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Pignol JP, Hoekstra N, Wilke D, Dahn H, Nolan M, Vicini F. Estimation of Annual Secondary Lung Cancer Deaths Using Various Adjuvant Breast Radiotherapy Techniques for Early-Stage Cancers. Front Oncol 2021; 11:713328. [PMID: 34434899 PMCID: PMC8381359 DOI: 10.3389/fonc.2021.713328] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Secondary lung cancer (SLC) can offset the benefit of adjuvant breast radiotherapy (RT), and risks compound sharply after 25 to 30 years. We hypothesized that SLC risk is mainly an issue for early-stage breast cancer, and that lives could be saved using different RT techniques. Patients and Methods The SEER database was used to extract breast patient age, stage survival, and radiotherapy utilization over time and per stage and to assess the factors associated with increased SLC risk with a multivariable competing risk Cox model. The number of SLC was calculated using the BEIR model modified with patient survival, age, and use of RT from the SEER database. Stage distribution and number of new breast cancer cases were obtained from the NAACCR. Mean lung dose for various irradiation techniques was obtained from measurement or literature. Results Out of the 765,697 non-metastatic breast cancers in the SEER database from 1988 to 2012, 49.8% received RT. RT significantly increased the SLC risk for longer follow-up (HR=1.58), early stage including DCIS, stage I and IIA (HR = 1.11), and younger age (HR=1.061) (all p<0.001). More advanced stages did not have significantly increased risk. In 2019, 104,743 early-stage breast patients received radiotherapy, and an estimated 3,413 will develop SLC (3.25%) leading to an excess of 2,900 deaths (2.77%). VMAT would reduce this mortality by 9.9%, hypofractionation 26 Gy in five fractions by 38.8%, a prone technique by 70.3%, 3D-CRT APBI by 43.3%, HDR brachytherapy by 71.1%, LDR by 80.7%, and robotic 4π APBI by 85.2%. Conclusions SLC after breast RT remains a clinically significant issue for early-stage breast cancers. This mortality could be significantly reduced using a prone technique or APBI.
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Affiliation(s)
- Jean-Philippe Pignol
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada.,Radiation Oncology Department, Erasmus MC, Rotterdam, Netherlands
| | - Nienke Hoekstra
- Radiation Oncology Department, Erasmus MC, Rotterdam, Netherlands
| | - Derek Wilke
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada
| | - Hannah Dahn
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada
| | - Maureen Nolan
- Radiation Oncology Department, Dalhousie University, Halifax, NS, Canada
| | - Frank Vicini
- Radiation Oncology, 21st Century Oncology, Farmington Hills, MI, United States
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Waheed A, Butt S, Ishtiaq A, Mansha MA, Mehreen S, Raza M, Yousaf M. Dosimetric Comparison of Whole Breast Radiotherapy Using Field-in-Field and Volumetric Modulated Arc Therapy Techniques in Left-Sided Breast Cancer Patients. Cureus 2021; 13:e15732. [PMID: 34285843 PMCID: PMC8286429 DOI: 10.7759/cureus.15732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction The radiotherapy of left-sided breast cancers is challenging because of neighboring critical organs, posing an increased risk of complications. Various radiation delivery techniques have been used to deliver the desired dose of radiation to the target area while keeping the doses to nearby structures within constraints. The main aim of this study is to quantify doses delivered to the organs at risk (OARs) including heart, left lung, spinal cord, and contralateral breast, and to the planning target volume (PTV) using Field-in-Field (FIF) and Volumetric Modulated Arc Therapy (VMAT). Patients and methods A retrospective review of 15 left-sided breast cancer patients was done. All the patients underwent breast-conserving surgery and adjuvant radiation. For every patient, two different radiation treatment plans were formulated and compared for the PTV coverage and doses to OARs, including heart, ipsilateral lung, spinal cord, and contralateral breast. The radiation treatment techniques utilized for this purpose were FIF and VMAT. The homogeneity index (HI), and conformity index (CI) required for the treatment planning were also calculated. Data was analyzed using Statistical Package for the Social Sciences (IBM Corp., Armonk, USA). An Independent T-test was used for statistical analysis. Results The mean age was 41 years and the majority of them were stage II. Total nine patients were given 4005centi Gray (cGy) in 15 fractions (fr) followed by 10Gy boost, hence receiving a total dose of 5005cGy in 20fr. While remaining six patients were given a total dose 4005cGy in 15fr without any boost. All patients were hypofractionated and the dose was delivered at a rate of 267cGy per fr. The FIF technique utilized in breast cancer radiation significantly reduced the mean doses to OARs: mean heart dose (3.81cGy), ipsilateral lung dose (V16- 15cGy), mean contralateral breast dose (0.03cGy), and maximum spinal cord dose (0.18cGy); as compared to VMAT technique which delivered comparatively higher doses: mean heart dose (8.85cGy), ipsilateral lung dose (V16- 19.82cGy), mean contralateral breast dose (4.59cGy), and maximum spinal cord dose (7.14cGy). There was a significant mean difference between doses of OARs and all p-values were statistically significant (p<0.005). Moreover, the FIF technique also improves the dose distribution of PTV in terms of dose homogeneity. However, the conformity index is more enhanced with VMAT as opposed to FIF. Conclusion The FIF technique is more advantageous than the VMAT planning technique because it provides better dose distribution in terms of PTV coverage and significantly lower doses to OARs in radiotherapy to left-sided breast cancer.
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Affiliation(s)
- Asmara Waheed
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sumera Butt
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Ali Ishtiaq
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Atif Mansha
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, PAK
| | - Sana Mehreen
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mohsin Raza
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Yousaf
- Department of Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Jensen CA, Funderud M, Lervåg C. Free breathing VMAT versus deep inspiration breath-hold 3D conformal radiation therapy for early stage left-sided breast cancer. J Appl Clin Med Phys 2021; 22:44-51. [PMID: 33638600 PMCID: PMC8035549 DOI: 10.1002/acm2.13208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/15/2020] [Accepted: 02/01/2021] [Indexed: 12/25/2022] Open
Abstract
The purpose of the in silico study was to compare free breathing volumetric modulated arc therapy (VMAT) to standard deep inspiration breath‐hold (DIBH) three‐dimensional conformal radiotherapy (3DCRT) and determine whether the former is a viable option for elderly patients with left‐sided early stage breast cancer. Data from 22 patients with early‐stage left breast carcinoma requiring breast‐only radiation therapy were used for this planning study. The robustness of VMAT plans when using the free breathing method was compared to that of standard 3DCRT plans using the DIBH method. The endpoints for evaluation were the target dose coverage as well as doses to the organs‐at‐risk. The free breathing VMAT plans produced a significantly higher mean dose to the heart and right breast than the DIBH‐3DCRT plans. Free breathing VMAT plans resulted in significantly better target coverage than did 3DCRT using DIBH. The external volume that received more than 40 Gy was significantly smaller in the VMAT plans. Free breathing VMAT is a viable alternative to DIBH 3DCRT in elderly patients with a limited life expectancy and in subjects who are unable to perform DIBH. The choice of treatment should be individualized, and all relevant risks ought to be considered.
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Affiliation(s)
- Christer A Jensen
- Department of Medicine and Healthcare, Møre & Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway.,Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Marit Funderud
- Department of Oncology, Møre & Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Christoffer Lervåg
- Department of Oncology, Møre & Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
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Takata T, Shiraishi K, Kumagai S, Arai N, Kobayashi T, Oba H, Okamoto T, Kotoku J. Calculating and estimating second cancer risk from breast radiotherapy using Monte Carlo code with internal body scatter for each out-of-field organ. J Appl Clin Med Phys 2020; 21:62-73. [PMID: 33128332 PMCID: PMC7769416 DOI: 10.1002/acm2.13060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/03/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022] Open
Abstract
Out-of-field organs are not commonly designated as dose calculation targets during radiation therapy treatment planning, but they might entail risks of second cancer. Risk components include specific internal body scatter, which is a dominant source of out-of-field doses, and head leakage, which can be reduced by external shielding. Our simulation study quantifies out-of-field organ doses and estimates second cancer risks attributable to internal body scatter in whole-breast radiotherapy (WBRT) with or without additional regional nodal radiotherapy (RNRT), respectively, for right and left breast cancer using Monte Carlo code PHITS. Simulations were conducted using a complete whole-body female model. Second cancer risk was estimated using the calculated doses with a concept of excess absolute risk. Simulation results revealed marked differences between WBRT alone and WBRT plus RNRT in out-of-field organ doses. The ratios of mean doses between them were as large as 3.5-8.0 for the head and neck region and about 1.5-6.6 for the lower abdominal region. Potentially, most out-of-field organs had excess absolute risks of less than 1 per 10,000 persons-year. Our study surveyed the respective contributions of internal body scatter to out-of-field organ doses and second cancer risks in breast radiotherapy on this intact female model.
