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Holt F, Ivanova A, Wang Z, Darby S, Duane F, Ntentas G, Oliveros S, Lavery B, Shah K, Eichholz A, Dodwell D, Taylor C. Estimated Doses to the Heart, Lungs and Oesophagus and Risks From Typical UK Radiotherapy for Early Breast Cancer During 2015-2023. Clin Oncol (R Coll Radiol) 2024; 36:e322-e332. [PMID: 38853062 DOI: 10.1016/j.clon.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Breast cancer radiotherapy can increase the risks of heart disease, lung cancer and oesophageal cancer. At present, the best dosimetric predictors of these risks are mean doses to the whole heart, lungs and oesophagus, respectively. We aimed to estimate typical doses to these organs and resulting risks from UK breast cancer radiotherapy. METHODS A systematic review and meta-analysis was conducted of planned or delivered mean doses to the whole heart, lungs or oesophagus from UK breast cancer radiotherapy in studies published during 2015-2023. Average mean doses were summarised for combinations of laterality and clinical targets. Heart disease and lung cancer mortality risks were then estimated using established models. RESULTS For whole heart, thirteen studies reported 2893 doses. Average mean doses were higher in left than in right-sided radiotherapy and increased with extent of clinical targets. For left-sided radiotherapy, average mean heart doses were: 2.0 Gy (range 1.2-8.0 Gy) breast/chest wall, 2.7 Gy (range 0.6-5.6 Gy) breast/chest wall with either axilla or supraclavicular nodes and 2.9 Gy (range 1.3-4.7 Gy) breast/chest wall with nodes including internal mammary. For right-sided radiotherapy, average mean heart doses were: 1.0 Gy (range 0.3-1.0 Gy) breast/chest wall and 1.2 Gy (range 1.0-1.4 Gy) breast/chest wall with either axilla or supraclavicular nodes. There were no whole heart dose estimates from right internal mammary radiotherapy. For whole lung, six studies reported 2230 doses. Average mean lung doses increased with extent of targets irradiated: 2.6 Gy (range 1.4-3.0 Gy) breast/chest wall, 3.0 Gy (range 0.9-5.1 Gy) breast/chest wall with either axilla or supraclavicular nodes and 7.1 Gy (range 6.7-10.0 Gy) breast/chest wall with nodes including internal mammary. For whole oesophagus, two studies reported 76 doses. Average mean oesophagus doses increased with extent of targets irradiated: 1.4 Gy (range 1.0-2.0 Gy) breast/chest wall with either axilla or supraclavicular nodes and 5.8 Gy (range 1.9-10.0 Gy) breast/chest wall with nodes including internal mammary. CONCLUSIONS The typical doses to these organs may be combined with dose-response relationships to estimate radiation risks. Estimated 30-year absolute lung cancer mortality risks from modern UK breast cancer radiotherapy for patients irradiated when aged 50 years were 2-6% for long-term continuing smokers, and <1% for non-smokers. Estimated 30-year mortality risks for heart disease were <1%.
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Affiliation(s)
- F Holt
- Nuffield Department of Population Health, University of Oxford, UK
| | - A Ivanova
- Nuffield Department of Population Health, University of Oxford, UK; Canadian Nuclear Safety Commission, Ottawa, Canada
| | - Z Wang
- Nuffield Department of Population Health, University of Oxford, UK
| | - S Darby
- Nuffield Department of Population Health, University of Oxford, UK
| | - F Duane
- St. Luke's Radiation Oncology Network and Trinity St. James' Cancer Institute, Ireland
| | - G Ntentas
- Nuffield Department of Population Health, University of Oxford, UK; Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, UK
| | - S Oliveros
- Nuffield Department of Population Health, University of Oxford, UK; Oxford University Hospitals, Oxford, UK
| | - B Lavery
- Oxford University Hospitals, Oxford, UK
| | - K Shah
- Oxford University Hospitals, Oxford, UK
| | - A Eichholz
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - D Dodwell
- Nuffield Department of Population Health, University of Oxford, UK; Oxford University Hospitals, Oxford, UK
| | - C Taylor
- Nuffield Department of Population Health, University of Oxford, UK; Oxford University Hospitals, Oxford, UK.
