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Jin Y, Zhao C, Wang L, Su Y, Shang D, Li F, Wang J, Liu X, Li J, Wang W. Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast-conserving surgery. Cancer Med 2024; 13:e6956. [PMID: 38247382 PMCID: PMC10905334 DOI: 10.1002/cam4.6956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/27/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast-conserving surgery (BCS) using deformable image registration (DIR). METHODS AND MATERIALS Seventeen eligible patients who underwent whole-breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC /CIPTV and the clinical factors was also assessed. RESULTS Significant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost-LCpre and PTVpost-PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume-to-breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index. CONCLUSIONS Despite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.
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Affiliation(s)
- Ying Jin
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Changhui Zhao
- Department of Oncology, Jinan Third People's HospitalJinan Cancer HospitalJinanChina
| | - Lizhen Wang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Ya Su
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Dongping Shang
- Department of Medical Physics, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
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Fargier-Bochaton O, Wang X, Dipasquale G, Laouiti M, Kountouri M, Gorobets O, Nguyen NP, Miralbell R, Vinh-Hung V. Prone versus supine free-breathing for right-sided whole breast radiotherapy. Sci Rep 2022; 12:525. [PMID: 35017568 PMCID: PMC8752750 DOI: 10.1038/s41598-021-04385-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/24/2021] [Indexed: 01/29/2023] Open
Abstract
Prone setup has been advocated to improve organ sparing in whole breast radiotherapy without impairing breast coverage. We evaluate the dosimetric advantage of prone setup for the right breast and look for predictors of the gain. Right breast cancer patients treated in 2010-2013 who had a dual supine and prone planning were retrospectively identified. A penalty score was computed from the mean absolute dose deviation to heart, lungs, breasts, and tumor bed for each patient's supine and prone plan. Dosimetric advantage of prone was assessed by the reduction of penalty score from supine to prone. The effect of patients' characteristics on the reduction of penalty was analyzed using robust linear regression. A total of 146 patients with right breast dual plans were identified. Prone compared to supine reduced the penalty score in 119 patients (81.5%). Lung doses were reduced by 70.8%, from 4.8 Gy supine to 1.4 Gy prone. Among patient's characteristics, the only significant predictors were the breast volumes, but no cutoff could identify when prone would be less advantageous than supine. Prone was associated with a dosimetric advantage in most patients. It sets a benchmark of achievable lung dose reduction.Trial registration: ClinicalTrials.gov NCT02237469, HUGProne, September 11, 2014, retrospectively registered.
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Affiliation(s)
| | - Xinzhuo Wang
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
- Radiation Oncology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Giovanna Dipasquale
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Mohamed Laouiti
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
- Service de Radio-Oncologie, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Melpomeni Kountouri
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
| | | | - Nam P Nguyen
- Radiation Oncology, Howard University, Washington, DC, USA
| | - Raymond Miralbell
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland.
- Université de Genève, Geneva, Switzerland.
- Centro de Protonterapia Quirónsalud, Pozuelo de Alarcón, 28223, Madrid, Spain.
- Servei de Radiooncologia, Institut Oncològic Teknon, Quironsalud, Vilana 12, 08022, Barcelona, Spain.
| | - Vincent Vinh-Hung
- Radiation Oncology Department, Geneva University Hospitals, Geneva, Switzerland
- CHU de Martinique, Fort-de-France, Martinique, France
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Yu T, Li Y, Sun T, Xu M, Wang W, Shao Q, Zhang Y, Li J, Yu J. A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery. Sci Rep 2021; 11:18017. [PMID: 34504253 PMCID: PMC8429685 DOI: 10.1038/s41598-021-97520-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
This study explored the dosimetric difference between hypofractionated whole-breast irradiation (HFWBI) with sequential boost (SEB) and simultaneous integrated boost (SIB) based on supine and prone positions to identify the superior boost mode and superior position. Thirty breast cancer patients eligible for HFWBI after breast-conserving surgery were enrolled. All patients underwent 3DCT simulation scanning in both supine and prone positions. For the SEB-HFWBI plan, the dose prescribed for the planning target volume (PTV) of whole breast (WB) was 2.67 Gy per fraction with a total of 15 fractions, followed by a sequential boost of 3.2 Gy per fraction to the PTV of tumor bed (TB) in 3 fractions. For the SIB-HFWBI plan, the dose prescribed for the PTV of WB was 2.67 Gy per fraction with a total of 15 fractions, with a simultaneously integrated boost of 3.2 Gy per fraction to the PTV of TB with a total of 15 fractions. Regardless of the position, for the PTV of TB, the conformal index (CI) in the SIB-HFWBI plans was greater than those in the SEB-HFWBI plans (T = − 8.114, − 8.114; both P < 0.05). The CI for the PTV of WB increased significantly in the prone position relative to the supine position in both two plans(Z = − 3.340, − 3.501; all P < 0.05). The study suggested that prone SIB-HFWBI might be more suitable for postoperative radiotherapy after breast-conserving surgery for early-stage breast cancer patients.