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Affiliation(s)
- Takeshi Takata
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Kenshiro Shiraishi
- Department of RadiologyTeikyo University School of Medicine2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Shinobu Kumagai
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Norikazu Arai
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Takenori Kobayashi
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Hiroshi Oba
- Department of RadiologyTeikyo University School of Medicine2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Takahide Okamoto
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
| | - Jun’ichi Kotoku
- Graduate School of Medical Care and TechnologyTeikyo University2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
- Central Radiology DivisionTeikyo University Hospital2‐11‐1 Kaga, Itabashi‐kuTokyo173‐8605Japan
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Measurement of the photon and thermal neutron doses of contralateral breast surface in breast cancer radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction and purpose:During the radiation therapy of tumoral breast, the contralateral breast (CB) will receive scattered doses. In the present study, the photon and thermal neutron dose values received by CB surface during breast cancer radiation therapy were measured.Materials and methods:The right breast region of RANDO phantom was considered as CB, and the measurements of photon and thermal neutron dose values were carried out on this region surface. The phantom was irradiated with 18 MV photon beams, and the dose values were measured with thermoluminescent dosimeter (TLD-600 and TLD-700) chips for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes in the presence of physical and dynamic wedges.Results:The total dose values (photon + thermal neutron) received by the CB surface in the presence of physical wedge were 12·06%, 15·75% and 33·40% of the prescribed dose, respectively, for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes. The corresponding dose values for dynamic wedge were 9·18%, 12·92% and 29·26% of the prescribed dose, respectively. Moreover, the results showed that treatment field size and wedge type affect the received photon and thermal neutron doses at CB surface.Conclusion:According to our results, the total dose values received at CB surface during breast cancer radiotherapy with high-energy photon beams are remarkable. In addition, the dose values received at CB surface when using a physical wedge were greater than when using a dynamic wedge, especially for medial tangential fields.
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Takano S, Omura M, Suzuki R, Tayama Y, Matsui K, Hashimoto H, Hongo H, Nagata H, Tanaka K, Hata M, Inoue T. Intensity-modulated radiation therapy using TomoDirect for postoperative radiation of left-sided breast cancer including lymph node area: comparison with TomoHelical and three-dimensional conformal radiation therapy. JOURNAL OF RADIATION RESEARCH 2019; 60:694-704. [PMID: 31365118 PMCID: PMC6805983 DOI: 10.1093/jrr/rrz052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/25/2019] [Indexed: 06/10/2023]
Abstract
Intensity-modulated radiation therapy (IMRT) delivers an excellent dose distribution compared with conventional three-dimensional conformal radiation therapy (3D-CRT) for postoperative radiation including the lymph nodes in breast cancer patients. The TomoTherapy system, developed exclusively for IMRT, has two treatment modes: TomoDirect (TD) with a fixed gantry angle for beam delivery, and TomoHelical (TH) with rotational beam delivery. We compared the characteristics of TD with TH and 3D-CRT plans in the breast cancer patients. Ten consecutive women with left breast cancer received postoperative radiation therapy using TD including the chest wall/residual breast tissue and level II-III axial and supraclavicular lymph node area. Fifty percent of the planning target volume (PTV) was covered with at least 50 Gy in 25 fractions. TD, TH and 3D-CRT plans were created for each patient, with the same dosimetric constraints. TD and TH showed better dose distribution to the PTV than 3D-CRT. TD and 3D-CRT markedly suppressed low-dose spread to the lung compared with TH. Total lung V5 and V10 were significantly lower, while V20 was significantly higher in the TD and 3D-CRT plans. The mean total lung, heart and contralateral breast doses were significantly lower using TD compared with the other plans. Compared with 3D-CRT and TH, TD can provide better target dose distribution with optimal normal-organ sparing for postoperative radiation therapy including the chest wall/residual breast tissue and lymph node area in breast cancer patients. TD is thus a useful treatment modality in these patients.
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Affiliation(s)
- Shoko Takano
- Shonan Kamakura General Hospital, Department of Radiation Oncology, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
- Yokohama City University Graduate School of Medicine, Department of Radiation Oncology, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Motoko Omura
- Shonan Kamakura General Hospital, Department of Radiation Oncology, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
| | - Ryoko Suzuki
- Cancer Institute Hospital, Department of Radiation Oncology, 3-8-31 Ariake, Koto-ku, Tokyo, Japan
| | - Yumiko Tayama
- Shonan Kamakura General Hospital, Department of Radiation Oncology, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
| | - Kengo Matsui
- Shonan Kamakura General Hospital, Department of Radiation Oncology, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
| | - Harumitsu Hashimoto
- Shonan Fujisawa Tokushukai Hospital, 1-5-1 Tsujidokandai, Fujisawa, Kanagawa, Japan
| | - Hideyuki Hongo
- Shonan Kamakura General Hospital, Department of Radiation Oncology, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
| | - Hironori Nagata
- Shonan Kamakura General Hospital, Department of Radiation Oncology, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
| | - Kumiko Tanaka
- Shonan Kamakura General Hospital, Department of Breast Surgery, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
| | - Masaharu Hata
- Yokohama City University Graduate School of Medicine, Department of Radiation Oncology, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Tomio Inoue
- Shonan Kamakura General Hospital, Advanced Medical Center, 1370-1 Okamoto, Kamakura, Kanagawa, Japan
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Long-term risks of secondary cancer for various whole and partial breast irradiation techniques. Radiother Oncol 2018; 128:428-433. [PMID: 29914648 DOI: 10.1016/j.radonc.2018.05.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION For early stage breast cancer patients, non-breast cancer mortality including secondary cancers and cardiac events can overshadow the benefit of adjuvant radiotherapy. This study evaluates the excess risk of secondary cancer for various breast radiotherapy techniques including accelerated partial breast irradiation (APBI). METHODS Secondary cancers Lifetime Attributable Risks (LAR) were calculated using a modified BEIR-VII formalism to account for the specific survival of breast cancer patients. Those survivals were extracted from the SEER database. Doses scattered to various organs were measured into a Rando phantom with custom-made breast phantoms. Treatments delivered typical doses of brachytherapy APBI (34 Gy in 10 fractions), external beam APBI (38.5 Gy in 10 fractions) using 3D-conformal, Cyberknife stereotactic (CK), or VMAT, as well as whole breast irradiation (WBI) delivering 42.5 Gy in 16 fractions. RESULTS WBI resulted in the highest total LAR, with 4.3% excess risk of secondary cancer for a patient treated at age 50 years. Lung cancers accounted for 75-97% of secondary malignancies. For a typical early stage patient irradiated at 50, the excess risks of secondary lung cancer were 1.1% for multicatheter HDR, between 2.2% and 2.5% for 3D-CRT or CK, 3.5% for VMAT APBI, and 3.8% for WBI. CONCLUSIONS APBI reduces the risk of secondary cancer 2-4 fold compared to WBI. These techniques are well suited for long-living early stage breast cancer patients. HDR brachytherapy and 3D-conformal APBI achieve mean lung doses between 1 and 1.5 Gy, which could serve as reference.
