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Onal C, Bozca R, Dolek Y, Elmali A, Guler OC. A Comparative Analysis of Implant-sparing Plan Versus Conventional Plans Utilizing Helical Tomotherapy in Breast Cancer Patients Undergoing Breast Reconstruction. In Vivo 2024; 38:1412-1420. [PMID: 38688603 PMCID: PMC11059874 DOI: 10.21873/invivo.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM To compare implant sparing irradiation with conventional radiotherapy (RT) using helical (H) and TomoDirect (TD) techniques in breast cancer patients undergoing immediate breast reconstruction (IBR). PATIENTS AND METHODS The dosimetric parameters of 40 patients with retropectoral implants receiving 50.4 Gy delivered in 28 fractions were analyzed. Three plans were created: H plan using conventional planning target volume (PTV) that included the chest wall, skin, and implant; TD plan using conventional PTV; and Hs plan using implant-sparing PTV. The H, TD, and Hs plans were compared for PTV doses, organ-at-risk (OAR) doses, and treatment times. RESULTS Dose distribution in the Hs plan was less homogeneous and uniform than that in the H and TD plans. The TD plan had lower lung, heart, contralateral breast, spinal cord, liver, and esophagus doses than the Hs plan. Compared to the Hs plan, the H plan had lower lung volume receiving 5Gy (V5) (39.1±3.9 vs. 41.2±3.9 Gy; p<0.001), higher V20 (12.3±1.3 vs. 11.5±2.6 Gy; p=0.02), and higher V30 (7.5±1.6 vs. 4.4±1.7 Gy; p<0.001). H plan outperformed Hs plan in heart dosimetric parameters except V20. The Hs plan had significantly lower mean implant doses (43.4±2.1 Gy) than the H plan (51.4±0.5 Gy; p<0.001) and the TD plan (51.9±0.6 Gy; p<0.001). Implementing an implant sparing technique for silicone dose reduction decreases lung doses. CONCLUSION Conventional H and TD plans outperform the implant sparing helical plan dosimetrically. Because capsular contracture during RT is unpredictable, long-term clinical outcomes are required to determine whether silicon should be spared.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey;
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Recep Bozca
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Yemliha Dolek
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Aysenur Elmali
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
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Talapatra K, Chitkara G, Murali-Nanavati S, Gupte A, Bardeskar NS, Behal S, Shaikh M, Atluri P. Practice of Tumor Bed Boost in Patients after Oncoplastic Breast-Conserving Surgery. Indian J Surg Oncol 2024; 15:63-70. [PMID: 38511033 PMCID: PMC10948658 DOI: 10.1007/s13193-023-01824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 03/22/2024] Open
Abstract
The practice of boost to the tumor bed after treatment with oncoplastic breast-conserving surgery (BCS) remains variable. Using a survey, the present study evaluated the current practice of tumor bed boost administered in women after oncoplastic BCS. Actively practicing radiation oncologists across India were sent a questionnaire on the practice of adjuvant whole-breast radiotherapy and tumor bed boost after oncoplastic BCS via email and encouraged to participate. Of the 54 radiation oncologists who participated, most (98.1%) used a linear accelerator for radiotherapy. Hypofractionation was preferred by 59.26%, standard fractionation by 7.41%, and the remaining selected the fractionation strategy based on various patient factors. In addition, 83.33% participants reported that they always planned tumor boost, 51.85% preferred photons for the boost, and 75.93% administered sequential boost. The most common dose for the boost was 12.5 Gy in five fractions (40.74%). Most participants (77.78%) revealed that they used a combination of methods for identifying the tumor bed. With respect to clip placement, most surgeons (96%) at the participants' centers placed ≥ 4 clips at the tumor site, with both the base and margins being preferred by surgeons (81.48%) for placement. Finally, 12.96% participants revealed that the surgeons always involved them during surgical planning, whereas 7.4% participants reported that they always included the surgeons during radiotherapy planning, suggesting that radiation oncologists and oncoplastic surgeons do not involve each other during surgical and radiotherapy planning, possibly leading to suboptimal treatment. This may be attributed to the absence of guidelines regarding boost practices after oncoplastic BCS.
