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Robatjazi M, Baghani HR, Porouhan P. Dosimetric comparison between different tangential field arrangements during left-sided breast cancer radiotherapy. Radiol Phys Technol 2021; 14:226-237. [PMID: 34043155 DOI: 10.1007/s12194-021-00621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to evaluate variations in dose distribution within the target volume and dose received by the organs at risk (OARs) for different tangential field arrangements during three-dimensional (3D) conformal treatment planning for left-sided breast cancer. Computed tomography (CT) images of 25 breast cancer patients were included, and three different mono-isocentric half-block (MIHB) treatment plans-parallel central axis technique (PCAXT), posterior border parallel technique (PBPT), and parallel quadrant technique (PQUDT)-were considered for each patient. The dosimetric and geometric parameters related to each followed plan were then extracted for the planning target volume (PTV) and the OARs, and compared. The results showed no significant differences among the extracted dosimetric and geometric parameters of the OARs for the different plans, while the Dmax, V95%, homogeneity index (HI), and conformity index (CI) values related to the PTV were significantly different (P < 0.05). The lowest Dmax and V95% values inside the PTV were related to the PCAXT plan. The best HI was achieved with the PBPT plan, whereas the best CI was observed for the PCAXT plan. The best correlation between the geometric and dosimetric parameters of the OARs was between V5Gy-central lung distance for the ipsilateral lung and the V5Gy-maximum heart distance for the heart in all plans. These results demonstrate that variations in the tangential field arrangement at the posterior border for optimal coverage of the PTV may not considerably affect the dose received by the OARs.
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Affiliation(s)
- Mostafa Robatjazi
- Medical Physics and Radiological Sciences Department, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Pejman Porouhan
- Radiation Oncology Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Parwaie W, Geraily G, Shirazi A, Yarahmadi M, Shakeri A, Ardekani MA. Evaluation of lung heterogeneity effects on dosimetric parameters in small photon fields using MAGIC polymer gel, Gafchromic film, and Monte Carlo simulation. Appl Radiat Isot 2020; 166:109233. [PMID: 32836165 DOI: 10.1016/j.apradiso.2020.109233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/20/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022]
Abstract
In this work, the performance of MAGIC polymer gel in measuring dosimetric parameters beyond lung heterogeneity in small fields was investigated. All data were obtained using MAGIC, EBT2, and MC in four small field sizes. The maximum local differences between MAGIC and MC were less than 5.1, 3.9, 3.1, and 2.6% for PDD values behind lung heterogeneity at 5, 10, 20, and 30 mm field sizes, respectively. The findings showed that MAGIC is a suitable tool for dosimetry behind low-density heterogeneity.
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Affiliation(s)
- Wrya Parwaie
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Geraily
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Alireza Shirazi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Yarahmadi
- Department of Medical Physics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ahmad Shakeri
- Valiasr Radiotherapy Oncology Center, Valiasr Hospital, Qom, Iran
| | - Mahdieh Afkhami Ardekani
- Department of Radiology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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The feasibility of a heart block with an electron compensation as an alternative whole breast radiotherapy technique in patients with underlying cardiac or pulmonary disease. PLoS One 2017; 12:e0184137. [PMID: 28863179 PMCID: PMC5580979 DOI: 10.1371/journal.pone.0184137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 08/18/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE We aimed to evaluate the feasibility of the heart block with electron compensation (HBE) technique, based on three-dimensional conformal radiotherapy (3D-CRT) in left-sided breast cancer patients with underlying cardiac or pulmonary disease. METHODS Twenty patients with left-sided breast cancer who were treated with whole breast radiotherapy (WBRT) were included in this study. Intensity-modulated radiotherapy (IMRT), 3D-CRT, and HBE treatment plans were generated for each patient. Based on the 3D-CRT plan, the HBE plan included a heart block from the medial tangential field to shield the heart and added an electron beam to compensate for the loss in target volume coverage. The dosimetric parameters for the heart and lung and the target volume between the three treatment types were compared. RESULTS Of the three plans, the HBE plan yielded the most significant reduction in the doses received by the heart and lung (heart Dmean: 5.1 Gy vs. 12.9 Gy vs. 4.0 Gy and lung Dmean: 11.4 Gy vs. 13.2 Gy vs. 10.5 Gy, for 3D-CRT, IMRT, and HBE, respectively). Target coverage with all three techniques was within the acceptable range (Dmean 51.0 Gy vs. 51.2 Gy vs. 50.6 Gy, for 3D-CRT, IMRT, and HBE, respectively). CONCLUSIONS The HBE plan effectively reduced the amount of radiation exposure to the heart and lung. It could be beneficial for patients who are vulnerable to radiation-related cardiac or pulmonary toxicities.
