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Onal C, Bozca R, Oymak E, Guler OC. Comparison of helical and TomoDirect techniques with simultaneous integrated boost in early breast cancer patients. Rep Pract Oncol Radiother 2023; 28:541-550. [PMID: 37795226 PMCID: PMC10547420 DOI: 10.5603/rpor.a2023.0058] [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] [Received: 02/27/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023] Open
Abstract
Background The aim of the study was to perform dosimetric comparisons of helical (H) and TomoDirect (TD) plans for whole-breast irradiation (WBI) with simultaneous integrated boost (SIB) in early-stage breast cancer patients undergoing breast conserving surgery. Materials and methods Fifty patients, 25 with left-side and 25 with right-side tumors, were determined for a treatment planning system for a total dose of 50.4Gy in 1.8Gy per fraction to WBI, with a SIB of 2.3Gy per fraction delivered to the tumor bed. The planning target volume (PTV) doses and the conformity (CI) and homogeneity indices (HI) for PTVbreast and PTVboost, as well as organ-at-risk (OAR) doses and treatment times, were compared between the H and TD plans. Results All plans met the PTV coverage criteria for the H plan, except for mean V107 of PTVbreast for TD plan. The H plan yielded better homogeneity and conformity of dose distribution compared to the TD plan. The ipsilateral mean lung doses were not significantly different between the two plans. The TD plans is advantageous for mean doses to the heart, contralateral breast and lung, spinal cord, and esophagus than the H plans. In both the H and TD plans, the right-sided breast patients had lower heart dose parameters than the left-sided breast patients. The TD plan is superior to the H plan in sparing the contralateral breast and lung by decreasing low-dose volumes. Conclusions While the OAR dose advantages of TD are appealing, shorter treatment times or improved dose homogeneity and conformity for target volume may be advantageous for H plan.
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Affiliation(s)
- Cem Onal
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Türkiye
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Türkiye
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Türkiye
| | - Recep Bozca
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Türkiye
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Türkiye
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Türkiye
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Balaji K, Ramasubramanian V. Integrated scoring approach to assess radiotherapy plan quality for breast cancer treatment. Rep Pract Oncol Radiother 2022; 27:707-716. [PMID: 36196407 PMCID: PMC9521686 DOI: 10.5603/rpor.a2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background Proposal of an integrated scoring approach assessing the quality of different treatment techniques in a radiotherapy planning comparison. This scoring method incorporates all dosimetric indices of planning target volumes (PTVs) as well as organs at risk (OARs) and provides a single quantitative measure to select an ideal plan. Materials and methods The radiotherapy planning techniques compared were field-in-field (FinF), intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), hybrid IMRT (H-IMRT), and hybrid VMAT (H-VMAT). These plans were generated for twenty-five locally advanced left-sided breast cancer patients. The PTVs were prescribed a hypofractionation dose of 40.5 Gy in 15 fractions. The integrated score for each planning technique was calculated using the proposed formula. Results An integrated score value that is close to zero indicates a superior plan. The integrated score that incorporates all dosimetric indices (PTVs and OARs) were 1.37, 1.64, 1.72, 1.18, and 1.24 for FinF, IMRT, VMAT, H-IMRT, and H-VMAT plans, respectively. Conclusion The proposed integrated scoring approach is scientific to select a better plan and flexible to incorporate the patient-specific clinical demands. This simple tool is useful to quantify the treatment techniques and able to differentiate the acceptable and unacceptable plans.
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Affiliation(s)
- Karunakaran Balaji
- School of Advanced Sciences, Vellore Institute of Technology, Vellore, India,Department of Radiation Oncology, Gleneagles Global Hospitals, Chennai, India
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Pfaffendorf C, Vonthein R, Krockenberger-Ziegler K, Dellas K, Schreiber A, Uhlemann D, Dinges S, Würschmidt F, Andreas P, Weinstrauch E, Eilf K, Rades D, Höller U, Combs SE, Kazmierczak R, Fehlauer F, Schreck U, Zimmer J, Dunst J, Krug D. Hypofractionation with simultaneous integrated boost after breast-conserving surgery: Long term results of two phase-II trials. Breast 2022; 64:136-142. [PMID: 35691249 PMCID: PMC9190051 DOI: 10.1016/j.breast.2022.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Methods Results Conclusion Hypofractionated breast radiotherapy with SIB was safe and feasible. The local control rate at 5 years was 99.6%. The rate of late grade 3 toxicity was 0.7%.
