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Sanklaa K, Pitikiattikul C, Rittiwong M, Thiamthan N, Turathong S, Sanghangthum T. Surface dose measurement by optically stimulated luminescent dosimeter: A phantom study. Radiography (Lond) 2024; 30:1405-1410. [PMID: 38955646 DOI: 10.1016/j.radi.2024.06.011] [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: 08/22/2023] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Radiotherapy is the standard treatment for breast cancer patients after surgery. However, radiotherapy can cause side effects such as dry and moist desquamation of the patient's skin. The dose calculation from a treatment planning system (TPS) might also be inaccurate. The purpose of this study is to measure the surface dose on the CIRS thorax phantom by an optically stimulated luminescent dosimeter (OSLD). METHODS The characteristics of OSLD were studied in terms of dose linearity, reproducibility, and angulation dependence on the solid water phantom. To determine the surface dose, OSLD (Landauer lnc., USA) was placed on 5 positions at the CIRS phantom (Tissue Simulation and Phantom Technology, USA). The five positions were at the tip, medial, lateral, tip-medial, and tip-lateral. Then, the doses from OSLD and TPS were compared. RESULTS The dosimeter's characteristic test was good. The maximum dose at a depth of 15 mm was 514.46 cGy, which was at 100%. The minimum dose at the surface was 174.91 cGy, which was at 34%. The results revealed that the surface dose from TPS was less than the measurement. The percent dose difference was -2.17 ± 6.34, -12.08 ± 3.85, and -48.71 ± 1.29 at the tip, medial, and lateral positions, respectively. The surface dose from TPS at tip-medial and tip-lateral was higher than the measurement, which was 12.56 ± 5.55 and 10.45 ± 1.76 percent dose different, respectively. CONCLUSION The percent dose difference is within the acceptable limit, except for the lateral position because of the body curvature. However, OSLD is convenient to assess the radiation dose, and further study is to measure in vivo. IMPLICATION FOR PRACTICE The OSL NanoDot dosimeter can be used for dose validation with a constant setup location. The measurement dose is higher than the dose from TPS, except for some tilt angles.
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Affiliation(s)
- K Sanklaa
- Department of Radiological Technology, Faculty of Allied Health Sciences, Thammasat University, Thailand.
| | - C Pitikiattikul
- Department of Radiological Technology, Faculty of Allied Health Sciences, Thammasat University, Thailand
| | - M Rittiwong
- Department of Radiological Technology, Faculty of Allied Health Sciences, Thammasat University, Thailand
| | - N Thiamthan
- Department of Radiological Technology, Faculty of Allied Health Sciences, Thammasat University, Thailand
| | - S Turathong
- Department of Radiology, Thammasat University Hospital, Thailand
| | - T Sanghangthum
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Thailand
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Recht A. Internal Mammary Node Irradiation Debate: Case Closed? Not Yet, and Maybe Never. J Clin Oncol 2024; 42:1871-1874. [PMID: 38498804 DOI: 10.1200/jco.23.02480] [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: 11/16/2023] [Revised: 01/03/2024] [Accepted: 02/05/2024] [Indexed: 03/20/2024] Open
Abstract
The IMN debate is still open and may never be closed for reasons outlined in this Comments and Controversies piece.
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Affiliation(s)
- Abram Recht
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Valiyaveettil D, Joseph D, Malik M. Cardiotoxicity in breast cancer treatment: Causes and mitigation. Cancer Treat Res Commun 2023; 37:100760. [PMID: 37714054 DOI: 10.1016/j.ctarc.2023.100760] [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: 07/02/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
Survivorship issues and treatment related toxicities have considerably increased in breast cancer patients following improved therapeutic options. Cardiotoxicity has been a major treatment related side effects in these patients. Despite this being a well-known entity, the real magnitude of the problem remains an enigma. The amount of research in mitigation of cardiotoxicity or its management in breast cancer survivors is limited and there is an urgent need for finding solutions for the problem. In this article, we are reviewing the agents that cause cardiotoxicity and suggesting a proposal for follow up of breast cancer survivors in an attempt to reduce the magnitude of impact on their quality of life.
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Affiliation(s)
| | - Deepa Joseph
- Department of Radiation Oncology, All India Institute of Medical sciences, Rishikesh, India.
| | - Monica Malik
- Nizam's Institute of Medical sciences, Hyderabad, India
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Chapman CH, Jagsi R, Griffith KA, Moran JM, Vicini F, Walker E, Dominello M, Abu-Isa E, Hayman J, Laucis AM, Mietzel M, Pierce L. Mediators of Racial Disparities in Heart Dose Among Whole Breast Radiotherapy Patients. J Natl Cancer Inst 2022; 114:1646-1655. [PMID: 35916737 PMCID: PMC9949587 DOI: 10.1093/jnci/djac120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 06/09/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Racial disparities in survival of patients with cancer motivate research to quantify treatment disparities and evaluate multilevel determinants. Previous research has not evaluated cardiac radiation dose in large cohorts of breast cancer patients by race nor examined potential causes or implications of dose disparities. METHODS We used a statewide consortium database to consecutively sample 8750 women who received whole breast radiotherapy between 2012 and 2018. We generated laterality- and fractionation-specific models of mean heart dose. We generated patient- and facility-level models to estimate race-specific cardiac doses. We incorporated our data into models to estimate disparities in ischemic cardiac event development and death. All statistical tests were 2-sided. RESULTS Black and Asian race independently predicted higher mean heart dose for most laterality-fractionation groups, with disparities of up to 0.42 Gy for Black women and 0.32 Gy for Asian women (left-sided disease and conventional fractionation: 2.13 Gy for Black women vs 1.71 Gy for White women, P < .001, 2-sided; left-sided disease and accelerated fractionation: 1.59 Gy for Asian women vs 1.27 Gy for White women, P = .002). Patient clustering within facilities explained 22%-30% of the variability in heart dose. The cardiac dose disparities translated to estimated excesses of up to 2.6 cardiac events and 1.3 deaths per 1000 Black women and 0.7 cardiac events and 0.3 deaths per 1000 Asian women vs White women. CONCLUSIONS Depending on laterality and fractionation, Asian women and Black women experience higher cardiac doses than White women. This may translate into excess radiation-associated ischemic cardiac events and deaths. Solutions include addressing inequities in baseline cardiac risk factors and facility-level availability and use of radiation technologies.
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Affiliation(s)
- Christina Hunter Chapman
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA,Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Reshma Jagsi
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Kent A Griffith
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Jean M Moran
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Eyad Abu-Isa
- Ascension Providence Hospital, Southfield, MI, USA
| | - James Hayman
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Anna M Laucis
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Melissa Mietzel
- Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI, USA
| | - Lori Pierce
- Correspondence to: Lori J. Pierce, MD, University of Michigan Rogel Comprehensive Cancer Center, Rm 4308, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA (e-mail: )
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Badescu MC, Badulescu OV, Scripcariu DV, Butnariu LI, Bararu-Bojan I, Popescu D, Ciocoiu M, Gorduza EV, Costache II, Rezus E, Rezus C. Myocardial Ischemia Related to Common Cancer Therapy-Prevention Insights. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071034. [PMID: 35888122 PMCID: PMC9325217 DOI: 10.3390/life12071034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 12/18/2022]
Abstract
Modern antineoplastic therapy improves survival and quality of life in cancer patients, but its indisputable benefits are accompanied by multiple and major side effects, such as cardiovascular ones. Endothelial dysfunction, arterial spasm, intravascular thrombosis, and accelerated atherosclerosis affect the coronary arteries, leading to acute and chronic coronary syndromes that negatively interfere with the oncologic treatment. The cardiac toxicity of antineoplastic agents may be mitigated by using adequate prophylactic measures. In the absence of dedicated guidelines, our work provides the most comprehensive, systematized, structured, and up-to-date analyses of the available literature focusing on measures aiming to protect the coronary arteries from the toxicity of cancer therapy. Our work facilitates the implementation of these measures in daily practice. The ultimate goal is to offer clinicians the necessary data for a personalized therapeutic approach for cancer patients receiving evidence-based oncology treatments with potential cardiovascular toxicity.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Dragos Viorel Scripcariu
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- 1st Surgical Oncology Unit, Regional Institute of Oncology, 2-4 General Henri Mathias Berthelot Street, 700483 Iasi, Romania
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Lăcrămioara Ionela Butnariu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Correspondence: (O.V.B.); (D.V.S.); (L.I.B.)
| | - Iris Bararu-Bojan
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (I.B.-B.); (M.C.)
| | - Eusebiu Vlad Gorduza
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Irina Iuliana Costache
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- Cardiology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (I.I.C.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Chen CP, Lin CY, Kuo CC, Chen TH, Lin SC, Tseng KH, Cheng HW, Chao HL, Yen SH, Lin RY, Feng CJ, Lu LS, Chiou JF, Hsu SM. Skin Surface Dose for Whole Breast Radiotherapy Using Personalized Breast Holder: Comparison with Various Radiotherapy Techniques and Clinical Experiences. Cancers (Basel) 2022; 14:cancers14133205. [PMID: 35804977 PMCID: PMC9264904 DOI: 10.3390/cancers14133205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: Breast immobilization with personalized breast holder (PERSBRA) is a promising approach for normal organ protection during whole breast radiotherapy. The aim of this study is to evaluate the skin surface dose for breast radiotherapy with PERSBRA using different radiotherapy techniques. Materials and methods: We designed PERSBRA with three different mesh sizes (large, fine and solid) and applied them on an anthropomorphic(Rando) phantom. Treatment planning was generated using hybrid, intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques to deliver a prescribed dose of 5000 cGy in 25 fractions accordingly. Dose measurement with EBT3 film and TLD were taken on Rando phantom without PERSBRA, large mesh, fine mesh and solid PERSBRA for (a) tumor doses, (b) surface doses for medial field and lateral field irradiation undergoing hybrid, IMRT, VMAT techniques. Results: The tumor dose deviation was less than five percent between the measured doses of the EBT3 film and the TLD among the different techniques. The application of a PERSBRA was associated with a higher dose of the skin surface. A large mesh size of PERSBRA was associated with a lower surface dose. The findings were consistent among hybrid, IMRT, or VMAT techniques. Conclusions: Breast immobilization with PERSBRA can reduce heart toxicity but leads to a build-up of skin surface doses, which can be improved with a larger mesh design for common radiotherapy techniques.
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Affiliation(s)
- Chiu-Ping Chen
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
| | - Chi-Yeh Lin
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
| | - Chia-Chun Kuo
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei 110, Taiwan
| | - Tung-Ho Chen
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
| | - Shao-Chen Lin
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan;
| | - Kuo-Hsiung Tseng
- Department of Electrical Engineering, National Taipei University of Technology, Taipei 10608, Taiwan;
| | - Hao-Wen Cheng
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan;
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsing-Lung Chao
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Sang-Hue Yen
- Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan; (C.-P.C.); (C.-Y.L.); (C.-C.K.); (H.-L.C.); (S.-H.Y.)
| | - Ruo-Yu Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
| | - Chen-Ju Feng
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
| | - Long-Sheng Lu
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan;
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
- International Ph.D. Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Jeng-Fong Chiou
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (L.-S.L.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (J.-F.C.); (S.-M.H.)
| | - Shih-Ming Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (R.-Y.L.); (C.-J.F.)
- Correspondence: (J.-F.C.); (S.-M.H.)