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Bagheri H, Rabie Mahdavi S, Shekarchi B, Manouchehri F, Farhood B. MEASUREMENT OF THE CONTRALATERAL BREAST PHOTON AND THERMAL NEUTRON DOSES IN BREAST CANCER RADIOTHERAPY: A COMPARISON BETWEEN PHYSICAL AND DYNAMIC WEDGES. RADIATION PROTECTION DOSIMETRY 2018; 178:73-81. [PMID: 28591863 DOI: 10.1093/rpd/ncx076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
This research aimed to measure the received photon and thermal neutron doses to contralateral breast (CB) in breast cancer radiotherapy for various field sizes in presence of physical and dynamic wedges. The measurement of photon and thermal neutron doses was carried out on right breast region of RANDO phantom (as CB) for 18 MV photon beams. The dose measurements were performed by thermoluminescent dosimeter chips. These measurements obtained for various field sizes in presence of physical and dynamic wedges. The findings of this study showed that the received doses (both of the photon and thermal neutron) to CB in presence of physical wedge for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes were 5.92, 6.36 and 6.77% of the prescribed dose, respectively as well as for dynamic wedge were 2.92, 4.63 and 5.60% of the prescribed dose, respectively. The results showed that the received photon and thermal neutron doses to CB increase with increment of field sizes. The received photon and thermal neutron doses to CB in presence of physical wedge were more than dynamic wedge. According to obtained findings, it is suggested that using a dynamic wedge is preferable than physical wedge, especially for medial tangential field.
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Affiliation(s)
- Hamed Bagheri
- Radiation and Wave Research Center, Aja University of Medical Science, Tehran, Iran
| | - Seyed Rabie Mahdavi
- Department of Medical Physics, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Shekarchi
- Radiation and Wave Research Center, Aja University of Medical Science, Tehran, Iran
| | | | - Bagher Farhood
- Medical Physics and Medical Engineering Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Chargari C, Goodman KA, Diallo I, Guy JB, Rancoule C, Cosset JM, Deutsch E, Magne N. Risk of second cancers in the era of modern radiation therapy: does the risk/benefit analysis overcome theoretical models? Cancer Metastasis Rev 2017; 35:277-88. [PMID: 26970966 DOI: 10.1007/s10555-016-9616-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the era of modern radiation therapy, the compromise between the reductions in deterministic radiation-induced toxicities through highly conformal devices may be impacting the stochastic risk of second malignancies. We reviewed the clinical literature and evolving theoretical models evaluating the impact of intensity-modulated radiation therapy (IMRT) on the risk of second cancers, as a consequence of the increase in volumes of normal tissues receiving low doses. The risk increase (if any) is not as high as theoretical models have predicted in adults. Moreover, the increase in out-of-field radiation doses with IMRT could be counterbalanced by the decrease in volumes receiving high doses. Clinical studies with short follow-up have not corroborated the hypothesis that IMRT would drastically increase the incidence of second cancers. In children, the risk of radiation-induced carcinogenesis increases from low doses and consequently the relative risk of second cancers after IMRT could be higher than in adults, justifying current developments of proton therapy with priority given to this population. Although only longer follow-up will allow a true assessment of the real impact of these modern techniques on radiation-induced carcinogenesis, a comprehensive risk-adapted strategy will help minimize the probability of second cancers.
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Affiliation(s)
- Cyrus Chargari
- Radiotherapy Department, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.,INSERM 1030, Molecular Radiotherapy, Gustave Roussy campus Cancer, Grand Paris, France
| | - Karyn A Goodman
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ibrahima Diallo
- U1018 Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Jean-Baptiste Guy
- Cellular and Molecular Radiotherapy Laboratory, EMR3738, 69921, Oullins, France.,Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Chloe Rancoule
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Jean-Marc Cosset
- Oncology/Radiotherapy Department, Institut Curie, 75005, Paris, France.,Charlebourg-La Défense Radiotherapy Center, Amethyst Group, La Garenne-Colombes, 92250, Paris, France
| | - Eric Deutsch
- INSERM 1030, Molecular Radiotherapy, Gustave Roussy campus Cancer, Grand Paris, France
| | - Nicolas Magne
- Cellular and Molecular Radiotherapy Laboratory, EMR3738, 69921, Oullins, France. .,Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France. .,Chef du Département de Radiothérapie, Directeur de la Recherche et de l'Innovation, Institut de Cancérologie Lucien Neuwirth, 108 bis, avenue Albert Raimond, BP 60008, 42270, Saint-Priest en Jarez cedex, France.
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Zahnreich S, Ebersberger A, Karle H, Kaina B, Schmidberger H. Quantification of Radiation Biomarkers in Leukocytes of Breast Cancer Patients Treated with Different Modalities of 3D-CRT or IMRT. Radiat Res 2016; 186:508-519. [DOI: 10.1667/rr14475.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Heiko Karle
- Radiation Oncology and Radiation Therapy and
| | - Bernd Kaina
- Toxicology, University Medical Center Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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Hybrid intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) technique versus three-dimensional (3D) conformal radiotherapy with SIB for breast radiotherapy: a planning comparison. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s146039691600008x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractAimThis study aims to compare conventional simultaneous integrated boost (SIB) planning technique with a hybrid SIB intensity-modulated radiation therapy (IMRT) technique with varying open tangent to IMRT field dose ratios. Furthermore, we investigated which of the dose ratios proves the most favourable as a class solution across a sample.MethodsIn total, 15 patients with conventional SIB treatment plans were re-planned with hybrid SIB IMRT technique using three differing open field:IMRT dose ratios, that is, 80:20, 70:30 and 60:40. Plans were compared using dosimetric comparison of organs at risk (OARs) and homogeneity and conformity indexes across target structures.ResultsAll hybrid plans reduced dose maximums and showed a reduction of high doses to both lungs but increased lower doses, that is, V5, with similar results discovered for the heart. Contralateral breast dose was shown to decrease V5 and V1 measures by hybrid arms, whereas increasing the V2. Left anterior descending artery dose and non-irradiated structures were reduced by all hybrid arms. The homogeneity and conformity increased across all hybrid arms. Qualitative assessment of all plans also favoured hybrid plans.FindingsHybrid plans produced superior dose conformity, homogeneity, reduced dose maximums and showed an improvement in most OAR parameters. The 70:30 hybrid technique exhibited greater benefits as a class solution to the sample than conventional plans due to superior dose conformity and homogeneity to target volumes.
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Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy during deep inspiratory breath hold for left-sided whole-breast irradiation: a comparative analysis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s1460396915000394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAimDeep inspiratory breath hold (DIBH) during left-breast irradiation helps to minimise cardiac irradiation by physically separating the heart from the left breast. The dose to organs-at-risk in intensity-modulated radiotherapy (IMRT) and opposed tangent three-dimensional conformal radiotherapy (3DCRT) during DIBH in patients with left-sided breast cancer was compared.Materials and methodsA total of 20 consecutive patients with left-sided breast cancer had a computed tomography scan utilising DIBH. Mean volumes of the heart, left anterior descending coronary artery, total lung and right breast receiving 5–95% of the prescription dose were calculated.ResultsTarget volume homogeneity was improved with IMRT and average mean dose to target was higher for 3DCRT (51·03 Gy) compared with IMRT (50·47 Gy, p<0·01). The average mean dose to the heart was lower with 3DCRT (87 versus 77 cGy, p<0·01). The average mean dose to the contralateral breast was also lower with 3DCRT (19 versus 17 cGy, p<0·01). Less monitor units (MUs) were required with 3DCRT with an average difference of 225 MU/fraction (p<0·01).FindingsUnder DIBH, absolute differences between 3DCRT and IMRT were minimal. 3DCRT under DIBH provided excellent dosimetric results in most patients with left-sided breast cancer without the need for IMRT.
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Lefebvre L, Doyeux K, Linca S, Challand T, Hanzen C. [Radiotherapy of a glioma in a pregnant woman: evaluation of the foetal dose in conformational 3D or intensity-modulated]. Cancer Radiother 2014; 18:763-6. [PMID: 25451673 DOI: 10.1016/j.canrad.2014.07.158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/23/2014] [Accepted: 07/02/2014] [Indexed: 10/24/2022]
Abstract
The purpose was to assess three treatments planning techniques including one in intensity-modulated radiation therapy (IMRT) for cerebral irradiation of pregnant woman, in order to limit the dose delivered to the foetus. The treatment provided was 60 Gy to the planning target volume. Estimated foetal dose was measured using an anthropomorphic phantom, on the upper and middle part of the uterus. The first plan consisted in four beams in conformational technique delivered from a Varian accelerator with a 120 leaves collimator, the second one used non-coplanar fields and the third one assessed IMRT. With the conformational technique, the dose at the upper part of the uterus was 8.3 mGy and 6.3 mGy at the middle part. The dose delivered to the foetus was higher with the non-coplanar fields. In IMRT, the dose at the upper part of the uterus was 23.8 mGy and 14.3 mGy at the middle part. The three plans used 6 MV X-rays. Because of the use of leaves and non-coplanar fields, IMRT does not seem to be the optimal technique for the treatment of pregnant woman. However, the dose delivered to the foetus remains low and below the dose of 100 mGy recommended by the International Commission of Radiological Protection. It seems possible to consider the use of this technique for a better sparing of organs at risk for the mother.
