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Miyasaka Y, ono T, Chai H, Souda H, Lee SH, Ishizawa M, Akamatsu H, Sato H, Iwai T. A robust treatment planning approach for chest motion in postmastectomy chest wall intensity modulated radiation therapy. J Appl Clin Med Phys 2024; 25:e14217. [PMID: 38018758 PMCID: PMC10795451 DOI: 10.1002/acm2.14217] [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: 06/09/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Chest wall postmastectomy radiation therapy (PMRT) should consider the effects of chest wall respiratory motion. The purpose of this study is to evaluate the effectiveness of robustness planning intensity modulated radiation therapy (IMRT) for respiratory movement, considering respiratory motion as a setup error. MATERIAL AND METHODS This study analyzed 20 patients who underwent PMRT (10 left and 10 right chest walls). The following three treatment plans were created for each case and compared. The treatment plans are a planning target volume (PTV) plan (PP) that covers the PTV within the body contour with the prescribed dose, a virtual bolus plan (VP) that sets a virtual bolus in contact with the body surface and prescribing the dose that includes the PTV outside the body contour, and a robust plan (RP) that considers respiratory movement as a setup uncertainty and performs robust optimization. The isocenter was shifted to reproduce the chest wall motion pattern and the doses were recalculated for comparison for each treatment plan. RESULT No significant difference was found between the PP and the RP in terms of the tumor dose in the treatment plan. In contrast, VP had 3.5% higher PTV Dmax and 5.5% lower PTV V95% than RP (p < 0.001). The RP demonstrated significantly higher lung V20Gy and Dmean by 1.4% and 0.4 Gy, respectively, than the PP. The RP showed smaller changes in dose distribution affected by chest wall motion and significantly higher tumor dose coverage than the PP and VP. CONCLUSION We revealed that the RP demonstrated comparable tumor doses to the PP in treatment planning and was robust for respiratory motion compared to both the PP and the VP. However, the organ at risk dose in the RP was slightly higher; therefore, its clinical use should be carefully considered.
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Affiliation(s)
- Yuya Miyasaka
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Takuya ono
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hongbo Chai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hikaru Souda
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Sung Hyun Lee
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Miyu Ishizawa
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hiroko Akamatsu
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Hiraku Sato
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Takeo Iwai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
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Mishra SS, Nanda S, Ahirwar MK, Rath SM. Advancing Precision in Post-mastectomy Chest Wall Radiotherapy: A Comparative Dosimetric Analysis of Volumetric-Modulated Arc Therapy (VMAT) and Intensity-Modulated Radiotherapy (IMRT) Based on Institutional Experience. Cureus 2023; 15:e38464. [PMID: 37276065 PMCID: PMC10235212 DOI: 10.7759/cureus.38464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Post-mastectomy radiation therapy (PMRT) is an important component in the management of breast cancer patients who have undergone mastectomy. Intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are two popular methods of delivering PMRT. With IMRT, high radiation doses are directed at the tumor, while exposure to healthy tissue is kept to a minimum. VMAT, on the other hand, is a more advanced version of IMRT that allows for faster radiation dose delivery while maintaining precision. The complexity of the VMAT treatment planning and delivery process, on the other hand, may increase the risk of technical errors, which can reduce treatment effectiveness. Studies have compared VMAT and IMRT in PMRT for breast cancer patients, but most have found no significant differences in treatment outcomes between the two methods. Individual patient factors such as treatment goals, available resources, and other characteristics may influence the choice between the two techniques. PURPOSE This prospective observational study aimed to compare the dosimetry of two cutting-edge modern radiotherapy techniques for post-mastectomy breast cancer patients receiving hypofractionated doses. METHODS For 58 patients with breast cancer, 116 plans for radiotherapy treatment were generated by both VMAT and IMRT. To maintain the uniformity of contouring, every CT image was contoured by the same physician, and Radiotherapy Oncology Group (RTOG) contouring guidelines were strictly followed during contouring. RESULTS Both techniques had comparable target volume coverage, but VMAT produced a significantly better