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Choi JI, Hardy-Abeloos C, Lozano A, Hanlon A, Vargas C, Maduro JH, Bradley J, Offersen B, Haffty B, Pankuch M, Amos R, Kim N, MacDonald SM, Kirova Y, Mutter RW. PTCOG international survey of practice patterns and trends in utilization of proton therapy for breast cancer. Clin Transl Radiat Oncol 2024; 48:100847. [PMID: 39280125 PMCID: PMC11399555 DOI: 10.1016/j.ctro.2024.100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/18/2024] Open
Abstract
Purpose/objectives The indications, techniques, and extent to which proton beam therapy (PBT) is employed for breast cancer are unknown. We seek to determine PBT utilization for breast cancer. Materials/methods The Particle Therapy Co-Operative Group (PTCOG) Breast Subcommittee developed an IRB-approved 29-question survey and sent it to breast cancer radiation oncologists at all active PBT centers worldwide in June 2023. Descriptive statistics were used to summarize responses, and comparisons by continent were performed using Fisher's exact tests. Results Of 79 surveys distributed, 28 recipients submitted responses (35 % response rate) representing fifteen U.S., 8 European, and 5 Asian centers (continent response rate 50 %, 38 %, and 18 %, respectively). Overall, 93 % reported treating breast cancer patients with PBT; 13 (50 %) have treated ≥100 breast cancer patients at their center since opening. Most (89 %) have pencil beam scanning technology. Nearly half (46 %) use moderate hypofractionation (15-20 fractions) for regional nodal irradiation and 42 % conventional fractionation (25-30 fractions). More European centers prefer hypofractionation (88 %) vs. Asian (50 %) and U.S. (21 %) centers (p = 0.003). Common patient selection methods were practitioner determination/patient preference (n = 16) and comparative plan evaluation (n = 15). U.S. centers reported the most experience with breast PBT, with 71 % having treated ≥100 breast cancer patients vs. 38 % in Europe and none in Asia (p = 0.001). Of respondent centers, 39 % enrolled ≥75 % of breast PBT patients on a research study. Conclusion Utilization, patient selection methods, and dose-fractionation approaches for breast cancer PBT vary worldwide. These survey data serve as a benchmark from which successor surveys can provide insight on practice pattern evolution.
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Affiliation(s)
- J Isabelle Choi
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- New York Proton Center, New York, NY, USA
| | | | - Alicia Lozano
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, USA
| | - Alexandra Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, USA
| | - Carlos Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - John H Maduro
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Julie Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, FL, USA
| | - Birgitte Offersen
- Dept of Experimental Clinical Oncology, Dept Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Bruce Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Mark Pankuch
- Department of Medical Physics, Northwestern Medicine Proton Center, Warrenville, IL, USA
| | - Richard Amos
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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Sharmin S, Sultana R, Mollah NU, Rasheed MO, Anika AS, Rassell M. Association of Radiation-Induced Acute Esophagitis With Dosimetric Parameters of Oesophagus in Breast Carcinoma Patients Receiving Supraclavicular Nodal Irradiation. Cureus 2024; 16:e60778. [PMID: 38903289 PMCID: PMC11188969 DOI: 10.7759/cureus.60778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION We conducted this investigation to ascertain the dosimetric properties such as the mean and maximum radiation dosage during radiotherapy as well as the extent of radiation exposure to the esophagus. These factors can potentially impact the development of esophagitis in breast cancer patients undergoing supraclavicular radiation. METHODOLOGY From January to June 2023, an observational study was conducted at Bangabandhu Sheikh Mujib Medical University in Bangladesh. The patients received radiation therapy (40.05 Gy in 15 parts) to the chest wall and supraclavicular node