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Affiliation(s)
- L Lefebvre
- Département de radiothérapie, centre Henri-Becquerel, rue d'Amiens, 76038 Rouen cedex 1, France
| | - K Doyeux
- Département de radiothérapie, centre Henri-Becquerel, rue d'Amiens, 76038 Rouen cedex 1, France
| | - S Linca
- Département de radiothérapie, centre Henri-Becquerel, rue d'Amiens, 76038 Rouen cedex 1, France
| | - T Challand
- Département de radiothérapie, centre Henri-Becquerel, rue d'Amiens, 76038 Rouen cedex 1, France
| | - C Hanzen
- Département de radiothérapie, centre Henri-Becquerel, rue d'Amiens, 76038 Rouen cedex 1, France.
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Merino Lara TR, Fleury E, Mashouf S, Helou J, McCann C, Ruschin M, Kim A, Makhani N, Ravi A, Pignol JP. Measurement of mean cardiac dose for various breast irradiation techniques and corresponding risk of major cardiovascular event. Front Oncol 2014; 4:284. [PMID: 25374841 PMCID: PMC4205812 DOI: 10.3389/fonc.2014.00284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/30/2014] [Indexed: 12/04/2022] Open
Abstract
After breast conserving surgery, early stage breast cancer patients are currently treated with a wide range of radiation techniques including whole breast irradiation (WBI), accelerated partial breast irradiation (APBI) using high-dose rate (HDR) brachytherapy, or 3D-conformal radiotherapy (3D-CRT). This study compares the mean heart’s doses for a left breast irradiated with different breast techniques. An anthropomorphic Rando phantom was modified with gelatin-based breast of different sizes and tumors located medially or laterally. The breasts were treated with WBI, 3D-CRT, or HDR APBI. The heart’s mean doses were measured with Gafchromic films and controlled with optically stimulated luminescent dosimeters. Following the model reported by Darby (1), major cardiac were estimated assuming a linear risk increase with the mean dose to the heart of 7.4% per gray. WBI lead to the highest mean heart dose (2.99 Gy) compared to 3D-CRT APBI (0.51 Gy), multicatheter (1.58 Gy), and balloon HDR (2.17 Gy) for a medially located tumor. This translated into long-term coronary event increases of 22, 3.8, 11.7, and 16% respectively. The sensitivity analysis showed that the tumor location had almost no effect on the mean heart dose for 3D-CRT APBI and a minimal impact for HDR APBI. In case of WBI large breast size and set-up errors lead to sharp increases of the mean heart dose. Its value reached 10.79 Gy for women with large breast and a set-up error of 1.5 cm. Such a high value could increase the risk of having long-term coronary events by 80%. Comparison among different irradiation techniques demonstrates that 3D-CRT APBI appears to be the safest one with less probability of having cardiovascular events in the future. A sensitivity analysis showed that WBI is the most challenging technique for patients with large breasts or when significant set-up errors are anticipated. In those cases, additional heart shielding techniques are required.
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Affiliation(s)
- Tomas Rodrigo Merino Lara
- Radiotherapy Unit, School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile ; Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Emmanuelle Fleury
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Shahram Mashouf
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Joelle Helou
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Claire McCann
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Anthony Kim
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Nadiya Makhani
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Ananth Ravi
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre , Toronto, ON , Canada ; Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada
| | - Jean-Philippe Pignol
- Department of Radiation Oncology, University of Toronto , Toronto, ON , Canada ; Department of Radiation Oncology, Erasmus MC , Rotterdam , Netherlands
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15
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[The issue of low doses in radiation therapy and impact on radiation-induced secondary malignancies]. Bull Cancer 2014; 100:1333-42. [PMID: 24257106 DOI: 10.1684/bdc.2013.1855] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several studies have well documented that the risk of secondary neoplasms is increasing among patients having received radiation therapy as part of their primary anticancer treatment. Most frequently, radiation-induced neoplasms occur in volume exposed to high doses. However, the impact of "low" doses (<5 Gy) in radiation-induced carcinogenesis should be clinically considered because modern techniques of intensity-modulated radiation therapy (IMRT) or stereotactic irradiation significantly increase tissue volumes receiving low doses. The risk inherent to these technologies remains uncertain and estimates closely depend on the chosen risk model. According to the (debated) linear no-threshold model, the risk of secondary neoplasms could be twice higher with IMRT, as compared to conformal radiation therapy. It seems that only proton therapy could decrease both high and low doses delivered to non-target volumes. Except for pediatric tumors, for which the unequivocal risk of second malignancies (much higher than in adults) should be taken into account, epidemiological data suggest that the risk of secondary cancer related to low doses could be very low, even negligible in some cases. However, clinical follow-up remains insufficient and a marginal increase in secondary tumors could counterbalance the benefit of a highly sophisticated irradiation technique. It therefore remains necessary to integrate the potential risk of new irradiation modalities in a risk-adapted strategy taking into account therapeutic objectives but also associated risk factors, such as age (essentially), chemotherapy, or life style.
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Abo-Madyan Y, Aziz MH, Aly MMOM, Schneider F, Sperk E, Clausen S, Giordano FA, Herskind C, Steil V, Wenz F, Glatting G. Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiother Oncol 2014; 110:471-6. [PMID: 24444525 DOI: 10.1016/j.radonc.2013.12.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 12/02/2013] [Accepted: 12/21/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE Second cancer risk after breast conserving therapy is becoming more important due to improved long term survival rates. In this study, we estimate the risks for developing a solid second cancer after radiotherapy of breast cancer using the concept of organ equivalent dose (OED). MATERIALS AND METHODS Computer-tomography scans of 10 representative breast cancer patients were selected for this study. Three-dimensional conformal radiotherapy (3D-CRT), tangential intensity modulated radiotherapy (t-IMRT), multibeam intensity modulated radiotherapy (m-IMRT), and volumetric modulated arc therapy (VMAT) were planned to deliver a total dose of 50 Gy in 2 Gy fractions. Differential dose volume histograms (dDVHs) were created and the OEDs calculated. Second cancer risks of ipsilateral, contralateral lung and contralateral breast cancer were estimated using linear, linear-exponential and plateau models for second cancer risk. RESULTS Compared to 3D-CRT, cumulative excess absolute risks (EAR) for t-IMRT, m-IMRT and VMAT were increased by 2 ± 15%, 131 ± 85%, 123 ± 66% for the linear-exponential risk model, 9 ± 22%, 82 ± 96%, 71 ± 82% for the linear and 3 ± 14%, 123 ± 78%, 113 ± 61% for the plateau model, respectively. CONCLUSION Second cancer risk after 3D-CRT or t-IMRT is lower than for m-IMRT or VMAT by about 34% for the linear model and 50% for the linear-exponential and plateau models, respectively.
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Affiliation(s)
- Yasser Abo-Madyan
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Radiation Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University, Egypt
| | - Muhammad Hammad Aziz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Physics, COMSATS Institute of Information and Technology, Islamabad, Pakistan
| | - Moamen M O M Aly
- Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Egypt
| | - Frank Schneider
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Sven Clausen
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Volker Steil
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Gerhard Glatting
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
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Comparison of Two Radiotherapeutic Hypofractionated Schedules in the Application of Tumor Bed Boost. Clin Breast Cancer 2013; 13:292-8. [DOI: 10.1016/j.clbc.2013.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 12/29/2012] [Accepted: 02/04/2013] [Indexed: 11/20/2022]
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Borges C, Cunha G, Monteiro-Grillo I, Vaz P, Teixeira N. Comparison of different breast planning techniques and algorithms for radiation therapy treatment. Phys Med 2013; 30:160-70. [PMID: 23735838 DOI: 10.1016/j.ejmp.2013.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/23/2013] [Accepted: 04/30/2013] [Indexed: 12/25/2022] Open
Abstract
This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques--forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT--and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques--f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART - were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.