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Affiliation(s)
- Ting Yu
- Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China
| | - Yankang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China
| | - Tao Sun
- Department of Radiation Physics, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China.
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, China.
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Lai J, Zhong F, Deng J, Hu S, Shen R, Luo H, Luo Y. Prone position versus supine position in postoperative radiotherapy for breast cancer: A meta-analysis. Medicine (Baltimore) 2021; 100:e26000. [PMID: 34011096 PMCID: PMC8136988 DOI: 10.1097/md.0000000000026000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This meta-analysis evaluates the difference of sparing organs at risk (OAR) in different position (Prone position and Supine position) with different breathing patterns (Free breathing, FB/Deep inspiration breath hold, DIBH) for breast cancer patients receiving postoperative radiotherapy and provides a useful reference for clinical practice. METHOD The relevant controlled trials of prone position versus supine position in postoperative radiotherapy for breast cancer were retrieved from the sources of PubMed, Cochrane Library, Embase, Web of Science and ClinicalTrails.gov. The principal outcome of interest was OAR doses (heart dose, left anterior descending coronary artery dose and ipsilateral lung dose) and target coverage. We mainly compared the effects of P-FB (Prone position FB) and S-FB (Supine position FB) and discussed the effects of DIBH combined with different positions on OAR dose in postoperative radiotherapy. We calculated summary standardized mean difference (SMD) and 95% confidence intervals (CI). The meta-analysis was performed using RevMan 5.4 software. RESULTS The analysis included 751 patients from 19 observational studies. Compared with the S-FB, the P-FB can have lower heart dose, left anterior descending coronary artery (LADCA) dose, and ipsilateral lung dose (ILL) more effectively, and the difference was statistically significant (heart dose, SMD = - 0.51, 95% CI - 0.66 ∼ - 0.36, P < .00001. LADCA dose, SMD = - 0.58, 95% CI - 0.85 ∼ - 0.31, P < .0001. ILL dose, SMD = - 2.84, 95% CI - 3.2 ∼ - 2.48, P < .00001). And there was no significant difference in target coverage between the S-FB and P-FB groups (SMD = - 0.1, 95% CI - 0.57 ∼ 0.36, P = .66). Moreover, through descriptive analysis, we found that P-DIBH (Prone position DIBH) has better sparing OAR than P-FB and S-DIBH (Supine position DIBH). CONCLUSION By this meta-analysis, compared with the S-FB we found that implementation of P-FB in postoperative radiotherapy for breast cancer can reduce irradiation of heart dose, LADCA dose and ILL dose, without compromising mean dose of target coverage. Moreover, P-DIBH might become the most promising way for breast cancer patients to undergo radiotherapy.