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Clinical and diagnosis characteristics of breast cancers in women with a history of radiotherapy in the first 30years of life: A French multicentre cohort study. Radiother Oncol 2017; 124:200-203. [PMID: 28733054 DOI: 10.1016/j.radonc.2017.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Irradiation (>3Gy) to the breast or axillae before 30years of age increases the risk of secondary breast cancer (SBC). The purpose of this article is to describe the clinical characteristics of SBC and the way of diagnosis in young women (before the age of national screening) in France who had received previous radiotherapy for a childhood or a young adulthood cancer. PATIENTS AND METHODS This retrospective, multicentre study reviewed the medical records of women with SBC before the age of the national screening who had received irradiation (≥3Gy) on part or all of the breast before 30years of age, for any type of tumour except BC. RESULTS A total of 121 SBC were detected in 104 women with previous radiotherapy. Twenty percent of SBC were detected during regular breast screening and 16% of the women had a regular radiological follow-up. CONCLUSION Our results points out that the main proportion of childhood cancer survivors did not benefit from the recommended breast cancer screening. This result is comparable to other previously published studies in other countries. A national screening programme is necessary and should take into account the patient's age, family history, personal medical history and previous radiotherapy to reduce the number of SBC diagnosed at an advanced stage.
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Rahimy E, Hong JC, Gross CP, Hu X, Soulos PR, Shafman T, Connor HJ, Ross R, Yu JB, Dosoretz A, Evans SB. Increased Number of Beam Angles Is Associated With Higher Cardiac Dose in Adjuvant Fixed Gantry Intensity Modulated Radiation Therapy of Left-Sided Breast Cancer. Int J Radiat Oncol Biol Phys 2017; 99:1137-1145. [PMID: 28864402 DOI: 10.1016/j.ijrobp.2017.06.2451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE To analyze the relationship between angle number and mean heart dose (MHD) in adjuvant fixed gantry intensity modulated radiation therapy (FG-IMRT) treatment of left-sided breast cancer as is currently practiced in the community. METHODS AND MATERIALS We performed a retrospective, multi-institutional review of women with left-sided breast cancer receiving adjuvant FG-IMRT between 2012 and 2014, encompassing 85 centers in 15 states. Bivariate and multivariate regression analyses were done to identify factors associated with MHD. Long-term cardiac risk was estimated according to a previously published model. RESULTS Of the 538 women included, 284 had >2 gantry angle treatment plans (multi-angle), and 254 had 2 gantry angle (standard) plans. Median MHD was higher in patients with multi-angle plans compared with standard (median 475 vs 203 cGy). Number of gantry angles was significantly associated with MHD, with multi-angle plans independently increasing MHD by 229 cGy. Absolute risk of acute coronary events 20 years after treatment was estimated as 7 excess events per 1000 women for standard plans, compared with 12 excess events for multi-angle plans. CONCLUSIONS Fixed gantry IMRT breast treatment plans with >2 gantry angles were associated with increased MHD, which translated to an increased cardiac risk. Clinicians should account for this potential drawback in treatment technique when assessing overall plan quality.
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Affiliation(s)
- Elham Rahimy
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
| | - Julian C Hong
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut; Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xin Hu
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Timothy Shafman
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut; 21st Century Oncology, Fort Myers, Florida
| | - Henry J Connor
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut; Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rudi Ross
- 21st Century Oncology, Fort Myers, Florida
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Arie Dosoretz
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; 21st Century Oncology, Fort Myers, Florida
| | - Suzanne B Evans
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
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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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Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy during deep inspiratory breath hold for left-sided whole-breast irradiation: a comparative analysis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s1460396915000394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAimDeep inspiratory breath hold (DIBH) during left-breast irradiation helps to minimise cardiac irradiation by physically separating the heart from the left breast. The dose to organs-at-risk in intensity-modulated radiotherapy (IMRT) and opposed tangent three-dimensional conformal radiotherapy (3DCRT) during DIBH in patients with left-sided breast cancer was compared.Materials and methodsA total of 20 consecutive patients with left-sided breast cancer had a computed tomography scan utilising DIBH. Mean volumes of the heart, left anterior descending coronary artery, total lung and right breast receiving 5–95% of the prescription dose were calculated.ResultsTarget volume homogeneity was improved with IMRT and average mean dose to target was higher for 3DCRT (51·03 Gy) compared with IMRT (50·47 Gy, p<0·01). The average mean dose to the heart was lower with 3DCRT (87 versus 77 cGy, p<0·01). The average mean dose to the contralateral breast was also lower with 3DCRT (19 versus 17 cGy, p<0·01). Less monitor units (MUs) were required with 3DCRT with an average difference of 225 MU/fraction (p<0·01).FindingsUnder DIBH, absolute differences between 3DCRT and IMRT were minimal. 3DCRT under DIBH provided excellent dosimetric results in most patients with left-sided breast cancer without the need for IMRT.
