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Vinh-Hung V, Benziane-Ouaritini N, Belhomme S, Magne N, Petit A, Gorobets O, Nguyen NP, Gustin P, Sargos P. Organ at risk dose-volume metrics in a series of hypofractionated breast radiotherapy with integrated boost. Med Dosim 2024:S0958-3947(24)00028-1. [PMID: 38910069 DOI: 10.1016/j.meddos.2024.05.004] [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: 04/07/2023] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024]
Abstract
Dose and volume metrics to organs at risk are used for evaluation and optimization in radiotherapy planning. However, the numerous choices of metrics can be confusing. In a series of patients treated with hypofractionation and an integrated boost for breast cancer, we aim to determine if a parsimonious selection of representative metrics can be identified. The dosimetries of 42 patients receiving 42 Gy to the breast, with or without nodal irradiation, and 51 Gy integrated boost to tumor bed in 15 fractions were reviewed. For each organ-heart, lungs, and contralateral breast-cumulative dose-volume histograms were used to extract values for 3 basic metric classes: Two additional classes were considered: Pearson correlation coefficient R was calculated between pairs of values within each basic class and with the 2 additional classes for each organ. The interquartile ranges of correlations for D.yy, Vrel.xx, and Vabs.xx were as follows: The mean dose correlated with all basic classes for the heart and lungs, and with dose D.yy and volumes at Vrel.10-Vabs.10 for the contralateral breast. The standard deviation correlated with Vrel.xx and Vabs.xx for the heart and lungs (R ≥ 0.70). Among the D.yy, D.50 (median dose) correlated with the mean and standard deviation for all organs (R = 0.65-0.96). The mean, standard deviation, and median doses were the preeminent correlators. These statistics appear to be parsimonious representatives of doses to organs. Further studies with other radiotherapy series will be necessary to validate these observations.
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Affiliation(s)
- Vincent Vinh-Hung
- Department of Radiotherapy, Centre Hospitalier Public du Cotentin, 50100 Cherbourg-en-Cotentin, France; Oncologisch Centrum, Universitair Ziekenhuis Brussel, 1090 Jette, Belgium.
| | | | - Sarah Belhomme
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France
| | - Nicolas Magne
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France
| | - Adeline Petit
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France
| | - Olena Gorobets
- Chirurgie Maxillofaciale, Cancer Tech Care Association, 66000 Perpignan, France
| | - Nam P Nguyen
- Radiation Oncology, Howard University, Washington DC 20060, USA
| | - Pierre Gustin
- Oncology Division, Centre Hospitalier de la Polynésie Française, 98716 Pirae, Tahiti, French Polynesia
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France
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Alaimo R, Ippolito E, Falconi R, Perrone Congedi F, Sciommari C, Silipigni S, Pellegrini R, Carnevale A, Greco C, Fiore M, D’Angelillo RM, Ramella S. Breast Volume Is a Predictor of Higher Heart Dose in Whole-Breast Supine Free-Breathing Volumetric-Modulated Arc Therapy Planning. Curr Oncol 2023; 30:10530-10538. [PMID: 38132402 PMCID: PMC10742666 DOI: 10.3390/curroncol30120768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
In breast cancer volumetric-modulated arc therapy (VMAT) planning, the rotation of the gantry around the target implies a greater dose spreading to the whole heart, compared to tangential-field standard treatment. A consecutive cohort of 121 breast cancer patients treated with the VMAT technique was investigated. The correlation of breast volume, heart volume and lung volume with mean heart dose (mHD) and mean and maximum LAD dose (mLAD dose, MLAD dose) was tested, and a subsequent a linear regression analysis was carried out. VMAT treatment plans from 56 left breast cancer and 65 right breast cancer patients were analyzed. For right-sided patients, breast volume was significantly correlated with mHD, mLAD and MLAD dose, while for left-sided patients, breast volume was significantly correlated with mHD and mLAD, while heart volume and lung volume were correlated with mHD, mLAD and MLAD dose. Breast volume was the only predictor of increased heart and LAD dose (p ≤ 0.001) for right-sided patients. In left-sided patients, heart and lung were also predictors of increased mHD (p = 0.005, p ≤ 0.001) and mean LAD dose (p = 0.009, p ≤ 0.001). In this study, we observed an increase in heart and LAD doses in larger-breasted patients treated with VMAT planning. In right-sided patients, breast volume was shown to be the only predictor of increased heart dose and LAD dose.
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Affiliation(s)
- Rita Alaimo
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Edy Ippolito
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rita Falconi
- Medical Physics Unit, S. Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy;
| | - Francesca Perrone Congedi
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Cecilia Sciommari
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Sonia Silipigni
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | | | - Alessia Carnevale
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
| | - Carlo Greco
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Michele Fiore
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | | | - Sara Ramella
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.A.); (F.P.C.); (C.S.); (S.S.); (A.C.); (C.G.); (M.F.); (S.R.)