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Affiliation(s)
- Kaustav Talapatra
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Garvit Chitkara
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Sridevi Murali-Nanavati
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Ajinkya Gupte
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Nikhil S. Bardeskar
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Shruti Behal
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Muzammil Shaikh
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
| | - Pooja Atluri
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, 400056 India
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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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Oymak E, Bozca R, Guler OC, Onal C. Contralateral breast radiation doses in breast cancer patients treated with helical tomotherapy. Med Dosim 2022; 48:61-66. [PMID: 36572598 DOI: 10.1016/j.meddos.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022]
Abstract
We aimed to evaluate contralateral breast doses calculated with a Treatment Planning System (TPS) and verified with metal oxide semiconductor field effect transistor (MOSFET) detectors in patients with early-stage breast cancer (BC) who received helical tomotherapy (HT) after breast-conserving surgery. The dosimetric data of 30 patients (15 left-sided and 15 right-sided) with BC treated with 50.4 Gy to the whole breast and 64.4 Gy to the tumor bed in 28 fractions were analyzed. TPS doses were calculated and MOSFET doses were measured in the contralateral breast (CB) at cranial, caudal, and midpoint and 2 cm lateral to the central point. TPS and MOSFET doses were compared in the entire cohort as well as by tumor location (inner vs outer quadrant) and planning target volume of the breast (<1200 cc vs ≥1200 cc). The average doses at superior, inferior, central, and lateral points calculated with the TPS were 0.26 ± 0.15 cGy, 0.21 ± 0.09 cGy, 0.65 ± 0.14 cGy, and 0.50 ± 0.11 cGy, respectively, and were 0.37 ± 0.16 cGy, 0.34 ± 0.12 cGy, 0.60 ± 0.18 cGy, and 0.34 ± 0.15 cGy, respectively in MOSFET readings. Except for the central point, TPS-calculated doses and MOSFET readings were differed. The doses to the CB in patients with inner and outer quadrant tumors were not significantly different. In patients with large breasts, MOSFET doses were higher at superior and lateral points than TPS doses, but TPS doses were greater at inferior points. MOSFET readings were higher than TPS calculated doses in patients with inner or outer quadrant tumors in small or large breast volumes. The dose calculated by the TPS and that measured by MOSFET differed by a very small amount. The maximum dose to the CB administered at the midpoint was 1.8 Gy, as calculated using the TPS and confirmed using MOSFET detectors, in patients with early-stage BC undergoing breast-only radiotherapy with HT.
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Affiliation(s)
- Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Turkey
| | - Recep Bozca
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey; Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
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Comparison of Heart and Lung Doses According to Tumor Bed Boost Techniques in Early-Stage Left-Sided Breast Cancer: Simultaneous Integrated Boost versus Sequential Boost. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070873. [PMID: 35888592 PMCID: PMC9318371 DOI: 10.3390/medicina58070873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
Background and Objectives: The boost dose to the tumor bed after whole breast irradiation (WBI) can be divided into sequential boost (SEQ) and simultaneous integrated boost (SIB). SIB using modern radiation therapy (RT) techniques, such as volumetric modulated arc therapy, allow the delivery of a highly conformal dose to the target volume and has a salient ability to spare at-risk organs. This study aimed to compare the radiation dose delivered to the heart and lungs according to boost technique and tumor bed location. Materials and Methods: RT planning data of 20 patients with early-stage left-sided breast cancer were used in this study. All patients were treated with volumetric modulated arc therapy after breast-conserving surgery with a sentinel lymph node biopsy. For each patient, two different plans, whole breast irradiation with simultaneous integrated boost (WBI-SIB) and sequential boost after WBI (WBI-SEQ), were generated. To compare the dose received by each organ at risk (OAR), dose-volume histogram data were analyzed. The mean dose (Dmean) and volume of each organ that received x Gy (Vx) were calculated and compared. Results: For the heart, the V10 was lower for the WBI-SIB plan than for the WBI-SEQ plan (5.223 ± 1.947% vs. 6.409 ± 2.545%, p = 0.008). For the left lung, the V5 was lower in the WBI-SIB plan than for the WBI-SEQ plan (27.385 ± 3.871% vs. 32.092 ± 3.545%, p < 0.001). The Dmean for the heart and left lung was lower for the WBI-SIB plan than for the WBI-SEQ plan (heart: 339.745 ± 46.889 cGy vs. 413.030 ± 52.456 cGy, p < 0.001; left lung: 550.445 ± 65.094 cGy vs. 602.270 ± 55.775 cGy, p < 0.001). Conclusions: The WBI-SIB plan delivered lower radiation doses to the heart and left lung than the WBI-SEQ plan in terms of Dmean and low-dose volume in hypofractionated RT of early-stage left-sided breast cancer patients. Furthermore, a large radiation dose per day may be advantageous, considering the radiobiologic aspects of breast cancer. Long-term follow-up data are needed to determine whether the dosimetric advantages of the WBI-SIB plan can lead to clinically improved patient outcomes and reduced late side effects.
