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Esmati E, Ghalehtaki R, Lashkari M, Babaei M, Saraee A, Mortazavi H, Saraee E. Examining the impact of the device used for contouring in saving time and increasing the ease of contouring patients in radiotherapy treatment. J Med Imaging Radiat Sci 2024; 55:203-211. [PMID: 38431450 DOI: 10.1016/j.jmir.2024.01.010] [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: 09/30/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION/BACKGROUND This study was designed to investigate the amount of time saved and the degree of contour difficulty between the two methods of contouring, mouse/keyboard, versus touch screen/stylus in radiotherapy. METHODS Each of 94 patients consisting of 26 breast cancer cases, 24 lymph nodes cases, 25 rectal cancer cases, and 19 heart cases has been contoured twice. One with a mouse/keyboard, and the next one with the touch screen/stylus. Three radiation oncologists participated in this study. Contouring information including measured time, estimated time spent, volume of contour performed and organ contoured are recorded. To evaluate the differences between the contouring methods, the results regarding target volume and time to completion were analyzed using two-way robust ANOVA. Ease of use and contouring difficulty were compared for differences in distribution of the response choices between the groups using Pearson chi-square test. RESULTS In this study, 94 clinical cases were studied. The average time required for contouring with the touch screen/stylus method was half the time needed for contouring patients with the mouse/keyboard method. The reduction in the time in breast cancer cases was the highest (48.2%) and the lowest in head and neck cancer cases (32.4%). In comparing the contoured volumes, no significant difference was observed between the two methods. the mean estimated time reported by the radiation oncologist in the mouse/keyboard method was 5.6 minutes longer and, in the touch screen/stylus method, was 3.9 minutes less than the actual measured time. CONCLUSIONS All the measured and analyzed variables show the superiority of contouring with the touch screen/stylus method and reduced the time required for patient contouring by an average of 50%.
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Affiliation(s)
- Ebrahim Esmati
- Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences
| | - Reza Ghalehtaki
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Lashkari
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Babaei
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Saraee
- Department of plastic and reconstructive surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamideh Mortazavi
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Saraee
- Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Chan RCK, Ng CKC, Hung RHM, Li YTY, Tam YTY, Wong BYL, Yu JCK, Leung VWS. Comparative Study of Plan Robustness for Breast Radiotherapy: Volumetric Modulated Arc Therapy Plans with Robust Optimization versus Manual Flash Approach. Diagnostics (Basel) 2023; 13:3395. [PMID: 37998531 PMCID: PMC10670672 DOI: 10.3390/diagnostics13223395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023] Open
Abstract
A previous study investigated robustness of manual flash (MF) and robust optimized (RO) volumetric modulated arc therapy plans for breast radiotherapy based on five patients in 2020 and indicated that the RO was more robust than the MF, although the MF is still current standard practice. The purpose of this study was to compare their plan robustness in terms of dose variation to clinical target volume (CTV) and organs at risk (OARs) based on a larger sample size. This was a retrospective study involving 34 female patients. Their plan robustness was evaluated based on measured volume/dose difference between nominal and worst scenarios (ΔV/ΔD) for each CTV and OARs parameter, with a smaller difference representing greater robustness. Paired sample t-test was used to compare their robustness values. All parameters (except CTV ΔD98%) of the RO approach had smaller ΔV/ΔD values than those of the MF. Also, the RO approach had statistically significantly smaller ΔV/ΔD values (p < 0.001-0.012) for all CTV parameters except the CTV ΔV95% and ΔD98% and heart ΔDmean. This study's results confirm that the RO approach was more robust than the MF in general. Although both techniques were able to generate clinically acceptable plans for breast radiotherapy, the RO could potentially improve workflow efficiency due to its simpler planning process.
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Affiliation(s)
- Ray C. K. Chan
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (R.C.K.C.); (Y.T.Y.L.); (Y.T.Y.T.); (B.Y.L.W.); (J.C.K.Y.)
| | - Curtise K. C. Ng
- Curtin Medical School, Curtin University, GPO Box U1987, Perth, WA 6845, Australia;
- Curtin Health Innovation Research Institute (CHIRI), Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Rico H. M. Hung
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China;
| | - Yoyo T. Y. Li
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (R.C.K.C.); (Y.T.Y.L.); (Y.T.Y.T.); (B.Y.L.W.); (J.C.K.Y.)
| | - Yuki T. Y. Tam
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (R.C.K.C.); (Y.T.Y.L.); (Y.T.Y.T.); (B.Y.L.W.); (J.C.K.Y.)
| | - Blossom Y. L. Wong
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (R.C.K.C.); (Y.T.Y.L.); (Y.T.Y.T.); (B.Y.L.W.); (J.C.K.Y.)
| | - Jacky C. K. Yu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (R.C.K.C.); (Y.T.Y.L.); (Y.T.Y.T.); (B.Y.L.W.); (J.C.K.Y.)
| | - Vincent W. S. Leung
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; (R.C.K.C.); (Y.T.Y.L.); (Y.T.Y.T.); (B.Y.L.W.); (J.C.K.Y.)
