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Korreman SS, Behrens CP, Hansen VN, Thygesen J, Andersen TL. New technologies from bench to bedside - report from the Nordic association for clinical physics 2023 symposium. Acta Oncol 2023; 62:1157-1160. [PMID: 37916999 DOI: 10.1080/0284186x.2023.2262111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Stine Sofia Korreman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Preibisch Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Vibeke Nordmark Hansen
- Department of Oncology, Copenhagen University Hospital, - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering and Procurement, Central Denmark Region, Aarhus Denmark
| | - Thomas Lund Andersen
- Department of Clinical Physiology & Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
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Racka I, Majewska K, Winiecki J, Kiluk K. Hybrid planning techniques for early-stage left-sided breast cancer: dose distribution analysis and estimation of projected secondary cancer-relative risk. Acta Oncol 2023; 62:932-941. [PMID: 37516978 DOI: 10.1080/0284186x.2023.2238553] [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: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate three techniques of irradiation of left-sided breast cancer patients, three-dimensional conformal radiotherapy (3D-CRT), hybrid Intensity-Modulated Radiotherapy (h-IMRT), and hybrid Volumetric-Modulated Arc Therapy (h-VMAT, h-ARC), in terms of dose distribution in the planning target volume (PTV) and organs at risk (OARs). The second aim was to estimate the projected relative risk of radiation-induced secondary cancers for hybrid techniques. MATERIALS AND METHODS Three treatment plans were prepared in 3D-CRT, h-IMRT, and h-VMAT techniques for each of the 40 patients, who underwent CT simulation in deep inspiration breath-hold (DIBH). For hybrid techniques, plans were created by combining 3D-CRT and dynamic fields with an 80%/20% dose ratio for 3D-CRT and IMRT or VMAT. Cumulative dose-volume histograms were used to compare dose distributions within the PTV and OARs (heart, left anterior descending coronary artery [LAD], left and right lung [LL, RL], right breast [RB]). Projected risk ratios for secondary cancers were estimated relative to 3D-CRT using the organ equivalent dose (OED) concept for the Schneider's linear exponential, plateau, and full mechanistic dose-response model. RESULTS All plans fulfilled the PTV criterium: V95%≥95%. Compared to 3D-CRT, both hybrid techniques showed significantly better target coverage (PTV: V95%>98%, p < 0.001), and the best conformality was achieved by h-ARC plans (CI: 1.18 ± 0.09, p < 0.001). Compared to 3D-CRT and h-ARC, h-IMRT increased the average sum of monitor units (MU) over 129.9% (p < 0.001). H-ARC increased the mean dose of contralateral organs and the LL V5Gy parameter (p < 0.001). Both hybrid techniques significantly reduced the Dmax of the heart by 5 Gy. Compared to h-IMRT, h-ARC increased secondary cancer projected relative risk ratios for LL, RL, and RB by 18, 152, and 81%, respectively. CONCLUSIONS The results confirmed that both hybrid techniques provide better target quality and OARs sparing than 3D-CRT. Hybrid VMAT delivers less MU compared to hybrid IMRT but may increase the risk of radiation-induced secondary malignancies.
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Affiliation(s)
- Iga Racka
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Center, Bydgoszcz, Poland
| | - Karolina Majewska
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Center, Bydgoszcz, Poland
| | - Janusz Winiecki
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Center, Bydgoszcz, Poland
- Clinic of Oncology and Brachytherapy, Collegium Medicum in Bydgoszcz, Nicholas Copernicus University, Torun, Poland
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Loap P, Vu-Bezin J, Monceau V, Jacob S, Fourquet A, Kirova Y. Dosimetric evaluation of the benefit of deep inspiration breath hold (DIBH) for locoregional irradiation of right breast cancer with volumetric modulated arctherapy (VMAT). Acta Oncol 2023; 62:150-158. [PMID: 36786671 DOI: 10.1080/0284186x.2023.2177976] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Right-lateralized cardiac substructures can be substantially exposed during right breast cancer (R-BC) radiotherapy. The cardiac benefit of deep inspiration breath hold (DIBH) is established in combination with volumetric modulated arctherapy (VMAT) for left breast cancer with regional node irradiation but is unknown for R-BC. This study evaluated the dosimetric benefit of DIBH for locoregional irradiation of R-BC with VMAT. MATERIAL AND METHODS All patients treated for R-BC with adjuvant locoregional DIBH-VMAT in the Department of Radiation Oncology of the Institut Curie (Paris, France) until December 2022 were included, corresponding to 15 patients. FB- and DIBH-VMAT plans were compared both for a normofractionated regimen (50 Gy/25fx) used for treatment and a replanned hypofractionated regimen (40 Gy/15fx). Dose to the heart, cardiac substructures (sinoatrial node (SAN), atrio-ventricular node (AVN), right coronary artery, left anterior descending coronary artery, left ventricle), ipsilateral lung and liver were retrieved and compared. RESULTS Mean heart dose (MHD) was 3.33 Gy with FB vs. 3.10 Gy with DIBH on normofractionated plans (p = 0.489), and 2.58 Gy with FB vs. 2.41 Gy with DIBH on hypofractionated plan (p = 0.489). The benefit of DIBH was not significant for any cardiac substructure. The most exposed cardiac substructure were the SAN (mean dose of 6.62 Gy for FB- and 5.64 Gy for DIBH-VMAT on normofractionated plans) and the RCA (mean dose of 4.21 Gy for FB- and 4.06 Gy for DIBH-VMAT on normofractionated plans). The maximum benefit was observed for the RCA with a median individual dose reduction of 0.84 Gy on normofractionated plans (p = 0.599). No significant dosimetric difference were observed for right lung. Liver mean dose was significantly lower with DIBH with median values decreasing from 2.54 Gy to 0.87 Gy (p = 0.01). CONCLUSION Adding DIBH to efficient cardiac-sparing radiotherapy techniques, such as VMAT, is not justified in the general case for locoregional R-BC irradiation. Specific R-BC patient subpopulations who could benefit from additional DIBH combination with locoregional VMAT are yet to be identified.