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Affiliation(s)
- Junming Lai
- Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang
| | - Fangyan Zhong
- Department of oncology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi
| | - Jianxiong Deng
- Department of oncology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi
| | - Shuang Hu
- Department of General Medicine, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang
| | - Ruoyan Shen
- Department of Second Institute of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, P.R. China
| | - Hui Luo
- Department of oncology, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, Jiangxi
| | - Yongbiao Luo
- Department of Radiation Oncology, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang
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Zhao C, Li J, Wang W, Gong G, Xu L, Zhang Y, Li F, Shao Q, Wang J, Liu X, Xu M. DE-MR simulation imaging for prone radiotherapy after breast-conserving surgery: assessing its application in lumpectomy cavity delineation based on deformable image registration. Radiat Oncol 2021; 16:91. [PMID: 34001182 PMCID: PMC8130288 DOI: 10.1186/s13014-021-01817-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background The application of delayed-enhancement magnetic resonance (DE-MR) simulation imaging in lumpectomy cavity (LC) delineation for prone radiotherapy in patients with an invisible seroma or a low seroma clarity score (SCS) after breast-conserving surgery (BCS) based on deformable image registration (DIR) was assessed. Methods Twenty-six patients who were suitable for radiotherapy in prone positions after BCS were enrolled, and both computed tomography (CT) and DE-MR simulation scans were acquired. The LC delineated based on titanium surgical clips on CT images was denoted as LCCT. The LC delineated based on the signal of cavity boundaries on fat-suppressed T2-weighted imaging (T2WI) and multiphase delayed-enhancement T1-weighted imaging (DE-T1WI), which was performed at 2 min, 5 min and 10 min postinjection, were denoted as LCT2, LC2T1, LC5T1 and LC10T1, respectively. Afterwards, DIR was performed to compare the volumes and locations of the LCs with MIM software. The generalized conformity index (CIgen) of inter (intra) observer (Inter-CIgen and Intra-CIgen) was also used to explore the inter(intra) observer variation for LC delineation on each image modality. Results LCCT–LC10T1 provided the best conformal index (CI) and degree of inclusion (DI), increasing by 2.08% and 4.48% compared to LCCT–LCT2, 11.36% and 2.94% for LCCT–LC2T1, and 8.89% and 7.69% for LC5T1–LCCT, respectively. The center of mass (COM) of LCCT–LC10T1 decreased by 17.86%, 6.12% and 13.21% compared with that of LCCT–LCT2, LCCT–LC2T1 and LCCT–LC5T1, respectively. The agreement of LC delineation was strongest for 10th min DE-TIWI (coefficient of variation, COV = 2.30%, Inter-CIgen = 87.06%, Intra-CIgen = 92.64%). Conclusion For patients with a low SCS (SCS ≤ 2) after BCS, it is feasible to contour the LC based on prone DE-MR simulation images. Furthermore, the LC derived from prone DE-T1WI at 10 min was found to be most similar to that derived from prone CT simulation scans using titanium surgical clips regardless of the volume and location of the LC. Inter (intra) variability was minimal for the delineation of the LC based on 10th min DE-TIWI.
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Affiliation(s)
- Changhui Zhao
- School of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China.
| | - Guanzhong Gong
- Department of Medical Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, Shandong Province, China
| | - Liang Xu
- Department of Medical Imagings, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Xijun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong Province, China
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Díaz-Gavela AA, Figueiras-Graillet L, Luis ÁM, Salas Segura J, Ciérvide R, del Cerro Peñalver E, Couñago F, Arenas M, López-Fernández T. Breast Radiotherapy-Related Cardiotoxicity. When, How, Why. Risk Prevention and Control Strategies. Cancers (Basel) 2021; 13:1712. [PMID: 33916644 PMCID: PMC8038596 DOI: 10.3390/cancers13071712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022] Open
Abstract
In recent decades, improvements in breast cancer management have increased overall patient survival; however, many cancer therapies have been linked to an important risk of cardiovascular adverse events. Cardio-oncology has been proposed as an emerging specialty to coordinate preventive strategies that improve the cardiovascular health of oncologic patients. It employs the most suitable personalized multidisciplinary management approach for each patient to optimize their cardiovascular health and improve their survival and quality of life. Radiotherapy is an essential part of the therapeutic regimen in breast cancer patients but can also increase the risk of cardiovascular disease. Therefore, minimizing the negative impact of radiation therapy is an important challenge for radiotherapy oncologists and cardiologists specializing in this field. The aim of the present review is to update our knowledge about radiation-induced cardiotoxicity in breast cancer patients by undertaking a critical review of the relevant literature to determine risk prevention and control strategies currently available.
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Affiliation(s)
- Ana Aurora Díaz-Gavela
- Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain;
- Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Lourdes Figueiras-Graillet
- Cardiooncology Clinic, Centro Estatal de Cancerología Miguel Dorantes Mesa, Xalapa-Enríquez 91130, Mexico;
| | - Ángel Montero Luis
- Radiation Oncology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain; (Á.M.L.); (R.C.)
| | - Juliana Salas Segura
- Cardio-oncology Unit, Hospital San Juan de Dios, San José 10103, Costa Rica;
- Cardiology Department, Hospital Clínica Bíblica. San José 10103, Costa Rica
| | - Raquel Ciérvide
- Radiation Oncology Department, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain; (Á.M.L.); (R.C.)
