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Hsieh CC, Yu CC, Chu CH, Chen WC, Chen MF. Radiation-induced skin and heart toxicity in patients with breast cancer treated with adjuvant proton radiotherapy: a comparison with photon radiotherapy. Am J Cancer Res 2023; 13:4783-4793. [PMID: 37970351 PMCID: PMC10636671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/27/2023] [Indexed: 11/17/2023] Open
Abstract
This study aimed to investigate the dose parameters and incidence of radiotherapy (RT)-associated toxicity in patients with left breast cancer (LBC) treated with proton-RT, compared with photon-RT. We collected data from 111 patients with LBC who received adjuvant RT in our department between August 2021 and March 2023. Among these patients, 24 underwent proton-RT and 87 underwent photon-RT. In addition to the dosimetric analysis for organs at risk (OARs), we measured NT-proBNP levels before and after RT. Our data showed that proton-RT improved dose conformity and reduced doses to the heart and lungs and was associated with a lower rate of increased NT-proBNP than did photon-RT. Regarding skin toxicity, the Dmax for 1 c.c. and 10 c.c. and the average dose to the skin-OAR had predictive roles in the risk of developing radiation-induced dermatitis. Although pencil beam proton-RT with skin optimization had a dose similar to that of skin-OAR compared with photon-RT, proton-RT still had a higher rate of radiation dermatitis (29%) than did photon RT (11%). Using mice 16 days after irradiation, we demonstrated that proton-RT induced a greater increase in interleukin 6 and transforming growth factor-β1 levels than did photon-RT. Furthermore, topical steroid ointment reduced the inflammatory response and severity of dermatitis induced by RT. In conclusion, we suggest that proton-RT with skin optimization spares high doses to OARs with acceptable skin toxicity. Furthermore, prophylactic topical steroid treatment may decrease radiation dermatitis by alleviating proton-induced inflammatory responses in vivo.
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Affiliation(s)
- Ching-Chuan Hsieh
- Department of General Surgery, Chang Gung Memorial HospitalChiayi, Taiwan
| | - Chi-Chang Yu
- Department of General Surgery, Chang Gung Memorial HospitalTaoyuan, Taiwan
| | - Chia-Hui Chu
- Department of General Surgery, Chang Gung Memorial HospitalTaoyuan, Taiwan
| | - Wen-Cheng Chen
- Department of Radiation Oncology, Chang Gung Memorial HospitalTaoyuan, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial HospitalTaoyuan, Taiwan
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Chen H, Piao Y, Yang D, Kuang P, Li Z, Liao G, Zhong H. The effect of respiratory capacity for dose sparing in left-sided breast cancer irradiation with active breathing coordinator technique. Front Oncol 2022; 12:989220. [PMID: 36263201 PMCID: PMC9576200 DOI: 10.3389/fonc.2022.989220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aimA subsequent cardiac toxicity is deemed to be dose-dependent for left-sided breast cancer irradiation. This study aims to demonstrate the effect of respiratory capacity for dose sparing when the deep inspiration breath hold with Active Breathing Coordinator technique (ABC-DIBH) is used in left-sided breast cancer irradiation.Methods74 left-sided breast cancer patients, who received whole breast or post-mastectomy chest wall radiotherapy with ABC-DIBH between 2020 and 2021 in our center, were retrospectively reviewed in this study. CT scans of free breath (FB) and ABC-DIBH were done for each patient, and two treatment plans with a prescription dose of 5000 cGy/25 Fr were designed separately. The dose to heart, left anterior descending artery (LAD) and lungs was compared between FB and ABC-DIBH. The correlation between individual parameters (dose to organs at risk (OARs) and minimum heart distance (MHD)) was analyzed, and the effect of respiratory capacity for dose sparing was assessed.ResultsThe plans with ABC-DIBH achieved lower Dmean for heart (34.80%, P < 0.01) and LAD (29.33%, P < 0.01) than those with FB. Regression analysis revealed that both Dmean and D2 of heart were negatively correlated with MHD in the plans with FB and ABC-DIBH, which decreased with the increase in MHD by 37.8 cGy and 309.9 cGy per 1mm, respectively. Besides, a lower Dmean of heart was related to a larger volume of ipsilateral lung in plans with FB. With the increase in volume of ipsilateral lung, the linear correlation was getting weaker and weaker until the volume of ipsilateral lung reached 1700 cc. Meanwhile, a negative linear correlation between Dmean of LAD and MHD in plans with FB and ABC-DIBH was observed, whose slope was 162.5 and 135.9 cGy/mm, respectively. Furthermore, when the respiratory capacity of ABC-DIBH reached 1L, and the relative ratio (ABC-DIBH/FB) reached 3.6, patients could obtain the benefit of dose sparing. The larger difference in respiratory capacity had no significant effect in the larger difference of MHD, Dmean of heart and Dmean of LAD between FB and ABC-DIBH.ConclusionThis study demonstrates the sufficiently good effect of ABC-DIBH when utilizing for cardiac sparing. It also reveals the correlations among individual parameters and the effect of respiratory capacity for dose sparing. This helps take optimal advantage of the ABC-DIBH technique and predict clinical benefits.