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Assessing radiation exposure of the left anterior descending artery, heart and lung in patients with left breast cancer: A dosimetric comparison between multicatheter accelerated partial breast irradiation and whole breast external beam radiotherapy. Radiother Oncol 2015; 117:459-66. [PMID: 26328940 DOI: 10.1016/j.radonc.2015.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/20/2015] [Accepted: 08/09/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE This study aims to quantify dosimetric reduction to the left anterior descending (LAD) artery, heart and lung when comparing whole breast external beam radiotherapy (WBEBRT) with multicatheter accelerated partial breast irradiation (MCABPI) for early stage left breast cancer. MATERIALS AND METHODS Planning CT data sets of 15 patients with left breast cancer receiving multicatheter brachytherapy post breast conserving surgery were used to create two independent treatment plans - WBEBRT prescribed to 50 Gy/25 fractions and MCABPI prescribed to 34 Gy/10 fractions. Dose parameters for (i) LAD artery, (ii) heart, and (iii) ipsilateral lung were calculated and compared between the two treatment modalities. RESULTS After adjusting for Equivalent Dose in 2 Gy fractions(EQD2), and comparing MCAPBI with WBEBRT, the largest dose reduction was for the LAD artery whose mean dose differed by a factor of 7.7, followed by the ipsilateral lung and heart with a factor of 4.6 and 2.6 respectively. Compared to WBEBRT, the mean MCAPBI LAD was significantly lower compared to WBEBRT (6.0 Gy vs 45.9 Gy; p<0.01). Mean MCAPBI heart D(0.1cc) (representing the dose received by the most highly exposed 0.1 cc of the risk organ, i.e. the dose peak) was significantly lower (16.3 Gy vs 50.6 Gy; p<0.01). Likewise, the mean heart dose (MHD) was significantly lower (2.3 Gy vs 6.0 Gy; p<0.01). Peak dose and mean lung dose (MLD) for ipsilateral lung was also lower for MCAPBI compared to WBEBRT (Peak dose: 22.2 Gy vs 52.0 Gy; p<0.01; MLD: 2.3 Gy vs 10.7 Gy; p<0.01). CONCLUSION Compared to WBEBRT, MCAPBI showed a significant reduction in radiation dose for the LAD, heart and lung. This may translate into better cardiac and pulmonary toxicities for patients undergoing MCAPBI.
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Beck RE, Kim L, Yue NJ, Haffty BG, Khan AJ, Goyal S. Treatment techniques to reduce cardiac irradiation for breast cancer patients treated with breast-conserving surgery and radiation therapy: a review. Front Oncol 2014; 4:327. [PMID: 25452938 PMCID: PMC4231838 DOI: 10.3389/fonc.2014.00327] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/30/2014] [Indexed: 12/25/2022] Open
Abstract
Thousands of women diagnosed with breast cancer each year receive breast-conserving surgery followed by adjuvant radiation therapy. For women with left-sided breast cancer, there is risk of potential cardiotoxicity from the radiation therapy. As data have become available to quantify the risk of cardiotoxicity from radiation, strategies have also developed to reduce the dose of radiation to the heart without compromising radiation dose to the breast. Several broad categories of techniques to reduce cardiac radiation doses include breath hold techniques, prone positioning, intensity-modulated radiation therapy, and accelerated partial breast irradiation, as well as many small techniques to improve traditional three-dimensional conformal radiation therapy. This review summarizes the published scientific literature on the various techniques to decrease cardiac irradiation in women treated to the left breast for breast cancer after breast-conserving surgery.