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Wright JL, Amini A, Bergom C, Milgrom SA. Summary of Cardiac Computed Tomographic Imaging in Cardio-Oncology: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography. Pract Radiat Oncol 2023; 13:488-495. [PMID: 37923491 DOI: 10.1016/j.prro.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The purpose of this document is to develop a summary of recommendations from the "Cardiac Computed Tomographic Imaging in Cardio-Oncology: An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT)" document and provide commentary on key recommendations that are relevant to radiation oncology. METHODS In July 2019, the SCCT convened a multidisciplinary panel of experts to develop a consensus document based on a literature search and a formal consensus process, which was separately published in 2022. A new panel consisting of the radiation oncologist from the original guideline and additional radiation oncologists was formed to address SCCT recommendations and their implications for radiation oncology. SUMMARY The SCCT consensus document included 6 core sections. Two of these sections were identified as particularly relevant to radiation oncologists. These include evaluation of shared risk factors and role of cardiac computed tomography in risk stratification of patients with cancer (section 1) and the role of cardiac computed tomography in the evaluation of the effects of radiation therapy (section 4). These recommendations are summarized, with additional commentary on the role of radiation oncologists as individual practitioners and radiation oncology practices as a whole in evaluation of coronary artery calcifications on computed tomography images; assessment of the effects of radiation therapy on cardiovascular risk after treatment; and management of patients at elevated risk of cardiovascular sequelae of treatment. Radiation oncologists should be aware of the recommendations in the SCCT consensus document and consider those elements that relate to their practice. This summary document calls attention to the key roles and limitations of radiation oncologists and radiation oncology practices in managing cardiotoxicity risk and highlights the need for ongoing study on the effects of radiation therapy on the heart, cardiac substructures, and long-term risk of cardiotoxicity related to treatment.
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Affiliation(s)
- Jean L Wright
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland.
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
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Saleh GA, Batouty NM, Gamal A, Elnakib A, Hamdy O, Sharafeldeen A, Mahmoud A, Ghazal M, Yousaf J, Alhalabi M, AbouEleneen A, Tolba AE, Elmougy S, Contractor S, El-Baz A. Impact of Imaging Biomarkers and AI on Breast Cancer Management: A Brief Review. Cancers (Basel) 2023; 15:5216. [PMID: 37958390 PMCID: PMC10650187 DOI: 10.3390/cancers15215216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
Breast cancer stands out as the most frequently identified malignancy, ranking as the fifth leading cause of global cancer-related deaths. The American College of Radiology (ACR) introduced the Breast Imaging Reporting and Data System (BI-RADS) as a standard terminology facilitating communication between radiologists and clinicians; however, an update is now imperative to encompass the latest imaging modalities developed subsequent to the 5th edition of BI-RADS. Within this review article, we provide a concise history of BI-RADS, delve into advanced mammography techniques, ultrasonography (US), magnetic resonance imaging (MRI), PET/CT images, and microwave breast imaging, and subsequently furnish comprehensive, updated insights into Molecular Breast Imaging (MBI), diagnostic imaging biomarkers, and the assessment of treatment responses. This endeavor aims to enhance radiologists' proficiency in catering to the personalized needs of breast cancer patients. Lastly, we explore the augmented benefits of artificial intelligence (AI), machine learning (ML), and deep learning (DL) applications in segmenting, detecting, and diagnosing breast cancer, as well as the early prediction of the response of tumors to neoadjuvant chemotherapy (NAC). By assimilating state-of-the-art computer algorithms capable of deciphering intricate imaging data and aiding radiologists in rendering precise and effective diagnoses, AI has profoundly revolutionized the landscape of breast cancer radiology. Its vast potential holds the promise of bolstering radiologists' capabilities and ameliorating patient outcomes in the realm of breast cancer management.
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Affiliation(s)
- Gehad A. Saleh
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Nihal M. Batouty
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (G.A.S.)
| | - Abdelrahman Gamal
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elnakib
- Electrical and Computer Engineering Department, School of Engineering, Penn State Erie, The Behrend College, Erie, PA 16563, USA;
| | - Omar Hamdy
- Surgical Oncology Department, Oncology Centre, Mansoura University, Mansoura 35516, Egypt;
| | - Ahmed Sharafeldeen
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Ali Mahmoud
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
| | - Mohammed Ghazal
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Jawad Yousaf
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Marah Alhalabi
- Electrical, Computer, and Biomedical Engineering Department, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates; (M.G.)
| | - Amal AbouEleneen
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Ahmed Elsaid Tolba
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
- The Higher Institute of Engineering and Automotive Technology and Energy, New Heliopolis, Cairo 11829, Egypt
| | - Samir Elmougy
- Computer Science Department, Faculty of Computers and Information, Mansoura University, Mansoura 35516, Egypt (A.E.T.)