conformity index than IMRT for both the left (0.71 vs. 0.65) and right (0.72 vs. 0.66) breasts (p-value < 0.05). VMAT plans had significantly higher low-dose spillage to the ipsilateral lung (V5Gy and V10Gy) but significantly lower high-dose spillage (V20Gy, V30Gy, and V40Gy) than IMRT plans (p-value < 0.05). Dmax and Dmean for the ipsilateral lung were comparable for both techniques. When compared to alternative treatment approaches, IMRT treatment plans were found to be more effective in minimizing radiation exposure to the heart for all patients with right-sided breast cancer, resulting in considerably lower levels of Dmean, V5Gy, V10Gy, V20Gy, and V35Gy. Plans for VMAT treatment were found to be significantly superior to left-side chest wall radiotherapy in terms of lower exposure to the heart for higher doses. IMRT plans, on the other hand, were successful in dramatically lowering the levels of Dmax that reached the spinal cord for both right- and left-sided breast cancers. CONCLUSION Apart from similar planning target volume (PTV) coverage to IMRT plans, VMAT produced significantly better conformity. VMAT plans have more low-dose spillage to normal tissues, while IMRT plans spare various organs at risk significantly better at lower doses in both right and left-sided breast cancer. VMAT was found to be better at sparing the heart (in left-sided breast cancer only) and ipsilateral lung at a high dose range. The best radiotherapy approach for breast cancer should be established on an individual basis, taking into account tumor laterality and the risk-benefit ratio.
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Affiliation(s)
- Shiv S Mishra
- Radiation Oncology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Siddhartha Nanda
- Radiation Oncology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Manish K Ahirwar
- Radiation Oncology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Swaroopa M Rath
- Medicine, Srirama Chandra Bhanja (SCB) Medical College and Hospital, Cuttack, IND
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Pan L, Du B, Zhu Z, Meng Q, Zhong R, Wang S. A comparative study of volumetric modulated arc therapy plans based on the equivalent uniform dose optimization for left-sided breast cancer. Radiat Phys Chem Oxf Engl 1993 2023. [DOI: 10.1016/j.radphyschem.2023.110945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Adeneye S, Akpochafor M, Adedewe N, Habeebu M, Jubril R, Adebayo A, Salako O, Joseph A, Ariyo I, Awhariado E, Lawal R. A Dosimetric Comparison of Volumetric Modulated Arc Therapy and Intensity Modulated Radiotherapy in Patients Treated with Post-Mastectomy Radiotherapy. Eur J Breast Health 2023; 19:92-98. [PMID: 36605476 PMCID: PMC9806941 DOI: 10.4274/ejbh.galenos.2022.2022-9-2] [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: 09/16/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
Objective Radiotherapy continues to play an important role in the management of breast cancer. This study compared the dosimetric differences between the techniques of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in breast cancer patients who had radiotherapy after mastectomy. Materials and Methods Forty post-mastectomy patients (19 right-sided breast and 21 left-sided breast) treated with the IMRT technique using 7-9 fields who were re-planned with VMAT using 2 coplanar arc on the Varian Vital beam linear accelerator between January, 2020 and August, 2021 were included in this study. The patients received 42 Gy in 15 fractions to the chest wall, lymph nodes and supraclavicular nodes. The dosimetric parameter for planning target volume (PTV), organs at risk (OAR) and the integral dose to the body were analysed. Student's t-test for two independent means was used to analyse the dosimetric differences between the plans. Results Clinical goals were achieved for both techniques. In terms of PTV coverage at 95% (IMRT: 712.17±233) vs (VMAT: 694.9±214) and the homogeneity index (IMRT: 0.075±0.04) vs (VMAT: 0.104±0.03), IMRT resulted in better dose coverage and homogeneity than VMAT. However, with the conformity index, no significant difference was seen. As regards the OARs, the mean doses, V5, V10, V20, V30, and V40 for the Ipsilateral-lung were lower in IMRT plans than in VMAT plans with a non-significant variation (p-values = 0.141, 0.416, 0.954, 0.443, and 1 respectively). Regarding the mean dose to the heart, low-dose volumes V5, V10, and high-dose volume V30 were significantly reduced in IMRT compared to VMAT. When comparing the dose to the contralateral breast, IMRT achieved a significantly lower mean dose than VMAT (2.9 vs 3.62, p = 0.0148). For MU, VMAT showed lower MU compared to IMRT with a non-significant difference. Conclusion With IMRT, better PTV coverage, homogeneity and OAR sparing were observed. Additionally, VMAT resulted in a lower delivery time than IMRT. Overall, both techniques offered dosimetric qualities that were clinically acceptable.