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Affiliation(s)
- Robert E Beck
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Leonard Kim
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Atif J Khan
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
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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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Borges C, Cunha G, Monteiro-Grillo I, Vaz P, Teixeira N. Comparison of different breast planning techniques and algorithms for radiation therapy treatment. Phys Med 2013; 30:160-70. [PMID: 23735838 DOI: 10.1016/j.ejmp.2013.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/23/2013] [Accepted: 04/30/2013] [Indexed: 12/25/2022] Open
Abstract
This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques--forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT--and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques--f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART - were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.
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Affiliation(s)
- C Borges
- Medicalconsult SA, Campo Grande, n° 56 - 8° A, 1700-093 Lisboa, Portugal.
| | - G Cunha
- Escola Superior de Tecnologias da Saúde, Avenida Dom João II, 1900-096 Lisboa, Portugal
| | - I Monteiro-Grillo
- Departamento de Radioterapia, Hospital de Santa Maria, Centro Hospitalar Lisboa, Norte, EPE, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - P Vaz
- Instituto Superior Técnico, Campus Tecnológico e Nuclear, Unidade de Protecção e Segurança Radiológica, Estrada Nacional 10 (ao km 139,7), 2695-066 Bobadela LRS, Portugal
| | - N Teixeira
- Escola Superior de Tecnologias da Saúde, Avenida Dom João II, 1900-096 Lisboa, Portugal
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Reardon KA, Read PW, Morris MM, Reardon MA, Geesey C, Wijesooriya K. A comparative analysis of 3D conformal deep inspiratory–breath hold and free-breathing intensity-modulated radiation therapy for left-sided breast cancer. Med Dosim 2013; 38:190-5. [DOI: 10.1016/j.meddos.2013.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 12/27/2012] [Accepted: 01/07/2013] [Indexed: 01/18/2023]
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Tsai PF, Lin SM, Lee SH, Yeh CY, Huang YT, Lee CC, Hong JH. The feasibility study of using multiple partial volumetric-modulated arcs therapy in early stage left-sided breast cancer patients. J Appl Clin Med Phys 2012; 13:3806. [PMID: 22955645 PMCID: PMC5718231 DOI: 10.1120/jacmp.v13i5.3806] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 03/01/2012] [Accepted: 04/26/2012] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to assess the feasibility of using a multiple partial volumetric‐modulated arcs therapy (MP‐VMAT) technique on the left breast irradiation and to evaluate the dosimetry and treatment efficiency. Ten patients with left‐sided breast cancer who had been treated by whole breast irradiation were selected for the treatment plan evaluation by using six partial volumetric modulated arcs. Each arc consisted of a 50° gantry rotation. The planning target volumes and the normal organs, including the right breast, the bilateral lungs, left ventricle, heart, and unspecified tissue, were contoured on the CT images. Dose‐volume histograms were generated and the delivery time for each arc was recorded. The PTV received greater than 95% of the V95 for all cases, and the maximum dose was within ±1% of 110% of the prescription dose. The mean homogeneity index (HI) was 10.61±0.99, and mean conformity index (CI) was 1.21±0.03. The mean dose, V5, V10, V25, and V30 of the heart were 7.61±1.38 Gy, 59.73% ±15.87%, 24.39% ±6.82%, 2.52% ±1.11%, and 1.57% ±0.71%, respectively. The volume of the left ventricle receiving 25 Gy was 5.15% ±2.23%. The total lung mean dose was 5.57±0.36 Gy, with V5 of 25.39% ±3.88% and V20 of 5.66% ±0.89%. The right breast received a mean dose of 2.13±0.22 Gy, with V5 of 1.83% ±1.22% and V10 of 0.04% ±0.12%. The mean dose of unspecified tissue was 5.34±0.37 Gy and V5 was 22.23% ±1.57%. The volume of the unspecified tissue receiving 50 Gy was 0.50% ±0.14%. The mean delivery time for each arc was 13.9 seconds. The average MU among ten patients was 511 MU (range 443 to 594 MUs). The MP‐VMAT technique for the left‐sided breast cancer patients achieved adequate target dose coverage while maintaining low doses to organs‐at‐risk, and therefore reduced the potential for induction of second malignancy and side effects. The highly efficient treatment delivery would be beneficial for improving patient throughput, providing patient comfort, and achieving precise treatment with the breathing control system. PACS number: 87.55.‐x, 87.55.D‐, 87.55.dk
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Affiliation(s)
- Ping-Fang Tsai
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
