 40 Gy. Four different plans were generated: 5-, 7, 9-field IMRT, and VMAT. The dose distributions for PGTV and PTV OARs (lungs, left ventricle, heart, thyroid gland, and breasts) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. Mean conformity index (CI) and homogeneity index (HI) for PGTV in 5F-, 7F-, 9F-IMRT, and VMAT were 1.01 and 1.10, 1.01 and 1.10, 1.01 and 1.10, and 1.01 and 1.11 (p = 0.963 and 0.843), whereas these 2 indices for PTV were 1.04 and 1.22, 1.03 and 1.19, 1.03 and 1.17, and 1.08 and 1.14 (p = 0.964 and 0.969), respectively. Dmean (Gy), V4 (%), D50 (Gy), and D80 (Gy) to the left and right breasts increased by 0.7 Gy and 0.1 Gy, 6.8% and 7.7%, 0.9 Gy and 1.7 Gy, and 1.0 Gy and 1.5 Gy in VMAT, respectively. The 9-beam IMRT plan had the highest MUs (25,762.4 MUs) and the longest treatment delivery time (10.7 minutes); whereas, the VMAT had the lowest MUs (13,345.0) and the shortest treatment delivery time (5.9 minutes). Seven- and 9-field IMRT and VMAT provide improved tumor coverage compared with 5F-IMRT, whereas VMAT shows higher treatment delivery efficiency than IMRT technique. Seven- and 9-field IMRT slightly reduce the low dose radiation exposure of breasts compared with VMAT technique. The 7- and 9-field IMRT and VMAT techniques both can be safely and efficiently delivered to patients with PMBCL.
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Affiliation(s)
- Li-Ming Xu
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China; Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
| | - Ming-Lei Kang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China; Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Bo Jiang
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qing-Feng Liu
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
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Chan TY, Tan PW, Tang JI. Intensity-modulated radiation therapy for early-stage breast cancer: is it ready for prime time? BREAST CANCER-TARGETS AND THERAPY 2017; 9:177-183. [PMID: 28360536 PMCID: PMC5365280 DOI: 10.2147/bctt.s127583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Whole breast external beam radiotherapy (WBEBRT) is commonly used as an essential arm in the treatment management of women with early-stage breast cancer. Dosimetry planning for conventional WBEBRT typically involves a pair of tangential fields. Advancement in radiation technology and techniques has the potential to improve treatment outcomes with clinically meaningful long-term benefits. However, this advancement must be balanced with safety and improved efficacy. Intensity-modulated radiation therapy (IMRT) is an advanced technique that shows promise in improving the planning process and radiation delivery. Early data on utilizing IMRT for WBEBRT demonstrate more homogenous dose distribution with reduction in organs at risk doses. This translates to toxicities reduction. The two common descriptors for IMRT are forward-planning "fields in field" and inverse planning. Unlike IMRT for other organs, the aim of IMRT for breast planning is to achieve dose homogeneity and not organ conformality. The aim of this paper was to evaluate whether IMRT is ready for prime time based on these three points: 1) workload impact, 2) the clinical impact on the patient's quality of life, and 3) the appropriateness and applicability to clinical practice.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
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Duma MN, Heinrich C, Schönknecht C, Chizzali B, Mayinger M, Devecka M, Kampfer S, Combs SE. Helical TomoTherapy for locally advanced or recurrent breast cancer. Radiat Oncol 2017; 12:31. [PMID: 28129767 PMCID: PMC5273793 DOI: 10.1186/s13014-016-0736-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose We report our experience of using helical tomotherapy (HT) to treat large and irregular shaped loco-regional advanced breast cancer target volumes embracing various organs at risk. Patients and methods We retrospectively analyzed 26 patients treated for very large, irregular shaped breast cancers. Patients were treated either with the intent to achieve local control in a primary setting (n = 14) or in a reirradiation setting (n = 12). The recurrence group was heavily pretreated with systemic therapy. Tumors were characterized by wide infiltration of the skin, encompassing mostly a complete hemithorax. The primary group underwent irradiation of supraclavicular, infraclavicular, axillary and parasternal lymphonodal region. Radiotherapy was combined with chemotherapy (n = 11). We assessed the PTV volume and its craniocaudal extension, the dose to the organs at risk, acute toxicity and survival. Results Median PTV was 2276 cm3 (1476–6837 cm3) with a median cranio-caudal extension of 28 cm (15–52 cm). The median dose to PTV was 40 Gy (32–60Gy). HT could be carried out in all patients without interruption. The acute toxicities were mild to moderate. The median LRFS and OS after radiotherapy was 21 and 57 months for the primary group versus 10 and 11 months for the recurrence group. Median PFS was 18 months (primary group) and 7 months (recurrence group). Conclusions HT is feasible for advanced thorax embracing target volumes with acceptable acute toxicity. Both curative and palliative indications can be considered good indications based on treatment volume and anatomical constellation.