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Maliko N, Stam MR, Boersma LJ, Vrancken Peeters MJTFD, Wouters MWJM, KleinJan E, Mulder M, Essers M, Hurkmans CW, Bijker N. Transparency in quality of radiotherapy for breast cancer in the Netherlands: a national registration of radiotherapy-parameters. Radiat Oncol 2022; 17:73. [PMID: 35413924 PMCID: PMC9003170 DOI: 10.1186/s13014-022-02043-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Radiotherapy (RT) is part of the curative treatment of approximately 70% of breast cancer (BC) patients. Wide practice variation has been reported in RT dose, fractionation and its treatment planning for BC. To decrease this practice variation, it is essential to first gain insight into the current variation in RT treatment between institutes. This paper describes the development of the NABON Breast Cancer Audit-Radiotherapy (NBCA-R), a structural nationwide registry of BC RT data of all BC patients treated with at least surgery and RT. Methods A working group consisting of representatives of the BC Platform of the Dutch Radiotherapy Society selected a set of dose volume parameters deemed to be surrogate outcome parameters, both for tumour control and toxicity. Two pilot studies were carried out in six RT institutes. In the first pilot study, data were manually entered into a secured web-based system. In the second pilot study, an automatic Digital Imaging and Communications in Medicine (DICOM) RT upload module was created and tested. Results The NBCA-R dataset was created by selecting RT parameters describing given dose, target volumes, coverage and homogeneity, and dose to organs at risk (OAR). Entering the data was made mandatory for all Dutch RT departments. In the first pilot study (N = 1093), quite some variation was already detected. Application of partial breast irradiation varied from 0 to 17% between the 6 institutes and boost to the tumour bed from 26.5 to 70.2%. For patients treated to the left breast or chest wall only, the average mean heart dose (MHD) varied from 0.80 to 1.82 Gy; for patients treated to the breast/chest wall only, the average mean lung dose (MLD) varied from 2.06 to 3.3 Gy. In the second pilot study 6 departments implemented the DICOM-RT upload module in daily practice. Anonymised data will be available for researchers via a FAIR (Findable, Accessible, Interoperable, Reusable) framework. Conclusions We have developed a set of RT parameters and implemented registration for all Dutch BC patients. With the use of an automated upload module registration burden will be minimized. Based on the data in the NBCA-R analyses of the practice variation will be done, with the ultimate aim to improve quality of BC RT. Trial registration Retrospectively registered.
Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02043-0.
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Affiliation(s)
- Nansi Maliko
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Marie-Jeanne T F D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Surgery, AmsterdamUMC, Amsterdam, the Netherlands
| | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute/Antoni Van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eline KleinJan
- Trusted Third Party, Medical Research Data Management, Deventer, The Netherlands
| | - Maurice Mulder
- Trusted Third Party, Medical Research Data Management, Deventer, The Netherlands
| | | | - Coen W Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Nina Bijker
- Department of Radiation Oncology, AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Ambrose L, Stanton C, Lewis L, Lamoury G, Morgia M, Carroll S, Bromley R, Atyeo J. Potential gains: Comparison of a mono-isocentric three-dimensional conformal radiotherapy (3D-CRT) planning technique to hybrid intensity-modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region. J Med Radiat Sci 2022; 69:75-84. [PMID: 33955205 PMCID: PMC8892437 DOI: 10.1002/jmrs.473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 04/01/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Until late 2018, standard of practice at the Northern Sydney Cancer Centre (NSCC) for breast and nodal treatment was a conformal mono-isocentric technique. A planning study comparing an existing mono-isocentric three-dimensional conformal radiotherapy (3D-CRT) planning technique to a hybrid intensity-modulated radiotherapy (hIMRT) approach for the whole breast and supraclavicular fossa (SCF) region was undertaken with the aim to improve plan quality by improving dose conformity/homogeneity across target volumes and reducing hotspots outside the target. METHODS A cohort of 17 patients was retrospectively planned using the proposed hIMRT technique, keeping the same planning constraints as the original treated breast and SCF 3D-CRT plan and normalising the 3D-CRT plans to achieve minimum breast/SCF target coverage to compare organs at risk (OARs). Normal tissue index (NTI) and homogeneity index (HI) were compared for plan quality as well as for evaluating OARs. RESULTS The hIMRT technique showed statistically significant improvements in NTI and HI, as well as improvement in maximum brachial plexus and thyroid doses. There was a negligible increase in maximum oesophagus dose which could be improved if used in optimisation. Other OAR doses in the irradiated region were comparable to the 3D-CRT plans, however maximum doses were reduced overall. CONCLUSION The hIMRT planning technique maintained clinically acceptable doses to OARs and reduced normal tissue dose while maintaining equivalent dose coverage to breast and SCF planning target volumes with improved conformity and homogeneity. The reduction in maximum doses promotes a favourable toxicity profile, with potential benefit of improved long-term cosmesis.
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Affiliation(s)
- Leigh Ambrose
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
| | - Cameron Stanton
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
| | - Lorraine Lewis
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
| | - Gillian Lamoury
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNSWAustralia
| | - Marita Morgia
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
| | - Susan Carroll
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNSWAustralia
| | - Regina Bromley
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
| | - John Atyeo
- Department of Radiation OncologyNorthern Sydney Cancer CentreRoyal North Shore HospitalSt LeonardsNSWAustralia
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Jagsi R, Griffith KA, Moran JM, Matuszak MM, Marsh R, Grubb M, Abu-Isa E, Dilworth JT, Dominello MM, Heimburger D, Lack D, Walker EM, Hayman JA, Vicini F, Pierce LJ. Comparative Effectiveness Analysis of 3D-Conformal Radiation Therapy Versus Intensity Modulated Radiation Therapy (IMRT) in a Prospective Multicenter Cohort of Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2022; 112:643-653. [PMID: 34634437 DOI: 10.1016/j.ijrobp.2021.09.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Simple intensity modulation of radiation therapy reduces acute toxicity compared with 2-dimensional techniques in adjuvant breast cancer treatment, but it remains unknown whether more complex or inverse-planned intensity modulated radiation therapy (IMRT) offers an advantage over forward-planned, 3-dimensional conformal radiation therapy (3DCRT). METHODS AND MATERIALS Using prospective data regarding patients receiving adjuvant whole breast radiation therapy without nodal irradiation at 23 institutions from 2011 to 2018, we compared the incidence of acute toxicity (moderate-severe pain or moist desquamation) in patients receiving 3DCRT versus IMRT (either inverse planned or, if forward-planned, using ≥5 segments per gantry angle). We evaluated associations between technique and toxicity using multivariable models with inverse-probability-of-treatment weighting, adjusting for treatment facility as a random effect. RESULTS Of 1185 patients treated with 3DCRT and conventional fractionation, 650 (54.9%) experienced acute toxicity; of 774 treated with highly segmented forward-planned IMRT, 458 (59.2%) did; and of 580 treated with inverse-planned IMRT, 245 (42.2%) did. Of 1296 patients treated with hypofractionation and 3DCRT, 432 (33.3%) experienced acute toxicity; of 709 treated with highly segmented forward-planned IMRT, 227 (32.0%) did; and of 623 treated with inverse-planned IMRT, 164 (26.3%) did. On multivariable analysis with inverse-probability-of-treatment weighting, the odds ratio for acute toxicity after inverse-planned IMRT versus 3DCRT was 0.64 (95% confidence interval, 0.45-0.91) with conventional fractionation and 0.41 (95% confidence interval, 0.26-0.65) with hypofractionation. CONCLUSIONS This large, prospective, multicenter comparative effectiveness study found a significant benefit from inverse-planned IMRT compared with 3DCRT in reducing acute toxicity of breast radiation therapy. Future research should identify the dosimetric differences that mediate this association and evaluate cost-effectiveness.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan.
| | - Kent A Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Margaret Grubb
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Eyad Abu-Isa
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Providence Ascension, Novi, Michigan
| | - Joshua T Dilworth
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Michael M Dominello
- Department of Radiation Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan
| | - David Heimburger
- Department of Radiation Oncology, Munson Healthcare, Traverse City, Michigan
| | - Danielle Lack
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - James A Hayman
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Frank Vicini
- Department of Radiation Oncology, GenesisCare, Farmington Hills, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
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10
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Jezierska K, Macała A, Krzyminiewski R, Woźniak P, Łukowiak M, Sękowska-Namiotko A, Podraza W. High Signal Resolution Pulse Oximetry as a Prognostic Indicator of Radiotherapy Toxicity: A Pilot Study. Pulse (Basel) 2022; 9:83-88. [PMID: 35083174 DOI: 10.1159/000519100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Radiotherapy plays a prominent role in the multidisciplinary treatment of cancers. Despite new irradiation techniques, radiation-induced cardiotoxicity remains a leading cause of morbidity and mortality. Therefore, prognostic indicators of radiotherapy toxicity are essential. This study aimed to investigate the influence of applied radiotherapy on the pulse wave recording and thereby on cardiovascular health, as well as to assess whether high signal resolution (HSR) pulse oximetry could be used as a prognostic indicator of radiotherapy toxicity. Methods A total of 19 patients treated with radiotherapy to the lung or left breast were analyzed. Pulse oximetry was performed on all eligible patients (before and after the administration of a radiation dose) using the PULS-HSR program, which increases the resolution of the pulse wave recording. Results Among the analyzed variables, we found the total dose administered to the target, as well as the treatment duration, significantly positively correlated with the change in ventricle/aorta volume ratio. The ventricle/aorta volume ratio parameter is the ratio between the area under the HSR pulse wave generated by the contraction of the left ventricle until the aortic valve closes and the area of the HSR pulse wave responsible for expansion and contraction of the aorta. Conclusion The pilot study indicates HSR pulse oximetry, especially the ventricle/aorta volume ratio parameter, as a potential prognostic indicator of toxicity from radiation for breast and lung cancers.
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Affiliation(s)
- Karolina Jezierska
- Department of Medical Physics, Pomeranian Medical University, Szczecin, Poland
| | - Agnieszka Macała
- Department of Medical Physics, West Pomeranian Oncology Center, Szczecin, Poland
| | | | - Piotr Woźniak
- Department of Medical Physics, West Pomeranian Oncology Center, Szczecin, Poland
| | - Magdalena Łukowiak
- Department of Medical Physics, West Pomeranian Oncology Center, Szczecin, Poland
| | - Anna Sękowska-Namiotko
- Department of Metrology and Optoelectronics, Gdańsk University of Technology, Gdańsk, Poland
| | - Wojciech Podraza
- Department of Medical Physics, Pomeranian Medical University, Szczecin, Poland
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11
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Rudra S, Roy A, Brenneman R, Gabani P, Roach MC, Ochoa L, Prather H, Appleton C, Margenthaler J, Peterson LL, Bagegni NA, Zoberi JE, Garcia-Ramirez J, Thomas MA, Zoberi I. Radiation-Induced Brachial Plexopathy in Patients With Breast Cancer Treated With Comprehensive Adjuvant Radiation Therapy. Adv Radiat Oncol 2020; 6:100602. [PMID: 33665488 PMCID: PMC7897772 DOI: 10.1016/j.adro.2020.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/15/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Our purpose was to describe the risk of radiation-induced brachial plexopathy (RIBP) in patients with breast cancer who received comprehensive adjuvant radiation therapy (RT). Methods and Materials Records for 498 patients who received comprehensive adjuvant RT (treatment of any residual breast tissue, the underlying chest wall, and regional nodes) between 2004 and 2012 were retrospectively reviewed. All patients were treated with conventional 3 to 5 field technique (CRT) until 2008, after which intensity modulated RT (IMRT) was introduced. RIBP events were determined by reviewing follow-up documentation from oncologic care providers. Patients with RIBP were matched (1:2) with a control group of patients who received CRT and a group of patients who received IMRT. Dosimetric analyses were performed in these patients to determine whether there were differences in ipsilateral brachial plexus dose distribution between RIBP and control groups. Results Median study follow-up was 88 months for the overall cohort and 92 months for the IMRT cohort. RIBP occurred in 4 CRT patients (1.6%) and 1 IMRT patient (0.4%) (P = .20). All patients with RIBP in the CRT cohort received a posterior axillary boost. Maximum dose to the brachial plexus in RIBP, CRT control, and IMRT control patients had median values of 56.0 Gy (range, 49.7-65.1), 54.8 Gy (47.4-60.5), and 54.8 Gy (54.2-57.3), respectively. Conclusions RIBP remains a rare complication of comprehensive adjuvant breast radiation and no clear dosimetric predictors for RIBP were identified in this study. The IMRT technique does not appear to adversely affect the development of this late toxicity.