| | - Sohail Contractor
- Department of Radiology, University of Louisville, Louisville, KY 40202, USA
| | - Ayman El-Baz
- Bioengineering Department, University of Louisville, Louisville, KY 40292, USA
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Jing H, Tang Y, Wang ZZ, Wei R, Jin JY, Li J, Zhao LY, Jin J, Liu YP, Song YW, Fang H, Chen B, Qi SN, Lu NN, Tang Y, Li N, Zhai YR, Zhang WW, Wang SL, Li YX. Individualized Clinical Target Volume for Irradiation of the Supraclavicular Region in Breast Cancer Based on Mapping of the Involved Ipsilateral Supraclavicular Lymph Nodes. Int J Radiat Oncol Biol Phys 2023; 115:922-932. [PMID: 36368434 DOI: 10.1016/j.ijrobp.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To map supraclavicular fossa-involved lymph nodes (SCF-LNs) in patients with nonmetastatic breast cancer, evaluate the coverage of widely adopted atlases, and propose modified borders for individualized regional irradiation. METHODS AND MATERIALS M0 patients with biopsy-proven SCF-LNs who were SCF treatment-naïve were included. The SCF was spatially divided into subregions, with each node mapped on the original images. The geographic misses after the borders of multiple atlases were evaluated and factors affecting SCF-LNs' spread pattern were analyzed. RESULTS From 1998 to 2022, 209 patients with 1242 SCF-LNs were eligible. Patients had a median of 4 nodes. At least 537 nodes (43.2%) in 147 patients (70.3%) were lateral to the sternocleidomastoid muscle (SCM), and 403 nodes (32.4%) in 127 patients (60.8%) were dorsal to the anterior scalene muscle (ASM). In the 88 patients with ≤3 SCF-LNs, at least 66 nodes (39.1%) in 40 patients (45.5%) were lateral to the SCM, and 34 nodes (20.1%) in 29 patients (33.0%) were dorsal to the ASM. These nodes were not covered by the Radiation Therapy Oncology Group (RTOG) atlas and partly within the Radiotherapy Comparative Effectiveness atlas. One hundred four patients (49.8%) had 432 SCF-LNs (34.8%) beyond the upper border of the European Society for Radiotherapy and Oncology (ESTRO) atlas. In multivariate regression, nodal sizes were associated with wider spread in the primary group. Being triple-negative (TN) subtype was associated with less spread in the recurrent group. Situation-based clinical target volumes (CTVs) were theorized, in which for a sequential spread, the posterior border could be the posterior scalene muscle or even be more constringent; otherwise, it should touch the anterior trapezius surface. CONCLUSIONS SCF-LNs tend to spread laterally and dorsally beyond the RTOG borders, even in M0 stages with ≤3 SCF-LNs. The ESTRO upper border does not guarantee coverage with multiple SCF-LNs. Nodal burden and non-TN types are predictive of wider dissemination. A situation-based CTV is possibly feasible. Deciphering the SCF-LN spread route is needed.
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Affiliation(s)
- Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Clinical Trials Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zong-Zhan Wang
- Department of Radiation Oncology, Qingdao Central Hospital, Qing Dao, Shan Dong, China
| | - Ran Wei
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Yi Jin
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Li
- Department of Radiation Oncology, Beijng Hospital, Beijing, China
| | - Li-Yun Zhao
- Department of Radiation Oncology, Beijng Hospital, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Rui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Madias JE. Right versus left breast radiation and coronary artery disease: is there a differential? Acta Cardiol 2023; 78:5-12. [PMID: 36378524 DOI: 10.1080/00015385.2022.2141431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is literature supporting the view that chest radiation (CR) for the management of primary or metastatic cancer of the mediastinum and chest, including breast cancer is associated with all types of heart disease, including coronary artery disease (CAD), manifesting during long-term follow-up. This review explores the literature about the association of CR for the management of cancer and CAD, particularly focussing on breast cancer, and further on the differential between CR for right versus left breast cancer. The balk of the literature suggests that there is higher incidence of CAD in patients undergoing left versus right-CR for breast cancer, and that cardiologists and oncologists need to become involved systematically in their assessment prior to CR and at subsequent follow-up.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA
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Zhang M, Cao L, Chen J, Li B, Huang X, Cai G, Xu C. Mapping of PET/CT-based regional nodes distribution of recurrent/advanced breast cancer and comparison with current delineation atlas. Br J Radiol 2022; 95:20220382. [PMID: 35731844 PMCID: PMC10996945 DOI: 10.1259/bjr.20220382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To localize the distribution of regional nodes in recurrent/advanced breast cancer patients based on 18-fludeoxyglucose (FDG) positron emission tomography/CT (PET/CT) images and validate the coverage of clinical target volumes (CTVs) for regional nodes with current contouring guidelines. METHODS We enrolled 154 recurrent/advanced breast cancer patients with FDG-avid regional nodes who underwent PET/CT between January 2018 and June 2020. Involvement of lymph node regions including axillary lymph node level I-III (ALN-I, ALN-II, ALN-III), Rotter's nodes (RN), medial supraclavicular (SC-M), lateral supraclavicular (SC-L) and internal mammary nodes (IMN) was recorded respectively. Coverage of the CTVs in different atlases and the locations of out-of-field were evaluated. RESULTS A total of 348 lymph node regions containing disease were identified, including ALN-I 109, ALN-II 46, ALN-III 36, RN 17, SC-M 68, SC-L 36 and IMN 36. Recurrent ALNs mainly located cranially and ventrally to the axillary vein (AV). Ipsilateral cervical nodes were simultaneously affected in 33/76 SC positive patients. RADCOMP (306/348) and RUIJIN (291/348) guidelines had higher coverage compared with RTOG (205/348) and ESTRO (202/348) guidelines (p < 0.001, respectively). In primary non-metastastic and recurrent patients, major missings located in SC-L (7/7, 17/17) and IMN (7/10, 15/19) for RTOG guideline while SC-L (7/7, 17/17) for ESTRO guideline (p < 0.001, respectively). Among recurrent patients, SC-M (22/31) was another major missing area for ESTRO guideline (p < 0.001). CONCLUSION The current guidelines effectively cover most regional nodes in postoperative breast cancer patients. SC-L and IMN were the major missing regions. Recurrent ALNs were most often seen in cranial and ventral to the AV. The CTV of patients with clinically positive SC was recommended to extend up to the hyoid level. The CTVs should be adjusted based on risks of recurrence individually. ADVANCES IN KNOWLEDGE The difference of regional nodes delineation between current guidelines mainly located in SC and IMN regions. High axilla including subclavicular nodes and the RN above AV for recurrent patients and the region between cricoid and hyoid for positive SC patients should be meticulously contoured.