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Semaniak A, Jodkiewicz Z, Skowrońska-Gardas A. Segmented photon beams technique for irradiation of postmastectomy patients. Rep Pract Oncol Radiother 2012; 17:85-92. [PMID: 24377005 DOI: 10.1016/j.rpor.2012.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 01/15/2012] [Indexed: 11/18/2022] Open
Abstract
AIM To present the segmented photon beams technique (SPBT) for irradiation of postmastectomy patients. BACKGROUND In majority of techniques for irradiation of posmastectomy patients, a few adjacent photon or electron beams were usually implemented in order to encompass different parts of the target. In the presented SPBT technique, the radiotherapy plan consists of 6 isocentric photon beams and the area CTV includes both the chest wall and the supraclavicular area. This makes it possible to provide a uniform dose to the CTV with no hot and cold points and enables the determination of doses for the entire volume of critical organs. METHODS AND MATERIAL The treatment forward-IMRT plan comprises six isocentric 4 and 15 MV photon beams. Modulation of the dose distribution for each field was obtained by applying three segments on average. The total dose of 45 Gy was administered in 20 fractions. Dose distributions in target volume and organs at risk were evaluated for 70 randomly chosen patients. RESULTS On average, 94.8% of the CTV volume received doses within 95-107% of the prescribed dose. The average volume of the heart receiving a dose of 30 Gy and lager was 2% for patients with left breast cancer. The average dose to the lung on the irradiation side was always lower than 15.5 Gy and the average V20 Gy was below 35.5%. CONCLUSIONS The SPBT complies with requirements for high dose homogeneity within the target volume and satisfactory level of sparing of organs at risk.
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Affiliation(s)
- Anna Semaniak
- Department of Medical Physics, Maria Skłodowska Curie Memorial Cancer Centre-Institute, Wawelska 15, 00-973 Warsaw, Poland
| | - Zbigniew Jodkiewicz
- Department of Radiotherapy, Maria Skłodowska Curie Memorial Cancer Centre-Institute, Wawelska 15, 00-973 Warsaw, Poland
| | - Anna Skowrońska-Gardas
- Department of Radiotherapy, Maria Skłodowska Curie Memorial Cancer Centre-Institute, Wawelska 15, 00-973 Warsaw, Poland
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Forward Intensity-Modulated Radiotherapy Planning in Breast Cancer to Improve Dose Homogeneity: Feasibility of Class Solutions. Int J Radiat Oncol Biol Phys 2012; 82:394-400. [DOI: 10.1016/j.ijrobp.2010.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 06/14/2010] [Accepted: 09/14/2010] [Indexed: 01/02/2023]
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16
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Morganti AG, Cilla S, de Gaetano A, Panunzi S, Digesù C, Macchia G, Massaccesi M, Deodato F, Ferrandina G, Cellini N, Scambia G, Piermattei A, Valentini V. Forward planned intensity modulated radiotherapy (IMRT) for whole breast postoperative radiotherapy. Is it useful? When? J Appl Clin Med Phys 2011; 12:3451. [PMID: 21587195 PMCID: PMC5718668 DOI: 10.1120/jacmp.v12i2.3451] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/10/2010] [Accepted: 01/10/2011] [Indexed: 11/23/2022] Open
Abstract
The purpose was to compare the dosimetric results observed in 201 breast cancer patients submitted to tangential forward intensity-modulated radiation therapy (IMRT) with those observed in 131 patients treated with a standard wedged 3D technique for postoperative treatment of whole breast, according to breast size and supraclavicular node irradiation. Following dosimetric parameters were used for the comparison: D(max), D(min), D(mean), V(95%) and V(107%) for the irradiated volume; D(max), D(mean), V(80%) and V(95%) for the ipsilateral lung; D(max), D(mean), V(80%) and V(95%) for the heart. Stratification was made according to breast size and supraclavicular (SCV) nodal irradiation. As respect to irradiated volume, a significant reduction of V(107%) (mean values: 7.0 ± 6.6 versus 2.4 ± 3.7, p < 0.001) and D(max) (mean % values: 111.2 ± 2.7 versus 107.7 ± 6.3, p < 0.001), and an increase of D(min) (mean % values: 65.0 ± 17.4 versus 74.9 ± 12.9, p < 0.001) were observed with forward IMRT. The homogeneity of dose distribution to target volume significantly improved with forward IMRT in all patient groups, irrespective of breast size or supraclavicular nodal irradiation. When patients treated with supraclavicular nodal irradiation were excluded from the analysis, forward IMRT slightly reduced V(80%) (mean values: 3.7 ± 2.6 versus 3.0 ± 2.4, p = 0.03) and V(95%) (mean values 1.9 ± 1.8 versus 1.2%± 1.5; p = 0.001) of the ipsilateral lung. The dose to the heart tended to be lower with IMRT but this difference was not statistically significant. Tangential forward IMRT in postoperative treatment of whole breast improved dosimetric parameters in terms of homogeneity of dose distribution to the target in a large sample of patients, independent of breast size or supraclavicular nodal irradiation. Lung irradiation was slightly reduced in patients not undergoing to supraclavicular irradiation.