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Affiliation(s)
- Samuel Adeneye
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | | | - Nusirat Adedewe
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria,* Address for Correspondence: E-mail:
| | - Muhammad Habeebu
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | | | - Abe Adebayo
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Omolola Salako
- Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Adedayo Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Inioluwa Ariyo
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Eseoghene Awhariado
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
| | - Rasak Lawal
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Idi-araba, Lagos, Nigeria
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Fogliata A, Parabicoli S, Paganini L, Reggiori G, Lobefalo F, Cozzi L, Franzese C, Franceschini D, Spoto R, Scorsetti M. Knowledge-based DVH estimation and optimization for breast VMAT plans with and without avoidance sectors. Radiat Oncol 2022; 17:200. [PMID: 36474297 PMCID: PMC9724419 DOI: 10.1186/s13014-022-02172-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To analyze RapidPlan knowledge-based models for DVH estimation of organs at risk from breast cancer VMAT plans presenting arc sectors en-face to the breast with zero dose rate, feature imposed during the optimization phase (avoidance sectors AS). METHODS CT datasets of twenty left breast patients in deep-inspiration breath-hold were selected. Two VMAT plans, PartArc and AvoidArc, were manually generated with double arcs from ~ 300 to ~ 160°, with the second having an AS en-face to the breast to avoid contralateral breast and lung direct irradiation. Two RapidPlan models were generated from the two plan sets. The two models were evaluated in a closed loop to assess the model performance on plans where the AS were selected or not in the optimization. RESULTS The PartArc plans model estimated DVHs comparable with the original plans. The AvoidArc plans model estimated a DVH pattern with two steps for the contralateral structures when the plan does not contain the AS selected in the optimization phase. This feature produced mean doses of the contralateral breast, averaged over all patients, of 0.4 ± 0.1 Gy, 0.6 ± 0.2 Gy, and 1.1 ± 0.2 Gy for the AvoidArc plan, AvoidArc model estimation, RapidPlan generated plan, respectively. The same figures for the contralateral lung were 0.3 ± 0.1 Gy, 1.6 ± 0.6 Gy, and 1.2 ± 0.5 Gy. The reason was found in the possible incorrect information extracted from the model training plans due to the lack of knowledge about the AS. Conversely, in the case of plans with AS set in the optimization generated with the same AvoidArc model, the estimated and resulting DVHs were comparable. Whenever the AvoidArc model was used to generate DVH estimation for a plan with AS, while the optimization was made on the plan without the AS, the optimizer evidentiated the limitation of a minimum dose rate of 0.2 MU/°, resulting in an increased dose to the contralateral structures respect to the estimation. CONCLUSIONS The RapidPlan models for breast planning with VMAT can properly estimate organ at risk DVH. Attention has to be paid to the plan selection and usage for model training in the presence of avoidance sectors.
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Affiliation(s)
- Antonella Fogliata
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Sara Parabicoli
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Lucia Paganini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Giacomo Reggiori
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Francesca Lobefalo
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Luca Cozzi
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - Ciro Franzese
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
| | - Davide Franceschini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Ruggero Spoto
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy
| | - Marta Scorsetti
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, Humanitas Research Hospital IRCCS, Milan-Rozzano, Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Milan-Pieve Emanuele, Italy
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Hennet M, Radonic S, Schneider U, Hartmann M. Retrospective evaluation of a robust hybrid planning technique established for irradiation of breast cancer patients with included mammary internal lymph nodes. Radiat Oncol 2022; 17:76. [PMID: 35428265 PMCID: PMC9013158 DOI: 10.1186/s13014-022-02039-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The irradiation of breast cancer patients with included internal mammary lymph nodes challenges radiation planning with regard to robustness and protection of OARs. In this publication, a feasible hybrid radiation technique is presented with a retrospective dosimetric and radiobiological analysis of patient data of our institute from 2016 to 2020 and robustness analysis.