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Ding Z, Zeng Q, Kang K, Xu M, Xiang X, Liu C. Evaluation of Plan Robustness Using Hybrid Intensity-Modulated Radiotherapy (IMRT) and Volumetric Arc Modulation Radiotherapy (VMAT) for Left-Sided Breast Cancer. Bioengineering (Basel) 2022; 9:bioengineering9040131. [PMID: 35447691 PMCID: PMC9028731 DOI: 10.3390/bioengineering9040131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: We aim to evaluate the robustness of multi-field IMRT and VMAT plans to target motion for left-sided BC radiotherapy. Methods: The 7-field hybrid IMRT (7F-H-IMRT) and 2-arc VMAT (2A-VMAT) plans were generated for ten left-sided BC patients. Shifts of 3 mm, 5 mm, and 10 mm in six directions were introduced and the perturbed dose distributions were recalculated. The dose differences (∆D) of the original plan and perturbed plan corresponded to the plan robustness for the structure. Results: Higher ∆D98%, ∆D95%, and ∆Dmean of CTV were observed in 2A-VMAT plans, which induced higher tumor control probability reductions. A higher ∆Dmean of CTV Boost was found in 7F-H-IMRT plans despite lower ∆D98% and ∆D95%. Shifts in the S-I direction exerted the largest effect on CTV and CTV Boost. Regarding OARs, shifts in R, P, and I directions contributed to increasing the received dose. The 2A-VMAT plans performed better dose sparing, but had a higher robustness in a high-dose volume of the left lung and heart. The 2A-VMAT plans decreased the max dose of LAD but exhibited lower robustness. Conclusion: The 2A-VMAT plans showed higher sensitivity to position deviation. Shifts in the S-I direction exerted the largest effect for CTV and CTV Boost.
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Chung SY, Oh J, Chang JS, Shin J, Kim KH, Chun KH, Keum KC, Suh CO, Kang SM, Kim YB. Risk of Cardiac Disease in Patients With Breast Cancer: Impact of Patient-Specific Factors and Individual Heart Dose From Three-Dimensional Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2021; 110:473-481. [PMID: 33421556 DOI: 10.1016/j.ijrobp.2020.12.053] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE This retrospective cohort study aimed to determine whether adjuvant radiation therapy increases the risk of cardiac toxicity in Asian women with breast cancer, with a focus on patient-specific factors. METHODS AND MATERIALS We evaluated women who underwent primary breast surgery for breast cancer with (n = 520) or without (n = 774) adjuvant radiation therapy between January 2005 and May 2013. Patients who underwent breast surgery without radiation therapy were categorized as patients who received 0 Gy to the heart. The primary endpoint was the occurrence of a breast cancer treatment-related heart disease (BCT-HD), defined as a diagnosis of angina pectoris, unstable angina, myocardial infarction, ischemic heart disease, heart failure, or atrial fibrillation. RESULTS In total, 1294 patients were included. The overall 5- and 10-year BCT-HD rates were 2.4% and 5.7%, respectively. The risk of an BCT-HD significantly increased per 1-Gy increase in the mean heart dose (adjusted hazard ratio: 1.23). Additionally, histories of hypertension (hazard ratio: 1.92), and diabetes (hazard ratio: 2.51) were found to be adverse risk factors, whereas regular physical exercise (hazard ratio: 0.17) was a protective factor. Subgroup analysis according to risk groups showed that the effect of increasing mean heart dose (per Gy) was similar between women without or with minimal risk factors (hazard ratio: 1.23) and women with multiple risk factors (hazard ratio: 1.27). CONCLUSIONS The results indicate a radiation dose-effect relationship for cardiac disease in breast cancer patients, highlighting that there remains a considerable risk of cardiac toxicity even with 3-dimensional radiation therapy planning. Thus, measures to minimize the heart dose in breast cancer patients undergoing adjuvant radiation therapy, even in those without any risk factor for cardiac disease, should be routinely implemented.
