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Liu Y, Fu Y, Peng Y, Ming J. Clinical decision support tool for breast cancer recurrence prediction using SHAP value in cooperative game theory. Heliyon 2024; 10:e24876. [PMID: 38312672 PMCID: PMC10835316 DOI: 10.1016/j.heliyon.2024.e24876] [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: 08/15/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Background Recurrence remains the primary cause of death in patients with breast cancer. Although machine learning can efficiently predict the prognosis of breast cancer patients, the black-box nature of the model may result in a lack of evidence for clinicians when making critical decisions. Methods In this study, our main objective was twofold: (1) to develop a clinical decision support tool for predicting the prognosis of breast cancer and (2) to identify and explore the key factors that influence breast cancer recurrence. To achieve this, we employed an explainable ensemble learning method called Shapley additive explanation (SHAP), which leverages cooperative game theory. Using real-world data from 1629 breast cancer patients, we analyzed and uncovered the key factors associated with breast cancer recurrence. Subsequently, we used these identified factors to create a recurrence prediction model and establish a decision mechanism for the tool. The proposed method not only provides accurate recurrence predictions but also offers transparent explanations for these predictions. Results By utilizing four key factors, namely, tumor size, clinical stage III, number of lymph node metastases, and age, our decision support tool for predicting breast cancer recurrence achieved significant improvements. The extra-tree model exhibited an increased area under the receiver operating characteristic curve (AUC) of 0.97, while the Random Forest model demonstrated an improved AUC of 0.96. We also offer a decision mechanism for a recurrence prediction model based on the identified key factors. This transparent and interpretable decision-making process facilitated by our explainable ensemble learning model enhances trust and promotes its applicability in clinical settings. Conclusions The proposed explainable ensemble learning method shows promising results in predicting breast cancer recurrence, outperforming existing methods with high accuracy and transparency. This advancement has the potential to significantly improve clinical decision-making and patient outcomes in breast cancer treatment.
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Affiliation(s)
- Ying Liu
- Special Needs Comprehensive Department, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
| | - Yating Fu
- Urumqi Stomatological Hospital, 196 Zhongshan Road, Tianshan District, 830002, Urumqi, China
| | - Yadong Peng
- Special Needs Comprehensive Department, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
- Oncology Department, The First Affiliated Hospital of Xiangnan University, Chenzhou, Hunan, 423000, China
| | - Jie Ming
- Medical Imaging Center, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830000, China
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Abstract
Breast cancer is the most prevalent cancer in women, and the second leading cause of cancer death in women in the United States. Radiation therapy is an important component in the multimodal management of breast cancer, including early stage and locally advanced breast cancers, as well as metastatic cases. Breast cancer radiation therapy has seen significant advancements over the past 20 years. This article discusses the latest advances in the radiotherapeutic management of breast cancer, especially focusing on the technological advances in radiation treatment planning and techniques that have exploited the understanding of radiation biology.
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Affiliation(s)
- Rituraj Upadhyay
- Department of Radiation Oncology, The Ohio State University Medical Center, The Arthur G. James Cancer Hospital D259, 460 W 10th Avenue, Columbus, OH 43210, USA
| | - Jose G Bazan
- Department of Radiation Oncology, The Ohio State University Medical Center, The Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio State University Comprehensive Cancer Center, 1145 Olentangy River Road, Columbus, OH 43212, USA.
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Wang J, Zhou B, Yang X, Tridandapani S, Lin J, Torres MA, Liu T. Ultrasound-Based Grading System for Radiation-Induced Acute Breast Toxicity. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1307-1317. [PMID: 36583524 DOI: 10.1002/jum.16144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES To introduce an ultrasound-based scoring system for radiation-induced breast toxicity and test its reliability. METHODS Breast ultrasound (BUS) was performed on 32 patients receiving breast radiotherapy (RT) to assess the radiation-induced acute toxicity. For each patient, both the untreated and irradiated breasts were scanned at five locations: 12:00, 3:00, 6:00, 9:00, and tumor bed to evaluate for heterogenous responses to radiation within the entire breast. In total, 314 images were analyzed. Based on ultrasound findings such as skin thickening, dermis boundary irregularity, and subcutaneous edema, a 4-level, Likert-like grading scheme is proposed: none (G0), mild (G1), moderate (G2), and severe (G3) toxicity. Two ultrasound experts graded the severity of breast toxicity independently and reported the inter- and intra-observer reliability of the grading system. Imaging findings were compared with standard clinical toxicity assessments using Common Terminology Criteria for Adverse Events (CTCAE). RESULTS The inter-observer Pearson correlation coefficient (PCC) was 0.87 (95% CI: 0.83-0.90, P < .001). For intra-observer repeatability, the PCC of the repeated scores was 0.83 (95% CI: 0.78-0.87, P < .001). Imaging findings were compared with standard clinical toxicity assessments using CTCAE scales. The PCC between BUS scores and CTCAE results was 0.62 (95% CI: 0.35-0.80, P < .001). Among all locations, 6:00 and tumor bed showed significantly greater toxicity compared with 12:00 (P = .04). CONCLUSIONS BUS can investigate the cutaneous and subcutaneous tissue changes after RT. This BUS-based grading system can complement subjective clinical assessments of radiation-induced breast toxicity with cutaneous and subcutaneous sonographic information.
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Affiliation(s)
- Jing Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Boran Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, Alabama, USA
| | - Jolinta Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Mylin A Torres
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
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Tseng J, Bazan JG, Minami CA, Schonberg MA. Not Too Little, Not Too Much: Optimizing More Versus Less Locoregional Treatment for Older Patients With Breast Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e390450. [PMID: 37327467 DOI: 10.1200/edbk_390450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Although undertreatment of older women with aggressive breast cancers has been a concern for years, there is increasing recognition that some older women are overtreated, receiving therapies unlikely to improve survival or reduce morbidity. De-escalation of surgery may include breast-conserving surgery over mastectomy for appropriate candidates and omitting or reducing extent of axillary surgery. Appropriate patients to de-escalate surgery are those with early-stage breast cancer, favorable tumor characteristics, are clinically node-negative, and who may have other major health issues. De-escalation of radiation includes reducing treatment course length through hypofractionation and ultrahypofractionation regimens, reducing treatment volumes through partial breast irradiation, omission of radiation for select patients, and reducing radiation dose to normal tissues. Shared decision making, which aims to facilitate patients making decisions concordant with their values, can guide health care providers and patients through complicated decisions optimizing breast cancer care.
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Affiliation(s)
| | - Jose G Bazan
- City of Hope Comprehensive Cancer Center, Duarte, CA
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Mumtaz S, Ali S, Mumtaz S, Pervaiz A, Tahir HM, Farooq MA, Mughal TA. Advanced treatment strategies in breast cancer: A comprehensive mechanistic review. Sci Prog 2023; 106:368504231175331. [PMID: 37231668 PMCID: PMC10450270 DOI: 10.1177/00368504231175331] [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] [Indexed: 05/27/2023]
Abstract
Breast cancer is a destructive lump type that affects women globally. Despite the availability of multi-directional therapeutic strategies, advanced stages of breast cancer are difficult to treat and impose major healthcare burdens. This situation reinforces the need to identify new potential therapeutic compounds with better clinical features. In this context, different treatment methods were included such as Endocrine therapy, chemotherapy, Radiation therapy, antimicrobial peptide-dependent growth inhibitor, liposome-based drug delivery, antibiotics used as a co-medication, photothermal, immunotherapy, and nano drug delivery systems such as Bombyx mori natural protein sericin and its mediated nanoparticles are promising biomedical agents. They have been tested as an anticancer agent against various malignancies in pre-clinical settings. The biocompatible and restricted breakdown properties of silk sericin and sericin-conjugated nanoparticles made them perfect contenders for a nanoscale drug-delivery system.
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Affiliation(s)
- Samaira Mumtaz
- Medical Toxicology and Entomology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Shaukat Ali
- Medical Toxicology and Entomology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Shumaila Mumtaz
- Medical Toxicology and Entomology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Asim Pervaiz
- Biomedical and Allied Health Sciences, University of Health Sciences Lahore, Lahore, Pakistan
| | - Hafiz M Tahir
- Medical Toxicology and Entomology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Muhammad A Farooq
- Medical Toxicology and Entomology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
| | - Tafail A Mughal
- Medical Toxicology and Entomology Laboratory, Department of Zoology, Government College University, Lahore, Pakistan
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Liu D, Zheng Z, Zhang S, Zhu C, Zhang H, Zhou Y. Analysis of risk factors related to acute radiation dermatitis in breast cancer patients during radiotherapy. J Cancer Res Ther 2022; 18:1903-1909. [PMID: 36647948 DOI: 10.4103/jcrt.jcrt_1203_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aims To investigate the incidence and influencing factors of acute radiation dermatitis (ARD) induced by radiotherapy in postoperative patients with breast cancer. Methods and Materials A retrospective analysis was conducted on 598 patients with breast cancer who received postoperative radiotherapy from November 18, 2014 to September 14, 2019. The radiotherapy technology included two-dimensional radiotherapy, three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and tomotherapy. The occurrence of ARD in patients was then followed up and recorded. The independent risk factors for radiation-induced dermatitis were analyzed by using an orderly logistic regression model. Results Of the 598 patients, 431 had mild skin reactions, including pigmentation and dry desquamation (grade 1), 151 developed wet desquamation and tender erythema (grade 2), and 16 had severe skin reactions, including flaky wet scaling and erosion (grade 3). There were no grade 4 skin reactions. The severity of ARD was independent of the following factors: Age, diabetes, allergy, quadrant, pathological type, the clinical stage, the tumor stage, triple-negative breast cancer, ki-67 expression, adjuvant chemotherapy, endocrine therapy, targeted therapy, radiotherapy area, and boost irradiation. However, it was found to be dependent on the body mass index, surgery type, radiotherapy technique, node stage, and the prophylactic use of topical agents. Conclusions ARD in response to postoperative radiotherapy in patients with breast cancer is common and mild. Clinicians and patients need to cultivate awareness of the potential risk factors involved and then intervene to alleviate skin reactions and improve the quality of life.
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Affiliation(s)
- Di Liu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan Province; Hubei Key Laboratory of Tumour Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhewen Zheng
- Hubei Key Laboratory of Tumour Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shuyuan Zhang
- Hubei Key Laboratory of Tumour Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Chunmei Zhu
- Hubei Key Laboratory of Tumour Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Hongyan Zhang
- Department of Radiation and Medical Oncology; Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yunfeng Zhou
- Department of Radiation and Medical Oncology; Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China
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Ji C, Zhao M, Wang C, Liu R, Zhu S, Dong X, Su C, Gu Z. Biocompatible Tantalum Nanoparticles as Radiosensitizers for Enhancing Therapy Efficacy in Primary Tumor and Metastatic Sentinel Lymph Nodes. ACS NANO 2022; 16:9428-9441. [PMID: 35666259 DOI: 10.1021/acsnano.2c02314] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Metastasis of breast carcinoma is commonly realized through lymphatic circulation, which seriously threatens the lives of breast cancer patients. Therefore, efficient therapy for both primary tumor and metastatic sentinel lymph nodes (SLNs) is highly desired to inhibit cancer growth and metastasis. During breast cancer treatment, radiotherapy (RT) is a common clinical method. However, the efficacy of RT is decreased by the radioresistance to a hypoxic microenvironment and inevitable side effects for healthy issues at high radiation doses. Considering the above-mentioned, we provide high biocompatible poly(vinylpyrrolidone) coated Ta nanoparticles (Ta@PVP NPs) for photothermal therapy (PTT) assisted RT for primary tumor and metastatic SLNs. On the one hand, for primary tumor treatment, Ta@PVP NPs with a high X-ray mass attenuation coefficient (4.30 cm2/kg at 100 keV) can deposit high radiation doses within tumors. On the other hand, for metastatic SLNs treatment, the effective delivery of Ta@PVP NPs from the primary tumor into SLNs is monitored by computed tomography and photoacoustic imaging, which greatly benefit the prognosis and treatment for metastatic SLNs. Moreover, Ta@PVP NPs-mediated PTT could enhance the RT effect, and immunogenic cell death caused by RT/PTT could induce an immune response to improve the therapeutic effect of metastatic SLNs. This study not only explores the potential of Ta@PVP NPs as effective radiosensitizers and photothermal agents for combined RT and PTT but also offers an efficient strategy to cure both primary tumor and metastatic SLNs in breast carcinoma.