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Affiliation(s)
- Maochen Zhang
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Biao Li
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao
Tong University, School of Medicine,
Shanghai, China
| | - Xinyun Huang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao
Tong University, School of Medicine,
Shanghai, China
| | - Gang Cai
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai
Jiao Tong University, School of Medicine,
Shanghai, China
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Variability of Target Volumes and Organs at Risk Delineation in Breast Cancer Radiation Therapy: Quality Assurance Results of the Pretrial Benchmark Case for the POTENTIAL Trial. Pract Radiat Oncol 2022; 12:397-408. [DOI: 10.1016/j.prro.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022]
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İNAN G, GÜL OV, BAŞARAN H. Sol Meme Kanseri Tanılı Olgularda Farklı Radyoterapi Teknikleri için Brakial Pleksus, Karotis Arter ve Tiroid Dozlarının Değerlendirilmesi. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.1002684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Hsieh MT, Aherne NJ, Ross W, Salindera S, Westhuyzen J, Winkley L, Shakespeare TP. Evaluation of apical clips placed during axillary dissection demonstrates potential under-coverage of axillary radiation therapy target volumes during breast cancer regional nodal irradiation. J Med Imaging Radiat Oncol 2021; 66:158-164. [PMID: 34821471 DOI: 10.1111/1754-9485.13349] [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: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Evidence-based Australian guidelines (eviQ) recommend adjuvant supraclavicular fossa irradiation after axillary lymph node dissection (ALND) in node-positive breast cancer patients. Disparity between surgically determined versus computed tomography (CT) determined nodal volumes may result in discontiguous nodal volumes and untreated nodal tissue. We examine the extent of untreated nodal tissue in women with breast cancer post-level II or III ALND and adjuvant radiation therapy (RT) using ESTRO contouring guidelines. METHODS Female breast cancer patients who underwent level II and III ALND with apical clip placement from 2016 to 2020 and CT simulated in supine position were included. CT-defined axillary level II-IV volumes were contoured using ESTRO guidelines. The distance between the apical clip and RT nodal volumes was measured to indicate extent of untreated tissue. RESULTS Of 34 eligible patients treated by 7 surgeons, 76% had level II ALND and 24% level III ALND. Only 5.9% of clips entirely encompassed the corresponding RT nodal volumes. 55.9% of clips fell within and 44.1% fell inferolaterally outside the corresponding RT nodal volumes. A median 3.6 cm (range 0-7.5 cm) of undissected nodal tissue would not be included within standard RT target volumes following eviQ recommendations. CONCLUSION There is a disparity between surgically determined versus CT determined axillary nodal volumes, leading to discontiguous nodal volumes and untreated axillary nodal tissue, despite following standard radiation contouring guidelines. Intraoperatively placed apical axillary clips may assist radiation oncologists to accurately delineate undissected nodal tissues at risk.
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Affiliation(s)
- Michael Ti Hsieh
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales, Australia.,RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia
| | - William Ross
- RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia.,Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Shehnarz Salindera
- Department of Surgery, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Lauren Winkley
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia.,RCS Faculty of Medicine, University of New South Wales, Coffs Harbour, New South Wales, Australia
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11
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Mireștean CC, Iancu RI, Iancu DPT. An Underestimated Toxicity Radiation-Induced Hypothyroidism in Patients Multimodally Treated for Breast Cancer. J Clin Med 2021; 10:jcm10235503. [PMID: 34884204 PMCID: PMC8658069 DOI: 10.3390/jcm10235503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/15/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
Radiation therapy is part of the therapeutic arsenal for breast cancer, whether it is adjuvant treatment after lumpectomy or radical mastectomy, or it is used as a palliative option in the case of metastatic or recurrent disease. Significant advances in diagnostic and therapeutic stratification of breast cancers have significantly prolonged survival, even in the metastatic stage. Exposure of patients during the course of the disease in a multidisciplinary therapeutic approach including chemotherapy, hormone therapy, targeted anti-HER therapies or CDK4/6 inhibitors had led to improved survival but with the price of additional toxicity. Among them, hypothyroidism is a well-known consequence of external radiation therapy, especially in the case of cervical region irradiation, including supraclavicular and infra-clavicular nodal levels. In this situation, the thyroid gland is considered as an organ at risk (OAR) and receives a significant dose of radiation. Subclinical hypothyroidism is a common endocrine disorder characterized by elevated TSH levels with normal levels of FT4 (free T4) and FT3 (free T3), and as a late effect, primary hypothyroidism is one of the late effects that significantly affects the quality of life for patients with breast cancer receiving multimodal treatment. Hypothyroidism has a significant impact on quality of life, most often occurring as late clinical toxicity, secondary to thyroid irradiation at doses between 30 and 70 Gy. Dose-volume parameters of irradiation, gland function at the beginning of the treatment and associated systemic therapies may be factors that alter thyroid radio-sensitivity and affect thyroid gland tolerance. In the case of head and neck tumor pathology, in which doses of >50 Gy are routinely used, the thyroid gland is generally considered as an OAR, the rate of radio-induced hypothyroidism being estimated at rates of between 20% and 52%. For breast cancer, the thyroid is often neglected in terms of dosimetry protection, the rate of late dysfunction being 6–21%.