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Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyeong-Hyeon Chun
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
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Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer. Radiat Oncol 2020; 15:235. [PMID: 33050920 PMCID: PMC7557053 DOI: 10.1186/s13014-020-01652-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) improves dose homogeneity and late toxicity compared to simple tangential techniques in adjuvant whole-breast radiotherapy for patients with breast cancer. Simultaneous-integrated boost (SIB) radiotherapy shortens the overall treatment time and improves dose homogeneity. However, prospective randomized trials regarding IMRT with SIB for adjuvant radiotherapy in breast cancer are lacking. METHODS The IMRT-MC2 (MINT) trial is a phase III prospective randomized controlled trial comparing IMRT with SIB (Arm A: whole breast 28 × 1.8 Gy, Boost 28 × 2.3 Gy) to 3D-conformal radiotherapy with a sequential boost (Arm B: whole breast 28 × 1.8 Gy, boost 8 × 2 Gy) in patients with breast cancer after BCS. Indication for boost radiotherapy was defined as age < 70 years or age > 70 years with presence of additional risk factors. This is a retrospective analysis of acute toxicity at one of two trial sites. RESULTS Five hundred two patients were randomized, of which 446 patients were eligible for this analysis. There was no statistically significant difference in terms of any grade radiation dermatitis between the two treatment arms at the end of treatment (p = 0.26). However, radiation dermatitis grade 2/3 (29.1% vs. 20.1 and 3.5% vs. 2.3%) occurred significantly more often in Arm A (p = 0.02). Breast/chest wall pain at the first follow-up visit was significantly more common in patients treated on Arm B (p = 0.02). CONCLUSIONS Treatment on both arms was well tolerated, however there were some differences regarding radiodermatitis and breast pain. Further analyses are ongoing. TRIAL REGISTRATION clinicaltrials.gov , NCT01322854 , registered 24th March 2011.
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Krug D, Baumann R, Krockenberger K, Vonthein R, Schreiber A, Boicev A, Würschmidt F, Weinstrauch E, Eilf K, Andreas P, Höller U, Dinges S, Piefel K, Zimmer J, Dellas K, Dunst J. Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: results of a prospective trial. Strahlenther Onkol 2020; 197:48-55. [PMID: 33001241 PMCID: PMC7801347 DOI: 10.1007/s00066-020-01689-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/31/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE We report results of a multicenter prospective single-arm phase II trial (ARO-2013-04, NCT01948726) of moderately accelerated hypofractionated radiotherapy with a simultaneous integrated boost (SIB) in patients with breast cancer receiving adjuvant radiotherapy after breast-conserving surgery. METHODS The eligibility criteria included unifocal breast cancer with an indication for adjuvant radiotherapy to the whole breast and boost radiotherapy to the tumor bed. The whole breast received a dose of 40 Gy and the tumor bed a total dose of 48 Gy in 16 fractions of 2.5 and 3 Gy, respectively. Radiotherapy could be given either as 3D conformal RT (3D-CRT) or as intensity-modulated radiotherapy (IMRT). The study was designed as a prospective single-arm trial to evaluate the acute toxicity of the treatment regimen. The study hypothesis was that the frequency of acute skin reaction grade ≥2 would be 20% or less. RESULTS From November 2013 through July 2014, 149 patients were recruited from 12 participating centers. Six patients were excluded, leaving 143 patients for analysis. Eighty-four patients (58.7%) were treated with 3D-CRT and 59 (41.3%) with IMRT. Adherence to the treatment protocol was high. The rate of grade ≥2 skin toxicity was 14.7% (95% confidence interval 9.8-21.4%). The most frequent grade 3 toxicity (11%) was hot flashes. CONCLUSION This study demonstrated low toxicity of and high treatment adherence to hypofractionated adjuvant radiotherapy with SIB in a multicenter prospective trial, although the primary hypothesis was not met.