Methods
The proposed hybrid irradiation technique consists of two IMRT tangents and two partial VMAT fields. The retrospective dosimetric and radiobiological evaluation are made for 217 patient treatments (right- and left-sided). The robustness is evaluated regarding an artificial swelling from 0.4 to 1.5 cm for a random example patient and compared to a pure VMAT planning technique with use of a virtual bolus. The out of field stray dose is calculated for a selected patient plan and compared to alternative radiation techniques.
Results
The coverage D95% of the PTVEval (with breast swelling of 1.5 cm) changes for the hybrid plan from 96.1 to 92.1% of prescribed dose and for the pure VMAT plan from 94.3 to 87%. The retrospective dosimetric evaluation of patient irradiations reveals a Dmean for total lung 6.5 ± 0.9 Gy (NTCP[Semenenko 2008] 2.8 ± 0.5%), ipsilateral lung 10.9 ± 1.5 Gy, contralateral lung 2.2 ± 0.6 Gy, heart 2.1 ± 1.1 Gy (ERR[Schneider 2017] 0.02 ± 0.17%) and contralateral breast 1.7 ± 0.6 Gy. The scatter dose of the hybrid irradiation technique is higher than for pure VMAT and lower than for pure IMRT irradiation.
Conclusions
The feasibility of the proposed planning technique is shown by treating many patients with this technique at our radiotherapy department. The hybrid radiation technique shows a good sparing of the OARs in the retrospective analysis and is robust with regards to a breast swelling of up to 1.5 cm. The slightly higher stray dose of the hybrid technique compared to a pure VMAT technique originates from higher number of MUs and lower conformity.
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Noblet C, Duthy M, Coste F, Saliou M, Samain B, Drouet F, Papazyan T, Moreau M. Implementation of volumetric-modulated arc therapy for locally advanced breast cancer patients: Dosimetric comparison with deliverability consideration of planning techniques and predictions of patient-specific QA results via supervised machine learning. Phys Med 2022; 96:18-31. [DOI: 10.1016/j.ejmp.2022.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/10/2022] [Accepted: 02/15/2022] [Indexed: 12/21/2022] Open
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Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
This study compares three different hybrid plans, for left-sided chest wall (CW) and nodal stations irradiation using a hypofractionated dose regimen.
Materials and methods:
Planning target volumes (PTVs) of 25 breast cancer patients that included CW, supraclavicular (SCL) and internal mammary node (IMN) were planned with 3 different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT and IMRT+VMAT. All hybrid plans were generated with a hypofractionated dose prescription of 40·5 Gy in 15 fractions. Seventy per cent of the dose was planned with the base-dose component and remaining 30% of the dose was planned with the hybrid component. All plans were evaluated based on the PTVs and organs at risk (OARs) dosimetric parameters.
Results:
The results for PTVs parameters have shown that the 3DCRT+IMRT and 3DCRT+VMAT plans were superior in uniformity index to the IMRT+VMAT plan. The OARs dose parameters were comparable between hybrid plans. The IMRT+VMAT plan provided a larger low dose volume spread to the heart and ipsilateral lung (p < 0·001). The 3DCRT+VMAT plan required less monitor units and treatment time (p = 0·005) than other plans.
Conclusion:
The 3DCRT+VMAT hybrid plan showed superior results with efficient treatment delivery and provide clinical benefit by reducing both low and high dose levels.