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Affiliation(s)
- Chao Ji
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Center for Excellence in Nanoscience, Institute of High Energy Physics and National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100049, China
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Maoru Zhao
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Center for Excellence in Nanoscience, Institute of High Energy Physics and National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100049, China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chengyan Wang
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Center for Excellence in Nanoscience, Institute of High Energy Physics and National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100049, China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ruixue Liu
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Center for Excellence in Nanoscience, Institute of High Energy Physics and National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100049, China
| | - Shuang Zhu
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Center for Excellence in Nanoscience, Institute of High Energy Physics and National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100049, China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xinghua Dong
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Center for Excellence in Nanoscience, Institute of High Energy Physics and National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100049, China
| | - Chunjian Su
- College of Mechanical and Electronic Engineering, Shandong University of Science and Technology, Qingdao 266590, China
| | - Zhanjun Gu
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Center for Excellence in Nanoscience, Institute of High Energy Physics and National Center for Nanoscience and Technology of China, Chinese Academy of Sciences, Beijing 100049, China
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Optoelectronic Technology, University of Chinese Academy of Sciences, Beijing 100049, China
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Thongsawad S, Srisatit S, Fuangrod T. Predicting gamma evaluation results of patient-specific head and neck volumetric-modulated arc therapy quality assurance based on multileaf collimator patterns and fluence map features: A feasibility study. J Appl Clin Med Phys 2022; 23:e13622. [PMID: 35584035 PMCID: PMC9278677 DOI: 10.1002/acm2.13622] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to develop a predictive model for patient-specific VMAT QA results using multileaf collimator (MLC) effect and texture analysis. The MLC speed, acceleration and texture analysis features were extracted from 106 VMAT plans as predictors. Gamma passing rate (GPR) was collected as a response class with gamma criteria of 2%/2 mm and 3%/2 mm. The model was trained using two machine learning methods: AdaBoost classification and bagged regression trees model. GPR was classified into the "PASS" and "FAIL" for the classification model using the institutional warning level. The accuracy of the model was assessed using sensitivity and specificity. In addition, the accuracy of the regression model was determined using the difference between predicted and measured GPR. For the AdaBoost classification model, the sensitivity/specificity was 94.12%/100% and 63.63%/53.13% at gamma criteria of 2%/2 mm and 3%/2 mm, respectively. For the bagged regression trees model, the sensitivity/specificity was 94.12%/91.89% and 61.18%/68.75% at gamma criteria of 2%/2 mm and 3%/2 mm, respectively. The root mean square error (RMSE) of difference between predicted and measured GPR was found at 2.44 and 1.22 for gamma criteria of 2%/2 mm and 3%/2 mm, respectively. The promising result was found at tighter gamma criteria 2%/2 mm with 94.12% sensitivity (both bagged regression trees and AdaBoost classification model) and 100% specificity (AdaBoost classification model).
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Affiliation(s)
- Sangutid Thongsawad
- Department of Nuclear Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand.,Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Somyot Srisatit
- Department of Nuclear Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | - Todsaporn Fuangrod
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
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9
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Jagsi R, Griffith KA, Moran JM, Matuszak MM, Marsh R, Grubb M, Abu-Isa E, Dilworth JT, Dominello MM, Heimburger D, Lack D, Walker EM, Hayman JA, Vicini F, Pierce LJ. Comparative Effectiveness Analysis of 3D-Conformal Radiation Therapy Versus Intensity Modulated Radiation Therapy (IMRT) in a Prospective Multicenter Cohort of Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2022; 112:643-653. [PMID: 34634437 DOI: 10.1016/j.ijrobp.2021.09.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Simple intensity modulation of radiation therapy reduces acute toxicity compared with 2-dimensional techniques in adjuvant breast cancer treatment, but it remains unknown whether more complex or inverse-planned intensity modulated radiation therapy (IMRT) offers an advantage over forward-planned, 3-dimensional conformal radiation therapy (3DCRT). METHODS AND MATERIALS Using prospective data regarding patients receiving adjuvant whole breast radiation therapy without nodal irradiation at 23 institutions from 2011 to 2018, we compared the incidence of acute toxicity (moderate-severe pain or moist desquamation) in patients receiving 3DCRT versus IMRT (either inverse planned or, if forward-planned, using ≥5 segments per gantry angle). We evaluated associations between technique and toxicity using multivariable models with inverse-probability-of-treatment weighting, adjusting for treatment facility as a random effect. RESULTS Of 1185 patients treated with 3DCRT and conventional fractionation, 650 (54.9%) experienced acute toxicity; of 774 treated with highly segmented forward-planned IMRT, 458 (59.2%) did; and of 580 treated with inverse-planned IMRT, 245 (42.2%) did. Of 1296 patients treated with hypofractionation and 3DCRT, 432 (33.3%) experienced acute toxicity; of 709 treated with highly segmented forward-planned IMRT, 227 (32.0%) did; and of 623 treated with inverse-planned IMRT, 164 (26.3%) did. On multivariable analysis with inverse-probability-of-treatment weighting, the odds ratio for acute toxicity after inverse-planned IMRT versus 3DCRT was 0.64 (95% confidence interval, 0.45-0.91) with conventional fractionation and 0.41 (95% confidence interval, 0.26-0.65) with hypofractionation. CONCLUSIONS This large, prospective, multicenter comparative effectiveness study found a significant benefit from inverse-planned IMRT compared with 3DCRT in reducing acute toxicity of breast radiation therapy. Future research should identify the dosimetric differences that mediate this association and evaluate cost-effectiveness.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan.
| | - Kent A Griffith
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Jean M Moran
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Robin Marsh
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Margaret Grubb
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Eyad Abu-Isa
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Providence Ascension, Novi, Michigan
| | - Joshua T Dilworth
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Michael M Dominello
- Department of Radiation Oncology, Karmanos Cancer Center, Wayne State University, Detroit, Michigan
| | - David Heimburger
- Department of Radiation Oncology, Munson Healthcare, Traverse City, Michigan
| | - Danielle Lack
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Eleanor M Walker
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - James A Hayman
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Frank Vicini
- Department of Radiation Oncology, GenesisCare, Farmington Hills, Michigan
| | - Lori J Pierce
- Department of Radiation Oncology, Medical School, University of Michigan, Ann Arbor, Michigan
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Étude des facteurs pronostiques de radiodermite aiguë dans le cancer du sein traité par irradiation conformationnelle adjuvante avec ou sans modulation d’intensité. Cancer Radiother 2022; 26:684-691. [DOI: 10.1016/j.canrad.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/17/2021] [Accepted: 12/15/2021] [Indexed: 01/09/2023]
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11
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Frederick A, Roumeliotis M, Grendarova P, Quirk S. Performance of a knowledge-based planning model for optimizing intensity-modulated radiotherapy plans for partial breast irradiation. J Appl Clin Med Phys 2021; 23:e13506. [PMID: 34936195 PMCID: PMC8906226 DOI: 10.1002/acm2.13506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate a knowledge‐based (KB) planning model for RapidPlan, generated using a five‐field intensity‐modulated radiotherapy (IMRT) class solution beam strategy and rigorous dosimetric constraints for accelerated partial breast irradiation (APBI). Materials and methods The RapidPlan model was configured using 64 APBI treatment plans and validated for 120 APBI patients who were not included in the training dataset. KB plan dosimetry was compared to clinical plan dosimetry, the clinical planning constraints, and the constraints used in phase III APBI trials. Dosimetric differences between clinical and KB plans were evaluated using paired two‐tailed Wilcoxon signed‐rank tests. Results KB planning was able to produce IMRT‐based APBI plans in a single optimization without manual intervention that are comparable or better than the conventionally optimized, clinical plans. Comparing KB plans to clinical plans, differences in PTV, heart, contralateral breast, and ipsilateral lung dose–volume metrics were not clinically significant. The ipsilateral breast volume receiving at least 50% of the prescription dose was statistically and clinically significantly lower in the KB plans. Conclusion KB planning for IMRT‐based APBI provides equivalent or better dosimetry compared to conventional inverse planning. This model may be reliably applied in clinical practice and could be used to transfer planning expertise to ensure consistency in APBI plan quality.
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Affiliation(s)
- Amy Frederick
- Department of Physics and AstronomyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Medical PhysicsTom Baker Cancer CentreCalgaryAlbertaCanada
| | - Michael Roumeliotis
- Department of Physics and AstronomyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Medical PhysicsTom Baker Cancer CentreCalgaryAlbertaCanada
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Petra Grendarova
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Radiation OncologyGrande Prairie Cancer CentreGrande PrairieAlbertaCanada
| | - Sarah Quirk
- Department of Physics and AstronomyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Medical PhysicsTom Baker Cancer CentreCalgaryAlbertaCanada
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
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12
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Piras A, Menna S, D'Aviero A, Marazzi F, Mazzini A, Cusumano D, Massaccesi M, Mattiucci GC, Daidone A, Valentini V, Boldrini L. New fractionations in breast cancer: a dosimetric study of 3D-CRT versus VMAT. J Med Radiat Sci 2021; 69:227-235. [PMID: 34551211 PMCID: PMC9163458 DOI: 10.1002/jmrs.530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/06/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Adjuvant radiation therapy (RT) following primary surgery in women affected by early breast cancer (EBC) plays a central role in reducing local recurrences and overall mortality. The FAST-FORWARD trial recently demonstrated that 1-week hypofractionated adjuvant RT is not inferior to the standard schedule in terms of local relapse, cosmetic outcomes and toxicity. The aim of this in silico study was to evaluate the dosimetric aspects of a 1-week RT course, administered through volumetric modulated arc therapy (VMAT), compared with traditional three-dimensional conformal radiation therapy (3D-CRT) with tangential fields. METHODS Patients affected by left-side EBC undergoing adjuvant RT were selected. ESTRO guidelines for the clinical target volume (CTV) delineation and FAST-FORWARD protocol for CTV to planning target volume (PTV) margin definition were followed. Total prescribed dose was 26 Gy in five fractions. The homogeneity index (HI) and the global conformity index (GCI) were taken into account for planning and dose distribution optimisation purposes. Both 3D-CRT tangential fields and VMAT plans were generated for each patient. RESULTS The analysis included 21 patients. PTV coverage comparison between 3D-CRT and VMAT plans showed significant increases for GCI (P < 0.05) in VMAT technique; no statistically significant differences were observed regarding HI. For organs at risks (OAR), statistically significant increases were observed in terms of skin V103% (P < 0.002) and ipsilateral lung V30% (P < 0.05) with 3D-CRT and of heart V5% (P < 0.05) with VMAT technique. CONCLUSIONS This in silico study showed that both 3D-CRT and VMAT are dosimetrically feasible techniques in the framework of 1-week hypofractionated treatments for left EBC.
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Affiliation(s)
- Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy
| | - Sebastiano Menna
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | | | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | | | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Mariangela Massaccesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gian Carlo Mattiucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonino Daidone
- Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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13
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Tekiki N, Kuroda M, Ishizaka H, Khasawneh A, Barham M, Hamada K, Konishi K, Sugimoto K, Katsui K, Sugiyama S, Watanabe K, Yoshio K, Katayama N, Ogata T, Ihara H, Kanazawa S, Asaumi J. New field-in-field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation-induced skin toxicities assessment. Mol Clin Oncol 2021; 15:193. [PMID: 34349992 PMCID: PMC8327075 DOI: 10.3892/mco.2021.2355] [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: 07/24/2020] [Accepted: 06/16/2021] [Indexed: 11/06/2022] Open
Abstract
The usefulness of the field-in-field with two reference points (FIF w/ 2RP) method, in which the dose reference points are set simultaneously at two positions in the irradiation field and the high-dose range is completely eliminated, was examined in the present study with the aim of decreasing acute skin toxicity in adjuvant breast radiotherapy (RT). A total of 573 patients with breast cancer who underwent postoperative whole breast RT were classified into 178 cases with wedge (W) method, 142 cases with field-in-field without 2 reference points (FIF w/o 2RP) method and 253 cases with FIF w/ 2RP method. Using the FIF w/ 2RP method, the high-dose range was the lowest among the three irradiation methods. The planning target volume (PTV) V105% and the breast PTV for evaluation (BPe) V105% decreased to 0.09 and 0.10%, respectively. The FIF w/ 2RP method vs. the FIF w/o 2RP method had a strong association (η) with PTV V105% (η=0.79; P<0.001) and BPe V105% (η=0.76; P<0.001). The FIF w/ 2RP method had a significant impact on lowering the skin toxicity grade in weeks 3 and 4, and increasing the occurrence of skin toxicity grade 0. The FIF w/ 2RP method vs. the W method had a moderate association with skin toxicity grade at week 3 (η=0.49; P<0.001). Using the FIF w/ 2RP method, the high-dose range V105% of the target decreased to 0%, and skin adverse events were decreased in conjunction. For patients with early-stage breast cancer, particularly patients with relatively small-sized breasts, the FIF w/ 2RP method may be an optimal irradiation method.
