1
|
Prokofev I, Salim N. Off-isocentric VMAT technique for breast cancer: Effective dose reduction to organs at risk and its applicability based on patient anatomy. J Appl Clin Med Phys 2024; 25:e14237. [PMID: 38207110 DOI: 10.1002/acm2.14237] [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: 11/03/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE This study aims to explore the off-isocentric volumetric modulated arc therapy (offVMAT) technique for breast cancer and determine its applicability based on patient anatomical parameters. METHODS We retrospectively analyzed 44 breast cancer patients with varied lymph node involvement using different arc designs. Off-isocentric techniques were benchmarked against previously published arc techniques: classic arcs (clVMAT), tangential arcs (tVMAT), and split arcs (spVMAT). During optimization, target coverage was made for all plans as close as possible to the criteria D99% > 95% and Dmax < 110% of the prescribed dose. A novel patient categorization, based on anatomical parameters (auxiliary structures) rather than lymph node involvement, is introduced. This categorization considers the volume of ipsilateral organs at risk (OARs) adjacent to the target. A binary regression model was developed on these anatomical parameters. It predicts the likelihood of offVMAT (P[offVMAT]) achieving better criteria. RESULTS Using the regression model, patients were divided into two groups: P(offVMAT) > 0.5 and P(offVMAT) < 0.5. For the P(offVMAT) > 0.5 group, most tVMAT plans are unable to achieve the clinical objectives. Comparing offVMAT with spVMAT, offVMAT exhibited better dose parameters for the heart (V20, V10, and D2 are 7.1, 2.4, and 1.5 times lower respectively), ipsilateral lung (V20, V10, V5 and the mean dose are 1.4, 1.3, 1.2, and 1.2 times lower respectively). The average doses to the contralateral side are consistent. In the P(offVMAT) < 0.5 group, the tVMAT technique showed increased doses at medium and high levels, yet reduced doses in contralateral OARs compared to spVMAT and offVMAT. spVMAT showed lower doses in the contralateral lung relative to the offVMAT technique, while clVMAT trailed in both groups. Validation of the model yielded a 90% accuracy rate. CONCLUSIONS The new off-isocentric breast planning technique effectively reduces doses to ipsilateral OARs, maintaining acceptable contralateral mean doses. This technique has an advantage over other techniques for patients with intricate anatomies. It is evaluated using anatomical parameters, which are also used to build binary regression model, which shows the dependence of anatomical parameters on whether offVMAT is preferred for individual patients. Also, such anatomical parameters provide a more objective and precise comparison between different planning techniques.
Collapse
Affiliation(s)
- Igor Prokofev
- Department of Radiotherapy, European Medical Center, Moscow, Russia
| | - Nidal Salim
- Department of Radiotherapy, European Medical Center, Moscow, Russia
| |
Collapse
|
2
|
Choi DH, Kim DW, Park SH, Ahn SH, Ahn WS, Lee R, Kim JS. Development of open access tool for automatic use factor calculation using DICOM-RT patient data. Phys Eng Sci Med 2023; 46:1043-1053. [PMID: 37470930 PMCID: PMC10480328 DOI: 10.1007/s13246-023-01272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/01/2023] [Indexed: 07/21/2023]
Abstract
Our study recalculated the use factor of linear accelerators (LINACs) by using an in-house program based on Digital Imaging and Communications in Medicine radiation therapy (DICOM-RT). We considered the impact of advancements and changes in treatment trends, including modality, technology, and radiation dose, on the use factor, which is one of the shielding parameters. In accordance with the methodology described in the NCRP 151 report, we computed the use factor for four linear accelerators (LINACs) across three hospitals. We analyzed the results based on the treatment techniques and treatment sites for three-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy or volumetric modulated arc therapy. Our findings revealed that the use factors obtained at 45° and 90° were 14.8% and 13.5% higher than those of the NCRP 151 report. In treatment rooms with a high 3D-CRT ratio, the use factor at a specific angle differed by up to 14.6% relative to the NCRP 151 report value. Our results showed a large difference in the use factor for specific sites such as the breast and spine, so it is recommended that each institution recalculate the use factor using patient's data.