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Affiliation(s)
- Soumon Rudra
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Randall Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Prashant Gabani
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Michael C Roach
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Laura Ochoa
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Heidi Prather
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.,Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine Appleton
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lindsay L Peterson
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Nusayba A Bagegni
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
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12
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Kim L, Loccoh EC, Sanchez R, Ruz P, Anaba U, Williams TM, Slivnick J, Vallakati A, Baliga R, Ayan A, Miller ED, Addison D. Contemporary Understandings of Cardiovascular Disease After Cancer Radiotherapy: a Focus on Ischemic Heart Disease. Curr Cardiol Rep 2020; 22:151. [PMID: 32964267 DOI: 10.1007/s11886-020-01380-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Radiation-induced cardiovascular disease, including coronary artery disease, is a well-known sequela of radiation therapy and represents a significant source of morbidity and mortality for cancer survivors. This review examines current literature and guidelines to care for this growing population of cancer survivors. RECENT FINDINGS The development of radiation-induced ischemic heart disease following radiation can lead even to early cardiotoxicities, inclusive of coronary artery disease, which limit cancer treatment outcomes. These coronary lesions tend to be diffuse, complex, and proximal. Early detection with multimodality imaging and targeted intervention is required to minimize these risks. Early awareness, detection, and management of radiation-induced cardiovascular disease are paramount as cancer survivorship continues to grow.
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Affiliation(s)
- Lisa Kim
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Emefah C Loccoh
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Reynaldo Sanchez
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Patrick Ruz
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Uzoma Anaba
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jeremy Slivnick
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Ajay Vallakati
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Ragavendra Baliga
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Ahmet Ayan
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Eric D Miller
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA.
- Division of Cancer Control and Prevention, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA.
- Division of Cardiology, The Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, 473 W. 12th Ave., Columbus, OH, 43210, USA.
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13
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Nehmeh SA, Fox JJ, Schwartz J, Ballangrud ÅM, Schöder H, Zhao Y, Strauss HW, Yu A, Gupta D, Powell SN, Ho AY. A pilot study of 13N-ammonia cardiac PET imaging to assess subacute cardiotoxicity following adjuvant intensity-modulated radiotherapy for locally advanced breast cancer. Clin Imaging 2020; 68:283-290. [PMID: 32919154 DOI: 10.1016/j.clinimag.2020.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/18/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE (1) Assess the feasibility of 13 N-ammonia cardiac PET (13 N-ammonia-PET) imaging in radiotherapy (RT) treatment position in locally-advanced breast cancer (LABC) patients. (2) Correlate pre-/post-RT changes in myocardial flow reserve (MFR) with the corresponding radiation heart dose. METHODS Ten left-sided LABC patients undergoing Volumetric Modulated-Arc-Therapy (VMAT) to chest wall and regional lymph nodes underwent a rest/stress 13 N-ammonia-PET at baseline and (median) 13 months post-RT. Changes in cardiac functions and coronary artery Ca2+ scoring between baseline and follow-up were correlated with average RT dose to the myocardium,3 coronary territories, and 17 myocardial segments. RESULTS Eight (of 10) patients successfully completed the study. The average rest (stress) global MBF (ml.g-1.min-1) for baseline (follow-up) were 0.83 ± 0.25 (2.4 ± 0.79) and 0.92 ± 0.30 (2.76 ± 0.71), respectively. Differences in MBF, heart rate, blood pressure, and rate-pressure product (RPP) between baseline and follow-up were insignificant (P > 0.1).Strong (R = 0.79; P < 0.01) and moderate (R = 0.53; P = 0.37) correlation existed between MBF Rest and MBF Stress, and RPP respectively. Four patients showed a reduction in MFR of up to ~41% in follow-up studies, increasing to ~52% in myocardial segments close to high-radiation isodose lines in 5/8 patients. Agatston Ca + 2 scoring were zero in both baseline and follow-up in six patients; two patients exhibited mild increase in Ca + 2 on follow-ups (range:10-20).Rest and stress LVEF's were normal (>50) for all patients in both studies. CONCLUSION The feasibility of 13 N-ammonia-PET imaging in treatment position of LABC patients was demonstrated. MFR at 1-year post-irradiation of the heart decreased in 50% of the patients. MFR may be a potential index for early detection of cardiotoxicity in BC patients receiving RT to the chest wall.
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Affiliation(s)
- Sadek A Nehmeh
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States of America.
| | - Joseph J Fox
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Jazmin Schwartz
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Åse M Ballangrud
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Yize Zhao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States of America
| | - Henry W Strauss
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Anthony Yu
- Department of Medicine, Cardiology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Dipti Gupta
- Department of Medicine, Cardiology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Simon N Powell
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America
| | - Alice Y Ho
- Department of Radiation Oncology, Cedar Sinai Medical Center, Los Angeles, CA, United States of America
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14
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Chen F, Jen YM, He K, Yin Z, Shi J. Heart-sparing effect of postmastectomy radiotherapy for breast cancer patients: A dosimetric study of cardiac substructures. Med Dosim 2020; 45:246-251. [PMID: 32111451 DOI: 10.1016/j.meddos.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
We investigated to what extent can the dose-volumes of the coronary artery and the cardiac substructures be reduced by using IMRT technique in left-sided breast cancer patients. We chose 40 pN2M0 patients treated with postmastectomy IMRT. The original treatment plans were retrieved and the (internal mammary nodes) IMNs and cardiac substructure delineations were added. Three sets of dose-volume parameters including the original plans without internal mammary irradiation (IMNI), the plans with IMNI, and the plans with dose constraints to the heart, were derived. In left-sided patients, when IMNI was included, the V30 for right ventricle (RV), left ventricle (LV), pulmonic valve (PV), and left anterior descending artery (LADA) were 56.37% ± 7.9%, 25.3% ± 7.3%, 48.3% ± 6.3%, and 69.7% ± 6.4%, respectively. Of the 4 main coronary arteries, LADA had the highest dose followed by the left main coronary artery (LMCA). LADA had a V40 of 62% ± 9.7% vs 13.5% ± 3.5%, and a V50 of 27.5% ± 4.7% vs 0, with and without IMNI. For the right-sided patients, the V30s for all the heart substructures were 0 with or without IMNI. When we set a dose constraint of V40 < 10% for the LADA in the left-sided patients, the PTV volumes covered by 50 Gy decreased by only 1%. IMNI increased the V30 of the right and left ventricle and significantly increased the V40 and V50 to the LADA of left-sided breast cancer patients. IMRT markedly reduces the dose to the main coronary arteries and the right and left ventricle.
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Affiliation(s)
- Fen Chen
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
| | - Yee-Min Jen
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China; Department of Radiation Oncology, Yee Zen General Hospital, Yang Mei, Taiwan.
| | - Kui He
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
| | - Zhaosheng Yin
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
| | - Junwen Shi
- Radiotherapy Center, Chenzhou No. 1 People's Hospital, Hunan, China
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15
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Kivanc H, Gultekin M, Gurkaynak M, Ozyigit G, Yildiz F. Dosimetric comparison of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for left-sided chest wall and lymphatic irradiation. J Appl Clin Med Phys 2019; 20:36-44. [PMID: 31680445 PMCID: PMC6909119 DOI: 10.1002/acm2.12757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/05/2018] [Accepted: 10/07/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction The aim of this study was to compare five different techniques for chest wall (CW) and lymphatic irradiation in patients with left‐sided breast carcinoma. Methods Three‐dimensional conformal radiotherapy (3DCRT), forward‐planned intensity‐modulated radiotherapy (FP‐IMRT), inverse‐planned IMRT (IP‐IMRT; 7‐ or 9‐field), and hybrid IP‐/FP‐IMRT were compared in 10 patients. Clinical target volume (CTV) included CW and internal mammary (IM), supraclavicular (SC), and axillary nodes. Planning target volumes (PTVs), CTVs, and organs at risks (OARs) doses were analyzed with dose–volume histograms (DVHs). Results No differences could be observed among the techniques for doses received by 95% of the volume (D95%) of lymphatics. However, the FP‐IMRT resulted in a significantly lower D95% dose to the CW‐PTV compared to other techniques (P = 0.002). The 9‐field IP‐IMRT achieved the lowest volumes receiving higher doses (hotspots). Both IP‐IMRT techniques provided similar mean doses (Dmean) for the left lung which were smaller than the other techniques. There was no difference between the techniques for maximum dose (Dmax) of right breast. However, FP‐IMRT resulted in lower Dmean and volume of right breast receiving at least 5 Gy doses compared to other techniques. Conclusion The dose homogeneity in CW‐CTV was better using IMRT techniques compared to 3DCRT. Especially 9‐field IP‐IMRT provided a more homogeneous dose distribution in IM and axillary CTVs. Moreover, the OARs volumes receiving low radiation doses were larger with IP‐IMRT technique, while volumes receiving high radiation doses were larger with FP‐IMRT technique. Hybrid IMRT plans were found to have the advantages of both FP‐ and IP‐IMRT techniques.
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Affiliation(s)
- Huseyin Kivanc
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Gurkaynak
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
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16
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Prevention, Diagnosis, and Management of Radiation-Associated Cardiac Disease. J Am Coll Cardiol 2019; 74:905-927. [DOI: 10.1016/j.jacc.2019.07.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/28/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022]
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17
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Duane FK, McGale P, Teoh S, Mortimer C, Broggio J, Darby SC, Dodwell D, Lavery B, Oliveros S, Vallis KA, Taylor CW. International Variation in Criteria for Internal Mammary Chain Radiotherapy. Clin Oncol (R Coll Radiol) 2019; 31:453-461. [PMID: 31060973 PMCID: PMC6575151 DOI: 10.1016/j.clon.2019.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/08/2019] [Accepted: 03/16/2019] [Indexed: 11/29/2022]
Abstract
AIMS Evidence has emerged that internal mammary chain (IMC) radiotherapy reduces breast cancer mortality, leading to changes in treatment guidelines. This study investigated current IMC radiotherapy criteria and the percentages of patients irradiated for breast cancer in England who fulfilled them. MATERIALS AND METHODS A systematic search was undertaken for national guidelines published in English during 2013-2018 presenting criteria for 'consideration of' or 'recommendation for' IMC radiotherapy. Patient and tumour variables were collected for patients who received breast cancer radiotherapy in England during 2012-2016. The percentages of patients fulfilling criteria stipulated in each set of guidelines were calculated. RESULTS In total, 111 729 women were recorded as receiving adjuvant breast cancer radiotherapy in England during 2012-2016 and full data were available on 48 095 of them. Percentages of patients fulfilling IMC radiotherapy criteria in various national guidelines were: UK Royal College of Radiologists 13% (6035/48 095), UK National Institute for Health and Care Excellence 18% (8816/48 095), Germany 32% (15 646/48 095), Ireland 56% (26 846/48 095) and USA 59% (28 373/48 095). Differences between countries occurred because in Ireland and the USA, treatment may be considered in some node-negative patients, whereas in the UK, treatment is considered if at least four axillary nodes are involved or for high-risk patients with one to three positive nodes. In Germany, treatment may be considered for all node-positive patients. CONCLUSIONS There is substantial variability between countries in criteria for consideration of IMC radiotherapy, despite guidelines being based on the same evidence. This will probably lead to large variations in practice and resource needs worldwide.