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Affiliation(s)
- Nouha Tekiki
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Hinata Ishizaka
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Abdullah Khasawneh
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Majd Barham
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kentaro Hamada
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kohei Konishi
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kohei Sugimoto
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama 700-8558, Japan
| | - Soichi Sugiyama
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kenta Watanabe
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kotaro Yoshio
- Department of Radiology, Okayama University Hospital, Okayama 700-8558, Japan
| | - Norihisa Katayama
- Department of Radiology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Takeshi Ogata
- Department of Radiology, Iwakuni Clinical Center, Iwakuni, Yamaguchi 740-8510, Japan
| | - Hiroki Ihara
- Department of Radiology, Tsuyama Chuo Hospital, Okayama 708-0841, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Junichi Asaumi
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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14
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Colciago RR, Cavallo A, Magri MC, Vitullo A, La Rocca E, Giandini C, Bonfantini F, Di Cosimo S, Baili P, Sant M, Pignoli E, Valdagni R, Lozza L, De Santis MC. Hypofractionated whole-breast radiotherapy in large breast size patients: is it really a resolved issue? MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2021; 38:107. [PMID: 34342725 DOI: 10.1007/s12032-021-01550-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the impact of breast size on acute and late side effects in breast cancer (BC) patients treated with hypofractionated radiotherapy (Hypo-RT). In this study we analyzed patients over 50 years with a diagnosis of early BC, candidate for Hypo-RT after conservative surgery. Acute and late skin toxicities were evaluated in accordance with the RTOG scale. Multivariable logistic analysis was performed using dosimetric/anatomical factors resulted associated with toxicity outcome in univariable analysis. Among patients treated between 2009 and 2015, 425 had at least 5 years of follow-up. At RT end, acute skin toxicity ≥ G2 and edema ≥ G2 occurred in 88 (20.7%) and 4 (0.9%) patients, respectively. The multivariable analysis showed association of skin toxicity with boost administration (p < 0.01), treated skin area (TSA) receiving more than 20 Gy (p = 0.027) and breast volume receiving 105% of the prescription dose (V105%) (p = 0.016), but not breast size. At 5 years after RT, fibrosis ≥ G1 occurred in 89 (20.9%) patients and edema ≥ G1 in 36 (8.5%) patients. Fibrosis resulted associated with breast volume ≥ 1000 cm3 (p = 0.04) and hypertension (p = 0.04). As for edema, multivariable logistic analysis showed a correlation with hypertension and logarithm of age, but not with boost administration. Breast volume had an unclear impact (p = 0.055). A recurrent association was found between acute and late toxicities and breast V105%, which is correlated with breast size. This may suggest that a more homogenous RT technique may be preferred for patients with larger breast size.
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Affiliation(s)
- Riccardo Ray Colciago
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy.,Department of Radiotherapy, Università Degli Studi di Milano Bicocca, Milan, Italy
| | - Anna Cavallo
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Chiara Magri
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angelo Vitullo
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Eliana La Rocca
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy. .,Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy.
| | - Carlotta Giandini
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy
| | - Francesca Bonfantini
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Serena Di Cosimo
- Department of Applied Research and Technological Development (DRAST), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuele Pignoli
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Riccardo Valdagni
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy.,Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy.,Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Lozza
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy
| | - Maria Carmen De Santis
- Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy
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15
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Park SH, Choi J. Analysis of Geometric and Dosimetric Effects of Bra Application to Support Large or Pendulous Breasts During Radiotherapy Planning: A Retrospective Single-Center Study. Technol Cancer Res Treat 2021; 20:15330338211027909. [PMID: 34180303 PMCID: PMC8243138 DOI: 10.1177/15330338211027909] [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] [Indexed: 11/16/2022] Open
Abstract
Purpose: To evaluate geometric and dosimetric effects of bra application during
radiotherapy planning for breast cancer patients with large and pendulous
breasts. Materials and Methods: Twenty patients with chest sizes >38 inches between April 2019 and July
2019 underwent radiotherapy planning with and without a radiation bra
(Chabner XRT®). Geometric and dosimetric parameters included the
breast volume, superior-inferior (SI) distance, separation (S) as the
distance of the longest diameter of the clinical target volume (CTV),
conformity number (CN), and homogeneity index (HI) of CTV. The organs at
risk (OARs) were defined as the lungs, heart, and liver. Results: The use of the radiation bra provided mean changes of −0.51 cm for S, −1.45
cm for SI, and −61.18 cc for breast volume (all P <
0.05). Breast volume was correlated with bra-related changes in cross
diameter (r = 0.641, P = 0.002) and volume (r = 0.680,
P = 0.001). Significant dose reductions were observed
for the lungs (mean V10: 19.58 cc, V20: 17.13 cc,
Dmean: 86.24 cGy) and heart (Dmean: 170.23 cGy).
No significant differences were observed for CN (0.62-0.67) and HI
(0.19-0.20) of the CTV. Conclusion: The application of a radiation bra was associated with better geometric and
dosimetric planning parameters, with a smaller CTV and lower doses to the
OARs (lungs and heart) in the radiotherapy field. In addition, we expect
that bra use during radiotherapy would provide emotional benefits.
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Affiliation(s)
- So Hyun Park
- Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, Jeju, South Korea
| | - Jinhyun Choi
- Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, Jeju, South Korea
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16
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Yaghoobi E, Shojaee S, Ramezani M, Alibolandi M, Charbgoo F, Nameghi MA, Khatami F, Ashjaei MS, Abnous K, Taghdisi SM. A novel targeted co-delivery system for transfer of epirubicin and antimiR-10b into cancer cells through a linear DNA nanostructure consisting of FOXM1 and AS1411 aptamers. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Wang L, Qiu G, Yu J, Zhang Q, Man L, Chen L, Zhang X, Ren Q, Xu H, Hua X. Effect of auto flash margin on superficial dose in breast conserving radiotherapy for breast cancer. J Appl Clin Med Phys 2021; 22:60-70. [PMID: 34028963 PMCID: PMC8200433 DOI: 10.1002/acm2.13287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/15/2021] [Accepted: 04/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the dose‐effect of Auto Flash Margin (AFM) on breast cancer's superficial tissues based on the Treatment Planning System (TPS) in the breast‐conserving radiotherapy plan. Methods A total of 16 breast‐conserving patients with early stage breast cancer were selected, using the X‐ray Voxel Monte Carlo (XVMC) algorithm. Then, every included case plan was designed using a 2 cm‐AFM (the value of AFM is 2 cm) and N‐AFM (without AFM). Under the condition of ensuring the same configuration of #MU and collimator, the absorbed dose after a simulated inspiratory motion was calculated again using the new plan center, which moved backward to the linac source. The dose difference between the measurement points between AFM and N‐AFM groups was compared. Results In the dose results, PTVV50Gy of the AFM group was superior to that of the N‐AFM group, PTVD2%, PTVDmean, Lung_IpsiV20Gy, Lung_IpsiDmean, and BodyDmax. Also, the dose results of the N‐AFM group were significantly higher than those of the AFM group. However, there was no significant difference between Lung_ContraV5Gy, HeartDmean, and Breast_ContraV10Gy in the two groups. In the collimator alignments at the same angle between groups, the AFM group formed an apparent air region outside the collimator compared with the N‐AFM group. In the XVMC algorithm feature parameter, the AFM group had less #MU, higher QE, and slightly longer optimization time. The #segments of both groups were close to the 240 control points preset by the plan. The validation results of EBT3 film in both groups were more significant than 95%, meeting the clinical plan's application requirements. The difference in film results between groups was mainly reflected in the dose distribution at the near‐source. 4DCT was used to summarize the maximum and minimum inspiratory motion distances of 7.31 ± 0.45 and 3.42 ± 0.91 mm respectively. Conclusions These results suggest that the AFM function application could significantly reduce the possibility of insufficient tumor target caused by inspiratory motion and ensure sufficient tumor target exposure.
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Affiliation(s)
- Lu Wang
- Department of Radiotherapy, Anshan Cancer Hospital, Anshan, Liaoning, China
| | - Gang Qiu
- Department of Oncology Ward 2, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jianhe Yu
- Department of Oncology Ward 3, Xinghua People's Hospital, Taizhou, Jiangsu, China
| | - Qunhui Zhang
- Surgical oncology, Anshan Cancer Hospital, Anshan, Liaoning, China
| | - Li Man
- Medical oncology, Anshan Cancer Hospital, Anshan, Liaoning, China
| | - Li Chen
- Department of Radiotherapy, Anshan Cancer Hospital, Anshan, Liaoning, China
| | - Xiaoxiao Zhang
- Department of Radiotherapy, Anshan Cancer Hospital, Anshan, Liaoning, China
| | - Qun Ren
- Department of Oncology Ward 3, Xinghua People's Hospital, Taizhou, Jiangsu, China
| | - Hongxia Xu
- Department of Oncology Ward 3, Xinghua People's Hospital, Taizhou, Jiangsu, China
| | - Xiaolong Hua
- Department of Radiotherapy, Xinghua People's Hospital, Taizhou, Jiangsu, China
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18
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Lee G, Tsui H, Koch CA, Fyles A. Are we missing the post-operative cavity in whole breast radiotherapy? J Med Imaging Radiat Sci 2021; 52:207-213. [PMID: 33926849 DOI: 10.1016/j.jmir.2021.03.003] [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: 02/05/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE Whole breast radiotherapy (RT) following breast-conserving surgery is a standard treatment option in early-stage breast cancer patients. The whole breast RT technique targets the entire breast, traditionally identified based on breast palpation and the lumpectomy scar. The aim of this study is to evaluate dosimetry of the tumour bed (cavity) and location of recurrence in women treated with breast radiotherapy without explicit cavity delineation. MATERIALS/METHODS 50 consecutive women previously treated with whole breast RT were retrospectively contoured to define the post-operative cavity with a 1.0 cm expansion for planning target volume (cPTV). The cavity and cPTV dosimetric coverage [volume receiving 92%(V92%) and 95%(V95%) prescription] were calculated. Cavity and cPTV location were classified as inside, at edge or outside of previous treatment fields and recurrence rates were collected. RESULTS Forty-five (90%) women had cavities located inside the previous treatment fields (CAVin) and 5 women (10%) had cavities located outside(4) or at edge(1) of previous fields (CAVout/edge). CAVout/edge were located in extreme aspects of the breast: lateral(3); medial(1); or superior(1). Mean cavity_V92% was 91.6% vs 98.5% for CAVout/edge vs CAVin (p = 0.042). Mean cPTV_V92% was 78.7% vs 97.2% for cPTVout/edge vs cPTVin (p<0.001). At 5-year follow-up, 20% (1/5) of the CAVout/edge had 1 in-breast recurrence near the cavity (at previous field edge). Within the CAVin cohort, 11 patients were lost to follow-up and 6% (2/34) patients had in-breast recurrence. CONCLUSIONS In patients treated with whole breast RT without cavity delineation, 10% did not have ideal dosimetric coverage of the cavity. Cavity delineation in treatment planning provides optimal tumour bed coverage for patients undergoing whole breast RT, and is of particular importance for the coverage of cavities located in the extreme margins of the breast.
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Affiliation(s)
- Grace Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Hugh Tsui
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - C Anne Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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19
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Lv R, Yang G, Huang Y, Wang Y. Dosimetric effects of supine immobilization devices on the skin in intensity-modulated radiation therapy for breast cancer: a retrospective study. BMC Cancer 2021; 21:384. [PMID: 33836670 PMCID: PMC8034111 DOI: 10.1186/s12885-021-08119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background The dose perturbation effect of immobilization devices is often overlooked in intensity-modulated radiation therapy (IMRT) for breast cancer (BC). This retrospective study assessed the dosimetric effects of supine immobilization devices on the skin using a commercial treatment planning system. Methods Forty women with BC were divided into four groups according to the type of primary surgery: groups A and B included patients with left and right BC, respectively, who received 50 Gy radiotherapy in 25 fractions after radical mastectomy, while groups C and D included patients with left and right BC, respectively, who received breast-conservation surgery (BCS) and 40.05 Gy in 15 fractions as well as a tumor bed simultaneous integrated boost to 45 Gy. A 0.2-cm thick skin contour and two sets of body contours were outlined for each patient. Dose calculations were conducted for the two sets of contours using the same plan. The dose differences were assessed by comparing the dose-volume histogram parameter results and by plan subtraction. Results The supine immobilization devices for BC resulted in significantly increased skin doses, which may ultimately lead to skin toxicity. The mean dose increased by approximately 0.5 and 0.45 Gy in groups A and B after radical mastectomy and by 2.7 and 3.25 Gy in groups C and D after BCS; in groups A–D, the percentages of total normal skin volume receiving equal to or greater than 5 Gy (V5) increased by 0.54, 1.15, 2.67, and 1.94%, respectively, while the V10 increased by 1.27, 1.83, 1.36, and 2.88%; the V20 by 0.85, 1.87, 2.76, and 4.86%; the V30 by 1.3, 1.24, 10.58, and 11.91%; and the V40 by 1.29, 0.65, 10, and 10.51%. The dose encompassing the planning target volume and other organs at risk, showed little distinction between IMRT plans without and with consideration of immobilization devices. Conclusions The supine immobilization devices significantly increased the dose to the skin, especially for patients with BCS. Thus, immobilization devices should be included in the external contour to account for dose attenuation and skin dose increment. Trial registration This study does not report on interventions in human health care.