Collapse
Affiliation(s)
- Dong Hyeok Choi
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
- Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Heavy Ion Therapy Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Wook Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
- Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Heavy Ion Therapy Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - So Hyun Park
- Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, Jeju, Republic of Korea
| | - So Hyun Ahn
- Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Woo Sang Ahn
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea.
| | - Rena Lee
- Department of Biomedical Engineering, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jin Sung Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
- Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Heavy Ion Therapy Research Institute, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
3
|
Pan L, Du B, Zhu Z, Meng Q, Zhong R, Wang S. A comparative study of volumetric modulated arc therapy plans based on the equivalent uniform dose optimization for left-sided breast cancer. Radiat Phys Chem Oxf Engl 1993 2023. [DOI: 10.1016/j.radphyschem.2023.110945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
|
4
|
Fogliata A, Parabicoli S, Paganini L, Reggiori G, Lobefalo F, Cozzi L, Franzese C, Franceschini D, Spoto R, Scorsetti M. Knowledge-based DVH estimation and optimization for breast VMAT plans with and without avoidance sectors. Radiat Oncol 2022; 17:200. [PMID: 36474297 PMCID: PMC9724419 DOI: 10.1186/s13014-022-02172-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To analyze RapidPlan knowledge-based models for DVH estimation of organs at risk from breast cancer VMAT plans presenting arc sectors en-face to the breast with zero dose rate, feature imposed during the optimization phase (avoidance sectors AS). METHODS CT datasets of twenty left breast patients in deep-inspiration breath-hold were selected. Two VMAT plans, PartArc and AvoidArc, were manually generated with double arcs from ~ 300 to ~ 160°, with the second having an AS en-face to the breast to avoid contralateral breast and lung direct irradiation. Two RapidPlan models were generated from the two plan sets. The two models were evaluated in a closed loop to assess the model performance on plans where the AS were selected or not in the optimization. RESULTS The PartArc plans model estimated DVHs comparable with the original plans. The AvoidArc plans model estimated a DVH pattern with two steps for the contralateral structures when the plan does not contain the AS selected in the optimization phase. This feature produced mean doses of the contralateral breast, averaged over all patients, of 0.4 ± 0.1 Gy, 0.6 ± 0.2 Gy, and 1.1 ± 0.2 Gy for the AvoidArc plan, AvoidArc model estimation, RapidPlan generated plan, respectively. The same figures for the contralateral lung were 0.3 ± 0.1 Gy, 1.6 ± 0.6 Gy, and 1.2 ± 0.5 Gy. The reason was found in the possible incorrect information extracted from the model training plans due to the lack of knowledge about the AS. Conversely, in the case of plans with AS set in the optimization generated with the same AvoidArc model, the estimated and resulting DVHs were comparable. Whenever the AvoidArc model was used to generate DVH estimation for a plan with AS, while the optimization was made on the plan without the AS, the optimizer evidentiated the limitation of a minimum dose rate of 0.2 MU/°, resulting in an increased dose to the contralateral structures respect to the estimation. CONCLUSIONS The RapidPlan models for breast planning with VMAT can properly estimate organ at risk DVH. Attention has to be paid to the plan selection and usage for model training in the presence of avoidance sectors.
Collapse
Affiliation(s)
- Antonella Fogliata
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Sara Parabicoli
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Lucia Paganini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Giacomo Reggiori
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Francesca Lobefalo
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Luca Cozzi
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - Ciro Franzese
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - Davide Franceschini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Ruggero Spoto
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Marta Scorsetti
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| |
Collapse
|
5
|
Choi DH, Kim DW, Ahn SH, Choi SH, Jang YJ, Kwon NH, Seok JH, Park SH, Ahn WS, Kim JS. Shielding evaluator actual treatment leaf: A program for automatic shielding assessment using patient data. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
6
|
Kwon NH, Shin DO, Ann SH, Kim JS, Choi SH, Kim DW. Analysis of radiation safety management status of medical linear accelerator facilities in Korea. NUCLEAR ENGINEERING AND TECHNOLOGY 2022. [DOI: 10.1016/j.net.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Ahrouch I, Van Gestel D, Koshariuk O, Kirkove C, Desmet A, Philippson C, Reynaert N, De Caluwe A. Unintended dose to the lower axilla in adjuvant radiotherapy for breast cancer: Differences between tangential beam and VMAT. Radiother Oncol 2021; 164:282-288. [PMID: 34648872 DOI: 10.1016/j.radonc.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate dosimetric differences in unintended dose to the lower axilla between 3D-standard (3DCRT), tangential beam forward intensity modulated radiotherapy (F-IMRT) and volumetric modulated arc therapy (VMAT). The objective is to evaluate whether results of clinical trials, such as the ACOSOG-Z011 trial, that evaluated omission of axillary clearance can be extrapolated towards more conformal techniques like VMAT. MATERIALS AND METHODS Twenty-five consecutive patients treated with whole breast radiotherapy alone (WBRT) using a F-IMRT technique were identified. Three additional plans were created for every patient: one plan using a single 270° arc (VMAT 1x270°), another using two small ≤90° opposing arcs (VMAT 2x < 90°) and thirdly a 3DCRT plan without F-IMRT. Axillary levels I-II were contoured after the treatment plans were made. RESULTS The volume of the axilla level I that was covered by the 50% isodose (V50%) was significantly higher for VMAT 2x < 90° (71.3 cm3, 84% of structure volume, p < 0.001) and VMAT 1x270° (68.8 cm3, 81%, p < 0.01) compared to 3DCRT (60.3 cm3, 71%) and F-IMRT (60.8 cm3, 72%). The V50% to the axilla level II, however, was low for all techniques: 12.3 cm3 (12%); 8.9 cm3 (9%); 4.3 cm3 (4%); 4.4 cm3 (4%) for VMAT 2x < 90°, VMAT 1x270°, 3DCRT, F-IMRT, respectively. For the higher doses (V90% and above), no clinically relevant differences were seen between the different modalities. CONCLUSION WBRT treatments with VMAT do not lead to a significant reduction of the unintended axillary dose in comparison with a tangential beam setup. Hence, concerning tumor control, VMAT can be applied to clinical situations similar to the Z0011 trial. The intermediate axillary dose is higher with VMAT, but the clinical consequence of this difference on toxicity is unknown.