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, 00128 Rome, Italy
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Van Parijs H, Cecilia-Joseph E, Gorobets O, Storme G, Adriaenssens N, Heyndrickx B, Verschraegen C, Nguyen NP, De Ridder M, Vinh-Hung V. Lung-heart toxicity in a randomized clinical trial of hypofractionated image guided radiation therapy for breast cancer. Front Oncol 2023; 13:1211544. [PMID: 38053657 PMCID: PMC10694354 DOI: 10.3389/fonc.2023.1211544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Background TomoBreast hypothesized that hypofractionated 15 fractions/3 weeks image-guided radiation therapy (H-IGRT) can reduce lung-heart toxicity, as compared with normofractionated 25-33 fractions/5-7 weeks conventional radiation therapy (CRT). Methods In a single center 123 women with stage I-II operated breast cancer were randomized to receive CRT (N=64) or H-IGRT (N=59). The primary endpoint used a composite four-items measure of the time to 10% alteration in any of patient-reported outcomes, physician clinical evaluation, echocardiography or lung function tests, analyzed by intention-to-treat. Results At 12 years median follow-up, overall and disease-free survivals between randomized arms were comparable, while survival time free from alteration significantly improved with H-IGRT which showed a gain of restricted mean survival time of 1.46 years over CRT, P=0.041. Discussion The finding establishes TomoBreast as a proof-of-concept that hypofractionated image-guided radiation-therapy can improve the sparing of lung-heart function in breast cancer adjuvant therapy without loss in disease-free survival. Hypofractionation is advantageous, conditional on using an advanced radiation technique. Multicenter validation may be warranted. Trial registration https://clinicaltrials.gov/ct2/show/NCT00459628. Registered 12 April 2007.
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Affiliation(s)
- Hilde Van Parijs
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elsa Cecilia-Joseph
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Olena Gorobets
- Department of Oral Surgery, University Hospital of Martinique, Fort-de-France, France
| | - Guy Storme
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Adriaenssens
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Claire Verschraegen
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC, United States
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
| | - Mark De Ridder
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincent Vinh-Hung
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Research, International Geriatric Radiotherapy Group, Washington, DC, United States
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
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Schoepen M, Speleers B, De Neve W, Vakaet V, Deseyne P, Paelinck L, Van Greveling A, Veldeman L, Detand J, De Gersem W. Four irradiation and three positioning techniques for whole-breast radiotherapy: Is sophisticated always better? J Appl Clin Med Phys 2022; 23:e13720. [PMID: 36106550 PMCID: PMC9680580 DOI: 10.1002/acm2.13720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 10/07/2023] Open
Abstract
PURPOSE We report on a dosimetrical study of three patient positions (supine, prone dive, and prone crawl) and four irradiation techniques for whole-breast irradiation (WBI): wedged-tangential fields (W-TF), tangential-field intensity-modulated radiotherapy (TF-IMRT), multi-beam IMRT (MB-IMRT), and intensity-modulated arc therapy (IMAT). This is the first study to evaluate prone crawl positioning in WBI and the first study to quantify dosimetrical and anatomical differences with prone dive positioning. METHODS We analyzed five datasets with left- and right-sided patients (n = 51). One dataset also included deep-inspiration breath hold (DIBH) data. A total of 252 new treatment plans were composed. Dose-volume parameters and indices of conformity were calculated for the planning target volume (PTV) and organs-at-risk (OARs). Furthermore, anatomical differences among patient positions were quantified to explain dosimetrical differences. RESULTS Target coverage was inferior for W-TF and supine position. W-TF proved overall inferior, and IMAT proved foremost effective in supine position. TF-IMRT proved competitive to the more demanding MB-IMRT and IMAT in prone dive, but not in prone crawl position. The lung-sparing effect was overall confirmed for both prone dive and prone crawl positioning and was largest for prone crawl. For the heart, no differences were found between prone dive and supine positioning, whereas prone crawl showed cardiac advantages, although minor compared to the established heart-sparing effect of DIBH. Dose differences for contralateral breast were minor among the patient positions. In prone crawl position, the ipsilateral breast sags deeper and the PTV is further away from the OARs than in prone dive position. CONCLUSIONS The prone dive and prone crawl position are valid alternatives to the supine position in WBI, with largest advantages for lung structures. For the heart, differences are small, which establishes the role of DIBH in different patient positions. These results may be of particular interest to radiotherapy centers with limited technical resources.
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Affiliation(s)
- Max Schoepen
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Department of Industrial Systems Engineering and Product Design, Faculty of Engineering and ArchitectureGhent UniversityKortrijkBelgium
| | - Bruno Speleers
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
| | - Vincent Vakaet
- Department of Radiation OncologyUniversity Hospital GhentGhentBelgium
| | - Pieter Deseyne
- Department of Radiation OncologyUniversity Hospital GhentGhentBelgium
| | - Leen Paelinck
- Department of Radiation OncologyUniversity Hospital GhentGhentBelgium
| | | | - Liv Veldeman
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Department of Radiation OncologyUniversity Hospital GhentGhentBelgium
| | - Jan Detand
- Department of Industrial Systems Engineering and Product Design, Faculty of Engineering and ArchitectureGhent UniversityKortrijkBelgium
| | - Werner De Gersem
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Department of Radiation OncologyUniversity Hospital GhentGhentBelgium
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Shumway DA, Atkins KM. Prone Whole-Breast Radiotherapy-Better Than Supine? JAMA Oncol 2022; 8:983-985. [PMID: 35616925 DOI: 10.1001/jamaoncol.2022.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dean A Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Katelyn M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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