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Affiliation(s)
- Camil Ciprian Mireștean
- Department of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
- Department of Surgery, Railways Clinical Hospital Iasi, 700506 Iași, Romania
| | - Roxana Irina Iancu
- Oral Pathology Department, Faculty of Dental Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Clinical Laboratory, “St. Spiridon” Emergency Universitary Hospital, 700111 Iași, Romania
- Correspondence: ; Tel.: +40-232-301-603
| | - Dragoș Petru Teodor Iancu
- Oncology and Radiotherapy Department, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Department of Radiation Oncology, Regional Institute of Oncology, 700483 Iași, Romania
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12
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Kuo CC, Chang CC, Cheng HW, Lin JC, Tsai JT. Impact of respiratory motion in dosimetric and clinical advantages for adjuvant left-sided breast radiotherapy. JOURNAL OF RADIATION RESEARCH 2021:rrab087. [PMID: 34611714 DOI: 10.1093/jrr/rrab087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/05/2021] [Indexed: 06/13/2023]
Abstract
We investigated the organ-sparing effect of the deep inspiration breath hold (DIBH) technique among different levels of lung expansion for left-side breast radiotherapy. This retrospective study enrolled 30 patients who received adjuvant left breast radiotherapy after breast-conserving surgery (BCS). Simulation scans of both DIBH and deep breathing four-dimensional computed tomography (4DCT) were acquired, and three treatment plans were generated for each patient. One plan was based on the DIBH images, and the other two plans were based on the mid-lung expansion (ME) and initial lung expansion (IE) phases retrieved from 4DCT data sets. Dosimetric comparisons and normal tissue complication probability (NTCP) models were conducted. We used image registration for displacement analysis and sought potential factors related to the dose benefit of DIBH. The DIBH plans resulted significantly lower doses to the heart, left ventricle (LV) and left anterior descending coronary artery (LAD), including the high- to low-dose areas, followed by the ME plans and IE plans (p < 0.05). DIBH reduced the risk of long-term cardiac mortality by 40% and radiation pneumonitis of the left lung by 37.96% compared with the IE plans (p < 0.001). The reduction in the mean dose to the heart and LV significantly correlated with anterior displacement of the left lung. The DIBH technique is a feasible tool to provide dosimetric and clinical advantages for adjuvant left-sided breast radiotherapy. Breathing pattern and the level of lung expansion seem to play an important role.
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Affiliation(s)
- Chia-Chuan Kuo
- Department of Radiation Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Chin-Chieh Chang
- Department of Radiation Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Hao-Wen Cheng
- Department of Radiation Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Jang-Chun Lin
- Department of Radiation Oncology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
| | - Jo-Ting Tsai
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
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13
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Sato K, Shimo T, Kato M, Natsume N, Fuchikami H, Takeda N, Okawa T. Computed tomography-guided partial-breast brachytherapy using implanted catheters as fiducial markers versus co-registered magnetic resonance imaging. Brachytherapy 2021; 20:1219-1225. [PMID: 34602344 DOI: 10.1016/j.brachy.2021.08.007] [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: 06/25/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Partial-breast irradiation (PBI) needs accurate cavity delineation with computed tomography (CT). In perioperative PBI using multicatheter-interstitial brachytherapy (MIB), catheters implanted during surgery were enabled as fiducial markers. Magnetic resonance imaging (MRI) can also assist delineation with CT. METHODS Patients receiving MIB-PBI were analyzed. Cavity visualization scores (CVSs) were categorized with CT. With catheter-based delineation (CBD), the relationship between cavity boundaries and catheters were used to contour the tumor bed. Co-registered MRI delineation (CMD) was also performed. The correlation between cavity volume and the excised tissue weight was compared for the two techniques. RESULTS The association between CVS and preoperative characteristics in 159 patients showed mammographic breast density (MBD) remained correlated to CVS on multiple regression analyses; CVS = 5.2-0.61 x MBD (p < 0.0001). In 43 patients, the cavity volumes determined with CBD vs CMD were 12.8 ± 6.4 cm3 vs 16.1 ± 12.4 cm3 (p < 0.0001), and their plots with excised weights showed the best fitting lines were 0.29 vs 0.48 (p < 0.0001), respectively. The correlation coefficients for CBD vs CMD were 0.65 vs 0.55 (p = 0.20) in low (CVS 1-3, n = 27) and 0.72 vs 0.58 (p = 0.36) in high visualized cavities (CVS 4-5, n = 16), respectively. CONCLUSIONS The use of implanted catheters as fiducial markers was associated with smaller cavities and greater correlations with the excised tissue weights than co-registration with MRI. This might be a useful technique, especially for patients with dense breasts on mammography.
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Affiliation(s)
- Kazuhiko Sato
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan.
| | - Takahiro Shimo
- Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Masahiro Kato
- Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Nana Natsume
- Department of Radiation Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Hiromi Fuchikami
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Naoko Takeda
- Department of Breast Oncology, Tokyo-West Tokushukai Hospital, Akishima, Tokyo, Japan
| | - Tomohiko Okawa
- Preventive Medical Center, Sano City Hospital, Sano, Tochigi, Japan
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14
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Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, Mitchell JD. Past, Present, and Future of Radiation-Induced Cardiotoxicity: Refinements in Targeting, Surveillance, and Risk Stratification. JACC CardioOncol 2021; 3:343-359. [PMID: 34604796 PMCID: PMC8463722 DOI: 10.1016/j.jaccao.2021.06.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
Radiation therapy is an important component of cancer therapy for many malignancies. With improvements in cardiac-sparing techniques, radiation-induced cardiac dysfunction has decreased but remains a continued concern. In this review, we provide an overview of the evolution of radiotherapy techniques in thoracic cancers and associated reductions in cardiac risk. We also highlight data demonstrating that in some cases radiation doses to specific cardiac substructures correlate with cardiac toxicities and/or survival beyond mean heart dose alone. Advanced cardiac imaging, cardiovascular risk assessment, and potentially even biomarkers can help guide post-radiotherapy patient care. In addition, treatment of ventricular arrhythmias with the use of ablative radiotherapy may inform knowledge of radiation-induced cardiac dysfunction. Future efforts should explore further personalization of radiotherapy to minimize cardiac dysfunction by coupling knowledge derived from enhanced dosimetry to cardiac substructures, post-radiation regional dysfunction seen on advanced cardiac imaging, and more complete cardiac toxicity data.