Collapse
Affiliation(s)
- Imane Ahrouch
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Olga Koshariuk
- Department of Radiation Oncology, Clinique St Elisabeth, Namur, Belgium
| | - Carine Kirkove
- Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Antoine Desmet
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Catherine Philippson
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Nick Reynaert
- Department of Medical Physics, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Alex De Caluwe
- Department of Radiation Oncology, Breast Working Group, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium.
| |
Collapse
|
8
|
Improvement of matching fields using coplanar field border method in postmastectomy radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
To propose a new matching method for the supraclavicular (SC) and tangential fields on three-dimensional radiotherapy (3DRT) for postmastectomy radiotherapy (PMRT).
Methods:
A method of matching coplanar field borders (CFB) between the tangential and SC fields was created in 3DRT. The collimator angle of the medial tangential field was calculated to coplanar the SC field. The proposed method performance was ultimately benchmarked using the half beam block (HBB) and traditional three-field monoisocenter (TTM) methods by dosimetric comparison. The decision score was then employed to clarify the performance among these methods.
Results:
The results show that the TTM method exhibited not only low doses on the organs at risk (OAR) but also on the matching fields. The CFB and HBB produced comparable results, but the ipsilateral lung yielded lesser amounts than the HBB. The decision score indicated a low performance level when using the TTM method, whereas the CBF method exhibited a slightly higher performance score than the HBB.
Findings:
The CFB exhibited good performance in terms of the dose on OARs and at the matching fields. This method offers a comparable level of performance to the HBB. Thus, the CFB offers an alternative method of significant interest in PMRT.
Collapse
|
9
|
Nakano H, Kawahara D, Tanabe S, Utsunomiya S, Takizawa T, Sakai M, Nakano T, Ohta A, Kaidu M, Ishikawa H. Calculated relative biological effectiveness (RBE) for initial DNA double-strand breaks (DSB) from flattening filter and flattening filter-free 6 MV X-ray fields. BJR Open 2021; 3:20200072. [PMID: 34286177 PMCID: PMC8256801 DOI: 10.1259/bjro.20200072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives We evaluated the radiobiological effectiveness based on the yields of DNA double-strand breaks (DSBs) of field induction with flattening filter (FF) and FF-free (FFF) photon beams. Methods We used the particle and heavy ion transport system (PHITS) and a water equivalent phantom (30 × 30 × 30 cm3) to calculate the physical qualities of the dose-mean lineal energy (yD) with 6 MV FF and FFF. The relative biological effectiveness based on the yields of DNA-DSBs (RBEDSB) was calculated for standard radiation such as 220 kVp X-rays by using the estimating yields of SSBs and DSBs. The measurement points used to calculate the in-field yD and RBEDSB were located at a depth of 3, 5, and 10 cm in the water equivalent phantom on the central axis. Measurement points at 6, 8, and 10 cm in the lateral direction of each of the three depths from the central axis were set to calculate the out-of-field yD and RBEDSB. Results The RBEDSB of FFF in-field was 1.7% higher than FF at each measurement depth. The RBEDSB of FFF out-of-field was 1.9 to 6.4% higher than FF at each depth measurement point. As the distance to out-of-field increased, the RBEDSB of FFF rose higher than those of FF. FFF has a larger RBEDSB than FF based on the yields of DNA-DSBs as the distance to out-of-field increased. Conclusions The out-of-field radiobiological effect of FFF could thus be greater than that of FF since the spreading of the radiation dose out-of-field with FFF could be a concern compared to the FF. Advances in knowledge The RBEDSB of FFF of out-of-field might be larger than FF.