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Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - René Baumann
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,Klinik für Radio-Onkologie, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Katja Krockenberger
- ZKS Lübeck, Universität zu Lübeck, Lübeck, Germany.,AMEDOM GmbH, Lübeck, Germany
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Lübeck, Germany
| | - Andreas Schreiber
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Alexander Boicev
- Klinik für Strahlentherapie und Radioonkologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Germany
| | | | - Evelyn Weinstrauch
- Praxis für Radioonkologie, Johanniter-Zentren für Medizinische Versorgung Stendal, Stendal, Germany
| | | | - Peter Andreas
- Abteilung für Strahlentherapie, Krankenhaus Buchholz, Buchholz in der Nordheide, Germany
| | | | - Stefan Dinges
- Klinik für Strahlentherapie & Radioonkologie, Lüneburg, Germany
| | - Karen Piefel
- Strahlenzentrum Hamburg MVZ, Hamburg, Germany.,Fachbereich Strahlentherapie, Ambulanzzentrum des UKE, Hamburg, Germany
| | - Jörg Zimmer
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Kathrin Dellas
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Dosimetric and Radiobiological Comparison of Five Techniques for Postmastectomy Radiotherapy with Simultaneous Integrated Boost. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9097352. [PMID: 32775448 PMCID: PMC7391102 DOI: 10.1155/2020/9097352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022]
Abstract
Purpose To compare five techniques for the postmastectomy radiotherapy (PMRT) with simultaneous integrated boost (SIB). Materials and Methods Twenty patients with left-sided breast cancer were retrospectively selected. Five treatment plans were created for each patient: TomoDirect (TD), unblocked helical TomoTherapy (unb-HT), blocked HT (b-HT), hybrid intensity-modulated radiotherapy (hy-IMRT), and fixed-field IMRT (ff-IMRT). A dose of 50.4 Gy in 28 fractions to PTVtotal and 60.2 Gy in 28 fractions to PTVboost were prescribed. The dosimetric parameters for targets and organs at risk (OARs), the normal tissue complication probability (NTCP), the second cancer complication probability (SCCP) for OARs, and the treatment efficiency were assessed and compared. Results TD plans and hy-IMRT plans had similar good dose coverage and homogeneity for both PTVboost and PTVtotal and superior dose sparing for the lungs and heart. The ff-IMRT plans had similar dosimetric results for the target volumes compared with the TD and hy-IMRT plans, but gave a relatively higher NTCP and SCCP for the lungs. The unb-HT plans exhibited the highest OAR mean dose, highest NTCP for the lungs (0.97 ± 1.25‰) and heart (4.58 ± 3.62%), and highest SCCP for the lungs (3.57 ± 0.05%) and contralateral breast (2.75 ± 0.29%) among all techniques. The b-HT plans significantly outperformed unb-HT plans with respect to the sparing of the lungs and heart. This technique also showed the best conformity index (0.73 ± 0.08) for PTVboost and the optimal NTCP for the lungs (0.03 ± 0.03‰) and heart (0.61 ± 0.73%). Concerning the delivery efficiency, the hy-IMRT and ff-IMRT achieved much higher delivery efficiency compared with TomoTherapy plans. Conclusion Of the five techniques studied, TD and hy-IMRT are considered the preferable options for PMRT with SIB for left-sided breast cancer treatment and can be routinely applied in clinical practice.
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Onal C, Efe E, Guler OC, Yildirim BA. Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery. In Vivo 2020; 33:2181-2189. [PMID: 31662554 DOI: 10.21873/invivo.11720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM To compare simultaneous-integrated boost (SIB) versus sequential-boost (SB) delivered in the context of whole-breast irradiation (WBI) via volumetric-modulated arc therapy (VMAT) and helical-tomotherapy (HT). MATERIALS AND METHODS Planning target-volume (PTV) dosimetric parameters and organs at risk (OAR) were analyzed for SB plan (50 Gy plus 16 Gy boost) and SIB plan (50.4 Gy WBI and 64.4 Gy tumor bed boost) in VMAT and HT techniques. RESULTS Conformity and homogeneity for target-volume doses were better in HT plans compared to VMAT plans. There were no significant differences in ipsilateral lung doses between VMAT and HT plans for SB/SIB techniques, except for a significantly higher lung V5 value with VMAT-SB, and lung V13 value with HT-SIB technique. HT provided a statistically significant decrease in contralateral lung mean V5. CONCLUSION The SIB technique showed better target-volume dose distribution in both HT and VMAT plans, and better sparing heart in HT compared to the SB technique.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Esma Efe
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Ozan C Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Berna A Yildirim
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
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Hybrid planning techniques for hypofractionated whole-breast irradiation using flattening filter-free beams. Strahlenther Onkol 2019; 196:376-385. [PMID: 31863154 DOI: 10.1007/s00066-019-01555-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility of flattening filter-free (FFF) photon beams in hybrid intensity-modulated radiation therapy (H-IMRT) and hybrid volumetric modulated arc therapy (H-VMAT) for left-sided whole-breast radiation therapy with a boost volume (RT) using a hypofractionated dose regimen. PATIENTS AND METHODS RT plans of 25 patients with left-sided early-stage breast cancer were created with H‑IMRT and H‑VMAT techniques under breath-hold conditions using 6‑MV FFF beams. In hybrid techniques, three-dimensional conformal radiotherapy (3DCRT) plans were kept as base-dose plans for the VMAT and IMRT plans. In addition, H‑IMRT in step-and-shoot mode was also calculated to assess its achievability with FFF beams. RESULTS All hybrid plans achieved the expected target coverage. H‑VMAT showed better coverage and homogeneity index results for the boost target (p < 0.002), while H‑IMRT presented better results for the whole-breast target (p < 0.001). Mean doses to normal tissues were comparable between both plans, while H‑IMRT reduced the low-dose levels to heart and ipsilateral lung (p < 0.05). H‑VMAT revealed significantly better results with regard to monitor units (MU) and treatment time (p < 0.001). CONCLUSION The 6‑MV FFF beam technique is feasible for large-field 3DCRT-based hybrid planning in whole-breast and boost planning target volume irradiation. For breath-hold patients, the H‑VMAT plan is superior to H‑IMRT for hypofractionated dose regimens, with reduced MU and treatment delivery time.