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Key Words
- CAC, coronary artery calcium
- CAD, coronary artery disease
- CMRI, cardiac magnetic resonance imaging
- CT, computed tomography
- HL, Hodgkin lymphoma
- LAD, left anterior descending artery
- LV, left ventricular
- MHD, mean heart dose
- NSCLC, non–small cell lung cancer
- RICD, radiation-induced cardiovascular disease
- RT, radiation therapy
- SBRT, stereotactic body radiation therapy
- breast cancer
- cancer survivorship
- childhood cancer
- esophageal cancer
- imaging
- lung cancer
- lymphoma
- radiation physics
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Affiliation(s)
- Carmen Bergom
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - Andrea K. Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Samson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
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15
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Trabulsi NH, Shabkah AA, Ujaimi R, Iskanderani O, Kadi MS, Aljabri N, Sharbatly L, AlOtaibi MN, Farsi AH, Nassif MO, Saleem AM, Akeel NY, Malibary NH, Samkari AA. Locally Advanced Breast Cancer: Treatment Patterns and Predictors of Survival in a Saudi Tertiary Center. Cureus 2021; 13:e15526. [PMID: 34277162 PMCID: PMC8269977 DOI: 10.7759/cureus.15526] [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] [Accepted: 06/08/2021] [Indexed: 11/11/2022] Open
Abstract
Background Breast cancer (BC) is the most common cancer in the Kingdom of Saudi Arabia (KSA) and the second leading cause of cancer-related mortality. About 40% of BC in KSA is locally advanced BC (LABC), which has been associated with poorer survival compared with early diagnosed BC. Objective To review the presentation and outcomes of LABC, including the characteristics of the disease, different treatment modalities, overall survival (OS), disease-free survival (DFS), and local recurrence in relation to different radiotherapy (RT) techniques. Methods We retrospectively reviewed the medical records of 153 female patients with pathologically proven LABC diagnosed at King Abdulaziz University Hospital, Jeddah, KSA, between 2009 and 2017. We obtained data on patient demographics, stage of cancer at diagnosis, tumor characteristics (subtype and receptor status), type of surgery, systemic treatments received (hormonal, targeted therapy, and chemotherapy), RT variables, and recurrence and death dates. Data were analyzed to assess OS and DFS by using Kaplan-Meier analyses and the log-rank test. Univariate and multivariate Cox proportional hazard regression analyses were used to explore and identify factors associated with survival. Results The median survival time in the study population was 9.16 years. Older age (65+ years) was associated with worse OS and DFS than was younger age (<65 years) (hazard ratio (HR) 3.20, 95% CI 1.48-6.90, P = 0.003 and HR 2.21, 95% CI 1.12-4.36, P = 0.022, respectively). Regarding the type of surgery, having a mastectomy was associated with worse OS and DFS than was having a lumpectomy (HR 2.44, 95% CI 0.97-6.12, P = 0.05 and HR 2.41, 95% CI 1.13-5.14, P = 0.023, respectively). Positive estrogen and progesterone receptor status was associated with better OS and DFS than was a negative estrogen or progesterone receptor status (HR 0.13, 95% CI 0.05-0.30, P < 0.001 and HR 0.21, 95% CI 0.11-0.41, P < 0.001, respectively). Patients who received RT had a lower risk of recurrence than did those who did not receive RT (P = 0.011). Moreover, three-dimensional conformal RT was associated with lower local recurrence than intensity-modulated RT or volumetric-modulated arc therapy (P = 0.003). Conclusion Multiple factors can affect the OS and DFS in LABC. Younger patients, having hormone-positive disease, and undergoing lumpectomy were associated with better outcomes. Adjuvant RT may improve local control and the use of three-dimensional conformal RT was superior for local control. Prospective studies with larger sample sizes are needed to further highlight these findings and to assess the role of chemotherapy and targeted therapy in patients with LABC.
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Affiliation(s)
- Nora H Trabulsi
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Alaa A Shabkah
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Reem Ujaimi
- Department of Radiation Oncology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Omar Iskanderani
- Department of Radiation Oncology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mai S Kadi
- Department of Community Medicine, King Abdulaziz University, Jeddah, SAU
| | - Nuran Aljabri
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Liane Sharbatly
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Manal N AlOtaibi
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ali H Farsi
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Mohammed O Nassif
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Abdulaziz M Saleem
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Nouf Y Akeel
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Nadim H Malibary
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ali A Samkari
- Department of Surgery, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Novikov SN, Krzhivitskii PI, Melnik YS, Valitova AA, Bryantseva ZV, Akulova IA, Kanaev SV. Atlas of sentinel lymph nodes in early breast cancer using single-photon emission computed tomography: implication for lymphatic contouring. Radiat Oncol J 2021; 39:8-14. [PMID: 33794569 PMCID: PMC8024181 DOI: 10.3857/roj.2020.00871] [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: 10/16/2020] [Accepted: 02/03/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE to determine the localization of sentinel lymph nodes (SLNs) in a large cohort of patients with breast cancer and validate the European Society for Therapeutic Radiology and Oncology (ESTRO), Radiation Therapy Oncology Group (RTOG), and Radiotherapy Comparative Effectiveness (RADCOMP) guidelines on regional lymph node clinical target volume (CTV-LN) delineation. MATERIALS AND METHODS A total of 254 women with cT1-3N0-1M0 breast cancer underwent single-photon emission computed tomography (SPECT-CT) visualization of SLNs after intra- and peritumoral injection of 99mTc-radiocolloids. All SPECT-CT images were fused with reference simulation computed tomography. A 3D atlas of SLNs was created and used for evaluation of CTV-LN defined by contouring guidelines. RESULTS SPECT-CT visualized 532 SLNs that were localized in axillary level I in 67.5%, level II in 15.4%, level III in 7.3%, internal mammary in 8.5%, and supraclavicular in 1.3% cases. The majority of level II-IV and internal mammary SLNs were inside the recommended CTV-LN. Axillary level I SLNs were covered by ESTRO and RTOG contours in 85% and 85% cases, respectively. "Out of contours" SLNs were mostly detected in lateral subgroup of level I LN (18.5%), while 98%-99% of anterior pectoral and central axillary SLNs were covered by CTV-LN. Internal mammary SLNs were visualized in 33 cases and were outside ESTRO and RTOG contours in 3 and 6 observations, respectively. CONCLUSION SPECT-CT atlas of SLNs demonstrated that in most cases ESTRO and RTOG guidelines correctly represented CTV-LNs with the exception of lateral subgroup of SLNs.