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Affiliation(s)
- Alessio G. Morganti
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Savino Cilla
- Medical Physics UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Andrea de Gaetano
- CNR‐Institute of Systems Analysis and Computer Science (IASI)BioMathLabRome
| | - Simona Panunzi
- CNR‐Institute of Systems Analysis and Computer Science (IASI)BioMathLabRome
| | - Cinzia Digesù
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Gabriella Macchia
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Mariangela Massaccesi
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Francesco Deodato
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Gabriella Ferrandina
- Gynaecology Oncology UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Numa Cellini
- Department of RadiotherapyPoliclinico Universitario “Agostino Gemelli”, Catholic UniversityRomeItaly
| | - Giovanni Scambia
- Gynecology Oncology DepartmentPoliclinico Universitario “Agostino Gemelli”, Catholic UniversityRomeItaly
| | - Angelo Piermattei
- Medical Physics UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Vincenzo Valentini
- Department of RadiotherapyPoliclinico Universitario “Agostino Gemelli”, Catholic UniversityRomeItaly
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17
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Sas-Korczyńska B, Sladowska A, Rozwadowska-Bogusz B, Dyczek S, Lesiak J, Kokoszka A, Korzeniowski S. Comparison between intensity modulated radiotherapy (IMRT) and 3D tangential beams technique used in patients with early-stage breast cancer who received breast-conserving therapy. Rep Pract Oncol Radiother 2010; 15:79-86. [PMID: 24376929 DOI: 10.1016/j.rpor.2010.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The most often found complications in patients with breast cancer who received radiotherapy are cardiac and pulmonary function disorders and development of second malignancies. AIM To compare the intensity modulated radiotherapy with the 3D tangential beams technique in respect of dose distribution in target volume and critical organs they generate in patients with early-stage breast cancer who received breast-conserving therapy. MATERIALS AND METHODS A dosimetric analysis was performed to assess the three radiotherapy techniques used in each of 10 consecutive patients with early-stage breast cancer treated with breast-conserving therapy. Radiotherapy was planned with the use of all the three techniques: 3D tangential beams with electron boost, IMRT with electron boost, and intensity modulated radiotherapy with simultaneous integrated boost. RESULTS The use of the IMRT techniques enables more homogenous dose distribution in target volume. The range of mean and median dose to the heart and lung was lower with the IMRT techniques in comparison to the 3D tangential beams technique. The range of mean dose to the heart amounted to 0.3-3.5 Gy for the IMRT techniques and 0.4-4.3 for the tangential beams technique. The median dose to the lung on the irradiated side amounted to 4.9-5 Gy for the IMRT techniques and 5.6 Gy for the 3D tangential beams technique. CONCLUSION The application of the IMRT techniques in radiotherapy patients with early-stage breast cancer allows to obtain more homogenous dose distribution in target volume, while permitting to reduce the dose to critical organs.
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Affiliation(s)
- Beata Sas-Korczyńska
- Breast and Thoracic Cancer Unit, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115 Kraków, Poland
| | - Anna Sladowska
- Medical Physics, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115 Kraków, Poland
| | - Bożena Rozwadowska-Bogusz
- Medical Physics, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115 Kraków, Poland
| | - Sonia Dyczek
- Diagnostic Radiology, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115 Kraków, Poland
| | - Jan Lesiak
- Medical Physics, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115 Kraków, Poland
| | - Anna Kokoszka
- Breast and Thoracic Cancer Unit, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115 Kraków, Poland
| | - Stanisław Korzeniowski
- Breast and Thoracic Cancer Unit, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115 Kraków, Poland
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18
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Dosimetric comparison of field in field intensity-modulated radiotherapy technique with conformal radiotherapy techniques in breast cancer. Jpn J Radiol 2010; 28:283-9. [DOI: 10.1007/s11604-010-0423-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 01/21/2010] [Indexed: 11/26/2022]
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