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Lee G, Parmar H, Li W, Shessel A. The Effect of Lumpectomy Cavity Changes on Planning Dose in Breast Radiotherapy Boost. J Med Imaging Radiat Sci 2019; 50:317-322. [PMID: 31176440 DOI: 10.1016/j.jmir.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The addition of a postoperative tumour bed (cavity) boost after whole-breast radiotherapy (RT) is known to decrease the risk of local in-breast recurrence. The purpose of this retrospective study is to assess breast excision cavity changes and planned doses at the time of initial boost RT treatments after the completion of whole-breast RT. METHODS Over a 4-month period, women with highly visible cavity on computed tomography (CT) and treated with whole-breast RT followed by a conformal photon boost to the tumour bed were identified. The patient's day 1 boost online cone beam CT (CBCT) and corresponding setup corrections were overlaid with the planning CT image. The cavity and dose evaluation volumes (DEVs = 1 cm expansion of the cavity, excluding 5 mm of lung and skin) were assessed. Dosimetric evaluations were performed for maximum and minimum cavity doses, cavity volume receiving 90% (V90) and 95% (V95) of prescription dose, and DEV receiving 85% (V85), 95%, and 105% (V105) of the prescription dose. The two-tailed student t-test and Pearson's correlation test were performed for statistical analysis. RESULTS Eighteen patients were included in the analysis. The CT cavity (CAVCT) volume (mean: 28.8 cc, SD 27.9) was larger than the CBCT cavity (CAVCBCT) volume (mean: 21.1 cc, SD: 22.4) (P value= .003). The CT DEV similarly decreased at the time of boost; DEVCT (mean: 113.9 cc, SD: 63.2) versus DEVCBCT (mean: 92.3 cc, SD: 50.8), (P = .002). A strong correlation was observed between the initial CT cavity volume and cavity shrinkage observed at time of boost (day 1 CBCT) (Pearson's r = 0.697; r2= 0.486, P = .001). Both time periods from surgery to CT (median: 92 days, range: 31-227) and from surgery to day 1 CBCT (median: 141 days, range: 56-265) were not associated with cavity volume change. However, an inverse correlation was observed between time from initial CT to day 1 boost CBCT (median: 33 days, range: 24-54) and % cavity volume change (Pearson's r = -0.642; r2= 0.4121, P = .004). Dosimetric evaluations of the cavity and DEV showed no significant differences in maximum, minimum, and target dose coverage between the CT and boost volumes. CONCLUSION In patients with breast cancer treated with a tumour bed boost after whole-breast RT, the postoperative cavity can shrink between the time of CT and day 1 boost. The extent of cavity reduction was greatest in patients with large postoperative cavities on initial CT. Despite the cavity size change, conformal boost fields provide adequate dose coverage to the cavity.