Collapse
Affiliation(s)
- Hisashi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Satoru Utsunomiya
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | | | - Madoka Sakai
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Toshimichi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Atsushi Ohta
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Japan
| | - Motoki Kaidu
- Department of Radiation Oncology, Niigata Neurosurgical Hospital, Niigata, 3057 Yamada, Nishi-ku, Niigata, Japan
| | - Hiroyuki Ishikawa
- Department of Radiation Oncology, Niigata Neurosurgical Hospital, Niigata, 3057 Yamada, Nishi-ku, Niigata, Japan
| |
Collapse
|
10
|
Costa E, Richir T, Robilliard M, Bragard C, Logerot C, Kirova Y, Fourquet A, De Marzi L. Assessment of a conventional volumetric-modulated arc therapy knowledge-based planning model applied to the new Halcyon© O-ring linac in locoregional breast cancer radiotherapy. Phys Med 2021; 86:32-43. [PMID: 34051551 DOI: 10.1016/j.ejmp.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/31/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the performance of a knowledge-based planning (KBP) model for breast cancer trained on plans performed on a conventional linac with 6 MV FF (flattening filter) beams and volumetric-modulated arc therapy (VMAT) for plans performed on the new jawless Halcyon© system with 6 MV FFF (flattening filter-free) beams. MATERIALS AND METHODS Based on the RapidPlan© (RP) KBP optimization engine, a DVH Estimation Model was first trained using 56 VMAT left-sided breast cancer treatment plans performed on a conventional linac, and validated on another 20 similar cases (without manual intervention). To determine the capacity of the model for Halcyon©, an additional cohort of 20 left-sided breast cancer plans was generated with RP and analyzed for both TrueBeam© and Halcyon© machines. Plan qualities between manual vs RP (followed by manual intervention) Halcyon© plans set were compared qualitatively by blinded review by radiation oncologists for 10 new independent plans. RESULTS Halcyon© plans generated with the VMAT model trained with conventional linac plans showed comparable target dose distribution compared to TrueBeam© plans. Organ sparingwas comparable between the 2 devices with a slight decrease in heart dose for Halcyon© plans. Nine out of ten automatically generated Halcyon© plans were preferentially chosen by the radiation oncologists over the manually generated Halcyon© plans. CONCLUSION A VMAT KBP model driven by plans performed on a conventional linac with 6 MV FF beams provides high quality plans performed with 6 MV FFF beams on the new Halcyon© linac.
Collapse
Affiliation(s)
- Emilie Costa
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France.
| | - Thomas Richir
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Magalie Robilliard
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Christel Bragard
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Christelle Logerot
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Youlia Kirova
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Alain Fourquet
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France
| | - Ludovic De Marzi
- Institut Curie, Radiation Oncology Department, 26 rue d'Ulm, Paris 75005, France; Institut Curie, University Paris Saclay, PSL Research University, Inserm LITO, Orsay, France
| |
Collapse
|
11
|
Organ at risk dose calculation for left sided breast cancer treatments using intraoperative electron radiotherapy: A Monte Carlo-based feasibility study. Appl Radiat Isot 2020; 156:108977. [DOI: 10.1016/j.apradiso.2019.108977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/14/2019] [Accepted: 11/07/2019] [Indexed: 12/24/2022]
|
12
|
Zhang Q, Liu J, Ao N, Yu H, Peng Y, Ou L, Zhang S. Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques. Sci Rep 2020; 10:1220. [PMID: 31988348 PMCID: PMC6985127 DOI: 10.1038/s41598-020-58134-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/12/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to estimate the radiation-related secondary cancer risks in organs during the treatment of breast cancer with different radiotherapy techniques, such as three-dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). The treatment plans for 26 patients with breast cancer who received whole-breast irradiation at a dose of 50 Gy included tangential field 3D-CRT with hard-wedges (W-TF), tangential field IMRT (2F-IMRT), multiple field IMRT (6F-IMRT), and double partial arcs (VMAT). Patients were divided into three groups according to the distance between the contralateral breast (CB) and the body of the sternum. Setup error was simulated by moving the isocenter, and the dose distribution was then recalculated without changing the field fluency distribution. Based on the linear-exponential, the plateau, and the full mechanistic dose-response models, the organ equivalent dose and excess absolute risk were calculated from dose-volume histograms to estimate the secondary cancer risks in organs. Compared with 3D-CRT, IMRT and VMAT showed excellent results regarding tumor conformity and homogeneity; however, the low dose volume to organs was considerably higher in 6F-IMRT and VMAT. Secondary cancer risks for 2F-IMRT were comparable or slightly lower than for W-TF, but considerably lower than for 6F-IMRT or VMAT. After setup error simulation, there was a small increase in secondary cancer risk for 2F-IMRT and an increase of 159% and 318% for 6F-IMRT and VMAT, respectively, compared with W-TF. Although these results were obtained in most patients, they did not necessarily apply to every individual. The secondary cancer risks in the CB decreased significantly in correlation with increased distance for all alternative techniques, although they were higher in VMAT and lower in 2F-IMRT regardless of the distance. After setup error simulation, the increased changes in secondary cancer risks in the CB were comparable between 2F-IMRT, 6F-IMRT, and VMAT, suggesting that the secondary cancer risks in the CB mainly depend on radiotherapy techniques and distance, although the effect of setup error cannot be ignored. In the contralateral lung (CL), the secondary cancer risks were almost independent from distance and depended mainly on radiotherapy techniques; they were rarely affected by setup error. VMAT was associated with a higher secondary cancer risk in the CL. For the ipsilateral lung (IL), the secondary cancer risks were higher than those in other organs because the IL receives high doses to achieve tumor control, and they were relatively lower in VMAT. This warrants special consideration when estimating the secondary cancer risk to the IL. The study results suggested that the optimal radiotherapy method for breast cancer should be determined on an individual basis and according to the balance between secondary cancer risks related to anatomic diversity and setup error, which can prevent blind selection of techniques.