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Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Jeremi Vu-Bezin
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Virginie Monceau
- Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - Sophie Jacob
- Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France
| | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
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Fogliata A, Parabicoli S, Paganini L, Reggiori G, Lobefalo F, Cozzi L, Franzese C, Franceschini D, Spoto R, Scorsetti M. Knowledge-based DVH estimation and optimization for breast VMAT plans with and without avoidance sectors. Radiat Oncol 2022; 17:200. [PMID: 36474297 PMCID: PMC9724419 DOI: 10.1186/s13014-022-02172-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To analyze RapidPlan knowledge-based models for DVH estimation of organs at risk from breast cancer VMAT plans presenting arc sectors en-face to the breast with zero dose rate, feature imposed during the optimization phase (avoidance sectors AS). METHODS CT datasets of twenty left breast patients in deep-inspiration breath-hold were selected. Two VMAT plans, PartArc and AvoidArc, were manually generated with double arcs from ~ 300 to ~ 160°, with the second having an AS en-face to the breast to avoid contralateral breast and lung direct irradiation. Two RapidPlan models were generated from the two plan sets. The two models were evaluated in a closed loop to assess the model performance on plans where the AS were selected or not in the optimization. RESULTS The PartArc plans model estimated DVHs comparable with the original plans. The AvoidArc plans model estimated a DVH pattern with two steps for the contralateral structures when the plan does not contain the AS selected in the optimization phase. This feature produced mean doses of the contralateral breast, averaged over all patients, of 0.4 ± 0.1 Gy, 0.6 ± 0.2 Gy, and 1.1 ± 0.2 Gy for the AvoidArc plan, AvoidArc model estimation, RapidPlan generated plan, respectively. The same figures for the contralateral lung were 0.3 ± 0.1 Gy, 1.6 ± 0.6 Gy, and 1.2 ± 0.5 Gy. The reason was found in the possible incorrect information extracted from the model training plans due to the lack of knowledge about the AS. Conversely, in the case of plans with AS set in the optimization generated with the same AvoidArc model, the estimated and resulting DVHs were comparable. Whenever the AvoidArc model was used to generate DVH estimation for a plan with AS, while the optimization was made on the plan without the AS, the optimizer evidentiated the limitation of a minimum dose rate of 0.2 MU/°, resulting in an increased dose to the contralateral structures respect to the estimation. CONCLUSIONS The RapidPlan models for breast planning with VMAT can properly estimate organ at risk DVH. Attention has to be paid to the plan selection and usage for model training in the presence of avoidance sectors.
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Affiliation(s)
- Antonella Fogliata
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Sara Parabicoli
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Lucia Paganini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Giacomo Reggiori
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Francesca Lobefalo
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Luca Cozzi
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - Ciro Franzese
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - Davide Franceschini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Ruggero Spoto
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Marta Scorsetti
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
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Korreman SS, Vogelius IR, Abdi AJ, Hansen SB, Behrens CP. Novel technologies in radiotherapy in the Nordic countries - report from the NACP2020/21 conference. Acta Oncol 2021; 60:1383-1385. [PMID: 34612766 DOI: 10.1080/0284186x.2021.1979250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stine Sofia Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ivan Richter Vogelius
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Ahmed Jibril Abdi
- Region of Southern Denmark, Clinical Engineering Department, Area of Diagnostic Radiology, Odense, Denmark
- Research and Innovation Unit, University of Southern Denmark, Odense, Denmark
| | - Søren Baarsgaard Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital Aarhus, Denmark
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