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Affiliation(s)
- Grace Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Henna Parmar
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Shessel
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Schreuder K, Maduro J, Spronk P, Bijker N, Poortmans P, van Dalen T, Struikmans H, Siesling S. Variation in the Use of Boost Irradiation in Breast-Conserving Therapy in the Netherlands: The Effect of a National Guideline and Cofounding Factors. Clin Oncol (R Coll Radiol) 2019; 31:250-259. [DOI: 10.1016/j.clon.2018.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/25/2022]
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13
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Aghili M, Barzegartahamtan M, Alikhassi A, Mohammadpour R. Investigation of electron boost radiotherapy in patients with breast cancer: Is a direct electron field optimal? Cancer Radiother 2018; 22:52-56. [PMID: 29398305 DOI: 10.1016/j.canrad.2017.08.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/07/2017] [Accepted: 08/02/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Historically, electron boost dose mainly was delivered by a direct field in adjuvant radiotherapy of breast cancer. In this prospective study, we investigated direct electron field, in terms of optimal coverage of tumour bed volume following localization using ultrasound and surgical clips. MATERIAL AND METHODS First, for all 24 patients, a breast sonographer drew perimeter of tumour bed on the breast skin. Then an electron boost field was outlined on the demarcated territory, and a lead wire marker compatible with CT scan was placed on the field borders by a 2cm margin. After CT scan simulation, all patients underwent adjuvant whole breast irradiation with 3D-conformal radiotherapy to 50Gy in 25 fractions. Then for boost radiotherapy, lead wire in CT images was countoured as electron boost field. Also, the tumour bed was contoured based on surgical clips (true clinical target volume and true planning target volume). Electron treatment planning was done for electron boost field. Finally isodose coverages for true planning target volume investigated. RESULTS On average, 16.68% of clips planning target volume (true planning target volume; range: 0.00 to 95%) received 90% oor more of the prescribed dose when the electron treatment plan was made. Isodose curves does not provide adequate coverage on the tumour bed (clips planning target volume) when electron boost treatment planning was generated for electron boost field (en face electron field). In fact, a part of target (planning target volume-c) is missed and more doses is absorbed in normal tissue. CONCLUSIONS Electron boost treatment planning (an en face electron field) following tumour bed localization using ultrasonography does not provide an optimized coverage of tumour bed volume.
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Affiliation(s)
- M Aghili
- Radiation Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - M Barzegartahamtan
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - A Alikhassi
- Department of Radiology, Imam Hospital, Tehran University of Medical Sciences, Tehran,Iran
| | - R Mohammadpour
- Department of Biostatistics, Health Sciences Research Centre, Mazandaran University of Medical Sciences, Sari, Iran
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Son SH, Choi KH, Kim SW. Dosimetric comparison of simultaneous integrated boost with whole-breast irradiation for early breast cancer. PLoS One 2017; 12:e0173552. [PMID: 28273157 PMCID: PMC5342275 DOI: 10.1371/journal.pone.0173552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/23/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose The purpose of this study was to identify a more suitable boost plan for simultaneously integrated boost scheme in patients with breast cancer by comparing among 3 types of whole-breast irradiation plus tumor bed boost plans. Methods Twenty patients who received radiotherapy following breast-conserving surgery for early breast cancer were enrolled in this study. We performed 1 type of electron plan (E1P plan) and 2 types of 3-dimensional conformal plans using a photon (P3P and P5P plans). The dosimetric parameters for the heart, total lung and the target volume between the 3 treatment types were compared. Results For the tumor bed, the difference in the mean dose between the 3 plans was maximally 0.1 Gy. For normal breast parenchyma, the difference in the mean dose between the 3 plans was maximally 1.1 Gy. In the dose range over the prescribed dose of 51 Gy, V55 and V60 in the E1P plan were lower than those in the P3P and P5P plans, which indicated that the E1P plan was more suitable than the P3P and P5P plans. In case of the heart and total lung, the values of clinically important parameters were slightly higher in the E1P plan than in the P3P and P5P plans. However, these differences were less than 2%. Conclusion We observed that a simple electron plan for tumor bed boost is preferable over multi-field photon plans in terms of the target volume coverage and normal tissue sparing.
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Affiliation(s)
- Seok Hyun Son
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
| | - Kyu Hye Choi
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shin-Wook Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Maier J, Knott B, Maerz M, Loeschel R, Koelbl O, Dobler B. Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study. Radiat Oncol 2016; 11:111. [PMID: 27577561 PMCID: PMC5006633 DOI: 10.1186/s13014-016-0687-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer. METHODS An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. RESULTS Significantly best target coverage and homogeneity was achieved using VMAT FFF with V95% = (98.7 ± 0.8) % and HI = (8.2 ± 0.9) % for the SIB and V95% = (98.3 ± 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a Dmean of (0.7 ± 0.1) Gy for the contralateral lung, (1.0 ± 0.2) Gy for the contralateral breast and (1.4 ± 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 ± 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 ± 0:07) min. CONCLUSION Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.