for three weeks. We were able to guess the following from the dose volume histogram (DVH) data: the length of the esophagus in the treatment area (i.e., the size of the esophagus that was visible on the planning CT scan), the maximum dose (Dmax), the mean dose (Dmean), and the volume of the 10Gy (V10Gy) and 20Gy (V20Gy) doses that were given to the esophagus. During radiotherapy, patients were checked on once a week, and the radiotherapy oncology group was used to evaluate and grade esophagitis Results: Patients with left-sided breast cancer showed a higher Dmean, Dmax, and length of the esophagus compared to those with right-sided breast cancer. Specifically, the Dmean was 6.7 (±2.1) Gy, the Dmax was 39.2 (±1.5) Gy, and the length of the esophagus was 6.1 (±1.2) Gy. Patients with left breast cancer had elevated V10Gy and V20Gy values for the esophagus, but the difference was not statistically significant. The incidence of V10Gy for right-sided breast cancer and left-sided breast cancer was 4.2% (±2.6%) and 19.8% (±9.2%), respectively. The V20Gy was 2.4% (±0.9%) for right-sided breast cancer and 13.09% (±5.0%) for left-sided breast cancer Conclusion: In conclusion, there is a strong association between the mean oesophageal dose and radiation to the left supraclavicular region following surgery in women with breast cancer and acute esophagitis. We can reduce esophageal toxicity by prescribing dose restrictions and performing precise delineation of the esophagus.
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Affiliation(s)
- Sadia Sharmin
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Rokaya Sultana
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Nazir Uddin Mollah
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Mamun O Rasheed
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Afsana Sharmin Anika
- Department of Clinical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Md Rassell
- Department of Surgical Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
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Shi J, Liu J, Tian G, Li D, Liang D, Wang J, He Y. Association of radiotherapy for stage I-III breast cancer survivors and second primary malignant cancers: a population-based study. Eur J Cancer Prev 2024; 33:115-128. [PMID: 37669169 DOI: 10.1097/cej.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE With life span extending, breast cancer survivors may face the possibility of developing second primary cancers (SPCs). The objective of this research is to investigate the risk factors, risk attribute to radiotherapy and the survivalship for SPCs. METHODS A total of 445 523 breast cancer patients were enrolled from Surveillance, Epidemiology, and End Results database in 2000-2018. The risk factors for SPCs development were confirmed by competing risk model, and then were integrated to the nomogram establishment. The cumulative incidence of SPCs including SBC (second breast cancer), SGC (second gynecological cancer), and SLC (second lung cancer) were estimated. The radiotherapy-associated risk for SPCs were evaluated by Poisson regression in radiotherapy and no-radiotherapy. Propensity score matching was used to reduce possible bias for survival comparison. RESULTS There were 57.63% patients in radiotherapy. The risk factors for developing SPCs were age, year, race, tumor size, stage, radiotherapy, grade, surgery, and histology. The cumulative incidence of SPCs was 7.75% in no-radiotherapy and 10.33% in radiotherapy. SLC, SBC, and SGC also appeared the similar results. The increased risk of developing SPCs were associated with radiotherapy in majority subgroups. The dynamic radiotherapy-associated risk for SPCs by age slightly increased risk was observed. Regardless radiotherapy or no-radiotherapy, the 10-year overall survival for SBC (radiotherapy: 59.41%; no-radiotherapy: 55.53%) and SGC (radiotherapy: 48.61%; no-radiotherapy: 35.53%) were worse than that among matched patients with only primary cancers. CONCLUSIONS Breast cancer survivors remained a high radiotherapy-associated risk for developing SPCs. The prognosis in radiotherapy was better than in no-radiotherapy for some specific SPCs. Largely attention should be paid to these patients.