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Affiliation(s)
- F K Duane
- St Luke's Radiation Oncology Network, St. James's Hospital, Dublin, Ireland.
| | - P McGale
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - S Teoh
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - C Mortimer
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - J Broggio
- Public Health England, Birmingham, UK
| | - S C Darby
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D Dodwell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - B Lavery
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Oliveros
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - K A Vallis
- CRUK/MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK
| | - C W Taylor
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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18
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Haussmann J, Budach W, Tamaskovics B, Bölke E, Corradini S, Djiepmo-Njanang FJ, Kammers K, Matuschek C. Which target volume should be considered when irradiating the regional nodes in breast cancer? Results of a network-meta-analysis. Radiat Oncol 2019; 14:102. [PMID: 31186015 PMCID: PMC6558843 DOI: 10.1186/s13014-019-1280-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/22/2019] [Indexed: 01/11/2023] Open
Abstract
Purpose/objective(s) Radiation treatment to the regional nodes results in an improvement in survival in breast cancer according to a meta-analysis of randomized trials. However, different volumes were targeted in these studies: breast or chestwall only (WBI/CWI), inclusion of the medial supraclavicular region and axillary apex (MS + WBI/CWI) or additional inclusion of the internal mammary chain (IM + MS + WBI/CWI). The benefit of treating the medial supraclavicular region and axillary apex compared to tangential breast or chestwall irradiation only remains unclear. Materials/methods A literature search was conducted identifying trials for adjuvant radiation volumes in nodal irradiation after breast surgery and axillary treatment. Events and effect sizes were extracted from the publications for the endpoints of overall survival (OS), breast cancer-specific survival (BCSS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and loco-regional control (LRC). A network meta-analysis was performed using MetaXL V5.3 with the inverse variance heterogeneity model. Results We found two randomized studies (n = 5836) comparing comprehensive nodal irradiation to sole breast treatment as well as one randomized (n = 1407) and one prospective cohort study (n = 3377) analysing the additional treatment of the internal mammary chain against sole local and supraclavicular and axillary apex radiation. Compared to WBI/CWI alone the treatment of IM + MS + WBI/CWI (HR = 0.88; CI:0.78-0.99; p = 0.036) results in improved OS unlike MS + WBI/CWI (HR = 0.99; CI:0.86-1.14; p = 0,89). These results are confirmed in BCSS: IM + MS + WBI/CWI (HR = 0.82; CI:0.72-0.92; p = 0.002) and MS + WBI/CWI (HR = 0.96; CI:0.79-1.18; p = 0.69). PFS is significantly improved with the treatment of MS + WBI/CWI (OR = 0.83; CI:0.71-0.97; p = 0.019). Both nodal treatment volumes improve LRC (MS + WBI/CWI OR = 0.74; CI:0.62-0.87; p = 0.004 and IM + MS + WBI/CWI OR = 0.60; CI:0.43-0.86; p < 0,001). Yet only the internal mammary nodes provide a benefit in DMFS (MS + WBI/CWI HR = 0.97; CI:0.81-1.16; p = 0.74 and IM + MS + WBI/CWI HR = 0.84; CI:0.75-0.94; p = 0.002). Conclusion Expanding the radiation field to the axillary apex and supraclavicular nodes after axillary node dissection reduced loco-regional recurrences without improvement in overall and cancer-specific survival. A prolongation in survival due to regional nodal irradiation is achieved when the internal mammary chain is included. This derives from a reduction in distant metastasis.
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Affiliation(s)
- Jan Haussmann
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University of Munich, Munich, Germany
| | | | - Kai Kammers
- Division of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
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HALFMOON TomoTherapy (Helical ALtered Fractionation for iMplant partial OmissiON): implant-sparing post-mastectomy radiotherapy reshaping the clinical target volume in the reconstructed breast. J Cancer Res Clin Oncol 2019; 145:1887-1896. [PMID: 31144158 DOI: 10.1007/s00432-019-02938-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the dosimetric feasibility of the radiation technique HALFMOON (Helical ALtered Fractionation for iMplant partial OmissiON) for post-mastectomy radiation therapy (PMRT) in intermediate-high-risk breast cancer patients with implant-based immediate breast reconstruction, where the clinical target volume (CTV) does not include the whole implant (implant-sparing approach). METHODS In the HALFMOON technique, the CTV consisted of skin, subcutaneous tissues, and pectoralis major muscle, excluding the implant, chest wall muscles, and rib plane. The HALFMOON plans were compared with conventionally contoured CTV plans, in which the whole implant, chest wall muscles, and ribs plane were included in the CTV, in a ratio 1:3. All patients underwent hypofractionated treatment of 40.05 Gy/15 fractions, using helical Tomotherapy®. RESULTS Eighteen patients undergoing HALFMOON technique were compared to 54 subjects treated with conventionally contoured CTV plans. No difference was found in the planning target volume coverage between the two groups. Conversely, a statistically relevant dose reduction in HALFMOON patients was observed for ipsilateral lung (D15%, p < 0.0001; D20%, p < 0.0001; D35%, p = 0.003), contralateral lung (D20%, p = 0.048), contralateral breast (D15%, p = 0.031; D20%, p = 0.047), and stomach (Dmean, p = 0.011). Regarding the implant, V90% and D50% decreased by 46% and 8%, respectively, in the HALFMOON plans (p < 0.0001). CONCLUSION The HALFMOON approach is technically feasible and resulted in high-dose conformity of the target with a significant reduction of radiation dose delivered to implant and other organs. A clinical study is needed to assess the impact on reconstruction cosmetic outcome and local control.
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Minimum breast distance largely explains individual variability in doses to contralateral breast from breast-cancer radiotherapy. Radiother Oncol 2019; 131:186-191. [DOI: 10.1016/j.radonc.2018.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022]
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Luo L, Cuaron J, Braunstein L, Gillespie E, Kahn A, McCormick B, Mah D, Chon B, Tsai H, Powell S, Cahlon O. Early outcomes of breast cancer patients treated with post-mastectomy uniform scanning proton therapy. Radiother Oncol 2018; 132:250-256. [PMID: 30414757 DOI: 10.1016/j.radonc.2018.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Postmastectomy proton radiotherapy improves normal tissue sparing in comparison to photon-based approaches. Several studies have reported dosimetry comparison and tolerable acute toxicity profile with limited follow-up. We report our institutional experience of postmastectomy proton radiation including clinical efficacy and toxicities. METHODS From December 2013 to February 2015, 42 consecutive patients who received mastectomy for non-metastatic breast cancer were treated with adjuvant chest wall and regional nodal proton therapy at a single proton center. 3D conformal uniform scanning with en face matching fields was used. RESULTS The median follow-up among patients was 35 months (range 1-55 months). There was one local failure, zero regional nodal failure, and six distant failures. The 3-year rate of locoregional disease-free survival was 96.3%, metastasis-free survival was 84.1%, and overall survival was 97.2%. The only local failure event occurred on the chest wall within the radiation field, approximately 2.5 years after the completion of radiation. Skin dermatitis, fatigue, and esophagitis were the most common acute toxicity. All patients developed grade 1 or 2 acute skin toxicity and there was no grade 3 or 4 acute skin toxicity. Proton radiation is able to achieve excellent target coverage with median PTV V95 over 95% and heart sparing with median mean heart dose less than 1 Gy (RBE). CONCLUSION With close to three years of median follow-up, post-mastectomy proton radiation has shown excellent locoregional control rates and favorable toxicity profile. Long-term adverse effect of heart-sparing radiation will require longer follow-up time and randomized clinical trials.
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Affiliation(s)
- Leo Luo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States.
| | - John Cuaron
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Lior Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Erin Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Atif Kahn
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Dennis Mah
- Procure Proton Therapy Center, Somerset, New Jersey 08873, United States
| | - Brian Chon
- Procure Proton Therapy Center, Somerset, New Jersey 08873, United States
| | - Henry Tsai
- Procure Proton Therapy Center, Somerset, New Jersey 08873, United States
| | - Simon Powell
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States
| | - Oren Cahlon
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065, United States.
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Brownlee Z, Garg R, Listo M, Zavitsanos P, Wazer DE, Huber KE. Late complications of radiation therapy for breast cancer: evolution in techniques and risk over time. Gland Surg 2018; 7:371-378. [PMID: 30175054 DOI: 10.21037/gs.2018.01.05] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Radiation therapy in combination with surgery, chemotherapy, and endocrine therapy as indicated, has led to excellent local and distant control of early stage breast cancers. With the majority of these patients surviving long term, mitigating the probability and severity of late toxicities is vital. Radiation to the breast, with or without additional fields for nodal coverage, has the potential to negatively impact long term cosmetic outcome of the treated breast as well as cause rare, but severe, complications due to incidental dosage to the heart, lungs and contralateral breast. The long-term clinical side-effects of breast radiation have been studied extensively. This review aims to discuss the risk of developing late complications following breast radiation and how modern techniques can be used to diminish these risks.
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Affiliation(s)
- Zachary Brownlee
- Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Rashi Garg
- Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Matthew Listo
- Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Peter Zavitsanos
- Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - David E Wazer
- Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.,Department of Radiation Oncology, Rhode Island Hospital and Brown University School of Medicine, Providence, RI, USA
| | - Kathryn E Huber
- Department of Radiation Oncology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
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Zhu Q, Kirova YM, Cao L, Arsene-Henry A, Chen J. Cardiotoxicity associated with radiotherapy in breast cancer: A question-based review with current literatures. Cancer Treat Rev 2018; 68:9-15. [DOI: 10.1016/j.ctrv.2018.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 12/25/2022]
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24
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Kuo L, Ballangrud ÅM, Ho AY, Mechalakos JG, Li G, Hong L. A VMAT planning technique for locally advanced breast cancer patients with expander or implant reconstructions requiring comprehensive postmastectomy radiation therapy. Med Dosim 2018; 44:150-154. [PMID: 29801668 DOI: 10.1016/j.meddos.2018.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/19/2018] [Accepted: 04/16/2018] [Indexed: 10/16/2022]
Abstract
Locally advanced breast cancer patients with expander or implant reconstructions who require comprehensive postmastectomy radiotherapy (PMRT) can pose unique treatment planning challenges. Traditional 3D conformal radiation techniques often result in large dose inhomogeneity throughout the treatment volumes, inadequate target coverage, or excessive normal tissue doses. We have developed a volumetric modulated arc therapy (VMAT) planning technique without entering through the ipsilateral arm that produced adequate target volume coverage, excellent homogeneity throughout the target volume, and acceptable doses to the normal structures. Twenty left-sided and 10 right-sided patients with either ipsilateral or bilateral permanent implants or tissue expanders who received comprehensive PMRT between October 2014 and February 2016 were included in this study. Ten left-sided cases used deep inspiration breath hold (DIBH) technique, and others used free breathing (FB). Planning target volume (PTV) included chestwall, internal mammary nodes (IMNs), supraclavicular, and axillary lymph nodes. A VMAT plan using 4 or 5 partial arcs with 6 MV photon beam avoiding entering through the ipsilateral arm was generated for each patient. Prescription dose was 50 Gy in 25 fractions. PTV coverage, maximum depth of IMNs, dose homogeneity and dose to the heart, lungs, thyroid, contralateral intact breast or implant, liver, stomach, left anterior descending artery, ipsilateral brachial plexus, esophagus, spinal cord, and total MU were evaluated. PTV D95% (Gy) was 49.6 ± 0.9, 48.7 ± 0.9, and 49.5 ± 1.1; PTV D05% (Gy) was 55.7 ± 0.6, 55.1 ± 1.4, and 55.0 ± 0.7; maximum depth of IMNs (cm) was 4.3 ± 0.9, 4.6 ± 1.1, and 4.9 ± 2.3; ipsilateral lung, V20Gy (%) was 29.0 ± 2.1, 28.8 ± 2.5, and 27.5 ± 3.4; heart mean dose (Gy) was 4.2 ± 0.4, 7.5 ± 1.1, and 6.6 ± 0.8 for right-sided FB, left-sided FB, and left-sided DIBH cases, respectively. D95% of IMNs all received 100% prescription dose. The maximum dose (Gy) to the left anterior descending artery was 33.8 ± 11.7 for left-sided FB and 31.4 ± 7.3 for left-sided DIBH. VMAT technique avoiding ipsilateral arm can produce acceptable clinical plans for locally advanced breast cancer patients with expander or implant reconstructions receiving comprehensive PMRT.