Collapse
Affiliation(s)
- Quanbin Zhang
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Jinbo Liu
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ningjian Ao
- Department of Biomedical Engineering, Jinan University, Guangzhou, China
| | - Hui Yu
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Yingying Peng
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Liya Ou
- Guangzhou Medical University, Guangzhou, China
| | - Shuxu Zhang
- Radiotherapy center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
13
|
Haciislamoglu E, Cinar Y, Gurcan F, Canyilmaz E, Gungor G, Yoney A. Secondary cancer risk after whole-breast radiation therapy: field-in-field versus intensity modulated radiation therapy versus volumetric modulated arc therapy. Br J Radiol 2019; 92:20190317. [PMID: 31295011 DOI: 10.1259/bjr.20190317] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In this study, we used the concept of organ-equivalent dose (OED) to evaluate the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for breast cancer. METHODS Using CT data set of 12 patients, we generated three different whole-breast radiation treatment plans using 50 Gy in 2 Gy fractions: three-dimensional conformal radiotherapy with a field-in-field (FinF) technique, intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). The OEDs were calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models. Secondary cancer risks of the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL) were estimated and compared. RESULTS The lowest EARs for the CB, CL, and IL were achieved with FinF, which reduced the EARs by 77%, 88%, and 56% relative to those with IMRT, and by 77%, 84%, and 58% relative to those with VMAT, respectively. The secondary cancer risk for FinF was significantly lower than those of IMRT and VMAT. OED-based secondary cancer risks for CB and IL were similar when IMRT and VMAT were used, but the risk for CL was statistically lower when VMAT was used. CONCLUSION The overall estimation of EAR indicated that the radiation-induced cancer risk of breast radiation therapy was lower with FinF than with IMRT and VMAT. Therefore, when secondary cancer risk is a major concern, FinF is considered to be the preferred treatment option in irradiation of whole-breast. ADVANCES IN KNOWLEDGE Secondary malignancy estimation after breast radiotherapy is becoming an important subject for comparative treatment planning.When secondary cancer risk a major concern, FinF technique is considered the preferred treatment option in whole breast patients.