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Affiliation(s)
- Ran Lv
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Guangyi Yang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yongzhi Huang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yanhong Wang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China.
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20
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Correlation between toxicity and dosimetric parameters for adjuvant intensity modulated radiation therapy of breast cancer: a prospective study. Sci Rep 2021; 11:3626. [PMID: 33574446 PMCID: PMC7878810 DOI: 10.1038/s41598-021-83159-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
ORCID: 0000–0001-6019–7309. In the treatment of breast cancer, intensity-modulated radiation therapy (IMRT) reportedly reduces the high-dose irradiation of at-risk organs and decreases the frequency of adverse events (AEs). Comparisons with conventional radiotherapy have shown that IMRT is associated with lower frequencies of acute and late-onset AEs. Here, we extended a prospective, observational, single-center study of the safety of IMRT to a second investigating center. Patients scheduled for adjuvant IMRT after partial or total mastectomy were given a dose of 50 Gy (25 fractions of 2 Gy over 5 weeks), with a simultaneous integrated boost in patients having undergone conservative surgery. 300 patients were included in the study, and 288 were analyzed. The median follow-up period was 2.1 years. The 2-year disease-free survival rate [95% CI] was 93.4% [89.2–96.0%]. Most AEs were mild. The most common AEs were skin-related—mainly radiodermatitis [in 266 patients (92.4%)] and hyperpigmentation (in 178 (61.8%)). 35% and 6% of the patients presented with grade 2 acute skin and esophageal toxicity, respectively. Only 4 patients presented with a grade 3 event (radiodermatitis). Smoking (odds ratio) [95% CI] = 2.10 [1.14–3.87]; p = 0.017), no prior chemotherapy (0.52 [0.27–0.98]; p = 0.044), and D98% for subclavicular skin (1.030 [1.001–1.061]; p = 0.045) were associated with grade ≥ 2 acute AEs. In a univariate analysis, the mean dose, (p < 0.0001), D2% (p < 0.0001), D50% (p = 0.037), D95% (p = 0.0005), D98% (p = 0.0007), V30Gy (p < 0.0001), and V45Gy (p = 0.0001) were significantly associated with grade ≥ 1 acute esophageal AEs. In a multivariate analysis, D95% for the skin (p < 0.001), D98% for the subclavicular skin and low D95% for the internal mammary lymph nodes were associated with grade ≥ 1 medium-term AEs. The safety profile of adjuvant IMRT after partial or total mastectomy is influenced by dosimetric parameters. Trial registration: ClinicalTrials.gov NCT02281149.
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21
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Fadavi P, Ahmadi HK, Diba AAY, Jafari F, Alamolhoda M. Dosimetric comparison of left sided whole breast irradiation with Tangential wedge beam, electron boosted Tangential wedged beam and asymmetric technique. J Family Med Prim Care 2020; 9:6135-6139. [PMID: 33681053 PMCID: PMC7928138 DOI: 10.4103/jfmpc.jfmpc_1476_20] [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: 07/18/2020] [Revised: 09/15/2020] [Accepted: 11/03/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Irradiation of the adjacent critical structures is inevitable in breast cancer radiotherapy (RT). Our purpose is to assess the dose distribution across the breast tissue and adjacent organs with our institutional asymmetric technique for left-sided breast cancer compared to the standard tangential wedged beam (TWB) and electron-boosted TWB techniques. Materials and Methods: The three RT planning were created for 30 consecutive patients with a focus on proper coverage of the planning target volume (PTV). The irritated doses into the heart, ipsilateral lung, and left anterior descending artery (LAD) were evaluated. Results: No significant difference was found in the mean values of relative PTV irradiated to 47.5 Gy, PTV dose and the volume of PTV, and critical organs between the treatments. The mean dose (Dmean) irradiated to the heart and LAD was lowest with the electron-boosted TWB. The Dmean to the heart was comparable between the TWB and asymmetric RT techniques, while the Dmean to LAD was significantly reduced with asymmetric technique versus TWB. The heart volume receiving ≥25 Gy and the Dmean to the left lung were significantly decreased with the asymmetric technique compared with TWB. The mean relative lung volume irradiated to ≥20 Gy was comparable between all techniques. The mean central lung distance was also significantly increased from 18.03 ± 4.5 cm with asymmetric RT to 37.47 ± 5.6 cm with TWB and to 27.67 ± 3.8 cm with electron-boosted TWB techniques. Conclusion: The asymmetric technique is useful for patients with breast cancer on the left side, having acceptable PTV coverage and considerably reduced cardiopulmonary doses.
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Affiliation(s)
- Pedram Fadavi
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Helaleh Khoshbakht Ahmadi
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Yousefi Diba
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jafari
- Radiation Oncology Research Center, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Alamolhoda
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
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22
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Ahmad I, Chufal KS, Bhatt CP, Miller AA, Bajpai R, Chhabra A, Chowdhary RL, Pahuja AK, Gairola M. Plan quality assessment of modern radiotherapy delivery techniques in left-sided breast cancer: an analysis stratified by target delineation guidelines. BJR Open 2020; 2:20200007. [PMID: 33330831 PMCID: PMC7736705 DOI: 10.1259/bjro.20200007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study compares planning techniques stratified by consensus delineation guidelines in patients undergoing whole-breast radiotherapy based on an objective plan quality assessment scale. METHODS 10 patients with left-sided breast cancer were randomly selected, and target delineation for intact breast was performed using Tangent (RTOG 0413), ESTRO, and RTOG guidelines. Consensus Plan Quality Metric (PQM) scoring was defined and communicated to the physicist before commencing treatment planning. Field-in-field IMRT (FiF), inverse IMRT (IMRT) and volumetric modulated arc therapy (VMAT) plans were created for each delineation. Statistical analyses utilised a two-way repeated measures analysis of variance, after applying a Bonferroni correction. RESULTS Total PQM score of plans for Tangent and ESTRO were comparable for FiF and IMRT techniques (FiF vs IMRT for Tangent, p = 0.637; FiF vs IMRT for ESTRO, p = 0.304), and were also significantly higher compared to VMAT. Total PQM score of plans for RTOG revealed that IMRT planning achieved a significantly higher score compared to both FiF and VMAT (IMRT vs FiF, p < 0.001; IMRT vs VMAT, p < 0.001). CONCLUSIONS Total PQM scores were equivalent for FiF and IMRT for both Tangent and ESTRO delineations, whereas IMRT was best suited for RTOG delineation. ADVANCES IN KNOWLEDGE FiF and IMRT planning techniques are best suited for ESTRO or Tangent delineations. IMRT also yields better results with RTOG delineation.
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Affiliation(s)
- Irfan Ahmad
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, India
| | - Kundan Singh Chufal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, India
| | - Chandi Prasad Bhatt
- Department of Radiation Oncology, Sarvodaya Hospital and Research Centre, Sector 8, Faridabad, Haryana, India
| | - Alexis Andrew Miller
- Department of Radiation Oncology, Illawara Cancer Care Centre, Wollongong NSW 2500, Australia
| | - Ram Bajpai
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Akanksha Chhabra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, India
| | - Rahul Lal Chowdhary
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, India
| | - Anjali Kakria Pahuja
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, New Delhi, India
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23
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Liu YC, Chang HM, Lin HH, Lu CC, Lai LH. Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer. J Clin Med 2020; 9:E3884. [PMID: 33260404 PMCID: PMC7760558 DOI: 10.3390/jcm9123884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to compare different types of right breast cancer radiotherapy planning techniques and to estimate the whole-body effective doses and the critical organ absorbed doses. The three planning techniques are intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT; two methods) and hybrid 3D-CRT/IMRT (three-dimensional conformal radiotherapy/intensity-modulated radiotherapy). The VMAT technique includes two methods to deliver a dose: non-continuous partial arc and continuous partial arc. A thermoluminescent dosimeter (TLD) is placed in the RANDO phantom to estimate the organ absorbed dose. Each planning technique applies 50.4 Gy prescription dose and treats critical organs, including the lung and heart. Dose-volume histogram was used to show the planning target volume (V95%), homogeneity index (HI), conformity index (CI), and other optimized indices. The estimation of whole-body effective dose was based on the International Commission on Radiation Protection (ICRP) Publication 60 and 103. The results were as follows: Continuous partial arc and non-continuous partial arc showed the best CI and HI. The heart absorbed doses in the continuous partial arc and hybrid 3D-CRT/IMRT were 0.07 ± 0.01% and 0% (V5% and V10%, respectively). The mean dose of the heart was lowest in hybrid 3D-CRT/IMRT (1.47 Gy ± 0.02). The dose in the left contralateral lung (V5%) was lowest in continuous partial arc (0%). The right ipsilateral lung average dose and V20% are lowest in continuous partial arc. Hybrid 3D-CRT/IMRT has the lowest mean dose to contralateral breast (organs at risk). The whole-body effective doses for ICRP-60 and ICRP-103 were highest in continuous partial arc (2.01 Sv ± 0.23 and 2.89 Sv ± 0.15, respectively). In conclusion, the use of VMAT with continuous arc has a lower risk of radiation pneumonia, while hybrid 3D-CRT/IMRT attain lower secondary malignancy risk and cardiovascular complications.
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Affiliation(s)
- Yi-Chi Liu
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 30015 Taiwan;
- Department of Radiation Oncology, Wei Gong Memorial Hospital, Miaoli 35148, Taiwan
| | - Hung-Ming Chang
- Department of General Surgery, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan;
| | - Hsin-Hon Lin
- Medical Physics Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan;
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Chia-Chun Lu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan;
| | - Lu-Han Lai
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
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24
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Wang H, Li Y, Khan SA, Luo Y. Prediction of breast cancer distant recurrence using natural language processing and knowledge-guided convolutional neural network. Artif Intell Med 2020; 110:101977. [PMID: 33250149 PMCID: PMC7983067 DOI: 10.1016/j.artmed.2020.101977] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
Distant recurrence of breast cancer results in high lifetime risks and low 5-year survival rates. Early prediction of distant recurrent breast cancer could facilitate intervention and improve patients' life quality. In this study, we designed an EHR-based predictive model to estimate the distant recurrent probability of breast cancer patients. We studied the pathology reports and progress notes of 6,447 patients who were diagnosed with breast cancer at Northwestern Memorial Hospital between 2001 and 2015. Clinical notes were mapped to Concept unified identifiers (CUI) using natural language processing tools. Bag-of-words and pre-trained embedding were employed to vectorize words and CUI sequences. These features integrated with clinical features from structured data were downstreamed to conventional machine learning classifiers and Knowledge-guided Convolutional Neural Network (K-CNN). The best configuration of our model yielded an AUC of 0.888 and an F1-score of 0.5. Our work provides an automated method to predict breast cancer distant recurrence using natural language processing and deep learning approaches. We expect that through advanced feature engineering, better predictive performance could be achieved.
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Affiliation(s)
- Hanyin Wang
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yikuan Li
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Seema A Khan
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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25
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Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy. Radiol Oncol 2020; 54:470-479. [PMID: 32990650 PMCID: PMC7585338 DOI: 10.2478/raon-2020-0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients’ individual anatomy, including breast volume. Patients and methods In the study, the whole heart and cardiac substructures were delineated for 60 patients using cardiac atlas. For each patient, 3D-CRT and t-IMRT plans were generated. The prescribed dose was 42.72 Gy in 16 fractions. Patients were divided into groups with small, medium, and large clinical target volume (CTV). Calculated dose distributions were compared amongst the two techniques and the three different groups of CTV. Results Mean absorbed dose to the whole heart (MWHD) (1.9 vs. 2.1 Gy, P < 0.005), left anterior descending coronary artery mean dose (8.2 vs. 8.4 Gy, P < 0.005) and left ventricle (LV) mean dose (3.0 vs. 3.2, P < 0.005) were all significantly lower with 3D-CRT technique compared to t-IMRT. Apical (8.5 vs. 9.0, P < 0.005) and anterior LV walls (5.0 vs. 5.4 Gy, P < 0.005) received the highest mean dose (Dmean). MWHD and LV-Dmean increased with increasing CTV size regardless of the technique. Low MWHD values (< 2.5 Gy) were achieved in 44 (73.3%) and 41 (68.3%) patients for 3D-CRT and t-IMRT techniques, correspondingly. Conclusions Our study confirms a considerable range of the planned doses within the heart for adjuvant 3D-CRT or t-IMRT in node-negative breast cancer. We observed differences in heart dosimetric metrics between the three groups of CTV size, regardless of the radiotherapy planning technique.