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Dosimetric Effect of Injection Ports in Tissue Expanders on Post-Mastectomy Volumetric Modulated Arc Therapy (VMAT) Planning for Left-Sided Breast Cancer. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to compare the dosimetric effect of traditional metallic ports and radio frequency identification (RFID) ports (Motiva Flora®) on post-mastectomy volumetric modulated arc therapy (VMAT) planning for left-sided breast cancer. Computed tomography (CT) simulation was performed on an anthropomorphic torso phantom by attaching two types of tissue expander on the left chest wall. For the comparison of CT artifacts, five points of interest were selected and compared: point A = central chest wall, B = medial chest wall, point C = lateral chest wall, point D = axilla, and point E = left anterior descending artery. VMAT planning using two partial arcs with a single isocenter was generated, and dosimetric parameters were investigated. Compared to metallic ports, RFID ports tremendously decreased distortion on CT images, with the exception of point D. The V5Gy, V10Gy, V15Gy, V20Gy, V30Gy, and Dmean values of the heart in RFID ports were lower than those in metallic ports. The V5Gy, V15Gy, V20Gy, V30Gy, and Dmean values of the ipsilateral lung in RFID ports were also lower than those in metallic ports. RFID ports showed superior dosimetric results for doses to the heart and lungs as compared to that in metallic ports.
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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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Zwicker F, Swartman B, Huber PE, Herfarth K, Debus J, Hauswald H. Lack of Relevant Haemogram Changes During Percutaneous Radiotherapy of Localised Prostate Cancer. In Vivo 2021; 34:1555-1563. [PMID: 32354962 DOI: 10.21873/invivo.11945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In percutaneous radiotherapy dose-distribution and volumetric-load of normal tissue varies in different radiation-techniques. Haematotoxicity may lead to deficiencies of the immune and blood system or to secondary malignancies. Therefore, regular blood-counts are carried out during fractionated radiotherapy. The aim was to investigate patient haemogram courses during radiotherapy of localised prostate-cancer treated with different radiation-techniques (n=3). PATIENTS AND METHODS In this prospective study, blood count changes were examined during fractionated radiotherapy (3D-conformal-RT/step-and-shoot-IMRT/helical-IMRT) on the prostate-region in localised prostate-cancer cases (n=50). RESULTS The whole patient group displayed a small but significant reduction in leukocytes. This reduction was higher in the two IMRT groups compared to the 3D-group but without any case of leukopenia. Haemoglobin- or thrombocyte-levels did not significantly change. CONCLUSION Regardless of the delivery mode used, localised fractionated irradiation of prostate region did not cause any clinically relevant haemogram changes in this study. These findings question the necessity of regular blood counts during fractionated radiotherapy of the prostate region for patients without any risk factors.
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Affiliation(s)
- Felix Zwicker
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany .,Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Benedict Swartman
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter E Huber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Henrik Hauswald
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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Liu YC, Chang HM, Lin HH, Lu CC, Lai LH. Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer. J Clin Med 2020; 9:E3884. [PMID: 33260404 PMCID: PMC7760558 DOI: 10.3390/jcm9123884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to compare different types of right breast cancer radiotherapy planning techniques and to estimate the whole-body effective doses and the critical organ absorbed doses. The three planning techniques are intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT; two methods) and hybrid 3D-CRT/IMRT (three-dimensional conformal radiotherapy/intensity-modulated radiotherapy). The VMAT technique includes two methods to deliver a dose: non-continuous partial arc and continuous partial arc. A thermoluminescent dosimeter (TLD) is placed in the RANDO phantom to estimate the organ absorbed dose. Each planning technique applies 50.4 Gy prescription dose and treats critical organs, including the lung and heart. Dose-volume histogram was used to show the planning target volume (V95%), homogeneity index (HI), conformity index (CI), and other optimized indices. The estimation of whole-body effective dose was based on the International Commission on Radiation Protection (ICRP) Publication 60 and 103. The results were as follows: Continuous partial arc and non-continuous partial arc showed the best CI and HI. The heart absorbed doses in the continuous partial arc and hybrid 3D-CRT/IMRT were 0.07 ± 0.01% and 0% (V5% and V10%, respectively). The mean dose of the heart was lowest in hybrid 3D-CRT/IMRT (1.47 Gy ± 0.02). The dose in the left contralateral lung (V5%) was lowest in continuous partial arc (0%). The right ipsilateral lung average dose and V20% are lowest in continuous partial arc. Hybrid 3D-CRT/IMRT has the lowest mean dose to contralateral breast (organs at risk). The whole-body effective doses for ICRP-60 and ICRP-103 were highest in continuous partial arc (2.01 Sv ± 0.23 and 2.89 Sv ± 0.15, respectively). In conclusion, the use of VMAT with continuous arc has a lower risk of radiation pneumonia, while hybrid 3D-CRT/IMRT attain lower secondary malignancy risk and cardiovascular complications.
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Affiliation(s)
- Yi-Chi Liu
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 30015 Taiwan;
- Department of Radiation Oncology, Wei Gong Memorial Hospital, Miaoli 35148, Taiwan
| | - Hung-Ming Chang
- Department of General Surgery, Wei Gong Memorial Hospital, Miaoli 35159, Taiwan;
| | - Hsin-Hon Lin
- Medical Physics Research Center, Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan;
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Chia-Chun Lu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan;
| | - Lu-Han Lai
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan
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