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Affiliation(s)
- LiCheng Kuo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Åse M Ballangrud
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Alice Y Ho
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - James G Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Linda Hong
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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25
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Impact of visual feedback on dose-volume histograms for organs at risk in postoperative radiotherapy with deep inspiration breath-holding for patients treated with breast-conserving therapy: a planning study. Breast Cancer 2018; 25:656-662. [PMID: 29761316 DOI: 10.1007/s12282-018-0870-8] [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: 02/23/2018] [Accepted: 05/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND We evaluated the effectiveness of visual feedback (VF) on radiotherapy with deep inspiration breath-holding (DIBH), and reviewed the dose for organs at risk (OARs). METHODS Respiratory motions during DIBH for 15 s were monitored during planning computed tomography (CT)-scanning and simulation for 40 patients after breast-conserving surgery from June 2007 to February 2008. For 22 of 40 patients, a goggle-type liquid crystal display monitor was used for VF. The opposing tangential field was planned. The prescribed dose was 50.0 Gy in 25 fractions. RESULTS The mean differences of the chest wall respiratory movement in DIBH between planning CT-scanning and simulation were 4.7 ± 2.6 mm for the patients without VF and 1.0 ± 0.9 mm for those with VF (p < 0.01). The mean chest wall excursion as a whole in DIBH using VF (2.0 ± 1.0 mm) was smaller than in those without VF (4.1 ± 2.4 mm) (p < 0.01). According to reproducibility and stability parameters, 4 mm was added as a posterior margin to the clinical target volume for RT with VF, and 10 mm for those without VF. The mean heart doses were 1.3 ± 0.5 Gy with VF and 2.4 ± 1.1 Gy without VF (p < 0.01). Mean dose and max dose of right breast were significantly reduced in procedures with VF use vs. in those without VF (p < 0.01 and < 0.01, respectively). CONCLUSIONS VF increases the accuracy of postoperative radiotherapy with DIBH, and also helps reduce the dose for OARs.
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26
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Jagsi R, Griffith KA, Moran JM, Ficaro E, Marsh R, Dess RT, Chung E, Liss AL, Hayman JA, Mayo CS, Flaherty K, Corbett J, Pierce L. A Randomized Comparison of Radiation Therapy Techniques in the Management of Node-Positive Breast Cancer: Primary Outcomes Analysis. Int J Radiat Oncol Biol Phys 2018; 101:1149-1158. [PMID: 30012527 DOI: 10.1016/j.ijrobp.2018.04.075] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Although inverse-planned intensity modulated radiotherapy (IMRT) and deep inspiration breath hold (DIBH) may allow for more conformal dose distributions, it is unknown whether using these technologies reduces cardiac or pulmonary toxicity of breast radiotherapy. METHODS AND MATERIALS A randomized controlled trial compared IMRT-DIBH versus standard, free-breathing, forward-planned, three-dimensional conformal radiotherapy in patients with left-sided, node-positive breast cancer in whom the internal mammary nodal region was targeted. Endpoints included dosimetric parameters and changes in pulmonary and cardiac perfusion and function, measured by single photon emission computed tomography (SPECT) scans and pulmonary function testing performed at baseline and 1 year post treatment. RESULTS Of 62 patients randomized, 54 who completed all follow-up procedures were analyzed. Mean doses to the ipsilateral lung, left ventricle, whole heart, and left anterior descending coronary artery were lower with IMRT-DIBH; the percent of left ventricle receiving ≥5 Gy averaged 15.8% with standard radiotherapy and 5.6% with IMRT-DIBH (P < .001). SPECT revealed no differences in perfusion defects in the left anterior descending coronary artery territory, the study's primary endpoint, but did reveal statistically significant differences (P = .02) in left ventricular ejection fraction (LVEF), a secondary endpoint. No differences were found for lung perfusion or function. CONCLUSION The small but statistically significant benefit in preservation of cardiac LVEF observed here should motivate future studies that include LVEF as a potentially meaningful endpoint. Future studies should disaggregate the impact of IMRT from that of DIBH. Clinical practice should recognize the importance of minimizing cardiac dose, even when already low in comparison to historical levels.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Kent A Griffith
- Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Edward Ficaro
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Eugene Chung
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Adam L Liss
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kevin Flaherty
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - James Corbett
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lori Pierce
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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27
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Bolukbasi Y, Saglam Y, Selek U, Topkan E, Kataria A, Unal Z, Alpan V. Reproducible Deep-inspiration Breath-hold Irradiation with Forward Intensity-modulated Radiotherapy for Left-sided Breast Cancer Significantly Reduces Cardiac Radiation Exposure Compared to Inverse Intensity-modulated Radiotherapy. TUMORI JOURNAL 2018; 100:169-78. [DOI: 10.1177/030089161410000209] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Aims and Background To investigate the objective utility of our clinical routine of reproducible deep-inspiration breath-hold irradiation for left-sided breast cancer patients on reducing cardiac exposure. Methods and Study Design Free-breathing and reproducible deep-inspiration breath-hold scans were evaluated for our 10 consecutive left-sided breast cancer patients treated with reproducible deep-inspiration breath-hold. The study was based on the adjuvant dose of 50 Gy in 25 fractions of 2 Gy/fraction. Both inverse and forward intensity-modulated radiotherapy plans were generated for each computed tomography dataset. Results Reproducible deep-inspiration breath-hold plans with forward intensity-modulated radiotherapy significantly spared the heart and left anterior descending artery compared to generated free-breathing plans based on mean doses – free-breathing vs reproducible deep-inspiration breath-hold, left ventricle (296.1 vs 94.5 cGy, P = 0.005), right ventricle (158.3 vs 59.2 cGy, P = 0.005), left anterior descending artery (171.1 vs 78.1 cGy, P = 0.005), and whole heart (173.9 vs 66 cGy, P = 0.005), heart V20 (2.2% vs 0%, P = 0.007) and heart V10 (4.2% vs 0.3%, P = 0.007) – whereas they revealed no additional burden on the ipsilateral lung. Reproducible deep-inspiration breath-hold and free-breathing plans with inverse intensity-modulated radiotherapy provided similar organ at risk sparing by reducing the mean doses to the left ventricle, left anterior descending artery, heart, V10-V20 of the heart and right ventricle. However, forward intensity-modulated radiotherapy showed significant reduction in doses to the left ventricle, left anterior descending artery, heart, right ventricle, and contralateral breast (mean dose, 248.9 to 12.3 cGy, P = 0.005). The mean doses for free-breathing vs reproducible deep-inspiration breath-hold of the proximal left anterior descending artery were 1.78 vs 1.08 Gy and of the distal left anterior descending artery were 8.11 vs 3.89 Gy, whereas mean distances to the 50 Gy isodose line of the proximal left anterior descending artery were 6.6 vs 3.3 cm and of the distal left anterior descending artery were 7.4 vs 4.1 cm, with forward intensity-modulated radiotherapy. Overall reduction in mean doses to proximal and distal left anterior descending artery with deep-inspiration breath-hold irradiation was 39% (P = 0.02) and 52% (P = 0.002), respectively. Conclusions We found a significant reduction of radiation exposure to the contralateral breast, left and right ventricles, as well as of proximal and especially distal left anterior descending artery with the deep-inspiration breath-hold technique with forward intensity-modulated radiotherapy planning.
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Affiliation(s)
- Yasemin Bolukbasi
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
| | - Yucel Saglam
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
| | - Ugur Selek
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
- Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Baskent University, School of Medicine, Adana, Turkey
| | | | - Zeynep Unal
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Vildan Alpan
- Department of Radiation Oncology, American Hospital, MD Anderson Radiation Treatment Center, Istanbul, Turkey
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Electron postmastectomy chest wall plus comprehensive nodal irradiation technique using Electron Monte Carlo dose algorithm. Med Dosim 2018; 43:230-236. [DOI: 10.1016/j.meddos.2017.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/25/2017] [Accepted: 08/28/2017] [Indexed: 11/22/2022]
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29
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Abdul Aziz A, Moussa L, Farouk M, Helal A, Abdo M. Significant reductions in heart and lung doses using semi lateral decubitus techniques for left sided breast cancer patients: A comparative dosimetric study with supine techniques. ALEXANDRIA JOURNAL OF MEDICINE 2017. [DOI: 10.1016/j.ajme.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Amr Abdul Aziz
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Lila Moussa
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed Farouk
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Azza Helal
- Medical Physics Unit, Radiology and Intervention Dept, Faculty of Medicine, Alexandria University, Egypt
- Physics Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahran Abdo
- Clinical Oncology Department, Faculty of Medicine, Alexandria University, Egypt
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30
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Li J, Wang X, Ma J, Yu X, Guo X, Zhang Z. Prospective evaluation of skin toxicities in patients receiving post-mastectomy irradiation of chest wall, supra/infraclavicular and internal mammary nodes delivered by conventional versus intensity-modulated radiotherapy technique. Oncotarget 2017; 8:80012-80019. [PMID: 29108383 PMCID: PMC5668116 DOI: 10.18632/oncotarget.20820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022] Open
Abstract
Background To determine whether IMRT could decrease skin toxicities in patients undergoing PMRT of chest wall, supra/infraclavicular (SCV), and internal mammary nodes (IMN) as compared to conventional technique. Materials and Methods Between 2009 and 2013, 106 patients treated with IMRT and 138 treated with conventional technique were followed up regularly. The skin toxicities were graded according to the CTCAE v4.0 issued by the NCI, and compared between groups. Results Grade 3 radiation dermatitis occurred in 49 patients (35.5%) in the conventional group and 14 (13.2%) in the IMRT group, and the difference was statistically significant (p < 0.001), favoring IMRT. Moist desquamation at the area associated with adjacent fields’ junctions or overlaps was observed in 35 patients (71.4%) in the conventional group and none in the IMRT group (p = 0.023). Grade 2 telangiectasia occurred in 32 patients (23.1%) in the conventional group and 9 (8.5%) in the IMRT group; this difference was statistically significant (p = 0.002), in favor of IMRT as well. Telangiectasias at the sub-sites associated with adjacent fields’ junctions or overlaps were observed in 26 patients (81.2%) in the conventional group and none in the IMRT group (p < 0.001). Further, 21 in the conventional group, who had initial moist desquamation at the sub-sites associated with adjacent fields’ overlaps or junctions, subsequently developed skin telangiectasias at the identical sub-sites. Conclusions IMRT-based post-mastectomy irradiation of chest wall, SCV and IMN might decrease the occurrence of initial moist desquamation as well as subsequent telangiectasia at the subsites associated with adjacent fields’ junctions or overlaps as compared to conventional technique.
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Affiliation(s)
- Juan Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaofang Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinli Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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31
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Taylor C, Correa C, Duane FK, Aznar MC, Anderson SJ, Bergh J, Dodwell D, Ewertz M, Gray R, Jagsi R, Pierce L, Pritchard KI, Swain S, Wang Z, Wang Y, Whelan T, Peto R, McGale P. Estimating the Risks of Breast Cancer Radiotherapy: Evidence From Modern Radiation Doses to the Lungs and Heart and From Previous Randomized Trials. J Clin Oncol 2017; 35:1641-1649. [PMID: 28319436 PMCID: PMC5548226 DOI: 10.1200/jco.2016.72.0722] [Citation(s) in RCA: 501] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose Radiotherapy reduces the absolute risk of breast cancer mortality by a few percentage points in suitable women but can cause a second cancer or heart disease decades later. We estimated the absolute long-term risks of modern breast cancer radiotherapy. Methods First, a systematic literature review was performed of lung and heart doses in breast cancer regimens published during 2010 to 2015. Second, individual patient data meta-analyses of 40,781 women randomly assigned to breast cancer radiotherapy versus no radiotherapy in 75 trials yielded rate ratios (RRs) for second primary cancers and cause-specific mortality and excess RRs (ERRs) per Gy for incident lung cancer and cardiac mortality. Smoking status was unavailable. Third, the lung or heart ERRs per Gy in the trials and the 2010 to 2015 doses were combined and applied to current smoker and nonsmoker lung cancer and cardiac mortality rates in population-based data. Results Average doses from 647 regimens published during 2010 to 2015 were 5.7 Gy for whole lung and 4.4 Gy for whole heart. The median year of irradiation was 2010 (interquartile range [IQR], 2008 to 2011). Meta-analyses yielded lung cancer incidence ≥ 10 years after radiotherapy RR of 2.10 (95% CI, 1.48 to 2.98; P < .001) on the basis of 134 cancers, indicating 0.11 (95% CI, 0.05 to 0.20) ERR per Gy whole-lung dose. For cardiac mortality, RR was 1.30 (95% CI, 1.15 to 1.46; P < .001) on the basis of 1,253 cardiac deaths. Detailed analyses indicated 0.04 (95% CI, 0.02 to 0.06) ERR per Gy whole-heart dose. Estimated absolute risks from modern radiotherapy were as follows: lung cancer, approximately 4% for long-term continuing smokers and 0.3% for nonsmokers; and cardiac mortality, approximately 1% for smokers and 0.3% for nonsmokers. Conclusion For long-term smokers, the absolute risks of modern radiotherapy may outweigh the benefits, yet for most nonsmokers (and ex-smokers), the benefits of radiotherapy far outweigh the risks. Hence, smoking can determine the net effect of radiotherapy on mortality, but smoking cessation substantially reduces radiotherapy risk.