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26
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Shariati L, Amouheidari A, Naji Esfahani H, Abed A, Haghjooy Javanmard S, Laher I, Ghasemi A, Vaseghi G. Protective effects of doxepin cream on radiation dermatitis in breast cancer: A single arm double-blind randomized clinical trial. Br J Clin Pharmacol 2020; 86:1875-1881. [PMID: 32040868 PMCID: PMC7444764 DOI: 10.1111/bcp.14238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS Breast cancer is the most frequently occurring cancer in women. Lumpectomy followed by radiotherapy is suggested to be as effective as a total mastectomy. Radiation-induced dermatitis often occurs as a result of breast radiotherapy. Recent studies suggest that doxepin has promising anti-inflammatory properties. This study was undertaken to evaluate the effects of doxepin therapy on radiation dermatitis. METHODS A double-blind randomized clinical trial was launched from 2016 to 2017, with a total of 48 patients who had undergone breast-conserving surgery and received postoperative radiation therapy. Radiotherapy was applied 5 days per week for 5 weeks. Adverse dermatological effects were evaluated by a physician at the beginning of the fifth week of radiotherapy and the patients were then randomly assigned (1:1 ratio) to receive either doxepin (5%) or placebo cream for 7 days. RESULTS There were no significant differences in the dermatitis grade between doxepin and placebo groups at baseline (P > .5). The occurrence of acute dermatitis (grade 2 or higher) was significantly lower with the use of doxepin than with placebo (P ≤ .0001, Zα = 1.96 at 95% confidence interval). CONCLUSION Doxepin cream prevents dermatitis grade 2 or higher during post-operative breast irradiation. Doxepin cream is easy to use, affordable and prevents pain and irritation.
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Affiliation(s)
- Laleh Shariati
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of PhysiologyIsfahan University of Medical SciencesIsfahanIran
- Department of Biomaterials, Nanotechnology and Tissue Engineering, School of Advanced Technologies in MedicineIsfahan University of Medical SciencesIsfahanIran
| | | | - Hajar Naji Esfahani
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of PhysiologyIsfahan University of Medical SciencesIsfahanIran
| | - Alireza Abed
- Physiology Research Center, Kashan University of Medical SciencesKashanIran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of PhysiologyIsfahan University of Medical SciencesIsfahanIran
| | - Ismail Laher
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Ahmad Ghasemi
- Applied Physiology Research Center, Cardiovascular Research Institute, Department of PhysiologyIsfahan University of Medical SciencesIsfahanIran
| | - Golnaz Vaseghi
- Isfahan Cardiovascular Research Center, Cardiovascular Research InstituteIsfahan University of Medical SciencesIsfahanIran
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27
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Measurement of the photon and thermal neutron doses of contralateral breast surface in breast cancer radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction and purpose:During the radiation therapy of tumoral breast, the contralateral breast (CB) will receive scattered doses. In the present study, the photon and thermal neutron dose values received by CB surface during breast cancer radiation therapy were measured.Materials and methods:The right breast region of RANDO phantom was considered as CB, and the measurements of photon and thermal neutron dose values were carried out on this region surface. The phantom was irradiated with 18 MV photon beams, and the dose values were measured with thermoluminescent dosimeter (TLD-600 and TLD-700) chips for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes in the presence of physical and dynamic wedges.Results:The total dose values (photon + thermal neutron) received by the CB surface in the presence of physical wedge were 12·06%, 15·75% and 33·40% of the prescribed dose, respectively, for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes. The corresponding dose values for dynamic wedge were 9·18%, 12·92% and 29·26% of the prescribed dose, respectively. Moreover, the results showed that treatment field size and wedge type affect the received photon and thermal neutron doses at CB surface.Conclusion:According to our results, the total dose values received at CB surface during breast cancer radiotherapy with high-energy photon beams are remarkable. In addition, the dose values received at CB surface when using a physical wedge were greater than when using a dynamic wedge, especially for medial tangential fields.
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28
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Hypofractionated Whole Breast Irradiation and Simultaneous Integrated Boost in Large-breasted Patients: Long-term Toxicity and Cosmesis. Clin Breast Cancer 2020; 20:527-533. [PMID: 32665192 DOI: 10.1016/j.clbc.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the impact of breast size on long-term toxicity and cosmesis in patients with breast cancer treated with hypofractionated simultaneous integrated boost (SIB) using volumetric modulated arc therapy (VMAT). PATIENTS AND METHODS Patients with early stage breast cancer were treated with 3-week hypofractionated SIB-VMAT to the whole breast (40.5 Gy) and tumor bed (48 Gy). Two cohorts were identified: small/medium- (< 1000 cm3) and large- (> 1000 cm3) breasted patients. Acute and late (at 2 and 5 years) skin toxicity and cosmetic data were analyzed. Univariate and multivariate analysis evaluated associations between toxicity and dosimetric/anatomical variables. RESULTS From August 2010 to March 2017, a total of 1160 patients were treated; 831 had at least 2 years of follow-up and were analyzed. Treated skin area (TSA) receiving at least 20 Gy > 400 cm2 and V105% of Boost > 5 cm3 were significant predictors for acute skin toxicity. Multivariate analysis at 2 years was significant for boost volume > 70 cm3, TSA > 400 cm2, and breast size > 1500 cm3. At 5 year analysis (352 patients), none of the analyzed variables was significant. For cosmetic outcome, only the breast size (> 1000 cm3) and the boost size > 70 cm3 at 2 and 5 years, respectively, confirmed significance. CONCLUSIONS The TSA > 400 cm2 resulted as a significant predictor of both acute and late skin toxicity at 2 years; however, at 5 years, no breast size or dosimetric parameter suggested indications for increased toxicity. A worse cosmetic outcome was recorded at the 2-year follow up for large breasts, but was not confirmed at the 5-year follow-up. These long-term data suggest that hypofractionated SIB-VMAT is a viable modality also in large-breasted patients.
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29
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Chen KW, Hsu HT, Lin JF, Yeh HL, Yeh DC, Lin CY, Chan S, Hsieh HY. Adjuvant whole breast radiotherapy with simultaneous integrated boost to tumor bed with intensity modulated radiotherapy technique in elderly breast cancer patients. Transl Cancer Res 2020; 9:S12-S22. [PMID: 35117944 PMCID: PMC8798908 DOI: 10.21037/tcr.2019.07.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/01/2019] [Indexed: 12/25/2022]
Abstract
Background Adjuvant whole breast radiotherapy is the standard of care for breast cancer patients after partial mastectomy. Intensity-modulated radiation therapy (IMRT) has been reported to reduce acute toxicities compared to conventional radiotherapy. IMRT with simultaneous integrated boost (SIB) technique can deliver higher doses to tumor bed and irradiate whole breast with a lower dose level to shorten overall treatment duration. This study presents the long-term results of adjuvant IMRT with SIB in elderly breast cancer patients who received partial mastectomy. Methods From January 2007 to January 2018, 93 elder breast cancer patients (≥65-year-old) who received IMRT with SIB technique after partial mastectomy were reviewed retrospectively. The axillary areas were managed with either sentinel lymph node biopsies or axillary lymph node dissection. The dose to whole breast was 50.4 Gy in 28 fractions in all patients and the dose to tumor bed was 61.6 to 66.4 Gy in 28 fractions. The primary end point is locoregional control. Secondary end points include: overall survival, breast cancer-specific survival, distant-metastases-free survival, disease-free survival, and acute and chronic toxicities. Results The median follow-up was 56.1 months. One patient had ipsilateral breast tumor recurrence, 3 patients had regional lymph node recurrence, and 9 patients had distant metastases. Death occurred in 5 patients, including 3 patients died of breast cancer progression. Five-year overall survival is 96.3% and 5-year locoregional recurrence-free survival is 96.4%. The 5-year breast cancer specific survival and 5-year distant metastases-free survival is 97.5% and 87.2%, respectively. Seven patients developed second primary cancer after RT. Eighty-one point seven percent patients had acute grade 1 dermatitis while 18.3% suffered from grade 2 dermatitis. The incidence of grade 1 pneumonitis and grade 1 stomatitis was 4.3% and 8.6%, respectively. Conclusions Adjuvant IMRT with SIB technique is a safe and effective treatment strategy for elderly breast cancer patients after partial mastectomy.
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Affiliation(s)
- Kuan-Wen Chen
- Department of Radiation Oncology, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - Hsiu-Ting Hsu
- Department of Radiation Oncology, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - Jia-Fu Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hui-Ling Yeh
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Dah-Cherng Yeh
- Department of General Surgery, Cheng-Ching Hospital, Chung-Kang Branch, Taichung, Taiwan
| | - Chin-Yao Lin
- Breast Medical Center, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - Siwa Chan
- Department of Medical Imaging, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - He-Yuan Hsieh
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
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30
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Lin JY, Yang X, Serra M, Miller AH, Godette KD, Kahn ST, Henry S, Brown G, Liu T, Torres MA. Full axillary lymph node dissection and increased breast epidermal thickness 1 year after radiation therapy for breast cancer. J Surg Oncol 2019; 120:1397-1403. [PMID: 31705561 DOI: 10.1002/jso.25757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/30/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND We previously reported a prospective study showing axillary lymph node dissection (ALND) is associated with increased breast skin thickening during and 6 weeks post-radiation therapy (RT), and now report ALND's long-term impact at 1 year. METHODS Among 66 women who received whole breast RT after lumpectomy, objective ultrasound measurements of epidermal thickness over four quadrants of the treated breast were measured at five time points: before RT, week 6 of RT, and 6 weeks, 6 months, and 1 year post-RT. Skin thickness ratio (STRA) was generated by normalizing for corresponding measurements of the contralateral breast. RESULTS A total of 2,436 ultrasound images were obtained. Among 63 women with evaluable data at 1 year, mean STRA significantly increased at 6 months (absolute mean increase of 65%, SD 0.054), and remained elevated at 1 year post-RT (absolute mean increase of 44%, SD 0.048). In multivariable analysis, ALND compared to sentinel lymph node biopsy, longer interval between surgery and RT, increased baseline STRA, and Caucasian race predicted for more severe changes in STRA at 1 year compared to baseline (all P < .05). CONCLUSIONS In the setting of whole breast RT, our findings suggest that ALND has long-term repercussions on breast skin thickening.
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Affiliation(s)
- Jolinta Y Lin
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Monica Serra
- Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Medicine, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrew H Miller
- Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Karen D Godette
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Shannon T Kahn
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Simone Henry
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Gabrielle Brown
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Tian Liu
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mylin A Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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31
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Kivanc H, Gultekin M, Gurkaynak M, Ozyigit G, Yildiz F. Dosimetric comparison of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for left-sided chest wall and lymphatic irradiation. J Appl Clin Med Phys 2019; 20:36-44. [PMID: 31680445 PMCID: PMC6909119 DOI: 10.1002/acm2.12757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 09/05/2018] [Accepted: 10/07/2018] [Indexed: 12/05/2022] Open
Abstract
Introduction The aim of this study was to compare five different techniques for chest wall (CW) and lymphatic irradiation in patients with left‐sided breast carcinoma. Methods Three‐dimensional conformal radiotherapy (3DCRT), forward‐planned intensity‐modulated radiotherapy (FP‐IMRT), inverse‐planned IMRT (IP‐IMRT; 7‐ or 9‐field), and hybrid IP‐/FP‐IMRT were compared in 10 patients. Clinical target volume (CTV) included CW and internal mammary (IM), supraclavicular (SC), and axillary nodes. Planning target volumes (PTVs), CTVs, and organs at risks (OARs) doses were analyzed with dose–volume histograms (DVHs). Results No differences could be observed among the techniques for doses received by 95% of the volume (D95%) of lymphatics. However, the FP‐IMRT resulted in a significantly lower D95% dose to the CW‐PTV compared to other techniques (P = 0.002). The 9‐field IP‐IMRT achieved the lowest volumes receiving higher doses (hotspots). Both IP‐IMRT techniques provided similar mean doses (Dmean) for the left lung which were smaller than the other techniques. There was no difference between the techniques for maximum dose (Dmax) of right breast. However, FP‐IMRT resulted in lower Dmean and volume of right breast receiving at least 5 Gy doses compared to other techniques. Conclusion The dose homogeneity in CW‐CTV was better using IMRT techniques compared to 3DCRT. Especially 9‐field IP‐IMRT provided a more homogeneous dose distribution in IM and axillary CTVs. Moreover, the OARs volumes receiving low radiation doses were larger with IP‐IMRT technique, while volumes receiving high radiation doses were larger with FP‐IMRT technique. Hybrid IMRT plans were found to have the advantages of both FP‐ and IP‐IMRT techniques.