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Affiliation(s)
- Johannes Maier
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Bernadette Knott
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Manuel Maerz
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Rainer Loeschel
- Ostbayerische Technische Hochschule Regensburg, Faculty of Computer Science and Mathematics, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany
| | - Barbara Dobler
- Department of Radiotherapy, Regensburg University Medical Center, Regensburg, Germany.
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External beam boost versus interstitial high-dose-rate brachytherapy boost in the adjuvant radiotherapy following breast-conserving therapy in early-stage breast cancer: a dosimetric comparison. J Contemp Brachytherapy 2016; 8:294-300. [PMID: 27648082 PMCID: PMC5018531 DOI: 10.5114/jcb.2016.61973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/07/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose This study aims to compare the dosimetric data of local tumor's bed dose escalation (boost) with photon beams (external beam radiation therapy – EBRT) versus high-dose-rate interstitial brachytherapy (HDR-BT) after breast-conserving treatment in women with early-stage breast cancer. Material and methods We analyzed the treatment planning data of 136 irradiated patients, treated between 2006 and 2013, who underwent breast-conserving surgery and adjuvant whole breast irradiation (WBI; 50.4 Gy) and boost (HDR-BT: 10 Gy in one fraction [n = 36]; EBRT: 10 Gy in five fractions [n = 100]). Organs at risk (OAR; heart, ipsilateral lung, skin, most exposed rib segment) were delineated. Dosimetric parameters were calculated with the aid of dose-volume histograms (DVH). A non-parametric test was performed to compare the two different boost forms. Results There was no difference for left-sided cancers regarding the maximum dose to the heart (HDR-BT 29.8% vs. EBRT 29.95%, p = 0.34). The maximum doses to the other OAR were significantly lower for HDR-BT (Dmax lung 47.12% vs. 87.7%, p < 0.01; rib 61.17% vs. 98.5%, p < 0.01; skin 57.1% vs. 94.75%, p < 0.01; in the case of right-sided breast irradiation, dose of the heart 6.00% vs. 16.75%, p < 0.01). Conclusions Compared to EBRT, local dose escalation with HDR-BT presented a significant dose reduction to the investigated OAR. Only left-sided irradiation showed no difference regarding the maximum dose to the heart. Reducing irradiation exposure to OAR could result in a reduction of long-term side effects. Therefore, from a dosimetric point of view, an interstitial boost complementary to WBI via EBRT seems to be more advantageous in the adjuvant radiotherapy of breast cancer.
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Aly MMOM, Glatting G, Jahnke L, Wenz F, Abo-Madyan Y. Comparison of breast simultaneous integrated boost (SIB) radiotherapy techniques. Radiat Oncol 2015; 10:139. [PMID: 26156086 PMCID: PMC4495684 DOI: 10.1186/s13014-015-0452-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 07/02/2015] [Indexed: 12/18/2022] Open
Abstract
Purpose To dosimetrically evaluate different breast SIB techniques with respect to target coverage and organs at risk (OARs) doses. Methods Four IMRT techniques were compared in 12 patients. Three techniques employ tangential whole breast irradiation with either two coplanar fields (T-2F), or four non-coplanar fields (T-NC), or one Volumetric Modulated Arc Therapy (T-VMAT) for the boost volume. The fourth technique is a fully-modulated VMAT technique (f-VMAT). Dosimetric parameters were compared for the boost and breast target volumes as well as OARs. Delivery efficiency was analysed based on number of monitor units (MUs) and estimated delivery time. Results T-VMAT and f-VMAT ranked highest with respect to integral assessment of boost and breast treatment quality measures. T-VMAT significantly outperformed f-VMAT with respect to ipsi-lateral lung and left-sided patients’ heart volumes ≥ 5 Gy (35 % ± 5 % vs. 52 % ± 6 % and 11 % ± 5 % vs. 22 % ± 6 %, respectively). f-VMAT significantly outperformed T-VMAT with respect to ipsi-lateral lung volume ≥ 20 Gy (13 % ± 2 % vs. 15 % ± 3 %) and heart volume ≥ 30 Gy in left breast cancer (0 % ± 0 % vs. 1 % ± 1 %). T-VMAT and f-VMAT needed 442 ± 58 and 1016 ± 152 MUs, respectively. Conclusions The hybrid T-VMAT is considered the technique of choice due to its balance of quality, efficiency and dose to OARs.
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Affiliation(s)
- Moamen M O M Aly
- Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| | - Gerhard Glatting
- Medical Radiation Physics/Radiation Protection, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lennart Jahnke
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,Department of Radiation Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University, Cairo, Egypt.