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Affiliation(s)
- Jin Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jian Liu
- The Service Center of Comprehensive Supervision Health Commission of Hebei Province
| | - Guo Tian
- Department of Medical Records, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Daojuan Li
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Di Liang
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
| | - Jun Wang
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University, The Tumor Hospital of Hebei Province
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Holt F, Probert J, Darby SC, Haviland JS, Coles CE, Kirby AM, Liu Z, Dodwell D, Ntentas G, Duane F, Taylor C. Proton Beam Therapy for Early Breast Cancer: A Systematic Review and Meta-analysis of Clinical Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:869-882. [PMID: 36868521 PMCID: PMC7615202 DOI: 10.1016/j.ijrobp.2023.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Adjuvant proton beam therapy (PBT) is increasingly available to patients with breast cancer. It achieves better planned dose distributions than standard photon radiation therapy and therefore may reduce the risks. However, clinical evidence is lacking. METHODS AND MATERIALS A systematic review of clinical outcomes from studies of adjuvant PBT for early breast cancer published in 2000 to 2022 was undertaken. Early breast cancer was defined as when all detected invasive cancer cells are in the breast or nearby lymph nodes and can be removed surgically. Adverse outcomes were summarized quantitatively, and the prevalence of the most common ones were estimated using meta-analysis. RESULTS Thirty-two studies (1452 patients) reported clinical outcomes after adjuvant PBT for early breast cancer. Median follow-up ranged from 2 to 59 months. There were no published randomized trials comparing PBT with photon radiation therapy. Scattering PBT was delivered in 7 studies (258 patients) starting 2003 to 2015 and scanning PBT in 22 studies (1041 patients) starting 2000 to 2019. Two studies (123 patients) starting 2011 used both PBT types. For 1 study (30 patients), PBT type was unspecified. Adverse events were less severe after scanning than after scattering PBT. They also varied by clinical target. For partial breast PBT, 498 adverse events were reported (8 studies, 358 patients). None were categorized as severe after scanning PBT. For whole breast or chest wall ± regional lymph nodes PBT, 1344 adverse events were reported (19 studies, 933 patients). After scanning PBT, 4% (44/1026) of events were severe. The most prevalent severe outcome after scanning PBT was dermatitis, which occurred in 5.7% (95% confidence interval, 4.2-7.6) of patients. Other severe adverse outcomes included infection, pain, and pneumonitis (each ≤1%). Of the 141 reconstruction events reported (13 studies, 459 patients), the most prevalent after scanning PBT was prosthetic implant removal (34/181, 19%). CONCLUSIONS This is a quantitative summary of all published clinical outcomes after adjuvant PBT for early breast cancer. Ongoing randomized trials will provide information on its longer-term safety compared with standard photon radiation therapy.
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Affiliation(s)
- Francesca Holt
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
| | - Jake Probert
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Joanne S Haviland
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Anna M Kirby
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Zulian Liu
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Department of Medical Physics, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Frances Duane
- St. Luke's Radiation Oncology Network and Trinity St. James's Cancer Institute, Dublin, Ireland
| | - Carolyn Taylor
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Mondragon LL, Lopez HP, Diaz AF, Lio IA, Guzman AO. Beyond the heart in hypofractionated radiotherapy and in the transition from 3D to IMRT/VMAT. Rep Pract Oncol Radiother 2023; 28:478-484. [PMID: 37795223 PMCID: PMC10547416 DOI: 10.5603/rpor.a2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/19/2023] [Indexed: 10/06/2023] Open
Abstract
Background The knowledge of the risks induced by radiation with hypofractionation regimens has only recently been estimated together with its implementation as a management standard. However, the dose to other risk organs with intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) is not clear, that is why this is only a reference study of radiation doses to organs at risk in hypofractionation in our center. Materials and methods We completed a retrospective and observational analysis of 1398 patients treated with adjuvant hypofractionated radiotherapy from 2015 to 2018, using the clinical records and dose-volume histogram of patients treated with moderate hypofractionated adjuvant radiotherapy. To analyze the institutional experience on the dosimetry of the esophagus and liver as risk organs in the use of moderate adjuvant hypofractionated radiotherapy in breast cancer. Results The dosimetry of the esophagus was 3271 cGy DMax, 177 cGy DMed, 68 cGy D50%, 500 cGy DcMAX with 3D RT and 4124 cGy DMax, 1242 cGy DMed, 934.50 cGy D50%, 3213 cGy DcMAX with IMRT/VMAT and the dosimetry for the liver was for right breast cancer 466 cGy DMed, 102 cGy D50% and 8% V20, for left breast cancer 22 cGy DMed, 6.10 cGy D50% and 0.3% V20. Conclusion The statistically significant differences in irradiation show the lack of consensus on the optimal restrictions in hypofractionation regimens to reduce clinical sequela; consequently, the variability in the specification of each radiation oncologist is observed; standardization in our center can lead to improvement in the quality of treatments.