| | - Elia del Cerro Peñalver
- Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain;
- Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Felipe Couñago
- Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain;
- Radiation Oncology, Hospital La Luz, 28003 Madrid, Spain
- Clinical Department, Faculty of Biomedicine, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Meritxell Arenas
- Radiation Oncology, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain;
- Universitat Rovira i Virgili. IISPV, 43204 Reus, Spain
| | - Teresa López-Fernández
- Cardio-oncology Unit. Cardiology Department, Hospital Universitario La Paz, 28046 Madrid, Spain;
- Hospital La Paz Institute for Health Research—IdiPAZ, 28046 Madrid, Spain
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Yu T, Li Y, Wang W, Li F, Wang J, Xu M, Zhang Y, Li J, Yu J. Interobserver Variability of Target Volumes Delineated in the Supine and Prone Positions Based on Computed Tomography Images for External-Beam Partial Breast Irradiation After Breast-Conserving Surgery: A Comparative Study. Front Oncol 2020; 10:323. [PMID: 32373505 PMCID: PMC7179679 DOI: 10.3389/fonc.2020.00323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Although the supine position remains the dominant position for external-beam partial breast irradiation (EB-PBI), the advantages of administering EB-PBI in the prone position have been recognized. The interobserver variability between target volumes delineated in the different positions for EB-PBI after breast-conserving surgery needs to be investigated. Methods: Twenty-seven patients suitable for EB-PBI were enrolled from July 2016 to April 2017. Supine and prone simulation CT images were sequentially acquired for all enrolled patients during free breathing. Five experienced radiotherapists delineated the target volumes for all patients on supine and prone simulation CT images. The selected parameters, including target volumes, the coefficient of variation (COV), the matching degree (MD), and so on, were calculated to analyze the interobserver variability. Results: Regardless of the patient position, the interobserver variability between tumor bed (TB) and clinical target volume (CTV) measurements in supine and prone positions were statistically significant (F = 31.34, 19.467; 44.000, 41.985; P = 0.000, 0.001; 0.000, 0.001). The interobserver variability of COVCTV was significantly greater in the supine position than in the prone position (T = 2.64, P = 0.014). Furthermore, the interobserver variabilities of MDTB and MDCTV were statistically lower in the supine position than in the prone position (Z = −3.460, −3.195, P = 0.000, 0.001). Conclusion: When delineating the target volume for EB-PBI, the interobserver variability in the prone position was lower than that in the supine position. Hence, the administration of EB-PBI in the prone position during free breathing is a reasonable option.
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Affiliation(s)
- Ting Yu
- Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - YanKang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinzhi Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute (Shandong Cancer Hospital), Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Chan TY, Tang JI, Tan PW, Roberts N. Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res 2018; 10:4853-4870. [PMID: 30425577 PMCID: PMC6205528 DOI: 10.2147/cmar.s172818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Neill Roberts
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Yu T, Xu M, Sun T, Shao Q, Zhang Y, Liu X, Li F, Wang W, Bin Li J. External-beam partial breast irradiation in a supine versus prone position after breast-conserving surgery for Chinese breast cancer patients. Sci Rep 2018; 8:15354. [PMID: 30337718 PMCID: PMC6193958 DOI: 10.1038/s41598-018-33741-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/07/2018] [Indexed: 11/29/2022] Open
Abstract
To investigate the differences in target volumes and dosimetric parameters between the supine and prone positions for external-beam partial breast irradiation (EB-PBI) after breast-conserving surgery (BCS) for Chinese breast cancer patients, thirty breast cancer patients who underwent three-dimensional conformal radiation therapy (3DCRT) EB-PBI after BCS were enrolled. Supine and prone scan sets were acquired during free breathing for all patients. Target volumes and organs at risk (OARs) including the heart, ipsilateral lung and bilateral breast were contoured by the same radiation oncologist. For each patient, supine and prone EB-PBI plans were generated based on the same planning criteria. The clinical target volume (CTV) and planning target volume (PTV) in the prone position were significantly greater than those in the supine position (P = 0.003, 0.004, respectively). A 0.95 Gy reduction in the mean dose (Dmean) to the heart (P = 0.000) was apparent in the supine position compared to the prone position. The Dmean to the ipsilateral lung was significantly lower in the prone position than in the supine position (1.59 Gy vs. 1.72 Gy, P = 0.029). Therefore, for Chinese breast cancer patients, carrying out 3DCRT EB-PBI in the prone position during free breathing is feasible.
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Affiliation(s)
- Ting Yu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong province, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China
| | - Tao Sun
- Department of Radiophysics, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China
| | - YingJie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China
| | - XiJun Liu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China
| | - FengXiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China.
| | - Jian Bin Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China.
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