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Wu S, Lai Y, He Z, Zhou Y, Chen S, Dai M, Zhou J, Lin Q, Chi F. Dosimetric comparison of the simultaneous integrated boost in whole-breast irradiation after breast-conserving surgery: IMRT, IMRT plus an electron boost and VMAT. PLoS One 2015; 10:e0120811. [PMID: 25781183 PMCID: PMC4363530 DOI: 10.1371/journal.pone.0120811] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 02/06/2015] [Indexed: 12/25/2022] Open
Abstract
Objectives To compare the target volume coverage and doses to organs at risks (OARs) using three techniques that simultaneous integrated boost (SIB) in whole-breast irradiation (WBI) after breast-conserving surgery, including intensity-modulated radiation therapy (IMRT), IMRT plus an electron boost (IMRT-EB), and volumetric-modulated arc therapy (VMAT). Methods A total of 10 patients with early-stage left-sided breast cancer after breast-conserving surgery were included in this study. IMRT, IMRT-EB and VMAT plans were generated for each patient. Results The conformity index (CI) of the planning target volumes evaluation (PTV-Eval) of VMAT was significantly superior to those of IMRT and IMRT-EB (P < 0.05). The CI of the PTV Eval-boost of VMAT was better than that of IMRT (P = 0.018) and IMRT-EB (P < 0.001), while the CI of the PTV Eval-boost of IMRT was better than that of IMRT-EB (P = 0.002). The V5, V10 and Dmean in ipsilateral lung with VMAT were significantly higher than IMRT (P < 0.05) and IMRT-EB (P < 0.05). The Dmean, V5 and V10 in heart with VMAT were significantly greater than those of IMRT and IMRT-EB (P < 0.05). There was no significant difference in the OARs between IMRT and IMRT-EB (P > 0.05). Conclusions Considered the target volume coverage and radiation dose delivered to the OARs (especially the heart and lung), IMRT may be more suitable for the SIB in WBI than IMRT-EB and VMAT. Additional clinical studies with a larger sample size will be needed to assess the long-term feasibility and efficacy of SIB using different radiotherapy techniques.
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Affiliation(s)
- Sangang Wu
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Youqun Lai
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Zhenyu He
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People’s Republic of China
| | - Yuan Zhou
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Shanyu Chen
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Mingming Dai
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Juan Zhou
- Xiamen Cancer Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
| | - Qin Lin
- Xiamen Cancer Center, Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of China
- * E-mail: (QL); (FC)
| | - Feng Chi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People’s Republic of China
- * E-mail: (QL); (FC)
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Ultrasound Accuracy in Determining the Tumor Depth for Boost Field Radiotherapy in Breast Cancer in Comparison With CT Scan Plus Clips. REPORTS OF RADIOTHERAPY AND ONCOLOGY 2015. [DOI: 10.5812/rro.2(1)2015.887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Breast conserving treatment for breast cancer: dosimetric comparison of sequential versus simultaneous integrated photon boost. BIOMED RESEARCH INTERNATIONAL 2014; 2014:827475. [PMID: 25162031 PMCID: PMC4137720 DOI: 10.1155/2014/827475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/27/2014] [Accepted: 07/06/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast conserving surgery followed by whole breast irradiation is widely accepted as standard of care for early breast cancer. Addition of a boost dose to the initial tumor area further reduces local recurrences. We investigated the dosimetric benefits of a simultaneously integrated boost (SIB) compared to a sequential boost to hypofractionate the boost volume, while maintaining normofractionation on the breast. METHODS For 10 patients 4 treatment plans were deployed, 1 with a sequential photon boost, and 3 with different SIB techniques: on a conventional linear accelerator, helical TomoTherapy, and static TomoDirect. Dosimetric comparison was performed. RESULTS PTV-coverage was good in all techniques. Conformity was better with all SIB techniques compared to sequential boost (P = 0.0001). There was less dose spilling to the ipsilateral breast outside the PTVboost (P = 0.04). The dose to the organs at risk (OAR) was not influenced by SIB compared to sequential boost. Helical TomoTherapy showed a higher mean dose to the contralateral breast, but less than 5 Gy for each patient. CONCLUSIONS SIB showed less dose spilling within the breast and equal dose to OAR compared to sequential boost. Both helical TomoTherapy and the conventional technique delivered acceptable dosimetry. SIB seems a safe alternative and can be implemented in clinical routine.
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