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Affiliation(s)
- C Borges
- Medicalconsult SA, Campo Grande, n° 56 - 8° A, 1700-093 Lisboa, Portugal.
| | - G Cunha
- Escola Superior de Tecnologias da Saúde, Avenida Dom João II, 1900-096 Lisboa, Portugal
| | - I Monteiro-Grillo
- Departamento de Radioterapia, Hospital de Santa Maria, Centro Hospitalar Lisboa, Norte, EPE, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - P Vaz
- Instituto Superior Técnico, Campus Tecnológico e Nuclear, Unidade de Protecção e Segurança Radiológica, Estrada Nacional 10 (ao km 139,7), 2695-066 Bobadela LRS, Portugal
| | - N Teixeira
- Escola Superior de Tecnologias da Saúde, Avenida Dom João II, 1900-096 Lisboa, Portugal
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Berris T, Mazonakis M, Stratakis J, Tzedakis A, Fasoulaki A, Damilakis J. Calculation of organ doses from breast cancer radiotherapy: a Monte Carlo study. J Appl Clin Med Phys 2013; 14:4029. [PMID: 23318389 PMCID: PMC5713920 DOI: 10.1120/jacmp.v14i1.4029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 08/06/2012] [Accepted: 08/16/2012] [Indexed: 11/28/2022] Open
Abstract
The current study aimed to: a) utilize Monte Carlo simulation methods for the assessment of radiation doses imparted to all organs at risk to develop secondary radiation induced cancer, for patients undergoing radiotherapy for breast cancer; and b) evaluate the effect of breast size on dose to organs outside the irradiation field. A simulated linear accelerator model was generated. The in-field accuracy of the simulated photon beam properties was verified against percentage depth dose (PDD) and dose profile measurements on an actual water phantom. Off-axis dose calculations were verified with thermoluminescent dosimetry (TLD) measurements on a humanoid physical phantom. An anthropomorphic mathematical phantom was used to simulate breast cancer radiotherapy with medial and lateral fields. The effect of breast size on the calculated organ dose was investigated. Local differences between measured and calculated PDDs and dose profiles did not exceed 2% for the points at depths beyond the depth of maximum dose and the plateau region of the profile, respectively. For the penumbral regions of the dose profiles, the distance to agreement (DTA) did not exceed 2 mm. The mean difference between calculated out-of-field doses and TLD measurements was 11.4% ± 5.9%. The calculated doses to peripheral organs ranged from 2.32 cGy up to 161.41 cGy depending on breast size and thus the field dimensions applied, as well as the proximity of the organs to the primary beam. An increase to the therapeutic field area by 50% to account for the large breast led to a mean organ dose elevation by up to 85.2% for lateral exposure. The contralateral breast dose ranged between 1.4% and 1.6% of the prescribed dose to the tumor. Breast size affects dose deposition substantially.
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Affiliation(s)
- T. Berris
- Department of Medical PhysicsFaculty of Medicine, University of CreteHeraklion, CreteGreece
| | - M. Mazonakis
- Department of Medical PhysicsFaculty of Medicine, University of CreteHeraklion, CreteGreece
| | - J. Stratakis
- Department of Medical PhysicsFaculty of Medicine, University of CreteHeraklion, CreteGreece
| | - A. Tzedakis
- Department of Medical PhysicsUniversity Hospital of HeraklionHeraklion, CreteGreece
| | - A. Fasoulaki
- Department of Radiotherapy and OncologyUniversity Hospital of HeraklionHeraklion, CreteGreece
| | - J. Damilakis
- Department of Medical PhysicsFaculty of Medicine, University of CreteHeraklion, CreteGreece
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Evaluation of organ-specific peripheral doses after 2-dimensional, 3-dimensional and hybrid intensity modulated radiation therapy for breast cancer based on Monte Carlo and convolution/superposition algorithms: Implications for secondary cancer risk assessment. Radiother Oncol 2013; 106:33-41. [DOI: 10.1016/j.radonc.2012.11.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 10/10/2012] [Accepted: 11/18/2012] [Indexed: 11/18/2022]
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21
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Kaplan H, Malmgren J, De Roos AJ. Risk of myelodysplastic syndrome and acute myeloid leukemia post radiation treatment for breast cancer: a population-based study. Breast Cancer Res Treat 2012; 137:863-7. [DOI: 10.1007/s10549-012-2386-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 12/12/2012] [Indexed: 11/28/2022]
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22
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Secondary malignancies in survivors of breast cancer: How to overcome the risk. Crit Rev Oncol Hematol 2012; 84 Suppl 1:e86-9. [DOI: 10.1016/j.critrevonc.2010.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 05/21/2010] [Accepted: 06/18/2010] [Indexed: 11/21/2022] Open
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Heymann S, Verstraet R, Pichenot C, Vergne E, Lefkopoulos D, Husson F, Kafrouni H, Mahe J, Kandalaft B, Bourhis J, Marsiglia H, Bourgier C. Modulation d’intensité en radiothérapie mammaire : développement d’une méthode innovante de champ dans le champ à l’institut Gustave-Roussy. Cancer Radiother 2011; 15:663-9. [DOI: 10.1016/j.canrad.2011.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 02/06/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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24
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Quinn A, Holloway L, Cutajar D, Hardcastle N, Rosenfeld A, Metcalfe P. Megavoltage cone beam CT near surface dose measurements: potential implications for breast radiotherapy. Med Phys 2011; 38:6222-7. [DOI: 10.1118/1.3641867] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Moon SK, Kim YS, Kim SY, Lee MJ, Keum HS, Kim SJ, Youn SM. A Dosimetric Analysis of IMRT and Multistatic Fields Techniques for Left Breast Radiotherapy. Med Dosim 2011; 36:276-83. [DOI: 10.1016/j.meddos.2010.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/20/2010] [Accepted: 05/27/2010] [Indexed: 10/18/2022]
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Stillie AL, Kron T, Herschtal A, Hornby C, Cramb J, Sullivan K, Chua B. Does inverse-planned intensity-modulated radiation therapy have a role in the treatment of patients with left-sided breast cancer? J Med Imaging Radiat Oncol 2011; 55:311-9. [DOI: 10.1111/j.1754-9485.2011.02273.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ayata HB, Güden M, Ceylan C, Kücük N, Engin K. Comparison of dose distributions and organs at risk (OAR) doses in conventional tangential technique (CTT) and IMRT plans with different numbers of beam in left-sided breast cancer. Rep Pract Oncol Radiother 2011; 16:95-102. [PMID: 24376964 DOI: 10.1016/j.rpor.2011.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 01/31/2011] [Accepted: 02/21/2011] [Indexed: 11/29/2022] Open
Abstract
AIM Our aim was to improve dose distribution to the left breast and to determine the dose received by the ipsilateral lung, heart, contralateral lung and contralateral breast during primary left-sided breast irradiation by using intensity modulated radiotherapy (IMRT) techniques compared to conventional tangential techniques (CTT). At the same time, different beams of IMRT plans were compared to each other in respect to CI, HI and organs at risk (OAR) dose. BACKGROUND Conventional early breast cancer treatment consists of lumpectomy followed by whole breast radiation therapy. CTT is a traditional method used for whole breast radiotherapy and includes standard wedged tangents (two opposed wedged tangential photon beams). The IMRT technique has been widely used for many treatment sites, allowing both improved sparing of normal tissues and more conformal dose distributions. IMRT is a new technique for whole breast radiotherapy. IMRT is used to improve conformity and homogeneity and used to reduce OAR doses. MATERIALS AND METHODS Thirty patients with left-sided breast carcinoma were treated between 2005 and 2008 using 6, 18 or mixed 6/18 MV photons for primary breast irradiation following breast conserving surgery (BCS). The clinical target volume [CTV] was contoured as a target volume and the contralateral breast, ipsilateral lung, contralateral lung and heart tissues as organs at risk (OAR). IMRT with seven beams (IMRT7), nine beams (IMRT9) and 11 beams (IMRT11) plans were developed and compared with CTT and among each other. The conformity index (CI), homogeneity index (HI), and doses to OAR were compared to each other. RESULTS ALL OF IMRT PLANS SIGNIFICANTLY IMPROVED CI (CTT: 0.76; IMRT7: 0.84; IMRT9: 0.84; IMRT11: 0.85), HI (CTT: 1.16; IMRT7: 1.12; IMRT9: 1.11; IMRT11: 1.11), volume of the ipsilateral lung receiving more than 20 Gy (>V20 Gy) (CTT: 14.6; IMRT7: 9.08; IMRT9: 8.10; IMRT11: 8.60), and volume of the heart receiving more than 30 Gy (>V30 Gy) (CTT: 6.7; IMRT7: 4.04; IMRT9: 2.80; IMRT11: 2.98) compared to CTT. All IMRT plans were found to significantly decrease >V20 Gy and >V30 Gy volumes compared to conformal plans. But IMRT plans increased the volume of OAR receiving low dose radiotherapy: volume of contralateral lung receiving 5 and 10 Gy (CTT: 0.0-0.0; IMRT7: 19.0-0.7; IMRT9: 17.2-0.66; IMRT11: 18.7-0.58, respectively) and volume of contralateral breast receiving 10 Gy (CTT: 0.03; IMRT7: 0.38; IMRT9: 0.60; IMRT11: 0.68). The differences among IMRT plans with increased number of beams were not statistically significant. CONCLUSION IMRT significantly improved conformity and homogeneity index for plans. Heart and lung volumes receiving high doses were decreased, but OAR receiving low doses was increased.