Collapse
Affiliation(s)
- Emel Haciislamoglu
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yunus Cinar
- Department of Radiation Oncology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Fatih Gurcan
- Department of Computer Engineering, Karadeniz Technical University Faculty of Engineering, Trabzon, Turkey
| | - Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gorkem Gungor
- Department of Radiation Oncology, Acibadem University, Istanbul, Turkey
| | - Adnan Yoney
- Department of Radiation Oncology, Acibadem University, Istanbul, Turkey
| |
Collapse
|
14
|
Bogue J, Wan J, Lavey RS, Parsai EI. Dosimetric comparison of VMAT with integrated skin flash to 3D field-in-field tangents for left breast irradiation. J Appl Clin Med Phys 2019; 20:24-29. [PMID: 30653831 PMCID: PMC6371015 DOI: 10.1002/acm2.12527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 10/21/2018] [Accepted: 10/28/2018] [Indexed: 12/13/2022] Open
Abstract
Volumetric modulated arc therapy (VMAT) has been implemented for left breast irradiation to reduce prescription dose to the heart and improve dose homogeneity across the targeted breast. Our in-house method requires application of a bolus during the optimization process with a target outside of the body, then removing the bolus during the final calculation in order to incorporate skin flash in VMAT plans. To quantify the dosimetric trade-offs between traditional 3D field-in-field tangents and VMAT with integrated skin flash for these patients, we compared nine consecutive patients who recently received radiation to their entire left breast but not their regional lymphatics. Tangent plans used non-divergent tangents of mixed energies and VMAT plans utilized four 6 MV arcs of roughly 260°. Mean dose to the heart, contralateral lung, and contralateral breast and their volume receiving 5%, 10%, and 20% of the prescription dose were higher in all nine VMAT plans than in the static tangential beam plans. For all critical structures, the mean VMAT DVH was higher in the low-dose region and crossed the 3D field-in-field DVH between 23.13% and 34.18% of the prescription dose (984.75-1454.70 cGy). However, the volume of the contralateral breast and heart receiving the prescription dose was slightly lower in the VMAT plans, but not statistically significant. VMAT provided superior homogeneity, with a mean homogeneity index of 9.41 ± 1.64 compared to 11.05 ± 1.82 for 3D tangents. Results indicate that VMAT spares the heart, contralateral lung, and contralateral breast from prescription dose at the cost of increasing their mean and low-dose volume and delivers a more homogenous dose distribution to the breast. For these reasons, VMAT is selectively applied at the request of the physician for left breast radiation without respiratory gating to spare the heart from prescription dose in cases of poor anatomical geometry.
Collapse
Affiliation(s)
- Jonathan Bogue
- Department of Radiation OncologyUniversity of Toledo Medical CenterToledoOHUSA
| | - Jui Wan
- Department of Radiation OncologyUniversity of Toledo Medical CenterToledoOHUSA
| | | | - E. Ishmael Parsai
- Department of Radiation OncologyUniversity of Toledo Medical CenterToledoOHUSA
| |
Collapse
|
15
|
The Role of Adjuvant Radiotherapy for a Case of Primary Breast Sarcoma: A Plan Comparison between Three Modern Techniques and a Review of the Literature. Case Rep Med 2018; 2018:4137943. [PMID: 29849658 PMCID: PMC5932497 DOI: 10.1155/2018/4137943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 12/25/2022] Open
Abstract
A 65-year-old woman, affected by a malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma) of the left breast, presented to our department to receive the postoperative radiotherapy. In the absence of prospective and randomized trials and investigations on breast sarcoma irradiation in literature, due to the rarity of this pathology, the role of adjuvant radiotherapy remains unclear. To identify the best radiotherapy technique for this patient, three methods were compared: 3D conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric arc therapy (VMAT) or RapidArc® (RA). 50 Gy was prescribed to the chest wall and 66 Gy to the tumor bed. Three plans were designed, and target coverage, organs-at-risk sparing, and treatment efficiency were compared. IMRT and RA improved both target coverage and dose uniformity/homogeneity. Planning objective for the lung is always satisfied comparing the different techniques, but the volume receiving 20 Gy drops to 17% by RA compared to 3D-CRT. The heart volume receiving 30 Gy was 10% by IMRT, against 13% and 16% by RA and 3D-CRT. The monitor unit (MU) required by 3D-CRT was 527 MU, followed by RA and IMRT. Treatment time was similar with 3D-CRT and RA but doubled using IMRT. Although all three radiotherapy techniques offered a satisfactory solution, RA and IMRT offer some improvement on target coverage, dose homogeneity, and conformity for this particular case of breast sarcoma.
Collapse
|
16
|
Milo MLH, Spejlborg H, Thorsen LBJ, Offersen BV. Pectus excavatum and adjuvant radiotherapy for early stage breast cancer: balancing dose to target versus heart. Acta Oncol 2017; 56:1653-1656. [PMID: 28835154 DOI: 10.1080/0284186x.2017.1354132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Harald Spejlborg
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | | | | |
Collapse
|
17
|
Bodez V, Duqueyroix F, Fourvel M, Pradon V, Roux V, Mége A, Garcia R. P19. Conformal segmented mono-isocentric radiotherapy vs. volumetric modulated arctherapy in senology. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
18
|
Boman E, Rossi M, Haltamo M, Skyttä T, Kapanen M. A new split arc VMAT technique for lymph node positive breast cancer. Phys Med 2016; 32:S1120-1797(16)30954-1. [PMID: 28029580 DOI: 10.1016/j.ejmp.2016.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/18/2016] [Accepted: 10/14/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate different volumetric modulated arc therapy (VMAT) field designs for lymph node positive breast cancer patients when compared to conventional static fields and standard VMAT designs. METHODS Nineteen breast cancer patients with lymph node involvement (eleven left and eight right sided) were retrospectively analyzed with different arc designs. Proposed split arc designs with total rotations of 2×190° and 2×240° were compared to conventional field in field (FinF) and previously published non-split arc techniques with the same amount of total rotations. RESULTS All VMAT plans were superior in dose conformity, when compared to the FinF plans. Split arc design decreased significantly ipsilateral lung dose and heart V5Gy for both left and right sided cases, when compared to non-split VMAT designs. For left sided cases no significant differences were seen in contralateral lung mean dose or V5Gy between different VMAT designs. For right sided cases the contralateral lung dose V5Gy was significantly higher in split VMAT group, when compared to non-split VMAT designs. The contralateral breast dose V5Gy increased significantly for split VMAT plans for both sides, when compared to non-split VMAT designs or FinF plans. CONCLUSIONS The proposed split VMAT technique was shown to be superior to previously published non-split VMAT and conventional FinF techniques significantly reducing dose to the ipsilateral lung and heart. However, this came with the expense of an increase in the dose to the contralateral breast and for right-sided cases to the contralateral lung.