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Affiliation(s)
| | - Ying Piao
- *Correspondence: Heli Zhong, ; Ying Piao,
| | | | | | | | | | - Heli Zhong
- *Correspondence: Heli Zhong, ; Ying Piao,
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Hu P, Li X, Liu W, Yan B, Xue X, Yang F, Ford JC, Portelance L, Yang Y. Dosimetry impact of gating latency in cine magnetic resonance image guided breath-hold pancreatic cancer radiotherapy. Phys Med Biol 2022; 67. [PMID: 35144247 DOI: 10.1088/1361-6560/ac53e0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/10/2022] [Indexed: 12/31/2022]
Abstract
Objective.We investigated dosimetry effect of gating latency in cine magnetic resonance image (cine MRI) guided breath-hold pancreatic cancer radiotherapy.Approach.The gating latency was calculated based on cine MRI obtained from 17 patients who received MRI guided radiotherapy. Because of the cine MRI-related latency, beam overshoot occurs when beam remains on while the tracking target already moves out of the target boundary. The number of beam on/off events was calculated from the cine MRI data. We generated both IMRT and VMAT plans for all 17 patients using 33 Gy prescription, and created motion plans by applying isocenter shift that corresponds to motion-induced tumor displacement. The GTV and PTV coverage and dose to nearby critical structures were compared between the motion and original plan to evaluate the dosimetry change caused by cine MRI latency.Main results.The time ratio of cine MRI imaging latency over the treatment duration is 6.6 ± 3.1%, the mean and median percentage of beam-on events <4 s are 67.0 ± 14.3% and 66.6%. When a gating boundary of 4 mm and a target-out threshold of 5% is used, there is no significant difference for GTV V33Gy between the motion and original plan (p = 0.861 and 0.397 for IMRT and VMAT planning techniques, respectively). However, the PTV V33Gy and stomach Dmax for the motion plans are significantly lower; duodenum V12.5 Gy and V18Gy are significantly higher when compared with the original plans, for both IMRT and VMAT planning techniques.Significance.The cine MRI gating latency can significantly decrease the dose delivered to the PTV, and increase the dose to the nearby critical structures. However, no significant difference is observed for the GTV coverage. The dosimetry impact can be mitigated by implementing additional beam-on control techniques which reduces unnecessary beam on events and/or by using faster cine MRI sequences which reduces the latency period.
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Affiliation(s)
- Panpan Hu
- Department of Engineering and Applied Physics, School of Physical Sciences, University of Science and Technology of China, Hefei, People's Republic of China.,Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xiaoyang Li
- Department of Engineering and Applied Physics, School of Physical Sciences, University of Science and Technology of China, Hefei, People's Republic of China.,Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Wei Liu
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Bing Yan
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xudong Xue
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.,Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Fei Yang
- Department of Radiation Oncology, The Miller School of Medicine, University of Miami, Miami, United States of America
| | - John Chetley Ford
- Department of Radiation Oncology, The Miller School of Medicine, University of Miami, Miami, United States of America
| | - Lorraine Portelance
- Department of Radiation Oncology, The Miller School of Medicine, University of Miami, Miami, United States of America
| | - Yidong Yang
- Department of Engineering and Applied Physics, School of Physical Sciences, University of Science and Technology of China, Hefei, People's Republic of China.,Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.,Department of Radiation Oncology, The Miller School of Medicine, University of Miami, Miami, United States of America
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Hou PY, Hsieh CH, Wu LJ, Hsu CX, Kuo DY, Lu YF, Tien HJ, Hsiao HW, Shueng PW, Hsu SM. Modern Rotational Radiation Techniques with Volumetric Modulated Arc Therapy or Helical Tomotherapy for Optimal Sparing of the Lung and Heart in Left-Breast Cancer Radiotherapy Plus Regional Nodal Irradiation: A Comparative Dosimetric Analysis. Cancers (Basel) 2021; 13:cancers13205043. [PMID: 34680189 PMCID: PMC8534109 DOI: 10.3390/cancers13205043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary For advanced left-breast cancer patients, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. Modern arc RT techniques, volumetric-modulated arc therapy (VMAT), or helical tomotherapy (HT), can minimize normal organ exposure without compromising disease control. The aim of this study is to identify which arc technique is optimal for patients receiving left-breast RT with RNI, and to explore distinct RNI volumes with or without IMN. A total of 108 eligible patients were enrolled (70 VMAT, 38 HT). VMAT reduced the mean dose and low-dose exposure to the heart, ipsilateral lung, whole lung, contralateral breast, and esophagus compared with HT. The advantage of VMAT for normal organ sparing was distinct when performing RNI with IMN irradiation. To limit normal organ exposure and reduce potential toxicities, VMAT is the optimal technique for patients with left-breast cancer