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Affiliation(s)
- Sergey Nikolaevich Novikov
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Pavel Ivanovich Krzhivitskii
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Yulia Sergeevna Melnik
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Alina Albertovna Valitova
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Zhanna Viktorovna Bryantseva
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Irina Alexandrovna Akulova
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Sergey Vasilevich Kanaev
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
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Nodooshan SJ, Amini P, Ashrafizadeh M, Tavakoli S, Aryafar T, Khalafi L, Musa AE, Mahdavi SR, Najafi M, Ahmadi A, Farhood B. Suberosin Attenuates the Proliferation of MCF-7 Breast Cancer Cells in Combination with Radiotherapy or Hyperthermia. Curr Drug Res Rev 2021; 13:148-153. [PMID: 33371865 DOI: 10.2174/2589977512666201228104528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/08/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
AIM The aim of this study was to determine the proliferation of MCF-7 following irradiation or hyperthermia as alone or pre-treatment with suberosin. BACKGROUND Radiotherapy is a major therapeutic modality for the control of breast cancer. However, hyperthermia can be prescribed for relief of pain or enhancing cancer cell death. Some studies have attempted its use as an adjuvant to improve therapeutic efficiency. Suberosin is a cumarin- derived natural agent that has shown anti-inflammatory properties. OBJECTIVE In this in vitro study, possible sensitization effect of suberosin in combination with radiation or hyperthermia was evaluated. METHODS MCF-7 breast cancer cells were irradiated or received hyperthermia with or without treatment with suberosin. The incidence of apoptosis as well as viability of MCF-7 cells were observed. Furthermore, the expressions of pro-apoptotic genes such as Bax, Bcl-2, and some caspases were evaluated using real-time PCR. RESULTS Both radiotherapy or hyperthermia reduced the proliferation of MCF-7 cells. Suberosin amplified the effects of radiotherapy or hyperthermia for induction of pro-apoptotic genes and reducing cell viability. CONCLUSION Suberosin has a potent anti-cancer effect when combined with radiotherapy or hyperthermia. It could be a potential candidate for killing breast cancer cells as well as increasing the therapeutic efficiency of radiotherapy or hyperthermia.
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Affiliation(s)
- Saeedeh Jafari Nodooshan
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Amini
- Department of Radiology, Faculty of Paramedical Science, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Ashrafizadeh
- Faculty of Engineering and Natural Sciences, Sabanci University, Orta Mahalle, Üniversite Caddesi No. 27, Orhanlı, Tuzla 34956, Istanbul, Turkey
| | - Saeed Tavakoli
- Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran
| | - Tayebeh Aryafar
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khalafi
- Omid Tehran Radiation Oncology Center, Physics Section, Tehran, Iran
| | - Ahmed Eleojo Musa
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Rabie Mahdavi
- Medical Physics Department, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Najafi
- Medical Technology Research Center, Institute of Health Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Akbar Ahmadi
- School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Farhood
- Departments of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
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18
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Lin D, Lapen K, Sherer MV, Kantor J, Zhang Z, Boyce LM, Bosch W, Korenstein D, Gillespie EF. A Systematic Review of Contouring Guidelines in Radiation Oncology: Analysis of Frequency, Methodology, and Delivery of Consensus Recommendations. Int J Radiat Oncol Biol Phys 2020; 107:827-835. [PMID: 32311418 PMCID: PMC8262136 DOI: 10.1016/j.ijrobp.2020.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/05/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Clinical trials have described variation in radiation therapy plan quality, of which contour delineation is a key component, and linked this to inferior patient outcomes. In response, consensus guidelines have been developed to standardize contour delineation. This investigation assesses trends in contouring guidelines and examines the methodologies used to generate and deliver recommendations. METHODS AND MATERIALS We conducted a literature search for contouring guidelines published after 1995. Of 11,124 citations, 332 were identified for full-text review to determine inclusion. We abstracted articles for the intent of the consensus process, key elements of the methodology, and mode of information delivery. A Fisher exact test was used to identify elements that differed among the guidelines generated for clinical trials and routine care. RESULTS Overall, 142 guidelines were included, of which 16 (11%) were developed for a clinical trial. There was an increase in guideline publication over time (0 from 1995-1999 vs 65 from 2015- 2019; P = .03), particularly among recommendations for stereotactic radiation and brachytherapy. The most common disease sites were head and neck (24%), gastrointestinal (12%), and gynecologic (12%). Methods used to develop recommendations included literature review (50%) and image-based methods (45%). Panels included a median of 10 physicians (interquartile range, 7-16); 70% of panels represented multidisciplinary expertise. Guidelines developed for a clinical trial were more likely to include an image-based approach, with quantitative analysis of contours submitted by the panel members and to publish a full set of image-based recommendations (P < .005). CONCLUSIONS This review highlights an increase in consensus contouring recommendations over time. Guidelines focus on disease sites, such as head and neck, with evidence supporting a correlation between treatment planning and patient outcomes, although variation exists in the approach to the consensus process. Elements that may improve guideline acceptance (ie, image-based consensus contour analysis) and usability (ie, inclusion of a full image set) are more common in guidelines developed for clinical trials.