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Affiliation(s)
- Hande Bas Ayata
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Metin Güden
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Cemile Ceylan
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Nadir Kücük
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Kayihan Engin
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
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Pignol JP, Keller BM, Ravi A. Doses to internal organs for various breast radiation techniques--implications on the risk of secondary cancers and cardiomyopathy. Radiat Oncol 2011; 6:5. [PMID: 21235766 PMCID: PMC3027128 DOI: 10.1186/1748-717x-6-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/14/2011] [Indexed: 01/20/2023] Open
Abstract
Background Breast cancers are more frequently diagnosed at an early stage and currently have improved long term outcomes. Late normal tissue complications induced by adjuvant radiotherapy like secondary cancers or cardiomyopathy must now be avoided at all cost. Several new breast radiotherapy techniques have been developed and this work aims at comparing the scatter doses of internal organs for those techniques. Methods A CT-scan of a typical early stage left breast cancer patient was used to describe a realistic anthropomorphic phantom in the MCNP Monte Carlo code. Dose tally detectors were placed in breasts, the heart, the ipsilateral lung, and the spleen. Five irradiation techniques were simulated: whole breast radiotherapy 50 Gy in 25 fractions using physical wedge or breast IMRT, 3D-CRT partial breast radiotherapy 38.5 Gy in 10 fractions, HDR brachytherapy delivering 34 Gy in 10 treatments, or Permanent Breast 103Pd Seed Implant delivering 90 Gy. Results For external beam radiotherapy the wedge compensation technique yielded the largest doses to internal organs like the spleen or the heart, respectively 2,300 mSv and 2.7 Gy. Smaller scatter dose are induced using breast IMRT, respectively 810 mSv and 1.1 Gy, or 3D-CRT partial breast irradiation, respectively 130 mSv and 0.7 Gy. Dose to the lung is also smaller for IMRT and 3D-CRT compared to the wedge technique. For multicatheter HDR brachytherapy a large dose is delivered to the heart, 3.6 Gy, the spleen receives 1,171 mSv and the lung receives 2,471 mSv. These values are 44% higher in case of a balloon catheter. In contrast, breast seeds implant is associated with low dose to most internal organs. Conclusions The present data support the use of breast IMRT or virtual wedge technique instead of physical wedges for whole breast radiotherapy. Regarding partial breast irradiation techniques, low energy source brachytherapy and external beam 3D-CRT appear safer than 192Ir HDR techniques.
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Affiliation(s)
- Jean-Philippe Pignol
- Radiation Oncology Department, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Dosimetric comparison of field in field intensity-modulated radiotherapy technique with conformal radiotherapy techniques in breast cancer. Jpn J Radiol 2010; 28:283-9. [DOI: 10.1007/s11604-010-0423-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 01/21/2010] [Indexed: 11/26/2022]
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Smith W, Menon G, Wolfe N, Ploquin N, Trotter T, Pudney D. IMRT for the breast: a comparison of tangential planning techniques. Phys Med Biol 2010; 55:1231-41. [DOI: 10.1088/0031-9155/55/4/022] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Bhatnagar AK, Beriwal S, Heron DE, Flickinger JC, Deutsch M, Huq MS, Sontag M, Shogan J. Initial Outcomes Analysis for Large Multicenter Integrated Cancer Network Implementation of Intensity Modulated Radiation Therapy for Breast Cancer. Breast J 2009; 15:468-74. [DOI: 10.1111/j.1524-4741.2009.00761.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Richter A, Sweeney R, Baier K, Flentje M, Guckenberger M. Effect of breathing motion in radiotherapy of breast cancer: 4D dose calculation and motion tracking via EPID. Strahlenther Onkol 2009; 185:425-30. [PMID: 19714303 DOI: 10.1007/s00066-009-1980-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 02/12/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the influence of breathing motion in postoperative whole-breast radiotherapy. PATIENTS AND METHODS For ten patients with left-sided breast cancer, radiotherapy treatment plans were generated based on conventional three-dimensional computed tomography (3D CT) studies: two techniques (segmented and wedge-based tangential fields) were compared. The influence of breathing motion on the dose to the target and organs at risk (OARs) was evaluated with four-dimensional (4D) dose calculation based on respiration-correlated CTs. Reproducibility of breathing motion was evaluated with electronic portal images (EPID) acquired in cine mode during treatment. RESULTS Differences in dose distributions were small between segmented and wedge techniques based on 3D studies. Because of small motion amplitude of the chest in the 4D CT studies (1.8 mm +/- 0.9 mm), target coverage was reduced by < 5% due to breathing motion. Differences between 3D and 4D dose calculation were similar for segmented and wedge techniques. Blurring of the dose distribution in 4D dose calculation resulted in lower doses to the OARs. Analysis of EPID movies proved good reproducibility of breathing motion observed in the 4D CT study. CONCLUSION Breathing motion was of minor relevance in postoperative radiotherapy treatment of breast cancer for both segmented and wedge tangential field techniques.
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Affiliation(s)
- Anne Richter
- University of Würzburg, Department of Radiation Oncology, Würzburg, Germany.
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Ares C, Khan S, Macartain AM, Heuberger J, Goitein G, Gruber G, Lutters G, Hug EB, Bodis S, Lomax AJ. Postoperative proton radiotherapy for localized and locoregional breast cancer: potential for clinically relevant improvements? Int J Radiat Oncol Biol Phys 2009; 76:685-97. [PMID: 19615828 DOI: 10.1016/j.ijrobp.2009.02.062] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/23/2009] [Accepted: 02/24/2009] [Indexed: 02/01/2023]
Abstract
PURPOSE To study the potential reduction of dose to organs at risk (OARs) with intensity-modulated proton radiotherapy (IMPT) compared with intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) photon radiotherapy for left-sided breast cancer patients. METHODS AND MATERIALS Comparative treatment-planning was performed using planning computed tomography scans of 20 left-sided breast cancer patients. For each patient, three increasingly complex locoregional volumes (planning target volumes [PTVs]) were defined: whole breast (WB) or chest wall (CW) = (PTV1), WB/CW plus medial-supraclavicular (MSC), lateral-supraclavicular (LSC), and level III axillary (AxIII) nodes = (PTV2) and WB/CW+MSC+LSC+AxIII plus internal mammary chain = (PTV3). For each patient, 3D-CRT, IMRT, and IMPT plans were optimized for PTV coverage. Dose to OARs was compared while maintaining target coverage. RESULTS All the techniques met the required PTV coverage except the 3D-CRT plans for PTV3-scenario. All 3D-CRT plans for PTV3 exceeded left-lung V20. IMPT vs. 3D-CRT: significant dose reductions were observed for all OARs using IMPT for all PTVs. IMPT vs. IMRT: For PTV2 and PTV3, low (V5) left lung and cardiac doses were reduced by a factor >2.5, and cardiac doses (V22.5) were by a factor of >20 lower with IMPT compared with IMRT. CONCLUSIONS When complex-target irradiation is needed, 3D-CRT often compromises the target coverage and increases the dose to OARs; IMRT can provide better results but will increase the integral dose. The benefit of IMPT is based on improved target coverage and reduction of low doses to OARs, potentially reducing the risk of late-toxicity. These results indicate a potential role of proton-radiotherapy for extended locoregional irradiation in left breast cancer.