Collapse
Affiliation(s)
- Eeva Boman
- Department of Oncology, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland; Department of Medical Physics, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland; Department of Radiation Oncology, Wellington Blood and Cancer Centre, Wellington Hospital, Wellington 6242, New Zealand.
| | - Maija Rossi
- Department of Oncology, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland; Department of Medical Physics, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland.
| | - Mikko Haltamo
- Department of Oncology, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland.
| | - Tanja Skyttä
- Department of Oncology, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland.
| | - Mika Kapanen
- Department of Oncology, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland; Department of Medical Physics, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland.
| |
Collapse
|
19
|
Maier J, Knott B, Maerz M, Loeschel R, Koelbl O, Dobler B. Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study. Radiat Oncol 2016; 11:111. [PMID: 27577561 PMCID: PMC5006633 DOI: 10.1186/s13014-016-0687-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer. METHODS An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. RESULTS Significantly best target coverage and homogeneity was achieved using VMAT FFF with V95% = (98.7 ± 0.8) % and HI = (8.2 ± 0.9) % for the SIB and V95% = (98.3 ± 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a Dmean of (0.7 ± 0.1) Gy for the contralateral lung, (1.0 ± 0.2) Gy for the contralateral breast and (1.4 ± 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 ± 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 ± 0:07) min. CONCLUSION Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.
Collapse
Affiliation(s)
- Johannes Maier
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Bernadette Knott
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Manuel Maerz
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Rainer Loeschel
- Ostbayerische Technische Hochschule Regensburg, Faculty of Computer Science and Mathematics, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Barbara Dobler
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany.
| |
Collapse
|
20
|
Lauche O, Kirova YM, Fenoglietto P, Costa E, Lemanski C, Bourgier C, Riou O, Tiberi D, Campana F, Fourquet A, Azria D. Helical tomotherapy and volumetric modulated arc therapy: New therapeutic arms in the breast cancer radiotherapy. World J Radiol 2016; 8:735-742. [PMID: 27648167 PMCID: PMC5002504 DOI: 10.4329/wjr.v8.i8.735] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/05/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse clinical and dosimetric results of helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) in complex adjuvant breast and nodes irradiation.
METHODS Seventy-three patients were included (31 HT and 42 VMAT). Dose were 63.8 Gy (HT) and 63.2 Gy (VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes (SCN) and internal mammary chain (IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort (7 mm vs 5 mm).
RESULTS For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC: 96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5% (HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2% (VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1% (HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9% (VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy (HT) and 4.6 ± 0.9 Gy (VMAT). Acute skin toxicity grade 3 was 5% in the two cohorts.
CONCLUSION HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.
Collapse
|
21
|
Perni S, Kim SK, Chin C, Pfister NT, Tiwari A, Horowitz DP. Radiation therapy for right-sided breast cancer in a patient with pectus excavatum: A comparison of treatment techniques. Pract Radiat Oncol 2016; 6:383-387. [PMID: 27211229 DOI: 10.1016/j.prro.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Subha Perni
- Department of Radiation Oncology, Columbia University/New York Presbyterian Hospital, New York, New York
| | - Samuel K Kim
- Department of Radiation Oncology, Columbia University/New York Presbyterian Hospital, New York, New York
| | - Christine Chin
- Department of Radiation Oncology, Columbia University/New York Presbyterian Hospital, New York, New York
| | - Neil T Pfister
- Department of Radiation Oncology, Columbia University/New York Presbyterian Hospital, New York, New York
| | - Akhil Tiwari
- Department of Radiation Oncology, Columbia University/New York Presbyterian Hospital, New York, New York
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University/New York Presbyterian Hospital, New York, New York.