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Affiliation(s)
- Huseyin Kivanc
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Melis Gultekin
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Gurkaynak
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokhan Ozyigit
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, School of Medicine, Hacettepe University, Ankara, Turkey
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32
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Karpf D, Sakka M, Metzger M, Grabenbauer GG. Left breast irradiation with tangential intensity modulated radiotherapy (t-IMRT) versus tangential volumetric modulated arc therapy (t-VMAT): trade-offs between secondary cancer induction risk and optimal target coverage. Radiat Oncol 2019; 14:156. [PMID: 31477165 PMCID: PMC6721379 DOI: 10.1186/s13014-019-1363-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background Adjuvant radiotherapy is the standard treatment after breast-conserving surgery. According to meta-analyses, adjuvant 3d-conventional irradiation reduces the risk of local recurrence and thereby improves long-term survival by 5–10%. However, there is an unintended exposure of organs such as the heart, lungs and contralateral breast. Irradiation of the left breast has been related to long-term effects like increased rates of coronary events as well as second cancer induction. Modern radiotherapy techniques such as tangential intensity modulated radiotherapy (t-IMRT) and tangential volumetric modulated arc therapy (t-VMAT) and particularly deep inspiration breath hold (DIBH) technique have been developed in order to improve coverage of target volume and to reduce dose to normal tissue. The aim of this study was to compare t-IMRT-plans with t-VMAT-plans in DIBH position for left-sided breast irradiation in terms of normal tissue exposure, i.e. of lungs, heart, left anterior descending coronary artery (LADCA), as well as homogeneity (HI) and conformity index (CI) and excess absolute risk (EAR) for second cancer induction for organs at risk (OAR) after irradiation. Methods Twenty patients, diagnosed with left-sided breast cancer and treated with breast-preserving surgery, were included in this planning study. For each patient DIBH-t-IMRT plan using 5 to 7 beams and t-VMAT plan using four rotations were generated to achieve 95% dose coverage to 95% of the volume. Data were evaluated on the basis of dose-volume histograms: Cardiac dose and LADCA (mean and maximum dose, D25% and D45%), dose to ipsilateral and contralateral lung (mean, D20%, D30%), dose to contralateral breast (mean dose), total monitor units, V5% of total body and normal tissue integral dose (NTID). In addition, homogeneity index and conformity index, as well as the excess absolute risk (EAR) to estimate the risk of second malignancy were calculated. Results T-IMRT showed a significant reduction in mean cardiac dose of 26% (p = 0.002) compared to t-VMAT, as well as a significant reduction in the mean dose to LADCA of 20% (p = 0.03). Following t-IMRT, mean dose to the left lung was increased by 5% (p = 0.006), whereas no significant difference was found in the mean dose to the right lung and contralateral breast between the two procedures. Monitor units were 31% (p = 0.000004) lower for t-IMRT than for t-VMAT. T-IMRT technique significantly reduced normal tissue integral dose (NTID) by 19% (p = 0.000005) and the V5% of total body by 24% (p = 0.0007). In contrast, t-VMAT improved CI and HI by 2% (p = 0.001) and 0.4% (p = 0.00001), respectively. EAR with t-IMRT was significantly lower, especially for contralateral lung and contralateral breast (2–5/10,000 person years) but not for ipsilateral lung. Conclusion Compared to t-VMAT, t-IMRT in left-sided breast irradiation significantly reduced dose to organs at risk as well as normal tissue integral dose, and V5% total body. EAR with t-IMRT was significantly lower for contralateral lung and contralateral breast. T-VMAT, however, achieved better homogeneity and conformity. This may be relevant in individual cases where sufficient coverage of medial lymphatic target volumes is warranted.
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Affiliation(s)
- Daniel Karpf
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany.,Medical Faculty of the Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mazen Sakka
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany
| | - Martin Metzger
- Division of Radiation Physics, Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany
| | - Gerhard G Grabenbauer
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany. .,Medical Faculty of the Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.
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Sheng Y, Li T, Yoo S, Yin FF, Blitzblau R, Horton JK, Ge Y, Wu QJ. Automatic Planning of Whole Breast Radiation Therapy Using Machine Learning Models. Front Oncol 2019; 9:750. [PMID: 31440474 PMCID: PMC6693433 DOI: 10.3389/fonc.2019.00750] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: To develop an automatic treatment planning system for whole breast radiation therapy (WBRT) based on two intensity-modulated tangential fields, enabling near-real-time planning. Methods and Materials: A total of 40 WBRT plans from a single institution were included in this study under IRB approval. Twenty WBRT plans, 10 with single energy (SE, 6MV) and 10 with mixed energy (ME, 6/15MV), were randomly selected as training dataset to develop the methodology for automatic planning. The rest 10 SE cases and 10 ME cases served as validation. The auto-planning process consists of three steps. First, an energy prediction model was developed to automate energy selection. This model establishes an anatomy-energy relationship based on principle component analysis (PCA) of the gray level histograms from training cases' digitally reconstructed radiographs (DRRs). Second, a random forest (RF) model generates an initial fluence map using the selected energies. Third, the balance of overall dose contribution throughout the breast tissue is realized by automatically selecting anchor points and applying centrality correction. The proposed method was tested on the validation dataset. Non-parametric equivalence test was performed for plan quality metrics using one-sided Wilcoxon Signed-Rank test. Results: For validation, the auto-planning system suggested same energy choices as clinical-plans in 19 out of 20 cases. The mean (standard deviation, SD) of percent target volume covered by 100% prescription dose was 82.5% (4.2%) for auto-plans, and 79.3% (4.8%) for clinical-plans (p > 0.999). Mean (SD) volume receiving 105% Rx were 95.2 cc (90.7 cc) for auto-plans and 83.9 cc (87.2 cc) for clinical-plans (p = 0.108). Optimization time for auto-plan was <20 s while clinical manual planning takes between 30 min and 4 h. Conclusions: We developed an automatic treatment planning system that generates WBRT plans with optimal energy selection, clinically comparable plan quality, and significant reduction in planning time, allowing for near-real-time planning.
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Affiliation(s)
- Yang Sheng
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, United States
| | - Taoran Li
- Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, United States.,Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States
| | - Sua Yoo
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, United States
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, United States
| | - Rachel Blitzblau
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Janet K Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina, Charlotte, NC, United States
| | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States.,Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, United States
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Mizuno N, Yamauchi R, Kawamori J, Itazawa T, Shimbo M, Nishimura K, Yamano T, Hatanaka S, Hariu M, Takahashi T. Evaluation of a new commercial automated planning software for tangential breast intensity-modulated radiation therapy. Radiol Phys Technol 2019; 12:249-259. [PMID: 31115835 DOI: 10.1007/s12194-019-00515-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022]
Abstract
Automated treatment planning may decrease the effort required in planning and promote increased routine clinical use of intensity-modulated radiation therapy (IMRT) for many breast cancer patients. The aim of this study was to evaluate a new commercial automated planning software for tangential breast IMRT by comparing it with clinical plans from whole-breast irradiation. We prospectively enrolled 150 patients with Stage 0-1 breast cancer who underwent breast-conserving surgery at our institution between September 2016 and August 2017. Total doses of 42.56 Gy in 16 fractions (n = 98) or 50 Gy in 25 fractions (n = 44) were used. All treatment plans were retrospectively re-planned using the automated breast planning (ABP) software. All automated plans generated clinically deliverable beam parameters with no patient body collision and no contralateral breast pass through. The mean homogeneity index of the automatically generated clinical target volume, percentage volume of lungs receiving dose more than 20 Gy, mean heart dose, and dose to the highest irradiated 2-cc volumes of the irradiated volume were 0.077 ± 0.019, 4.2% ± 1.2%, 142 ± 69 cGy, and 105.8% ± 1.7% (prescribed dose: 100%), respectively. The mean planning time was 4.8 ± 1.4 min. The ABP software demonstrated high clinical acceptability and treatment planning cost efficiency for tangential breast IMRT. The ABP software may be useful for delivering high-quality treatment to a majority of patients with early-stage breast cancer.
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Affiliation(s)
- Norifumi Mizuno
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan. .,Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan.
| | - Ryouhei Yamauchi
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Tomoko Itazawa
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Munefumi Shimbo
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Keiichiro Nishimura
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Takafumi Yamano
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Shogo Hatanaka
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Masatsugu Hariu
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8550, Japan
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Miranda FA, Vieira MTL, Moraes FYD, Marta GN, Carvalho HDA, Hanna SA. Cosmesis in patients with breast neoplasia submitted to the hypofractionated radiotherapy with of intensity-modulated beam. ACTA ACUST UNITED AC 2019; 64:1023-1030. [PMID: 30570055 DOI: 10.1590/1806-9282.64.11.1023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the cosmetic satisfaction of patients diagnosed with breast cancer submitted to the hypofractionated radiotherapy with IMRT (hIMRT) technique and its correlation with dosimetric data of the radiotherapy planning. METHODS The retrospective cohort study that assessed women with a diagnosis of malignant breast neoplasia submitted to the conservative treatment or radical mastectomy and treated with hIMRT. In the period between August 2007 to December 2014, in a philanthropic / private institution, 170 records were selected. The cosmetic assessment was carried out by means of the Harvard/RTOG/NSABP scale with one-year minimum range after treatment. The collected dosimetric data were: breast / chest wall volume, volume that received 95% (V95%) and 107% (V107%) of the prescribed dose. RESULTS The volume of the treated breasts ranged from 169 to 2.103 ml (median = 702; IQR: 535 to 914 ml). Median V95% was 86.7% (54.6-96.6%; IQR: 80.0% to 90.6%); eight (5.7%) patients had V95% higher than 95%. Median V107% was 0% (0%-16.3%; IQR: 0.0% to 0.3% and 13); 9.3% patients had V107% higher than 2%. One hundred and thirty-three (78.2%) patients responded to the cosmetic assessment: 99 (74.4%) considered the cosmetic results excellent. Significant associations between cosmetic assessment and breast volume (p=0.875), V95% (p=0.294) e V107% (p=0.301) were not found. CONCLUSION The cosmetic results showed favorable when using hIMRT, and the lack of correlation with usual the dosimetric data illustrates the capacity of hIMRT to minimize the heterogeneity of the dose in this endpoint, even in voluminous breasts.
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Affiliation(s)
| | | | - Fabio Ynoe de Moraes
- Radiation Medicine Program, Princess Margaret Hospital University of Toronto, Toronto, Ontario, Canada
| | - Gustavo Nader Marta
- Radiation Oncologist of Hospital Sírio-Libanês - SP and Instituto do Câncer do Estado de São Paulo, São Paulo (SP), Brasil
| | - Heloísa de Andrade Carvalho
- Radiation Oncologist of Hospital Sírio-Libanês - SP and Instituto de Radiologia (InRad) - SP, São Paulo (SP), Brasil
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Kim H, Kwak J, Jung J, Jeong C, Yoon K, Lee SW, Ahn SD, Choi EK, Kim SS, Cho B. Automated Field-In-Field (FIF) Plan Framework Combining Scripting Application Programming Interface and User-Executed Program for Breast Forward IMRT. Technol Cancer Res Treat 2019; 17:1533033818810391. [PMID: 30384804 PMCID: PMC6259058 DOI: 10.1177/1533033818810391] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: To develop an one-click option on treatment planning system that enables for the
automated breast FIF planning by combining the Eclipse Scripting application programming
interfaces and user-executed programming in Windows. Methods: Scripting application programming interfaces were designed to promote automation in
clinical workflow associated with radiation oncology. However, scripting cannot provide
all functions that users want to perform. Thus, a new framework proposes to integrate
the benefits of the scripting application and user-executed programming for the
automated field-in-field technique. We adopted the Eclipse Scripting applications, which
provide an interface between treatment planning system server and client and enable for
running the executed program to create dose clouds and adjust the planning parameters
such as multi-leaf collimator placements and monitor unit values. Importantly, all tasks
are designed to perform with one-click option on treatment planning system, including
the automated pushback of the proposed plan to the treatment planning system. Results: The plans produced from the proposed framework were validated against the manual
field-in-field plans with 40 retrospective breast patient cases in planning efficiency
and plan quality. The elapsed time for running the framework was less than 1 minute,
which significantly reduced the manual multi-leaf collimator/monitor unit adjustment
time. It decreased the total planning time by more than 50%, relative to the manual
field-in-field planning. In dosimetric aspects, the mean and maximum dose of the heart,
lung, and whole breast did not exceed 1% deviation from the manual plans in most patient
cases, while maintaining the target dose coverage and homogeneity index inside the
target volume. From numerical analysis, the automated plans were demonstrated to be
sufficiently close to the manual plans. Conclusion: The combination of scripting applications and user-executed programming for automated
breast field-in-field planning accomplished a significant enhancement in planning
efficiency without degrading the plan quality, relative to the manual field-in-field
procedure.