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Affiliation(s)
- Carmen Ares
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
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Dose Distribution Analysis of Axillary Lymph Nodes for Three-Dimensional Conformal Radiotherapy With a Field-in-Field Technique for Breast Cancer. Int J Radiat Oncol Biol Phys 2009; 73:80-7. [DOI: 10.1016/j.ijrobp.2008.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Revised: 04/08/2008] [Accepted: 04/09/2008] [Indexed: 11/22/2022]
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Morganti AG, Cilla S, Valentini V, Digesu' C, Macchia G, Deodato F, Ferrandina G, Cece MG, Cirocco M, Garganese G, Di Lullo L, Traficante D, Scarabeo F, Panunzi S, De Gaetano A, Sallustio G, Cellini N, Sofo L, Piermattei A, Scambia G. Phase I-II studies on accelerated IMRT in breast carcinoma: technical comparison and acute toxicity in 332 patients. Radiother Oncol 2008; 90:86-92. [PMID: 19010560 DOI: 10.1016/j.radonc.2008.10.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 10/23/2008] [Accepted: 10/23/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the results in terms of dosimetric parameters and acute toxicity of two clinical studies (MARA-1 and MARA-2) on accelerated IMRT-based postoperative radiotherapy. These results are compared with historical control group (CG) of patients treated with "standard" 3D postoperative radiotherapy. MATERIALS AND METHODS Prescribed dose to the breast was 50.4Gy in the CG, 40Gy in MARA-1 (low risk of local recurrence), and 50Gy in MARA-2 (medium-high risk of recurrence). The tumor bed total dose was 60.4Gy (sequential 10Gy electron boost), 44Gy (concomitant 4Gy boost), and 60Gy (concomitant 10Gy boost) in CG, MARA-1 and MARA-2 studies, respectively. Overall treatment time was of 32 fractions for CG (6.4weeks); 16 fractions for MARA-1 study (3.2weeks) and 25 fractions for MARA-2 study (5weeks). RESULTS Three hundred and thirty two patients were included in the analysis. Dosimetric analysis showed D(max) and V(107%) reduction (p<0.001) and D(min) improvement (p<0.001) in the PTV in patients treated with IMRT. Grade 2 acute skin toxicity was 33.6%, 13.1%, and 45.1% in the CG, MARA-1, and MARA-2, respectively (p<0.001), and grade 3 acute skin toxicity was 3.1%, 1.0%, and 2.0%, respectively. Similarly, larger PTV and use of chemotherapy with anthracyclines and taxanes were associated with a greater acute toxicity. With a median follow-up of 31 months, no patients showed local or nodal relapse. CONCLUSIONS A simplified step and shoot IMRT technique allowed better PTV coverage and reduced overall treatment time (CG, 6.6weeks; MARA-1, 3.2weeks; MARA-2, 5weeks) with acceptable short-term toxicity.
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Affiliation(s)
- Alessio G Morganti
- Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
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Ruben JD, Davis S, Evans C, Jones P, Gagliardi F, Haynes M, Hunter A. The Effect of Intensity-Modulated Radiotherapy on Radiation-Induced Second Malignancies. Int J Radiat Oncol Biol Phys 2008; 70:1530-6. [DOI: 10.1016/j.ijrobp.2007.08.046] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 08/26/2007] [Accepted: 08/27/2007] [Indexed: 11/30/2022]
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Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, Vu TTT, Truong P, Ackerman I, Paszat L. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008; 26:2085-92. [PMID: 18285602 DOI: 10.1200/jco.2007.15.2488] [Citation(s) in RCA: 526] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Dermatitis is a frequent adverse effect of adjuvant breast radiotherapy. It is more likely in full-breasted women and when the radiation is distributed nonhomogeneously in the breast. Breast intensity-modulated radiation therapy (IMRT) is a technique that ensures a more homogeneous dose distribution. PATIENTS AND METHODS A multicenter, double-blind, randomized clinical trial was performed to test if breast IMRT would reduce the rate of acute skin reaction (notably moist desquamation), decrease pain, and improve quality of life compared with standard radiotherapy using wedges. Patients were assessed each week during and up to 6 weeks after radiotherapy. RESULTS A total of 358 patients were randomly assigned between July 2003 and March 2005 in two Canadian centers, and 331 were included in the analysis. Breast IMRT significantly improved the dose distribution compared with standard radiation. This translated into a lower proportion of patients experiencing moist desquamation during or up to 6 weeks after their radiation treatment; 31.2% with IMRT compared with 47.8% with standard treatment (P = .002). A multivariate analysis found the use of breast IMRT (P = .003) and smaller breast size (P < .001) were significantly associated with a decreased risk of moist desquamation. The use of IMRT did not correlate with pain and quality of life, but the presence of moist desquamation did significantly correlate with pain (P = .002) and a reduced quality of life (P = .003). CONCLUSION Breast IMRT significantly reduced the occurrence of moist desquamation compared with a standard wedged technique. Moist desquamation was correlated with increased pain and reduction in the quality of life.
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Affiliation(s)
- Jean-Philippe Pignol
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre T2-144, 2075, Bayview Ave, Toronto, Ontario, M4N 3M5 Canada.
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Abstract
PURPOSE OF REVIEW New radiotherapy techniques are under development to improve tumor control and to decrease the long-term side effects of breast cancer. These include accelerated partial breast irradiation, intensity modulated and image guided radiotherapy. RECENT FINDINGS Follow-up data of multicatheter brachytherapy accelerated partial breast irradiation and intraoperative electron beam radiotherapy confirm excellent 5-year local control rates in well selected patients. Early side effects seem to be improved, but recent data show increasing skin toxicity in multicatheter and intracavitary balloon brachytherapy. Intraoperative radiotherapy, proton beam partial breast irradiation, intensity modulated and image guided radiotherapy improve dose homogeneity and decrease normal tissue complication probability. For breast-only treatment, two tangential fields with different segments provide an attractive and feasible alternative to the conventional technique. The proposed intensity modulated radiotherapy techniques for comprehensive locoregional radiotherapy, however, result in increased doses to the contralateral lung and breast. SUMMARY Input from long-term clinical data on new radiotherapy techniques is needed. Consensus on target volume contouring and dose volume constraints for nontarget tissue has not yet been reached. Further research on skin toxicity with multicatheter or intracavitary brachytherapy is needed to improve the results.
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Affiliation(s)
- Erik Van Limbergen
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium.
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Harrison RM, Wilkinson M, Rawlings DJ, Moore M. Doses to critical organs following radiotherapy and concomitant imaging of the larynx and breast. Br J Radiol 2008; 80:989-95. [PMID: 18065644 DOI: 10.1259/bjr/32814323] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The development of conformal radiotherapy carries with it the implication of an increased number of imaging procedures at various stages throughout the overall treatment, principally for verification at some, or all, of the treatment fractions. This raises the issue of the balance between the benefit of these additional imaging exposures and the associated risk of radiocarcinogenesis arising from them. As such, it is necessary to appreciate the doses to critical organs for which individual carcinogenic risks have been estimated. In this study, doses to these organs have been measured with lithium fluoride thermoluminescence dosimetry loaded in anthropomorphic phantoms and subjected to realistic radiotherapy treatments of the larynx and breast, including concomitant CT and electronic portal imaging exposures associated with localization and verification of these treatments. Even for large numbers of concomitant images of either modality, arising from imaging at every fraction, the leakage and scatter from the radiotherapy itself is shown to dominate the overall organ dose, with imaging procedures generally contributing 5-20% of the total organ dose.
