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Bagnera S, Milanesio L, Brachet Cota PB, Berrino C, Cataldi A, Gatti G, Mondini G, Paino O, Comello EG, Orlassino R, Pasquino M, Cante D, La Porta MR, Patania S, La Valle G. Does accelerated hypofractionated adjuvant whole-breast radiotherapy increase mammographic density or change mammographic features? Br J Radiol 2015; 88:20150312. [PMID: 26393385 DOI: 10.1259/bjr.20150312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare mammographic features before and after accelerated hypofractionated adjuvant whole-breast radiotherapy (AWB-RT) and to evaluate possible appearance of modifications. METHODS A retrospective review of 177 females before and after an AWB-RT treatment (follow-up ranging from 5 to 9 years) was performed by four radiologists focused in breast imaging who independently evaluated diffuse mammographic density patterns and reported on possible onset of focal alterations; modifications in density and fibrosis with parenchymal distortion were deemed as indicators of AWB-RT treatment impact in breast imaging. RESULTS Prevalent mammographic density (D) patterns in the 177 females evaluated were according to the American College of Radiology-Breast Imaging Reporting and Data System (ACR-BIRADS): D1, fibroadipose density (score percentage from 55.9% to 43.5%); and D2, scattered fibroglandular density (from 42.9% to 32.7%). No change in diffuse mammographic density and no significant difference in mammographic breast parenchymal structure were observed. "No change" was reported with score percentage from 87% to 79.6%. Appearance of fibrosis with parenchymal distortion was reported by all radiologists in only two cases (1.1%, p = 0.3); dystrophic calcification was identified with percentage score from 2.2% to 3.3% (small type) and from 9.6% to 12.9% (coarse type). CONCLUSION No statistically significant changes in follow-up mammographies 5-9 years after AWB-RT were detected, justifying large-scale selection of AWB-RT treatment with no risk of altering radiological breast parameters of common use in tumour recurrence detection. ADVANCES IN KNOWLEDGE The hypofractionated radiotherapy (AWB-RT treatment) is a new proven, safe and effective modality in post-operative patients with early breast cancer with excellent local control and survival. In our study, the absence of changes in mammographic density patterns and in breast imaging before and after AWB-RT treatment (up to 5-9 years after radiotherapy) justifies large-scale use of AWB-RT treatment without hindrance in tumour recurrence diagnosis.
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Affiliation(s)
- Silvia Bagnera
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
| | - Luisella Milanesio
- 2 Breast Screening Unit (Regional Reference Center), Regional Hospital A.O.U. City of Health and Science of Turin, Turin, Italy
| | - Piero B Brachet Cota
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
| | - Carla Berrino
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
| | - Aldo Cataldi
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
| | - Giovanni Gatti
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
| | - Guido Mondini
- 3 Department of Surgery , Ivrea Community Hospital (A.S.L. TO4), Turin, Italy
| | - Ovidio Paino
- 3 Department of Surgery , Ivrea Community Hospital (A.S.L. TO4), Turin, Italy
| | - Erika G Comello
- 4 Department of Pathology, Ivrea Community Hospital (A.S.L. TO4), Turin, Italy
| | - Renzo Orlassino
- 4 Department of Pathology, Ivrea Community Hospital (A.S.L. TO4), Turin, Italy
| | - Massimo Pasquino
- 5 Department of Medical Physics, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | - Domenico Cante
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
| | - Maria R La Porta
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
| | - Sebastiano Patania
- 1 Department of Diagnostic Imaging and RT-A.S.L. TO4 (Ciriè Community Hospital, Ivrea Community Hospital, Chivasso Community Hospital), Turin, Italy
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Cante D, Rosa La Porta M, Casanova-Borca V, Sciacero P, Girelli G, Pasquino M, Franco P, Ozzello F. Accelerated Hypofractionated Adjuvant Whole Breast Radiotherapy with Concomitant Photon Boost after Conserving Surgery for Early Stage Breast Cancer: A Prospective Evaluation on 463 Patients. Breast J 2011; 17:586-93. [DOI: 10.1111/j.1524-4741.2011.01159.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roozen K, Kron T, Haworth A, Franich R. Evaluation of EBT radiochromic film using a multiple exposure technique. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2011; 34:281-9. [PMID: 21431440 DOI: 10.1007/s13246-011-0067-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 03/10/2011] [Indexed: 11/26/2022]
Abstract
Radiochromic film is a self developing two-dimensional dosimeter system that is widely used in radiotherapy. Since its development some 40 years ago many improvements have been made; however the sensitivity can vary across the film and a non-linear dose response remains. The former can be addressed using a double exposure technique; however this technique assumes that the response is linear so that the dose distribution is incorrectly measured. We are proposing the use of two homogenous exposures; one performed prior, the other after the irradiation to be measured. In this 'multiple exposure technique' (MET), the first homogenous exposure can be used to correct for variations in response in different parts of the film, while the second homogenous exposure allows correction for non-linearity of response with dose. The MET was tested with a 60° wedged field and an Intensity Modulated Radiation Therapy fluence map produced by a computerised treatment planning system. In the wedge field measurements, the MET profile showed agreement within 0.6 cGy for 80% of the field compared to ionisation chamber dose values. A comparison of a TPS generated fluence map dose distribution with one measured using conventionally calibrated EBT, and another measured with MET calibrated EBT, showed similar agreement. The MET would be particularly useful for the assessment of highly inhomogenous dose distributions with high maximum dose such as encountered in hypofractionated radiation therapy.
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Affiliation(s)
- Karl Roozen
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC 8081, Australia.
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Schneider U, Besserer J, Mack A. Hypofractionated radiotherapy has the potential for second cancer reduction. Theor Biol Med Model 2010; 7:4. [PMID: 20149259 PMCID: PMC2829001 DOI: 10.1186/1742-4682-7-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 02/11/2010] [Indexed: 11/10/2022] Open
Abstract
Background and Purpose A model for carcinoma and sarcoma induction was used to study the dependence of carcinogenesis after radiotherapy on fractionation. Materials and methods A cancer induction model for radiotherapy doses including fractionation was used to model carcinoma and sarcoma induction after a radiation treatment. For different fractionation schemes the dose response relationships were obtained. Tumor induction was studied as a function of dose per fraction. Results If it is assumed that the tumor is treated up to the same biologically equivalent dose it was found that large dose fractions could decrease second cancer induction. The risk decreases approximately linear with increasing fraction size and is more pronounced for sarcoma induction. Carcinoma induction decreases by around 10% per 1 Gy increase in fraction dose. Sarcoma risk is decreased by about 15% per 1 Gy increase in fractionation. It is also found that tissue which is irradiated using large dose fractions to dose levels lower than 10% of the target dose potentially develop less sarcomas when compared to tissues irradiated to all dose levels. This is not observed for carcinoma induction. Conclusions It was found that carcinoma as well as sarcoma risk decreases with increasing fractionation dose. The reduction of sarcoma risk is even more pronounced than carcinoma risk. Hypofractionation is potentially beneficial with regard to second cancer induction.
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Affiliation(s)
- Uwe Schneider
- Radiotherapy Hirslanden AG, Institute for Radiotherapy, Rain 34, Aarau, Switzerland.
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