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Affiliation(s)
- Carolyn Taylor
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Candace Correa
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Frances K. Duane
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marianne C. Aznar
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Stewart J. Anderson
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Jonas Bergh
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - David Dodwell
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Marianne Ewertz
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Richard Gray
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Reshma Jagsi
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Lori Pierce
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Kathleen I. Pritchard
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Sandra Swain
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Zhe Wang
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Yaochen Wang
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Tim Whelan
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Richard Peto
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Paul McGale
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - for the Early Breast Cancer Trialists’ Collaborative Group
- Carolyn Taylor, Frances K. Duane, David Dodwell, Richard Gray, Zhe Wang, Yaochen Wang, Richard Peto, and Paul McGale, University of Oxford, Oxford, United Kingdom; Candace Correa, Regional Cancer Center, Utica, NY; Marianne C. Aznar, Rigshospitalet, Copenhagen; Marianne Ewertz, Odense University Hospital, Odense, Denmark; Stewart J. Anderson, University of Pittsburgh, Pittsburgh, PA; Jonas Bergh, Karolinska Institutet and University Hospital, Stockholm, Sweden; Reshma Jagsi and Lori Pierce, University of Michigan, Ann Arbor MI; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto; Tim Whelan, Juravinski Cancer Centre and McMaster University, Hamilton, Ontario, Canada; and Sandra Swain, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Wang J, Yang Z, Hu W, Chen Z, Yu X, Guo X. Intensity modulated radiotherapy with fixed collimator jaws for locoregional left-sided breast cancer irradiation. Oncotarget 2017; 8:33276-33284. [PMID: 28402279 PMCID: PMC5464867 DOI: 10.18632/oncotarget.16634] [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: 08/29/2016] [Accepted: 03/08/2017] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study is to evaluate the intensity modulated radiotherapy (IMRT) with the fixed collimator jaws technique (FJT) for the left breast and regional lymph node. The targeted breast tissue and the lymph nodes, and the normal tissues were contoured for 16 left-sided breast cancer patients previously treated with radiotherapy after lumpectomy. For each patient, treatment plans using different planning techniques, i.e., volumetric modulated arc therapy (VMAT), tangential IMRT (tangential-IMRT), and IMRT with FJT (FJT-IMRT) were developed for dosimetric comparisons. A dose of 50Gy was prescribed to the planning target volume. The dose-volume histograms were generated, and the paired t-test was used to analyze the dose differences. FJT-IMRT had similar mean heart volume receiving 30Gy (V30 Gy) with tangential-IMRT (1.5% and 1.6%, p = 0.41), but inferior to the VMAT (0.8%, p < 0.001). In the average heart mean dose comparison, FJT-IMRT had the lowest value, and it was 0.6Gy lower than that for the VMAT plans (p < 0.01). A significant dose increase in the contralateral breast and lung was observed in VMAT plans. Compared with tangential-IMRT and VMAT plans, FJT-IMRT reduced the mean dose of thyroid, humeral head and cervical esophageal by 47.6% (p < 0.01) and 45.7% (p < 0.01), 74.3% (p = < 0.01) and 73% (p = < 0.01), and 26.7% (p = < 0.01) and 29.2% (p = < 0.01). In conclusion, compared with tangential-IMRT and VMAT, FJT-IMRT plan has the lowest thyroid, humeral head and cervical esophageal mean dose and it can be a reasonable treatment option for a certain subgroup of patients, such as young left-breast cancer patients and/or patients with previous thyroid disease.
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Affiliation(s)
- Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Zhaozhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Zhi Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, 200032, Shanghai, China
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Lee PY, Lin CY, Chen SW, Chien CR, Chu CN, Hsu HT, Liang JA, Lin YJ, Shiau AC. A topology-based method to mitigate the dosimetric uncertainty caused by the positional variation of the boost volume in breast conservative radiotherapy. Radiat Oncol 2017; 12:55. [PMID: 28320428 PMCID: PMC5359879 DOI: 10.1186/s13014-017-0801-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/14/2017] [Indexed: 12/25/2022] Open
Abstract
Background To improve local control rate in patients with breast cancer receiving adjuvant radiotherapy after breast conservative surgery, additional boost dose to the tumor bed could be delivered simultaneously via the simultaneous integrated boost (SIB) modulated technique. However, the position of tumor bed kept changing during the treatment course as the treatment position was aligned to bony anatomy. This study aimed to analyze the positional uncertainties between bony anatomy and tumor bed, and a topology-based approach was derived to stratify patients with high variation in tumor bed localization. Methods Sixty patients with early-stage breast cancer or ductal carcinoma in situ were enrolled. All received adjuvant whole breast radiotherapy with or without local boost via SIB technique. The delineation of tumor bed was defined by incorporating the anatomy of seroma, adjacent surgical clips, and any architectural distortion on computed tomography simulation. A total of 1740 on-board images were retrospectively analyzed. Positional uncertainty of tumor bed was assessed by four components: namely systematic error (SE), and random error (RE), through anterior-posterior (AP), cranial-caudal (CC), left-right (LR) directions and couch rotation (CR). Age, tumor location, and body-mass factors including volume of breast, volume of tumor bed, breast thickness, and body mass index (BMI) were analyzed for their predictive role. The appropriate margin to accommodate the positional uncertainty of the boost volume was assessed, and the new plans with this margin for the tumor bed was designed as the high risk planning target volume (PTV-H) were created retrospectively to evaluate the impact on organs at risk. Results In univariate analysis, a larger breast thickness, larger breast volume, higher BMI, and different tumor locations correlated with a greater positional uncertainty of tumor bed. However, BMI was the only factor associated with displacements of surgical clips in the multivariate analysis and patients with higher BMI were stratified as high variation group. When image guidance was aligned to bony structures, the SE and RE of clip displacement were consistently larger in the high variation group. The corresponding PTV-H margins for the high- and low-variation groups were 7, 10, 10 mm and 4, 9, 6 mm in AP, CC, LR directions, respectively. The heart dose between the two plans was not significantly different, whereas the dosimetric parameters for the ipsilateral lung were generally higher in the new plans. Conclusions In patients with breast cancer receiving adjuvant radiotherapy, a higher BMI is associated with a greater positional uncertainty of the boost tumor volume. More generous margin should be considered and it can be safely applied through proper design of beam arrangement with advanced treatment techniques.
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Affiliation(s)
- Peng-Yi Lee
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan
| | - Chih-Yuan Lin
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan
| | - Shang-Wen Chen
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan.,Department of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Nan Chu
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan
| | - Hsiu-Ting Hsu
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan.,Department of Medicine, China Medical University, Taichung, Taiwan
| | - Ying-Jun Lin
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan
| | - An-Cheng Shiau
- Department of Radiation Oncology, China Medical University Hospital, 2nd Yu-De Road, North District, Taichung City, Taiwan. .,Department of Medicine, China Medical University, Taichung, Taiwan. .,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
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Cuaron JJ, MacDonald SM, Cahlon O. Novel applications of proton therapy in breast carcinoma. Chin Clin Oncol 2017; 5:52. [PMID: 27558253 DOI: 10.21037/cco.2016.06.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/28/2016] [Indexed: 12/18/2022]
Abstract
This review will focus on the indications, clinical experience, and technical considerations of proton beam radiation therapy in the treatment of patients with breast cancer. For patients with early stage disease, proton therapy delivers less dose to non-target breast tissue for patients receiving partial breast irradiation (PBI) therapy, which may result in improved cosmesis but requires further investigation. For patients with locally advanced breast cancer requiring treatment to the regional lymph nodes, proton therapy allows for an improved dosimetric profile compared with conventional photon and electron techniques. Early clinical results demonstrate acceptable toxicity. The possible reduction in cardiopulmonary events as a result of reduced dose to organs at risk will be tested in a randomized control trial of protons vs. photons.
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Affiliation(s)
- John J Cuaron
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
| | - Shannon M MacDonald
- Massachusetts General Hospital, Francis H. Burr Proton Therapy Center, Boston, MA 02114-7250, USA
| | - Oren Cahlon
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Lee J, Hua KL, Hsu SM, Lin JB, Lee CH, Lu KW, Dai KY, Huang XN, Huang JZ, Wu MH, Chen YJ. Development of delineation for the left anterior descending coronary artery region in left breast cancer radiotherapy: An optimized organ at risk. Radiother Oncol 2017; 122:423-430. [PMID: 28087071 DOI: 10.1016/j.radonc.2016.12.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 11/27/2016] [Accepted: 12/23/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The left anterior descending coronary artery (LAD) and diagonal branches (DBs) are blurred on computed tomography (CT). We aimed to define the LAD region (LADR) with adequate inclusion of the LAD and DBs and contouring consistency. METHODS AND MATERIALS The LADR was defined using coronary CT angiograms. The inclusion ratio was used to assess the LAD and DBs inclusion by the LADR. Four radiation oncologists delineated the LAD and LADR, using contrast-enhanced CT of 15 patients undergoing left breast radiotherapy. The Sørensen-Dice similarity index (DSI), Jaccard similarity index (JSI), and Hausdorff distance (HD) were calculated to assess similarity. The mean dose (Dmean) and maximum dose (Dmax) to the LAD and LADR were calculated to compare consistency. Correlations were evaluated using Pearson's correlation coefficient. RESULTS The inclusion ratio of the LAD by the LADR was 96%. The mean DSI, JSI, and HD values were respectively 27.9%, 16.7%, and 0.42mm for the LAD, and 83.1%, 73.0%, and 0.18mm for the LADR. The Dmean between the LAD and LADR were strongly correlated (r=0.93). CONCLUSION Delineation of the LADR significantly improved contouring similarity and consistency for dose reporting. This could optimize dose estimation for breast radiotherapy.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Lung Hua
- Department of Computer Science and Information Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Shih-Ming Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Taiwan
| | - Chou-Hsien Lee
- Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Kuo-Wei Lu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kun-Yao Dai
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Xu-Nian Huang
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jun-Zhao Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Meng-Hao Wu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, Taiwan.