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Affiliation(s)
- M N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany.
| | - C Heinrich
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Praxis für Strahlentherapie, Hausham, Germany
| | - C Schönknecht
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - B Chizzali
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Devecka
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany
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In vivo skin dose measurement using MOSkin detectors in tangential breast radiotherapy. Phys Med 2016; 32:1466-1474. [PMID: 27842982 DOI: 10.1016/j.ejmp.2016.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/04/2016] [Accepted: 10/24/2016] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study is to measure patient skin dose in tangential breast radiotherapy. Treatment planning dose calculation algorithm such as Pencil Beam Convolution (PBC) and in vivo dosimetry techniques such as radiochromic film can be used to accurately monitor radiation doses at tissue depths, but they are inaccurate for skin dose measurement. A MOSFET-based (MOSkin) detector was used to measure skin dose in this study. Tangential breast radiotherapies ("bolus" and "no bolus") were simulated on an anthropomorphic phantom and the skin doses were measured. Skin doses were also measured in 13 patients undergoing each of the techniques. In the patient study, the EBT2 measurements and PBC calculation tended to over-estimate the skin dose compared with the MOSkin detector (p<0.05) in the "no bolus radiotherapy". No significant differences were observed in the "bolus radiotherapy" (p>0.05). The results from patients were similar to that of the phantom study. This shows that the EBT2 measurement and PBC calculation, while able to predict accurate doses at tissue depths, are inaccurate in predicting doses at build-up regions. The clinical application of the MOSkin detectors showed that the average total skin doses received by patients were 1662±129cGy (medial) and 1893±199cGy (lateral) during "no bolus radiotherapy". The average total skin doses were 4030±72cGy (medial) and 4004±91cGy (lateral) for "bolus radiotherapy". In some cases, patient skin doses were shown to exceed the dose toxicity level for skin erythema. Hence, a suitable device for in vivo dosimetry is necessary to accurately determine skin dose.