| |
Collapse
|
22
|
Dong P, Yu V, Nguyen D, Demarco J, Woods K, Boucher S, Low DA, Sheng K. Feasibility of using intermediate x-ray energies for highly conformal extracranial radiotherapy. Med Phys 2014; 41:041709. [PMID: 24694129 DOI: 10.1118/1.4868464] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To investigate the feasibility of using intermediate energy 2 MV x-rays for extracranial robotic intensity modulated radiation therapy. METHODS Two megavolts flattening filter free x-rays were simulated using the Monte Carlo code MCNP (v4c). A convolution/superposition dose calculation program was tuned to match the Monte Carlo calculation. The modeled 2 MV x-rays and actual 6 MV flattened x-rays from existing Varian Linacs were used in integrated beam orientation and fluence optimization for a head and neck, a liver, a lung, and a partial breast treatment. A column generation algorithm was used for the intensity modulation and beam orientation optimization. Identical optimization parameters were applied in three different planning modes for each site: 2, 6 MV, and dual energy 2/6 MV. RESULTS Excellent agreement was observed between the convolution/superposition and the Monte Carlo calculated percent depth dose profiles. For the patient plans, overall, the 2/6 MV x-ray plans had the best dosimetry followed by 2 MV only and 6 MV only plans. Between the two single energy plans, the PTV coverage was equivalent but 2 MV x-rays improved organs-at-risk sparing. For the head and neck case, the 2 MV plan reduced lips, mandible, tongue, oral cavity, brain, larynx, left and right parotid gland mean doses by 14%, 8%, 4%, 14%, 24%, 6%, 30% and 16%, respectively. For the liver case, the 2 MV plan reduced the liver and body mean doses by 17% and 18%, respectively. For the lung case, lung V 20, V 10, and V5 were reduced by 13%, 25%, and 30%, respectively. V 10 of heart with 2 MV plan was reduced by 59%. For the partial breast treatment, the 2 MV plan reduced the mean dose to the ipsilateral and contralateral lungs by 27% and 47%, respectively. The mean body dose was reduced by 16%. CONCLUSIONS The authors showed the feasibility of using flattening filter free 2 MV x-rays for extracranial treatments as evidenced by equivalent or superior dosimetry compared to 6 MV plans using the same inverse noncoplanar intensity modulated planning method.
Collapse
Affiliation(s)
- Peng Dong
- Department of Radiation Oncology, University of California Los Angeles, California 90095
| | - Victoria Yu
- Department of Radiation Oncology, University of California Los Angeles, California 90095
| | - Dan Nguyen
- Department of Radiation Oncology, University of California Los Angeles, California 90095
| | - John Demarco
- Department of Radiation Oncology, University of California Los Angeles, California 90095
| | - Kaley Woods
- RadiaBeam Technologies, Santa Monica, California 90404
| | | | - Daniel A Low
- Department of Radiation Oncology, University of California Los Angeles, California 90095
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, California 90095
| |
Collapse
|
23
|
Lee B, Lee S, Sung J, Yoon M. Radiotherapy-induced secondary cancer risk for breast cancer: 3D conformal therapy versus IMRT versus VMAT. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2014; 34:325-331. [PMID: 24705154 DOI: 10.1088/0952-4746/34/2/325] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study evaluated the secondary cancer risk to various organs due to radiation treatment for breast cancer. Organ doses to an anthropomorphic phantom were measured using a photoluminescent dosimeter (PLD) for breast cancer treatment with 3D conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). Cancer risk based on the measured dose was calculated using the BEIR (Biological Effects of Ionizing Radiation) VII models. The secondary dose per treatment dose (50.4 Gy) to various organs ranged from 0.02 to 0.36 Gy for 3D-CRT, but from 0.07 to 8.48 Gy for IMRT and VMAT, indicating that the latter methods are associated with higher secondary radiation doses than 3D-CRT. The result of the homogeneity index in the breast target shows that the dose homogeneity of 3D-CRT was worse than those of IMRT and VMAT. The organ specific lifetime attributable risks (LARs) to the thyroid, contralateral breast and ipsilateral lung per 100 000 population were 0.02, 19.71, and 0.76 respectively for 3D-CRT, much lower than the 0.11, 463.56, and 10.59 respectively for IMRT and the 0.12, 290.32, and 12.28 respectively for VMAT. The overall estimation of LAR indicated that the radiation-induced cancer risk due to breast radiation therapy was lower with 3D-CRT than with IMRT or VMAT.
Collapse
Affiliation(s)
- Boram Lee
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea. Department of Radiation Oncology, Sun Medical Center, Daejeon, Korea
| | | | | | | |
Collapse
|
24
|
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.
Collapse
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.
| |
Collapse
|