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Affiliation(s)
- Lorena Lio Mondragon
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Hidralba Pérez Lopez
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Adolfo Fernández Diaz
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Iván Avilés Lio
- Department of Radiotherapy, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, México City, México
| | - Alejandro Olmos Guzman
- Department of Radiotherapy, National Medical Center of Bajío, Instituto Mexicano del Seguro Social, León, Guanajuato, México
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Mohammed Amin SS, Faraj KA, Kamangar TM, Yarahmadi M. Comparison of esophagus dose in breast cancer patients undergoing supraclavicular irradiation with and without esophagus countering. J Cancer Res Ther 2023; 19:S603-S607. [PMID: 38384025 DOI: 10.4103/jcrt.jcrt_771_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/13/2022] [Indexed: 02/23/2024]
Abstract
CONTEXT Esophagus toxicity and the risk of esophageal cancer are linked to radiation dose to the esophagus in breast cancer patients undergoing supraclavicular irradiation. AIMS The aim of this study was to evaluate the impact of esophagus contouring on the dose received in the esophagus in breast cancer patients undergoing supraclavicular irradiation. SETTING AND DESIGN This study included 30 treatment plans for breast cancer patients who received 50 Gy/25 fractions (2 Gy/fraction/day) using 3D-conformal radiation therapy (3D-CRT) to the whole breast or chest wall and supraclavicular. METHODS AND MATERIALS Our study included two groups: the non-sparing group was the treatment plan in which the esophagus was not delineated and the esophagus sparing group was generated, in which the plans were modified to spare the esophagus. The maximum dose, mean dose, and percentage of esophagus volume received, 5, 10, 15, and 20 Gy, respectively (V5, V10, V15, and V20), were used to evaluate both groups. STATISTICAL ANALYSIS One-way analysis of variance was used. A P value <0.05 was considered statistically significant. RESULTS The esophagus sparing group plans show a reduction in the esophageal mean dose Dmean (5.72 ± 5.15) Gy when compared to the non-sparing group (7.83 ± 3.31) Gy. Likewise, the maximum dose, V5, V10, V15, and V20 were reduced in the esophagus sparing group. All dosimetric parameters were significantly higher (P < 0.05) in patients with left breast cancer for both groups. CONCLUSION Our results suggest that it is possible to reduce the dose to the esophagus by considering the esophagus during treatment planning while maintaining plan quality. This reduction could lead to the greatest predicted decrease in acute esophagitis and esophageal cancer.
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Affiliation(s)
- Soma S Mohammed Amin
- Department of Anesthesia, College of Health and Medical Technology in Sulaimani, Sulaimaniyah Polytechnic University, Sulaimaniyah, Iran
| | - Kharman A Faraj
- Department of Physics, College of Science, University of Sulaimani, Sulaimaniyah, Iran
| | - Tara Molanaie Kamangar
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehran Yarahmadi
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Kerr AJ, Dodwell D, McGale P, Holt F, Duane F, Mannu G, Darby SC, Taylor CW. Adjuvant and neoadjuvant breast cancer treatments: A systematic review of their effects on mortality. Cancer Treat Rev 2022; 105:102375. [PMID: 35367784 PMCID: PMC9096622 DOI: 10.1016/j.ctrv.2022.102375] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Amanda J Kerr
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Paul McGale
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Francesca Holt
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Fran Duane
- St Luke's Radiation Oncology Network, St. James's Hospital, Dublin, Ireland.
| | - Gurdeep Mannu
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Carolyn W Taylor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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