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Haciislamoglu E, Colak F, Canyilmaz E, Zengin AY, Yilmaz AH, Yoney A, Bahat Z. The choice of multi-beam IMRT for whole breast radiotherapy in early-stage right breast cancer. SPRINGERPLUS 2016; 5:688. [PMID: 27350922 PMCID: PMC4899391 DOI: 10.1186/s40064-016-2314-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/10/2016] [Indexed: 01/19/2023]
Abstract
The aim of this study was to identify a rational strategy for the selection of multi-beam IMRT in patients with right breast cancer through the comparison of dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) using five different radiotherapy modalities. This was a retrospective study using computed tomography scans from ten patients with early-stage right breast cancer who had been treated previously. Three dimensional conformal radiotherapy (3DCRT), forward-planned IMRT (for-IMRT), inverse-planned IMRT (inv-IMRT), helical tomotherapy (HT), and volumetric-modulated arc therapy (VMAT) were planned for each patient. The plans were compared according to dose–volume histogram analysis. The most significant impact of inverse-planned multi-beam modalities for right breast cancer was the reduction of Dmax, Dmean, V53.5 and prescribed dose volume (cc) outside of the PTV (breast) (OB-V50) of the PTV. HT decreased the ipsilateral OAR volumes receiving higher doses. In exchange, HT also increased the volumes receiving low doses, which is known to lead to an increased rate of radiation-induced secondary malignancies. The heart, LAD, and contralateral doses for 3DCRT and for-IMRT were significantly lower than those for inv-IMRT, HT, and VMAT. In addition, inv-IMRT demonstrated an increase in exposed volume of heart, LAD, ipsilateral lung, and contralateral lung compared with those parameters for HT or VMAT. Although it is known to reduce cardiac toxicity with breath hold technique in left sided breast cancer, similarly it is possible for 3DCRT and for-IMRT techniques in right sided breast cancer even in free breathing.
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Affiliation(s)
- Emel Haciislamoglu
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Fatma Colak
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Yasar Zengin
- Department of Radiation Oncology, Faculty of Medicine, Kanuni Research and Education Hospital, Trabzon, Turkey
| | - Ahmet Hakan Yilmaz
- Department of Nuclear Physics, Faculty of Science, Karadeniz Technical University, Trabzon, Turkey
| | - Adnan Yoney
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Zumrut Bahat
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Avanzo M, Trovo M, Stancanello J, Jena R, Roncadin M, Toffoli G, Zuiani C, Capra E. Hypofractionation of partial breast irradiation using radiobiological models. Phys Med 2015; 31:1022-1028. [PMID: 26508014 DOI: 10.1016/j.ejmp.2015.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/10/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To reduce the fraction number in Partial Breast Irradiation (PBI) with initial prescription of 40 Gy in 10 fractions using radiobiological models with specific focus on risk of moderate/severe radiation-induced fibrosis (RIF) and report clinical results. METHODS AND MATERIALS 68 patients (patient group A) were treated with 40 Gy in 10 fractions delivered by field-in-field, forward-planned IMRT. Isotoxic regimens with decreasing number of fractions were calculated using Biological Effective Dose (BED) to the breast. Risk for RIF in hypofractionated treatment was predicted by calculating NTCP from DVHs of group A rescaled to fractions and dose of novel regimens. Moderate/severe RIF was prospectively scored during follow-up. Various NTCP models, with and without incomplete repair correction, were assessed from difference to observed incidence of RIF. In order to verify the value for α/β of 3 Gy assumed for breast, we fitted α/β to observed incidences of moderate/severe RIF. RESULTS Treatments with 35 Gy/7f and 28 Gy/4f were selected for the fraction reduction protocol. 75 patients (group B) were treated in 35 Gy/7f. Incidence of moderate/severe RIF was 5.9% in group A, 5.3% in group B. The NTCP model with correction for incomplete repair had lowest difference from observed RIF. The α/β obtained from fitting was 2.8 (95%CIs 1.1-10.7) Gy. CONCLUSIONS The hypofractionated regimen was well tolerated. The model for NTCP corrected for incomplete repair was the most accurate and an assumed α/β value of 3 Gy is consistent with our patient data. The hypofractionation protocol is continuing with patients treated with 28 Gy/4f.
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Affiliation(s)
- Michele Avanzo
- Medical Physics Department, CRO Aviano, 33081 Aviano, Italy.
| | - Marco Trovo
- Radiation Oncology Department, CRO Aviano, 33081 Aviano, Italy
| | | | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Mario Roncadin
- Radiation Oncology Department, CRO Aviano, 33081 Aviano, Italy
| | - Giulia Toffoli
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Chiara Zuiani
- Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, 33100 Udine, Italy
| | - Elvira Capra
- Medical Physics Department, CRO Aviano, 33081 Aviano, Italy
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