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Postmastectomy Radiation Therapy of Early Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Multibeam inverse intensity-modulated radiotherapy (IMRT) for whole breast irradiation: a single center experience in China. Oncotarget 2016; 6:35063-72. [PMID: 26393681 PMCID: PMC4741509 DOI: 10.18632/oncotarget.5278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/04/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose To present the clinical experience in our cancer center with multibeam inverse intensity-modulated radiotherapy (IMRT) for early stage breast cancer (BC) patients with whole breast irradiation (WBI). Methods We retrospectively analyzed 622 patients with Stage 0 to III BC treated from 2008 to 2011 with wide local excision and WBI, using an inverse IMRT technique. All of the patients were prescribed a total dose of 50 Gy to the whole breast in 2-Gy fractions, followed by a tumor bed boost of 10 Gy in 5 fractions using an electron beam. Results Of all of the patients, 132 (21.2%) received whole breast plus regional lymph node (RLN) irradiation. 438 of 622 patients had records of acute skin toxicity based on common terminology criteria (CTC) for adverse events. Two hundred eighty (64%) patients had Grade 0/1 toxicity, 153 (35%) had Grade 2 and only 4 patients experienced grade 3 toxicity. Seventy patients (16%) had moist desquamation. Univariate analysis revealed that breast planning target volume was the only predictive factor for Grade ≥2 acute dermatitis (P = 0.002). After 4 years, 170 patients reported cosmetic results by self-assessment, of whom 151 (89%) patients reported good/excellent cosmetic results, and 17 (11%) patients reported fair assessments. For invasive cancer, the four-year rate of freedom from locoregional recurrence survival was 98.3%. Regarding carcinoma in situ, no patients experienced recurrence. Conclusion BC patients who underwent conservative surgery followed by inverse IMRT plan exhibited acceptable acute toxicities and clinical outcomes. Longer follow-up is needed.
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Pham TT, Ward R, Latty D, Owen C, Gebski V, Chojnowski J, Kelly C, Ahern V, Tiver K, Stuart K, Wang W. Left-sided breast cancer loco-regional radiotherapy with deep inspiration breath-hold: Does volumetric-modulated arc radiotherapy reduce heart dose further compared with tangential intensity-modulated radiotherapy? J Med Imaging Radiat Oncol 2016; 60:545-53. [PMID: 27094588 DOI: 10.1111/1754-9485.12459] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 02/12/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Left-sided breast cancer radiotherapy has been associated with an increase in cardiac mortality. This study investigated the potential heart-sparing effect of volumetric-modulated arc radiotherapy (VMAT). We compared VMAT to tangential intensity-modulated radiotherapy (t-IMRT) in the loco-regional treatment of left-sided breast cancer, including internal mammary nodal irradiation, based on deep inspiration breath-hold (DIBH) and free-breathing (FB). METHODS Radiotherapy for 15 patients was re-planned. Four plans were compared: t-IMRT-DIBH; VMAT-DIBH; t-IMRT-FB; VMAT-FB. Prescribed dose was 50 Gy in 25 fractions. T-IMRT plans were generated using tangentially orientated fields. VMAT plans were generated using two partial arcs (average arc 190°). RESULTS Mean heart dose (MHD) was 5 ± 2.4 Gy, 5.7 ± 1.4 Gy, 9.7 ± 3.3 Gy and 8.1 ± 2.0 Gy for t-IMRT-DIBH, VMAT-DIBH, IMRT-FB and VMAT-FB respectively. The difference in MHD between IMRT-DIBH and VMAT-DIBH was not significant (P = 0.14). VMAT-DIBH significantly spared the volume of heart irradiated to doses of 20 Gy and above (p < 0.05), however, resulted in a significantly higher V5 Gy (P < 0.001), compared to t-IMRT-DIBH. VMAT-DIBH resulted in higher combined lung mean (11 ± 0.8 Gy vs. 8.8 ± 1.1 Gy, P < 0.001) and higher contralateral breast mean dose (5 ± 1 Gy vs. 1.6 ± 1.2 Gy, P < 0.001) compared with t-IMRT-DIBH. CONCLUSIONS On average, there was no significant difference in MHD between VMAT-DIBH and t-IMRT-DIBH. However, VMAT-DIBH was found to benefit a select group of patients. For patients in whom the MHD was >6.3 Gy with t-IMRT-DIBH, the use of VMAT-DIBH resulted in a benefit in reducing the MHD.
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Affiliation(s)
- Trang T Pham
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia.,Breast Cancer Institute, Westmead, Sydney, New South Wales, Australia
| | - Rachel Ward
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Drew Latty
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Catherine Owen
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Val Gebski
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jacek Chojnowski
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Christopher Kelly
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Verity Ahern
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia.,Breast Cancer Institute, Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Kenneth Tiver
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia.,Breast Cancer Institute, Westmead, Sydney, New South Wales, Australia
| | - Kirsty Stuart
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia.,Breast Cancer Institute, Westmead, Sydney, New South Wales, Australia
| | - Wei Wang
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia.,Breast Cancer Institute, Westmead, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Paul Wright G, Drinane JJ, Sobel HL, Chung MH. Left-Sided Breast Irradiation does not Result in Increased Long-Term Cardiac-Related Mortality Among Women Treated with Breast-Conserving Surgery. Ann Surg Oncol 2015; 23:1117-22. [DOI: 10.1245/s10434-015-4949-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Indexed: 01/31/2023]
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Tyran M, Mailleux H, Tallet A, Fau P, Gonzague L, Minsat M, Moureau-Zabotto L, Resbeut M. Volumetric-modulated arc therapy for left-sided breast cancer and all regional nodes improves target volumes coverage and reduces treatment time and doses to the heart and left coronary artery, compared with a field-in-field technique. JOURNAL OF RADIATION RESEARCH 2015; 56:927-937. [PMID: 26386255 PMCID: PMC4628222 DOI: 10.1093/jrr/rrv052] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 06/05/2023]
Abstract
We compared two intensity-modulated radiotherapy techniques for left-sided breast treatment, involving lymph node irradiation including the internal mammary chain. Inverse planned arc-therapy (VMAT) was compared with a forward-planned multi-segment technique with a mono-isocenter (MONOISO). Ten files were planned per technique, delivering a 50-Gy dose to the breast and 46.95 Gy to nodes, within 25 fractions. Comparative endpoints were planning target volume (PTV) coverage, dose to surrounding structures, and treatment delivery time. PTV coverage, homogeneity and conformality were better for two arc VMAT plans; V95%(PTV-T) was 96% for VMAT vs 89.2% for MONOISO. Homogeneity index (HI)(PTV-T) was 0.1 and HI(PTV-N) was 0.1 for VMAT vs 0.6 and 0.5 for MONOISO. Treatment delivery time was reduced by a factor of two using VMAT relative to MONOISO (84 s vs 180 s). High doses to organs at risk were reduced (V30(left lung) = 14% using VMAT vs 24.4% with MONOISO; dose to 2% of the volume (D2%)(heart) = 26.1 Gy vs 32 Gy), especially to the left coronary artery (LCA) (D2%(LCA) = 34.4 Gy vs 40.3 Gy). However, VMAT delivered low doses to a larger volume, including contralateral organs (mean dose [Dmean](right lung) = 4 Gy and Dmean(right breast) = 3.2 Gy). These were better protected using MONOISO plans (Dmean(right lung) = 0.8 Gy and Dmean(right breast) = 0.4 Gy). VMAT improved PTV coverage and dose homogeneity, but clinical benefits remain unclear. Decreased dose exposure to the LCA may be clinically relevant. VMAT could be used for complex treatments that are difficult with conventional techniques. Patient age should be considered because of uncertainties concerning secondary malignancies.
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Affiliation(s)
- Marguerite Tyran
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Hugues Mailleux
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Agnes Tallet
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Pierre Fau
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Laurence Gonzague
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Mathieu Minsat
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Laurence Moureau-Zabotto
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Michel Resbeut
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
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Exposure of the Heart in Breast Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2003 to 2013. Int J Radiat Oncol Biol Phys 2015; 93:845-53. [DOI: 10.1016/j.ijrobp.2015.07.2292] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/16/2015] [Accepted: 07/29/2015] [Indexed: 11/20/2022]
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Supraclavicular and infraclavicular lymph node delineation in breast cancer patients: a proposal deriving from a comparative study. TUMORI JOURNAL 2015; 101:478-86. [PMID: 25983090 DOI: 10.5301/tj.5000330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/20/2022]
Abstract
AIMS AND BACKGROUND Current advances in radiotherapy for breast cancer require knowledge of the anatomy of irradiated areas to minimize geographic miss and spare organs at risk. This study aimed at defining a contouring approach for supraclavicular (SC) and infraclavicular (IC) nodes after mastectomy or conservative surgery in patients with breast cancer. METHODS AND STUDY DESIGN In 15 patients, SC and IC nodes were contoured on computed tomography slices according to Madu et al and Dijkema et al. After analyzing relapse sites, as reported by Reed et al, our approach was defined. The 3 methods were compared in all patients, quantifying differences in contours by percentage overlap (PO). RESULTS In our approach, SC node delineation is similar to Madu et al in the ventral and medial landmarks, but includes the lateral SC nodes described by Dijkema et al. The lateral landmarks are the scalenus anterior and medius muscle lateral border and the clavicle. Dorsal boundaries are the scalenus anterior and medius muscle ventral and lateral surfaces and the subclavian artery ventral border. In IC node delineation, major differences emerged in cranial and dorsal limits which, in our approach, are the pectoralis minor muscle upper edge and the subclavian axillary artery ventral side. Our mean and median volumes and POs were between the other 2 methods. CONCLUSIONS This study contributes to standardizing draining node contouring, so as to reduce variability and minimize geographic miss.
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Cuaron JJ, Chon B, Tsai H, Goenka A, DeBlois D, Ho A, Powell S, Hug E, Cahlon O. Early toxicity in patients treated with postoperative proton therapy for locally advanced breast cancer. Int J Radiat Oncol Biol Phys 2015; 92:284-91. [PMID: 25754632 DOI: 10.1016/j.ijrobp.2015.01.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/02/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To report dosimetry and early toxicity data in breast cancer patients treated with postoperative proton radiation therapy. METHODS AND MATERIALS From March 2013 to April 2014, 30 patients with nonmetastatic breast cancer and no history of prior radiation were treated with proton therapy at a single proton center. Patient characteristics and dosimetry were obtained through chart review. Patients were seen weekly while on treatment, at 1 month after radiation therapy completion, and at 3- to 6-month intervals thereafter. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Frequencies of toxicities were tabulated. RESULTS Median dose delivered was 50.4 Gy (relative biological equivalent [RBE]) in 5 weeks. Target volumes included the breast/chest wall and regional lymph nodes including the internal mammary lymph nodes (in 93%). No patients required a treatment break. Among patients with >3 months of follow-up (n=28), grade 2 dermatitis occurred in 20 patients (71.4%), with 8 (28.6%) experiencing moist desquamation. Grade 2 esophagitis occurred in 8 patients (28.6%). Grade 3 reconstructive complications occurred in 1 patient. The median planning target volume V95 was 96.43% (range, 79.39%-99.60%). The median mean heart dose was 0.88 Gy (RBE) [range, 0.01-3.20 Gy (RBE)] for all patients, and 1.00 Gy (RBE) among patients with left-sided tumors. The median V20 of the ipsilateral lung was 16.50% (range, 6.1%-30.3%). The median contralateral lung V5 was 0.34% (range, 0%-5.30%). The median maximal point dose to the esophagus was 45.65 Gy (RBE) [range, 0-65.4 Gy (RBE)]. The median contralateral breast mean dose was 0.29 Gy (RBE) [range, 0.03-3.50 Gy (RBE)]. CONCLUSIONS Postoperative proton therapy is well tolerated, with acceptable rates of skin toxicity. Proton therapy favorably spares normal tissue without compromising target coverage. Further follow-up is necessary to assess for clinical outcomes and cardiopulmonary toxicities.
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Affiliation(s)
- John J Cuaron
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brian Chon
- Procure Proton Therapy Center, Somerset, New Jersey
| | - Henry Tsai
- Procure Proton Therapy Center, Somerset, New Jersey
| | - Anuj Goenka
- Procure Proton Therapy Center, Somerset, New Jersey
| | | | - Alice Ho
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Simon Powell
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Eugen Hug
- Procure Proton Therapy Center, Somerset, New Jersey
| | - Oren Cahlon
- Memorial Sloan-Kettering Cancer Center, New York, New York; Procure Proton Therapy Center, Somerset, New Jersey.