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Affiliation(s)
- Diana Lin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael V Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Jolie Kantor
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lindsay M Boyce
- Memorial Sloan Kettering Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Walter Bosch
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Deborah Korenstein
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York.
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19
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Beaton L, Nica L, Tyldesley S, Sek K, Ayre G, Aparicio M, Gondara L, Speers C, Nichol A. PET/CT of breast cancer regional nodal recurrences: an evaluation of contouring atlases. Radiat Oncol 2020; 15:136. [PMID: 32487183 PMCID: PMC7268399 DOI: 10.1186/s13014-020-01576-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/19/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To validate the Radiation Therapy Oncology Group (RTOG) and European Society for Radiotherapy and Oncology (ESTRO) breast cancer nodal clinical target volumes (CTVs) and to investigate the Radiotherapy Comparative Effectiveness Consortium (RADCOMP) Posterior Neck volume in relation to regional nodal recurrences (RNR). METHODS From a population-based database, 69 patients were identified who developed RNR after curative treatment for breast cancer. RNRs were detected with 18-fluorodeoxyglucose-positron emission tomography-computed tomography (PET/CT). All patients were treatment-naïve for RNR when imaged. The RTOG and ESTRO nodal CTVs and RADCOMP Posterior Neck volumes were contoured onto a template patient's CT. RNRs were contoured on each PET/CT and deformed onto the template patient's CT. Each RNR was represented by a 5 mm diameter epicentre, and categorized as 'inside', 'marginal' or 'outside' the CTV boundaries. RESULTS Sixty-nine patients with 226 nodes (median 2, range 1-11) were eligible for inclusion. Thirty patients had received adjuvant tangent and regional nodal radiotherapy, 16 tangent-only radiotherapy and 23 no adjuvant radiotherapy. For the RTOG CTVs, the RNR epicentres were 70% (158/226) inside, 4% (8/226) marginal and 27% (60/226) outside. They included the full extent of the RNR epicentres in 38% (26/69) of patients. Addition of the RADCOMP Posterior Neck volume increased complete RNR coverage to 48% (33/69) of patients. For the ESTRO CTVs, the RNR epicentres were 73% (165/226) inside, 2% (4/226) marginal and 25% (57/226) outside. They included the full extent of the RNR epicentres in 57% (39/69) of patients. Addition of the RADCOMP Posterior Neck volume increased complete RNR coverage to 70% (48/69) of patients. CONCLUSIONS The RTOG and ESTRO breast cancer nodal CTVs do not fully cover all potential areas of RNR, but the ESTRO nodal CTVs provided full coverage of all RNR epicentres in 19% more patients than the RTOG nodal CTVs. With addition of the RADCOMP Posterior Neck volume to the ESTRO CTVs, 70% of patients had full coverage of all RNR epicentres.
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Affiliation(s)
- Laura Beaton
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Luminita Nica
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Scott Tyldesley
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Kenny Sek
- Department of Nuclear Medicine, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Gareth Ayre
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Maria Aparicio
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Lovedeep Gondara
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Caroline Speers
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada.
- Cancer Surveillance and Outcomes, BC Cancer, Vancouver Centre, Vancouver, British Columbia, Canada.
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Central Review of Radiation Therapy Planning Among Patients with Breast-Conserving Surgery: Results from a Quality Assurance Process Integrated into the INSEMA Trial. Int J Radiat Oncol Biol Phys 2020; 107:683-693. [PMID: 32437921 DOI: 10.1016/j.ijrobp.2020.04.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE After publication of the radiation field design in the American College of Surgeons Oncology Group Z0011 trial, a radiation therapy quality assurance review was integrated into the Intergroup-Sentinel-Mamma (INSEMA) trial. We aimed to investigate the role of patient characteristics, extent of axillary surgery, and radiation techniques for dose distribution in ipsilateral axillary levels. METHODS AND MATERIALS INSEMA (NCT02466737) has randomized 5542 patients who underwent breast-conserving surgery. Of these, 276 patients from 108 radiation therapy facilities were included in the central review, using the planning records of the first 3 patients treated at each site. RESULTS Of the 276 patients, 41 had major deviations (ie, no axillary contouring or submission of insufficient records) leading to exclusion. A total of 235 (85.1%) radiation therapy planning records were delineated according to the INSEMA protocol, including 9 (3.8%) cases with minor deviations. At least 25% of INSEMA patients were unintentionally treated with ≥95% of the prescribed breast radiation dose in axillary level I. Approximately 50% of patients were irradiated with a median radiation dose of more than 85% of prescription dose in level I. Irradiated volumes and applied doses were significantly lower in levels II and III compared with level I. However, 25% of patients still received a median radiation dose of ≥75% of prescription dose to level II. Subgroup analysis revealed a significant association between incidental radiation dose in the axilla and obesity. Younger age, boost application, and fractionation schedule showed no impact on axillary dose distribution. CONCLUSIONS Assuming ≥80% of prescribed breast dose as the optimal dose for curative radiation of low-volume disease in axillary lymph nodes, at least 50% of reviewed INSEMA patients received an adequate dose in level I, even with contemporary 3-dimensional techniques. Dose coverage was much less in axillary levels II and III, and far below therapeutically relevant doses.
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