who are undergoing RT with RNI. Abstract Background: For advanced breast cancer with lymph node involvement, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. However, an extensive RT volume is associated with normal organ exposure, which increases the toxicity and affects patient outcomes. Modern arc RT techniques can improve normal organ sparing compared with conventional techniques. The aim of this study was to explore the optimal technique for left-breast RT with RNI. Methods: We retrospectively reviewed patients receiving RT with RNI for left-breast cancer. We used modern arc RT techniques with either volumetric-modulated arc therapy (VMAT) or helical tomotherapy (HT) with a novel block technique, and compared differences in dosimetry parameters between the two groups. Subgroup analysis of RNI with or without internal mammary node (IMN) volume was also performed. Results: A total of 108 eligible patients were enrolled between 2017 and 2020, of whom 70 received VMAT and 38 received HT. The median RT dose was 55 Gy. No significant differences were found regarding the surgery, RT dose, number of fractions, target volume, and RNI volume between the VMAT and HT groups. VMAT reduced the heart mean dose more than HT (3.82 vs. 5.13 Gy, p < 0.001), as well as the cardiac parameters of V5–V20, whole-lung mean dose, lung parameters of V5–V20, and contralateral-breast and esophagus mean dose. In the subgroup analysis of RNI with IMNs, the advantage of VMAT persisted in protecting the heart, lung, contralateral breast, and esophagus. HT was beneficial for lowering the thyroid mean dose. For RNI without IMN, VMAT improved the low-dose exposure of the heart and lung, but HT was similar to VMAT in terms of heart, whole-lung, and contralateral-breast mean dose. Conclusions: For patients with left-breast cancer receiving adjuvant RT with RNI, VMAT reduced the exposure dose to the heart, lung, contralateral breast, and esophagus compared with HT. VMAT was superior to HT in terms of normal organ sparing in the patients who underwent RNI with IMN irradiation. Considering the reduction in normal organ exposure and potential toxicity, VMAT is the optimal technique for patients receiving RNI when deep inspiration breath-hold is not available.
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Affiliation(s)
- Pei-Yu Hou
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Chen-Hsi Hsieh
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Le-Jung Wu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Chen-Xiong Hsu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Deng-Yu Kuo
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Yueh-Feng Lu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Hui-Ju Tien
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Hsiu-Wen Hsiao
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Pei-Wei Shueng
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Correspondence: (P.-W.S.); (S.-M.H.); Tel.: +886-2-8966-7000 (ext. 1031) (P.-W.S.); +886-2-2826-5858 (S.-M.H.); Fax: +886-2-2820-1095 (S.-M.H.)
| | - Shih-Ming Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Correspondence: (P.-W.S.); (S.-M.H.); Tel.: +886-2-8966-7000 (ext. 1031) (P.-W.S.); +886-2-2826-5858 (S.-M.H.); Fax: +886-2-2820-1095 (S.-M.H.)
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Chen CH, Hsieh CC, Chang CS, Chen MF. A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy. Cancer Manag Res 2020; 12:9173-9182. [PMID: 33061609 PMCID: PMC7532038 DOI: 10.2147/cmar.s269893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background A better understanding of the organs-at-risk (OAR) dose metrics and the related toxicity induced by radiotherapy (RT) for left breast cancer (BC) will improve the quality of life. This study addressed the issue for left-BC patients treated with intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT). Patients and Methods Between 2012 and 2018, 308 left-BC patients underwent adjuvant RT at our hospital. Before June 2015, 134 patients were treated with 3D-CRT. Thereafter, 174 patients underwent IMRT. The patient’s characteristics in the IMRT group did not significantly different compared to those in the 3D-CRT group. Results Among the total study population, the incidence of ≥grade 2 radiation dermatitis (RID) was 17.3%. Higher volumes receiving 105% (≥5.7%) and 107% (≥1%) of prescribed dose and 3D-CRT technique were associated with a higher risk of RID. Regarding lung toxicity, the mean lung dose (≥10.2Gy) and V20 (≥20%) of ipsilateral lung were significantly associated with the incidence of RT-induced pulmonary changes. By dosimetry analysis, IMRT achieved better dose conformity and delivered lower mean doses to heart and ipsilateral lung compared to 3D-CRT. Furthermore, propensity sore and multivariate analysis showed that IMRT technique helped to reduce RT-induced dermatitis and lung toxicity. Conclusion Our data suggest that the volume of OAR exposed to higher doses is a predictor of RT-induced toxicity. Adjuvant RT with IMRT technique offered better dose conformity and spared high-dose levels to OARs to reduce radiation-related morbidity for BC patients.
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Affiliation(s)
- Chia-Hsin Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Chuan Hsieh
- Department of General Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Shen Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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