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Lin Y, Wang B. Dosimetric absorption of intensity-modulated radiotherapy compared with conventional radiotherapy in breast-conserving surgery. Oncol Lett 2014; 9:9-14. [PMID: 25435927 PMCID: PMC4246647 DOI: 10.3892/ol.2014.2704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to investigate the dosimetric benefits between intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CR) among patients receiving breast-conserving surgery. A dosimetric comparison of IMRT and CR was evaluated in 20 patients with early-stage breast cancer using a three-dimensional treatment planning system. The prescribed mammary gland dose was completed in 25 fractions with a total dose of 5,000 cGy. Homogeneity of the planning target volume (PTV), irradiation dose and volume of organs at risk (OARs) were evaluated through a dose-volume histogram. For the homogeneity of PTV, the average volume receiving 95% of the prescribed dose in the IMRT plan was similar to that in the CR plan (97 vs. 96%, respectively). With regard to normal tissue sparing in OARs, the ipsilateral lung V20 in the IMRT and CR plans was 27.8 and 20.8%, respectively. The mean dose and V30 of the heart for five patients were 598.4 versus 348.3 cGy and 10.06 versus 5.3%, respectively. The mean dose sparing the heart or lung was markedly reduced in the IMRT plan compared with the CR plan. The results of the current study demonstrated that whole breast IMRT improves PTV dose distribution and improves normal tissue sparing in OARs.
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Affiliation(s)
- Yang Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Benzhong Wang
- Department of Breast Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Left-sided whole breast irradiation with hybrid-IMRT and helical tomotherapy dosimetric comparison. BIOMED RESEARCH INTERNATIONAL 2014; 2014:741326. [PMID: 25170514 PMCID: PMC4121994 DOI: 10.1155/2014/741326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/19/2014] [Accepted: 06/26/2014] [Indexed: 12/25/2022]
Abstract
Purpose. Limited-tomotherapy and hybrid-IMRT treatment techniques were compared for reductions in ipsilateral and contralateral lung, heart, and contralateral breast radiation doses. Methods and Materials. Thirty consecutively treated left-sided early-stage breast cancer patients were scheduled for lTomo and hIMRT. For the hIMRT plan conventional tangential-field and four-field IMRT plans were combined with different weightings in the prescribed dose. For the lTomo plan a geometrically limited arc was designed for the beamlet entrance. A Dp of 50.4 Gy in 28 fractions was used for the PTV. The dose coverage, homogeneity index, conformity index of the target, and the dose volumes of critical structures were compared. Results. Both modalities presented similar target coverage. The homogeneity and conformity were improved for lTomo with P < 0.001 and P = 0.006, respectively. In the lTomo plan a concave dose distribution was generated with significant dose reductions in both high and low dose regions for ipsilateral lung and heart (P < 0.001). Conclusions. lTomo plan can have similar dose coverage and better homogeneity and conformity to the target. By properly designing the directionally and completely blocked structure, lTomo plan was developed successfully in reducing doses to the healthy tissues for early-stage left-sided breast cancer radiotherapy.
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Osman SOS, Hol S, Poortmans PM, Essers M. Volumetric modulated arc therapy and breath-hold in image-guided locoregional left-sided breast irradiation. Radiother Oncol 2014; 112:17-22. [PMID: 24825176 DOI: 10.1016/j.radonc.2014.04.004] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the effects of using volumetric modulated arc therapy (VMAT) and/or voluntary moderate deep inspiration breath-hold (vmDIBH) in the radiation therapy (RT) of left-sided breast cancer including the regional lymph nodes. MATERIALS AND METHODS For 13 patients, four treatment combinations were compared; 3D-conformal RT (i.e., forward IMRT) in free-breathing 3D-CRT(FB), 3D-CRT(vmDIBH), 2 partial arcs VMAT(FB), and VMAT(vmDIBH). Prescribed dose was 42.56 Gy in 16 fractions. For 10 additional patients, 3D-CRT and VMAT in vmDIBH only were also compared. RESULTS Dose conformity, PTV coverage, ipsilateral and total lung doses were significantly better for VMAT plans compared to 3D-CRT. Mean heart dose (D(mean,heart)) reduction in 3D-CRT(vmDIBH) was between 0.9 and 8.6 Gy, depending on initial D(mean,heart) (in 3D-CRT(FB) plans). VMAT(vmDIBH) reduced the D(mean,heart) further when D(mean,heart) was still >3.2 Gy in 3D-CRT(vmDIBH). Mean contralateral breast dose was higher for VMAT plans (2.7 Gy) compared to 3DCRT plans (0.7 Gy). CONCLUSIONS VMAT and 3D-CRT(vmDIBH) significantly reduced heart dose for patients treated with locoregional RT of left-sided breast cancer. When Dmean,heart exceeded 3.2 Gy in 3D-CRT(vmDIBH) plans, VMAT(vmDIBH) resulted in a cumulative heart dose reduction. VMAT also provided better target coverage and reduced ipsilateral lung dose, at the expense of a small increase in the dose to the contralateral breast.
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Affiliation(s)
- Sarah O S Osman
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - Sandra Hol
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - Philip M Poortmans
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - Marion Essers
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands.
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Shah C, Badiyan S, Berry S, Khan AJ, Goyal S, Schulte K, Nanavati A, Lynch M, Vicini FA. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol 2014; 112:9-16. [PMID: 24813095 DOI: 10.1016/j.radonc.2014.04.009] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/06/2014] [Accepted: 04/18/2014] [Indexed: 12/12/2022]
Abstract
Breast cancer radiotherapy represents an essential component in the overall management of both early stage and locally advanced breast cancer. As the number of breast cancer survivors has increased, chronic sequelae of breast cancer radiotherapy become more important. While recently published data suggest a potential for an increase in cardiac events with radiotherapy, these studies do not consider the impact of newer radiotherapy techniques commonly utilized. Therefore, the purpose of this review is to evaluate cardiac dose sparing techniques in breast cancer radiotherapy. Current options for cardiac protection/avoidance include (1) maneuvers that displace the heart from the field such as coordinating the breathing cycle or through prone patient positioning, (2) technological advances such as intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT), and (3) techniques that treat a smaller volume around the lumpectomy cavity such as accelerated partial breast irradiation (APBI), or intraoperative radiotherapy (IORT). While these techniques have shown promise dosimetrically, limited data on late cardiac events exist due to the difficulties of long-term follow up. Future studies are required to validate the efficacy of cardiac dose sparing techniques and may use surrogates for cardiac events such as biomarkers or perfusion imaging.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Shahed Badiyan
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, United States
| | - Sameer Berry
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Atif J Khan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey & Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey & Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Kevin Schulte
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Anish Nanavati
- Department of Oncology, Georgetown University School of Medicine, Washington DC United States
| | - Melanie Lynch
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Frank A Vicini
- Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, United States.
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Mackenzie P, Fyles A, Wang W, Chung C. Advanced radiotherapy techniques for breast cancer to minimize cardiovascular risk. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
SUMMARY Radiotherapy plays an integral role in the management of breast cancer and has been demonstrated to reduce the risk of recurrence and improve overall survival. Recent reports in the literature have suggested a dose-dependent risk of cardiovascular disease following radiation treatment for breast cancer. This article highlights new advances in radiotherapy for breast cancer that may help minimize radiotherapy doses to the heart.
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Affiliation(s)
- Penny Mackenzie
- Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5V 2V1, Canada
| | - Anthony Fyles
- Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5V 2V1, Canada
| | - Wei Wang
- Westmead Cancer Centre, Sydney, Australia
| | - Caroline Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5V 2V1, Canada
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Pasler M, Lutterbach J, Björnsgard M, Reichmann U, Bartelt S, Georg D. VMAT techniques for lymph node-positive left sided breast cancer. Z Med Phys 2014; 25:104-11. [PMID: 24743059 DOI: 10.1016/j.zemedi.2014.03.008] [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] [Received: 12/19/2013] [Revised: 03/06/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the plan quality of two different volumetric modulated arc therapy (VMAT) techniques for lymph node-positive left-sided breast cancer. METHODS Two VMAT plans were generated for 10 lymph node-positive left-sided breast cancer patients: one plan using one single segment of a full rotation, typically an arc segment of 230° (1s-VMAT); and a second plan consisting of 2 small tangential arc segments of about 50° (2s-VMAT). For plan comparison, various dose and dose volume metrics (Dmean, D98%, D2% for target volumes, D2%, Dmean and Vx% for organs at risk (OAR)) were evaluated. RESULTS Both techniques fulfilled both clinical target dose and OAR goals. 1s-VMAT achieved a slightly better homogeneity and better target coverage (D2%= 54.2 ± 0.7 Gy, D98%= 30.3 ± 1.8 Gy) compared to 2s-VMAT (D2%= 55.0 ± 1.1 Gy, D98%= 29.9 ± 1.7 Gy). For geometrical reasons, OAR sparing was noticeable but not significant better using 2s-VMAT, particularly heart and contralateral breast. The heart received a mean dose of 4.4 ± 0.8 Gy using 1s-VMAT and 3.3 ± 1.0 Gy using 2s-VMAT; the contralateral breast received 1.5 ± 0.3 Gy and 0.9 ± 0.3 Gy, respectively. CONCLUSIONS A VMAT technique based on two small tangential arc segments enables improved OAR sparing; the differences between the two techniques in target coverage and homogeneity are minor. Patient age and -anatomy must be considered for each individual case when deciding which technique to be used.
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Affiliation(s)
- Marlies Pasler
- Lake Constance Radiation Oncology Center Singen, Friedrichshafen, Germany.
| | | | - Mari Björnsgard
- Lake Constance Radiation Oncology Center Singen, Friedrichshafen, Germany
| | - Ursula Reichmann
- Lake Constance Radiation Oncology Center Singen, Friedrichshafen, Germany
| | - Susanne Bartelt
- Lake Constance Radiation Oncology Center Singen, Friedrichshafen, Germany
| | - Dietmar Georg
- Department of Radiooncology, Medical University Vienna/AKH Wien, Vienna, Austria; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University Vienna, Vienna, Austria
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Seemann I, te Poele JAM, Hoving S, Stewart FA. Mouse bone marrow-derived endothelial progenitor cells do not restore radiation-induced microvascular damage. ISRN CARDIOLOGY 2014; 2014:506348. [PMID: 25101181 PMCID: PMC4005028 DOI: 10.1155/2014/506348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/06/2014] [Indexed: 11/24/2022]
Abstract
Background. Radiotherapy is commonly used to treat breast and thoracic cancers but it also causes delayed microvascular damage and increases the risk of cardiac mortality. Endothelial cell proliferation and revascularization are crucial to restore microvasculature damage and maintain function of the irradiated heart. We have therefore examined the potential of bone marrow-derived endothelial progenitor cells (BM-derived EPCs) for restoration of radiation-induced microvascular damage. Material & Methods. 16 Gy was delivered to the heart of adult C57BL/6 mice. Mice were injected with BM-derived EPCs, obtained from Eng(+/+) or Eng(+/-) mice, 16 weeks and 28 weeks after irradiation. Morphological damage was evaluated at 40 weeks in transplanted mice, relative to radiation only and age-matched controls. Results. Cardiac irradiation decreased microvascular density and increased endothelial damage in surviving capillaries (decrease alkaline phosphatase expression and increased von Willebrand factor). Microvascular damage was not diminished by treatment with BM-derived EPCs. However, BM-derived EPCs from both Eng(+/+) and Eng(+/-) mice diminished radiation-induced collagen deposition. Conclusion. Treatment with BM-derived EPCs did not restore radiation-induced microvascular damage but it did inhibit fibrosis. Endoglin deficiency did not impair this process.
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Affiliation(s)
- Ingar Seemann
- Division of Biological Stress Response (H3), The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Johannes A. M. te Poele
- Division of Biological Stress Response (H3), The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Saske Hoving
- Division of Biological Stress Response (H3), The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Fiona A. Stewart
- Division of Biological Stress Response (H3), The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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