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Affiliation(s)
- R M Harrison
- Regional Medical Physics Department, Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UK.
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Selvaraj RN, Beriwal S, Pourarian RJ, Lalonde RJ, Chen A, Mehta K, Brunner G, Wagner KA, Yue NJ, Huq SM, Heron DE. Clinical Implementation of Tangential Field Intensity Modulated Radiation Therapy (IMRT) Using Sliding Window Technique and Dosimetric Comparison with 3D Conformal Therapy (3DCRT) in Breast Cancer. Med Dosim 2007; 32:299-304. [DOI: 10.1016/j.meddos.2007.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 03/06/2007] [Accepted: 03/09/2007] [Indexed: 10/22/2022]
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Jamema SV, Sharma PK, Laskar S, Deshpande DD, Shrivastava SK. Treatment planning comparison of electron arc therapy and photon intensity modulated radiotherapy for Askin’s tumor of chest wall. Radiother Oncol 2007; 84:257-65. [PMID: 17719111 DOI: 10.1016/j.radonc.2007.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 07/16/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE A dosimetric study to quantitatively compare radiotherapy treatment plans for Askin's tumor using Electron Arc (EA) vs. photon Intensity Modulated Radiotherapy (IMRT). MATERIALS AND METHODS Five patients treated with EA were included in this study. Treatment plans were generated for each patient using EA and IMRT. Plans were compared using dose volume histograms (DVH) of the Planning Target Volume (PTV) and Organs at Risk (OAR). RESULTS IMRT resulted in superior PTV coverage, and homogeneous dose distribution compared to EA. For EA, 92% of the PTV was covered to 85% of the dose compared to IMRT in which 96% was covered to 95% of the dose. V(107) that represents the hot spot within the PTV was more in IMRT compared to EA: 7.4(+/-2)% vs. 3(+/-0.5)%, respectively. With PTVs located close to the spinal cord (SC), the dose to SC was more with EA, whereas for PTVs located away from the SC, the dose to SC was more with IMRT. The cardiac dose profile was similar to that of SC. Ipsilateral lung received lower doses with IMRT while contralateral lung received higher dose with IMRT compared to EA. For non-OAR normal tissues, IMRT resulted in large volumes of low dose regions. CONCLUSIONS IMRT resulted in superior PTV coverage and sparing of OAR compared to EA plans. Although IMRT seems to be superior to EA, one needs to keep in mind the volume of low dose regions associated with IMRT, especially while treating young children.
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Affiliation(s)
- Swamidas V Jamema
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, India.
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DeWyngaert JK, Jozsef G, Mitchell J, Rosenstein B, Formenti SC. Accelerated Intensity-Modulated Radiotherapy to Breast in Prone Position: Dosimetric Results. Int J Radiat Oncol Biol Phys 2007; 68:1251-9. [PMID: 17637396 DOI: 10.1016/j.ijrobp.2007.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 03/30/2007] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the physics and dosimetry results of a trial of accelerated intensity-modulated radiotherapy to the whole breast with a concomitant boost to the tumor bed in patients treated in the prone position. METHODS AND MATERIALS Patients underwent computed tomography planning and treatment in the prone position on a dedicated treatment platform. The platform has an open aperture on the side to allow for the index breast to fall away from the chest wall. Noncontrast computed tomography images were acquired at 2.5- or 3.75-mm-thick intervals, from the level of the mandible to below the diaphragm. A dose of 40.5 Gy was delivered to the entire breast at 2.7-Gy fractions in 15 fractions. An additional dose of 0.5 Gy was delivered as a concomitant boost to the lumpectomy site, with a 1-cm margin, using inverse planning, for a total dose of 48 Gy in 15 fractions. No more than 10% of the heart and lung volume was allowed to receive >18 and >20 Gy, respectively. RESULTS Between September 2003 and August 2005, 91 patients were enrolled in the study. The median volume of heart that received > or =18 Gy was 0.5%, with a maximal value of 4.7%. The median volume of ipsilateral lung that received > or =20 Gy was 0.8%, with a maximum of 7.2%. CONCLUSION This technique for whole breast radiotherapy is feasible and enables an accelerated regimen in the prone position while sparing the lung and heart.
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Affiliation(s)
- J Keith DeWyngaert
- Department of Radiation Oncology, New York University School of Medicine, 160 E. 34th Street, New York, NY 10016, USA. /edu
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Wilking N, Lidbrink E, Wiklund T, Erikstein B, Lindman H, Malmström P, Kellokumpu-Lehtinen P, Bengtsson NO, Söderlund G, Anker G, Wist E, Ottosson S, Salminen E, Ljungman P, Holte H, Nilsson J, Blomqvist C, Bergh J. Long-term follow-up of the SBG 9401 study comparing tailored FEC-based therapy versus marrow-supported high-dose therapy. Ann Oncol 2007; 18:694-700. [PMID: 17301072 DOI: 10.1093/annonc/mdl488] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose was to investigate adjuvant marrow-supportive high-dose chemotherapy compared with an equitoxicity-tailored comparator arm. PATIENTS AND METHODS Five hundred and twenty-five women below the age of 60 years with operated high-risk primary breast cancer were randomised to nine cycles of granulocyte colony-stimulating factor supported and individually tailored FEC (5-fluorouracil, epirubicin, cyclophosphamide), (n = 251) or standard FEC followed by marrow-supported high-dose therapy with CTCb (cyclophosphamide, thiotepa, carboplatin) therapy (n = 274), followed by locoregional radiotherapy and tamoxifen for 5 years. RESULTS There were 104 breast cancer relapses in the tailored FEC group versus 139 in the CTCb group (double triangular method by Whitehead, P = 0.046), with a median follow-up of all included patients of 60.8 months. The event-free survival demonstrated 121 and 150 events in the tailored FEC- and CTCb group, respectively [P = 0.074, hazard ratio (HR) 0.804, 95% confidence interval (CI) 0.633-1.022]. Ten patients in the tailored FEC regimen developed acute myeloid leukaemia (AML)/myelodysplasia (MDS). One hundred deaths occurred in the tailored FEC group and 121 in the CTCb group (P = 0.287, HR 0.866, 95% CI 0.665-1.129). CONCLUSION The update of this study shows an improved outcome linked to the tailored FEC treatment in relation to breast cancer relapse, but also an increased incidence of AML/MDS.
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Affiliation(s)
- N Wilking
- Department of Oncology, Karolinska Institutet, S-171 76 Stockholm, Sweden
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Weber DC, Ares C, Lomax AJ, Kurtz JM. Radiation therapy planning with photons and protons for early and advanced breast cancer: an overview. Radiat Oncol 2006; 1:22. [PMID: 16857055 PMCID: PMC1553457 DOI: 10.1186/1748-717x-1-22] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 07/20/2006] [Indexed: 11/26/2022] Open
Abstract
Postoperative radiation therapy substantially decreases local relapse and moderately reduces breast cancer mortality, but can be associated with increased late mortality due to cardiovascular morbidity and secondary malignancies. Sophistication of breast irradiation techniques, including conformal radiotherapy and intensity modulated radiation therapy, has been shown to markedly reduce cardiac and lung irradiation. The delivery of more conformal treatment can also be achieved with particle beam therapy using protons. Protons have superior dose distributional qualities compared to photons, as dose deposition occurs in a modulated narrow zone, called the Bragg peak. As a result, further dose optimization in breast cancer treatment can be reasonably expected with protons. In this review, we outline the potential indications and benefits of breast cancer radiotherapy with protons. Comparative planning studies and preliminary clinical data are detailed and future developments are considered.
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Affiliation(s)
- Damien C Weber
- Department of Radiation Medicine, Paul Scherrer Institute, Villigen-PSI, Switzerland
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Carmen Ares
- Department of Radiation Medicine, Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - Antony J Lomax
- Department of Radiation Medicine, Paul Scherrer Institute, Villigen-PSI, Switzerland
| | - John M Kurtz
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
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