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Affiliation(s)
- Hojin Kim
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungwon Kwak
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chiyoung Jeong
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungjun Yoon
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungchul Cho
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Intensity-modulated radiation therapy with simultaneous integrated boost for locally advanced breast cancer: a prospective study on toxicity and quality of life. Sci Rep 2019; 9:2759. [PMID: 30808911 PMCID: PMC6391390 DOI: 10.1038/s41598-019-39469-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/25/2019] [Indexed: 11/23/2022] Open
Abstract
Radiotherapy after breast conserving surgery and mastectomy with node positive disease has been shown to reduce risk of recurrence and mortality in the treatment of breast cancer. Intensity-modulated radiation therapy (IMRT) after conservative surgery offers several advantages over conventional RT including improved acute and late toxicity and quality of life (QoL). We undertook this study to prospectively evaluate acute (≤90 days after last dose of radiotherapy) and long-term (>90 days) cutaneous, esophageal, and fibrosis toxicity and QoL in breast cancer patients treated by adjuvant IMRT after breast surgery. We included patients with complex volumes for which 3D RT does not allow a good coverage of target volumes and sparing organs at risk. We report here an interim analysis with a median follow-up of 13.1 months (range, 6.5–25.9 months). Most of the acute toxicity was cutaneous (95.9%) and oesophageal (59.6%), and mostly grade 1 and 2. Medium-term cutaneous toxicity rate was 25.6%, and mostly grade 1. Medium-term esophageal toxicity was rare (1.8%). In this series acute oesophageal toxicity was found to be associated with dosimetric factors. QoL was well preserved throughout the study, and aesthetic outcomes were good. Based on these data, tomotherapy may be a favorable alternative to other techniques in patients needing a complex irradiation of the breast and lymph node volumes.
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Wang W, Gang GJ, Siewerdsen JH, Stayman JW. Volume-of-interest Imaging Using Multiple Aperture Devices. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2019; 10948:1094823. [PMID: 31057199 PMCID: PMC6494467 DOI: 10.1117/12.2513427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Volume-of-interest (VOI) imaging is a promising strategy for dose reduction in computed tomography (CT) while retaining image quality. However, implementation of VOI-CT has been challenged by the lack of adequate hardware and the interior tomography reconstruction problem. Multiple aperture devices (MAD) are a novel filtration scheme that can achieve x-ray fluence field modulation in a compact design with small translations. In this work, we propose a general approach for VOI imaging using MADs. MAD trajectories are designed to dynamically tailor the fluence for prescribed VOI. A penalized-likelihood reconstruction algorithm is proposed for fully truncated projections extended with scout views. Physical experiments were conducted to verify the feasibility for non-centered elliptic VOIs. Image quality and dose were estimated and compared with standard fullfield protocols. The ability of MAD-based VOI imaging to retain high image quality while significantly decreasing the total dose is demonstrated, suggesting the potential for dose reduction in clinical CT applications.
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Affiliation(s)
- W Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, USA 21205
| | - G J Gang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, USA 21205
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, USA 21205
| | - J W Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, USA 21205
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Dewan A, Chufal KS, Dewan AK, Pahuja A, Mehrotra K, Singh R, Chaudhary RL, Suresh T, Mishra M, Sundari AV, Bommera S, Narang R, Pathak P, Mitra S, Sharma SK, Gairola M. Simultaneous integrated boost by Intensity Modulated Radiotherapy (SIB-IMRT) in patients undergoing breast conserving surgery – A clinical and dosimetric perspective. J Egypt Natl Canc Inst 2018; 30:165-171. [DOI: 10.1016/j.jnci.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/25/2023] Open
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Borm KJ, Loos M, Oechsner M, Mayinger MC, Paepke D, Kiechle MB, Combs SE, Duma MN. Acute radiodermatitis in modern adjuvant 3D conformal radiotherapy for breast cancer - the impact of dose distribution and patient related factors. Radiat Oncol 2018; 13:218. [PMID: 30404664 PMCID: PMC6223003 DOI: 10.1186/s13014-018-1160-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/22/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose This study was performed to evaluate skin toxicity during modern three-dimensional conformal radiotherapy (3D-CRT) and to evaluate the importance of dose distribution and patient related factors. Material and methods This study comprises 255 patients with breast cancer treated with tangential three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery between 03/2012 and 05/2017. The median prescribed dose was 50.4 Gy (range 50–50.4) and 92.2% of the patients received a sequential boost of 10–16 Gy. Adverse skin toxicities (according to CTCAE v. 4.03 and the occurrence of moist desquamations) were assessed at the end of treatment. The dose distribution in the skin (5 mm strip from the patient outline) and in the CTV was evaluated and correlated to the CTCAE scores and the occurrence of moist desquamation. Results 42.4% of the patients developed grade I, 55.7% grade II and 2% grade III skin toxicities. Moist desquamation was observed in 59 cases (23.1%). Dose distribution within the CTV and skin was homogenous with only small areas receiving 107% of the prescribed dose (median: 0.7 cm3) in the CTV and 105% (median 0.5 cm3) in the skin. On univariate analysis breast size as well as V107%(CTV), V105%(skin) and V80%(skin) correlated significantly (p < 0.05) with the incidence of skin toxicity. On multivariate analysis only V80%(skin) was confirmed as independent risk factor. Conclusion Modern tangential multi-field 3D-CRT allows a homogeneous dose distribution with similar skin toxicity as compared to studies performing IMRT. Dose distribution within the skin (V80%) might have a relevant impact on the severity of skin toxicity and the occurrence of moist desquamation.
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Affiliation(s)
- Kai J Borm
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | | | - Markus Oechsner
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Michael C Mayinger
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Marion B Kiechle
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar, Technical University, Munich, Germany
| | - Stephanie E Combs
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK)-Partner Site Munich, 81675, Munich, Germany.,Institute of Innovative Radiohterapy, Helmholtzzentrum München, Munich, Germany
| | - Marciana N Duma
- Department of Radiotherapy, Klinikum Rechts der Isar, Technical University, Munich, Germany. .,Institute of Innovative Radiohterapy, Helmholtzzentrum München, Munich, Germany. .,Department of Radiation Oncology, Klinikum rechts der Isar/ TU Munchen, Ismaninger Strasse 22, 81675, Munchen, Germany.
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Zeverino M, Petersson K, Kyroudi A, Jeanneret-Sozzi W, Bourhis J, Bochud F, Moeckli R. A treatment planning comparison of contemporary photon-based radiation techniques for breast cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 7:32-38. [PMID: 33458403 PMCID: PMC7807600 DOI: 10.1016/j.phro.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/24/2018] [Accepted: 08/17/2018] [Indexed: 01/03/2023]
Abstract
Background and purpose Adjuvant radiation therapy (RT) of the whole breast (WB) is still the standard treatment for early breast cancer. A variety of radiation techniques is currently available according to different delivery strategies. This study aims to provide a comparison of six treatment planning strategies commonly adopted for breast-conserving adjuvant RT and to use the Pareto concept in an attempt to assess the degree of plan optimization. Materials and methods Two groups of six left- and five right-sided cases with different dose prescriptions were involved (22 patients in total). Field-in-Field (FiF), two and four Fields static-IMRT (sIMRT-2f and sIMRT-4f), Volumetric-Modulated-Arc-Therapy (VMAT), Helical Tomotherapy (HT) and Static-Angles Tomotherapy (TomoDirect™ – TD) were planned. Dose volume constraints were taken from the RTOG protocol 1005. Pareto fronts were built for a selected case to evaluate the reliability of the plan optimization process. Results The best target dose coverage was observed for TD able to improve significantly (p < 0.01) the V95% in a range varying from 1.2% to 7.5% compared to other techniques. The V105% was significantly reduced up to 2% for HT (p < 0.05) although FiF and VMAT produced similar values. For the ipsilateral lung, V5Gy, V10Gy and Dmean were significantly lower than all other techniques (p < 0.02) for TD while the lowest value of V20Gy was observed for HT. The maximum dose to contralateral breast was significantly lowest for TD (p < 0.02) and for FiF (p < 0.05). Minor differences were observed for the heart in left-sided patients. Plans for all tested techniques were found to lie on their respective Pareto fronts. Conclusions Overall, TD provided significantly better results in terms of target coverage and dose sparing of ipsilateral lung with respect to all other evaluated techniques. It also significantly minimized dose to contralateral breast together with FiF. Pareto front analysis confirmed the reliability of the optimization for a selected case.
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Affiliation(s)
- Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Kristoffer Petersson
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Archonteia Kyroudi
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Wendy Jeanneret-Sozzi
- Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Francois Bochud
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
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Ratosa I, Jenko A, Oblak I. Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning. Radiol Oncol 2018; 52:233-244. [PMID: 30210048 PMCID: PMC6137355 DOI: 10.2478/raon-2018-0026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/12/2018] [Indexed: 02/08/2023] Open
Abstract
Background Breast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size. Conclusions Inhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.
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Affiliation(s)
- Ivica Ratosa
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Aljasa Jenko
- Division of Radiotherapy, Department of Medical Physics, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Irena Oblak
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Lee TF, Sung KC, Chao PJ, Huang YJ, Lan JH, Wu HY, Chang L, Ting HM. Relationships among patient characteristics, irradiation treatment planning parameters, and treatment toxicity of acute radiation dermatitis after breast hybrid intensity modulation radiation therapy. PLoS One 2018; 13:e0200192. [PMID: 30011291 PMCID: PMC6047778 DOI: 10.1371/journal.pone.0200192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
To evaluate the relationships among patient characteristics, irradiation treatment planning parameters, and treatment toxicity of acute radiation dermatitis (RD) after breast hybrid intensity modulation radiation therapy (IMRT). The study cohort consisted of 95 breast cancer patients treated with hybrid IMRT. RD grade ≥2 (2+) toxicity was defined as clinically significant. Patient characteristics and the irradiation treatment planning parameters were used as the initial candidate factors. Prognostic factors were identified using the least absolute shrinkage and selection operator (LASSO)-based normal tissue complication probability (NTCP) model. A univariate cut-off dose NTCP model was developed to find the dose-volume limitation. Fifty-two (54.7%) of ninety-five patients experienced acute RD grade 2+ toxicity. The volume of skin receiving a dose >35 Gy (V35) was the most significant dosimetric predictor associated with RD grade 2+ toxicity. The NTCP model parameters for V35Gy were TV50 = 85.7 mL and γ50 = 0.77, where TV50 was defined as the volume corresponding to a 50% incidence of complications, and γ50 was the normalized slope of the volume-response curve. Additional potential predictive patient characteristics were energy and surgery, but the results were not statistically significant. To ensure a better quality of life and compliance for breast hybrid IMRT patients, the skin volume receiving a dose >35 Gy should be limited to <85.7 mL to keep the incidence of RD grade 2+ toxicities below 50%. To avoid RD toxicity, the volume of skin receiving a dose >35 Gy should follow sparing tolerance and the inherent patient characteristics should be considered.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Kuo-Chiang Sung
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.,Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Jen-Hong Lan
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Horng-Yuan Wu
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
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44
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Lin JC, Tsai JT, Chou YC, Li MH, Liu WH. Compared with intensity-modulated radiotherapy, image-guided radiotherapy reduces severity of acute radiation-induced skin toxicity during radiotherapy in patients with breast cancer. Cancer Med 2018; 7:3622-3629. [PMID: 29968974 PMCID: PMC6089195 DOI: 10.1002/cam4.1630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 11/11/2022] Open
Abstract
Radiotherapy (RT) is an effective treatment for breast cancer. The side effects of breast irradiation, including skin toxicity in the irradiation field, cause considerable discomfort. This study compared the severity of skin toxicity caused by image-guided RT (IGRT) and intensity-modulated RT (IMRT) combined with an electronic portal imaging device (EPID) in breast cancer. This study retrospectively analyzed 458 patients with breast cancer who had received RT. The patients were divided into two groups: 302 and 156 patients in the IMRT and IGRT groups. In the IGRT group, 8 and 148 patients had received helical tomotherapy irradiation and IMRT with cone-beam computed tomography. Simple and multiple logistic regression analyses were used to estimate the relationship between RT technique and the severity of radiation skin toxicity. In our study, 284, 97, and 6 patients exhibited grades I, II, and III radiation dermatitis (RD). Moreover, 75 patients in the IMRT group (24.80%) and 22 patients in the IGRT group (14.10%) exhibited grade II RD. All patients with grade III RD were in the IMRT group (2.00%). No patient exhibited grade IV RD. The patients in the IGRT group exhibited less severity of RD than in the IMRT group. The severity of acute RD due to IGRT is significantly lower than that due to IMRT with EPID.
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Affiliation(s)
- Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Hsien Li
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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45
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Fogliata A, De Rose F, Stravato A, Reggiori G, Tomatis S, Scorsetti M, Cozzi L. Evaluation of target dose inhomogeneity in breast cancer treatment due to tissue elemental differences. Radiat Oncol 2018; 13:92. [PMID: 29764450 PMCID: PMC5952506 DOI: 10.1186/s13014-018-1022-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monte Carlo simulations were run to estimate the dose variations generated by thedifference arising from the chemical composition of the tissues. METHODS CT datasets of five breast cancer patients were selected. Mammary gland was delineated as clinical target volume CTV, as well as CTV_lob and CTV_fat, being the lobular and fat fractions of the entire mammary gland. Patients were planned for volumetric modulated arc therapy technique, optimized in the Varian Eclipse treatment planning system. CT, structures and plans were imported in PRIMO, based on Monte Carlo code Penelope, to run three simulations: AdiMus, where the adipose and muscle tissues were automatically assigned to fat and lobular fractions of the breast; Adi and Mus, where adipose and muscle, respectively were assigned to the whole mammary gland. The specific tissue density was kept identical from the CT dataset. Differences in mean doses in the CTV_lob and CTV_fat structures were evaluated for the different tissue assignments. Differences generated by the tissue composition and estimated by Acuros dose calculations in Eclipse were also analysed. RESULTS From Monte Carlo simulations, the dose in the lobular fraction of the breast, when adipose tissue is assigned in place of muscle, is overestimated by 1.25 ± 0.45%; the dose in the fat fraction of the breast with muscle tissue assignment is underestimated by 1.14 ± 0.51%. Acuros showed an overestimation of 0.98 ± 0.06% and an underestimation of 0.21 ± 0.14% in the lobular and fat portions, respectively. Reason of this dissimilarity resides in the fact that the two calculations, Monte Carlo and Acuros, differently manage the range of CT numbers and the material assignments, having Acuros an overlapping range, where two tissues are both present in defined proportions. CONCLUSION Although not clinically significant, the dose deposition difference in the lobular and connective fat fraction of the breast tissue lead to an improved knowledge of the possible dose distribution and homogeneity in the breast radiation treatment.
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Affiliation(s)
- A Fogliata
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy.
| | - F De Rose
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - A Stravato
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - G Reggiori
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - S Tomatis
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy
| | - M Scorsetti
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy.,Humanitas University, Biomedical Science Faculty, Milan, Rozzano, Italy
| | - L Cozzi
- Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Via Manzoni 56, 20089, Milan, Rozzano, Italy.,Humanitas University, Biomedical Science Faculty, Milan, Rozzano, Italy
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46
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Alghufaili AH, Shanmugarajah L, Kumaraswamy LK. Correlating the depth of compensation to the 3-D shape of the breast to achieve homogeneous dose distribution using the electronic tissue compensation treatment technique. Med Dosim 2018. [PMID: 29525491 DOI: 10.1016/j.meddos.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our study aimed to correlate the overall 3-dimensional (3-D) shape of the breast to the compensation depth to produce a homogeneous dose distribution using the electronic tissue compensation (ECOMP) treatment technique. The study involved creating a number of semioval water phantoms with the diameter of the larger axis representing the breast separation and the shorter axis representing the distance from the chest wall to the apex of the breast. Multiple plans with 2 tangential fields were created for each phantom using different transmission penetration depths (TPDs) to determine the optimum TPD value based on the evaluation of dose uniformity and maximum hot spot. Optimum TPD values from the semioval water phantom plans were plotted on a graph as a function of separation and radius and were used as guidelines to choose the optimum TPD for the breast patient's cases. A total of 10 patients who had been treated with radiation therapy using ECOMP tangential fields were randomly selected. The separation and the radius of the breast were measured for 3 regions (superior, middle, and inferior) to retrospectively determine the optimum TPD from the graph for each region. These TPD values were then used to plan the breast cases. For all the patients studied, the optimized TPD technique produced a lower average homogeneity index (HI) value of 0.658 than the standard ECOMP technique of 0.856. These results showed that optimized TPD technique produced a more homogeneous dose distribution than the standard ECOMP technique. By measuring the breast size based on breast separation and the chest wall-to-apex distance at different locations along the superior-inferior axis of the breast, the optimum TPD can be determined at each location to provide a homogeneous dose distribution. A module can be created within the planning system to automatically assign the optimum TPD for both tangential fields so uniform fluence maps can be achieved throughout the whole breast volume. This method can serve as a guideline in ECOMP during the treatment planning to obtain a homogeneous dose distribution.
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Affiliation(s)
| | | | - Lalith K Kumaraswamy
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263; Department of Medical Physics, State University of New York at Buffalo, Buffalo, NY 14260.
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47
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Bagheri H, Rabie Mahdavi S, Shekarchi B, Manouchehri F, Farhood B. MEASUREMENT OF THE CONTRALATERAL BREAST PHOTON AND THERMAL NEUTRON DOSES IN BREAST CANCER RADIOTHERAPY: A COMPARISON BETWEEN PHYSICAL AND DYNAMIC WEDGES. RADIATION PROTECTION DOSIMETRY 2018; 178:73-81. [PMID: 28591863 DOI: 10.1093/rpd/ncx076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
This research aimed to measure the received photon and thermal neutron doses to contralateral breast (CB) in breast cancer radiotherapy for various field sizes in presence of physical and dynamic wedges. The measurement of photon and thermal neutron doses was carried out on right breast region of RANDO phantom (as CB) for 18 MV photon beams. The dose measurements were performed by thermoluminescent dosimeter chips. These measurements obtained for various field sizes in presence of physical and dynamic wedges. The findings of this study showed that the received doses (both of the photon and thermal neutron) to CB in presence of physical wedge for 11 × 13, 11 × 17 and 11 × 21 cm2 field sizes were 5.92, 6.36 and 6.77% of the prescribed dose, respectively as well as for dynamic wedge were 2.92, 4.63 and 5.60% of the prescribed dose, respectively. The results showed that the received photon and thermal neutron doses to CB increase with increment of field sizes. The received photon and thermal neutron doses to CB in presence of physical wedge were more than dynamic wedge. According to obtained findings, it is suggested that using a dynamic wedge is preferable than physical wedge, especially for medial tangential field.
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Affiliation(s)
- Hamed Bagheri
- Radiation and Wave Research Center, Aja University of Medical Science, Tehran, Iran
| | - Seyed Rabie Mahdavi
- Department of Medical Physics, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Shekarchi
- Radiation and Wave Research Center, Aja University of Medical Science, Tehran, Iran
| | | | - Bagher Farhood
- Medical Physics and Medical Engineering Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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48
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Li X, Wang L, Wang J, Han X, Xia B, Wu S, Hu W. Dosimetric benefits of automation in the treatment of lower thoracic esophageal cancer: Is manual planning still an alternative option? Med Dosim 2017; 42:289-295. [PMID: 28754289 DOI: 10.1016/j.meddos.2017.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/02/2017] [Accepted: 06/22/2017] [Indexed: 12/25/2022]
Abstract
This study aimed to design automated volumetric-modulated arc therapy (VMAT) plans in Pinnacle auto-planning and compare it with manual plans for patients with lower thoracic esophageal cancer (EC). Thirty patients with lower thoracic EC were randomly selected for replanning VMAT plans using auto-planning in Pinnacle treatment planning system (TPS) version 9.10. Historical plans of these patients were then compared. Dose-volume histogram (DVH) statistics, dose uniformity, and dose homogeneity were analyzed to evaluate treatment plans. Auto-planning was superior in terms of conformity index (CI) and homogeneity index (HI) for planning target volume (PTV), significantly improving 8.2% (p = 0.013) and 25% (p = 0.007) compared with manual planning, respectively, and decreasing dose of heart and liver irradiated by 20 to 40 Gy and 5 to 30 Gy, respectively (p < 0.05). Meanwhile, auto-planning further reduced the maximum dose (Dmax) of spinal cord by 6.9 Gy compared with manual planning (p = 0.000). Additionally, manual planning showed the significantly lower low-dose volume (V5) for the lung (p = 0.005). For auto-planning, the V5 of the lung was significantly associated with the relative volume index (the volume ratio of PTV to the lung), and the correlation coefficient (R) and p-value were 0.994 and 0.000. Pinnacle auto-planning achieved superior target conformity and homogeneity and similar target coverage compared with historical manual planning. Most of organs at risk (OARs) sparing was significantly improved by auto-planning except for the V5 of the lung, and the low dose distribution was highly associated with PTV volume and lung volume in auto-planning.
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Affiliation(s)
- Xiadong Li
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Lu Wang
- Department of Gynecology and Obstetrics, Hangzhou Women's Hospital, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, Zhejiang, China
| | - Jiahao Wang
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China.
| | - Xu Han
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Bing Xia
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Shixiu Wu
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, Zhejiang, China
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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49
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Guttmann DM, Gabriel P, Kennedy C, Rate W, Grizos W, Nagda S, Wojtowicz L, Lin L, Freedman GM. Comparison of acute toxicities between contemporary forward-planned 3D conformal radiotherapy and inverse-planned intensity-modulated radiotherapy for whole breast radiation. Breast J 2017; 24:128-132. [PMID: 28703444 DOI: 10.1111/tbj.12857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/24/2016] [Accepted: 11/18/2016] [Indexed: 11/30/2022]
Abstract
The use of inverse-planned intensity-modulated radiation therapy for whole breast radiation treatment has become more prevalent, but this may impose an increased cost on the health system. We hypothesized that when applied with the same treatment planning goals, tangential forward-planned field-in-field 3D conformal radiotherapy and tangential inverse-planned intensity-modulated radiotherapy would be associated with comparable toxicities. Women who underwent tangential whole breast irradiation at our institution from 2011 to 2015 planned using either forward-planned field-in-field 3D conformal radiotherapy or intensity-modulated radiotherapy were retrospectively analyzed. Grade 2+ Radiation dermatitis was the primary endpoint. A total of 201 and 212 women had undergone field-in-field 3D conformal radiotherapy and intensity-modulated radiotherapy, respectively. No differences were observed between the two modalities regarding acute radiation dermatitis, breast pain, or fatigue. In a multivariable logistic regression that incorporated the use of boost, hypofractionation, use of chemotherapy, patient positioning, use of a supraclavicular field, and breast planning target volume, intensity-modulated radiotherapy was not correlated with different rates of Grade 2+ radiation dermatitis. This study supports the routine first-line use of field-in-field 3D conformal radiotherapy for whole breast radiation instead of tangential intensity-modulated radiotherapy from the standpoint of equivalence in acute toxicity. Further investigation is needed to assess whether there are subgroups of women who may still benefit from intensity-modulated radiotherapy.
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Affiliation(s)
- David M Guttmann
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Gabriel
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Kennedy
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William Rate
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William Grizos
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Suneel Nagda
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Wojtowicz
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lilie Lin
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gary M Freedman
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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50
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Kokuryo D, Aoki I, Yuba E, Kono K, Aoshima S, Kershaw J, Saga T. Evaluation of a combination tumor treatment using thermo-triggered liposomal drug delivery and carbon ion irradiation. Transl Res 2017; 185:24-33. [PMID: 28482173 DOI: 10.1016/j.trsl.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 02/03/2023]
Abstract
The combination of radiotherapy with chemotherapy is one of the most promising strategies for cancer treatment. Here, a novel combination strategy utilizing carbon ion irradiation as a high-linear energy transfer (LET) radiotherapy and a thermo-triggered nanodevice is proposed, and drug accumulation in the tumor and treatment effects are evaluated using magnetic resonance imaging relaxometry and immunohistology (Ki-67, n = 15). The thermo-triggered liposomal anticancer nanodevice was administered into colon-26 tumor-grafted mice, and drug accumulation and efficacy was compared for 6 groups (n = 32) that received or did not receive the radiotherapy and thermo trigger. In vivo quantitative R1 maps visually demonstrated that the multimodal thermosensitive polymer-modified liposomes (MTPLs) can accumulate in the tumor tissue regardless of whether the region was irradiated by carbon ions or not. The tumor volume after combination treatment with carbon ion irradiation and MTPLs with thermo-triggering was significantly smaller than all the control groups at 8 days after treatment. The proposed strategy of combining high-LET irradiation and the nanodevice provides an effective approach for minimally invasive cancer treatment.
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Affiliation(s)
- Daisuke Kokuryo
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan; Graduate School of System Informatics, Kobe University, Kobe, Hyogo, Japan
| | - Ichio Aoki
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan.
| | - Eiji Yuba
- Graduate School of Engineering, Osaka Prefecture University, Sakai, Osaka, Japan
| | - Kenji Kono
- Graduate School of Engineering, Osaka Prefecture University, Sakai, Osaka, Japan
| | | | - Jeff Kershaw
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan
| | - Tsuneo Saga
- National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan
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