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Comparison of sliding window and field-in-field techniques for tangential whole breast irradiation using the Halcyon and Synergy Agility systems. Radiat Oncol 2021; 16:213. [PMID: 34742291 PMCID: PMC8571882 DOI: 10.1186/s13014-021-01942-y] [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: 08/13/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To implement a tangential treatment technique for whole breast irradiation using the Varian Halcyon and to compare it with Elekta Synergy Agility plans. METHODS For 20 patients two comparable treatment plans with respect to dose coverage and normal tissue sparing were generated. Tangential field-in-field treatment plans (Pinnacle/Synergy) were replanned using the sliding window technique (Eclipse/Halcyon). Plan specific QA was performed using the portal Dosimetry and the ArcCHECK phantom. Imaging and treatment dose were evaluated for treatment delivery on both systems using a modified CIRS Phantom. RESULTS The mean number of monitor units for a fraction dose of 2.67 Gy was 515 MUs and 260 MUs for Halcyon and Synergy Agility plans, respectively. The homogeneity index and dose coverage were similar for both treatment units. The plan specific QA showed good agreement between measured and calculated plans. All Halcyon plans passed portal dosimetry QA (3%/2 mm) with 100% points passing and ArcCheck QA (3%/2 mm) with 99.5%. Measurement of the cumulated treatment and imaging dose with the CIRS phantom resulted in lower dose to the contralateral breast for the Halcyon plans. CONCLUSIONS For the Varian Halcyon a plan quality similar to the Elekta Synergy device was achieved. For the Halcyon plans the dose contribution from the treatment fields to the contralateral breast was even lower due to less interleaf transmission of the Halcyon MLC and a lower contribution of scattered dose from the collimator system.
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Hou PY, Hsieh CH, Wu LJ, Hsu CX, Kuo DY, Lu YF, Tien HJ, Hsiao HW, Shueng PW, Hsu SM. Modern Rotational Radiation Techniques with Volumetric Modulated Arc Therapy or Helical Tomotherapy for Optimal Sparing of the Lung and Heart in Left-Breast Cancer Radiotherapy Plus Regional Nodal Irradiation: A Comparative Dosimetric Analysis. Cancers (Basel) 2021; 13:cancers13205043. [PMID: 34680189 PMCID: PMC8534109 DOI: 10.3390/cancers13205043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary For advanced left-breast cancer patients, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. Modern arc RT techniques, volumetric-modulated arc therapy (VMAT), or helical tomotherapy (HT), can minimize normal organ exposure without compromising disease control. The aim of this study is to identify which arc technique is optimal for patients receiving left-breast RT with RNI, and to explore distinct RNI volumes with or without IMN. A total of 108 eligible patients were enrolled (70 VMAT, 38 HT). VMAT reduced the mean dose and low-dose exposure to the heart, ipsilateral lung, whole lung, contralateral breast, and esophagus compared with HT. The advantage of VMAT for normal organ sparing was distinct when performing RNI with IMN irradiation. To limit normal organ exposure and reduce potential toxicities, VMAT is the optimal technique for patients with left-breast cancer who are undergoing RT with RNI. Abstract Background: For advanced breast cancer with lymph node involvement, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. However, an extensive RT volume is associated with normal organ exposure, which increases the toxicity and affects patient outcomes. Modern arc RT techniques can improve normal organ sparing compared with conventional techniques. The aim of this study was to explore the optimal technique for left-breast RT with RNI. Methods: We retrospectively reviewed patients receiving RT with RNI for left-breast cancer. We used modern arc RT techniques with either volumetric-modulated arc therapy (VMAT) or helical tomotherapy (HT) with a novel block technique, and compared differences in dosimetry parameters between the two groups. Subgroup analysis of RNI with or without internal mammary node (IMN) volume was also performed. Results: A total of 108 eligible patients were enrolled between 2017 and 2020, of whom 70 received VMAT and 38 received HT. The median RT dose was 55 Gy. No significant differences were found regarding the surgery, RT dose, number of fractions, target volume, and RNI volume between the VMAT and HT groups. VMAT reduced the heart mean dose more than HT (3.82 vs. 5.13 Gy, p < 0.001), as well as the cardiac parameters of V5–V20, whole-lung mean dose, lung parameters of V5–V20, and contralateral-breast and esophagus mean dose. In the subgroup analysis of RNI with IMNs, the advantage of VMAT persisted in protecting the heart, lung, contralateral breast, and esophagus. HT was beneficial for lowering the thyroid mean dose. For RNI without IMN, VMAT improved the low-dose exposure of the heart and lung, but HT was similar to VMAT in terms of heart, whole-lung, and contralateral-breast mean dose. Conclusions: For patients with left-breast cancer receiving adjuvant RT with RNI, VMAT reduced the exposure dose to the heart, lung, contralateral breast, and esophagus compared with HT. VMAT was superior to HT in terms of normal organ sparing in the patients who underwent RNI with IMN irradiation. Considering the reduction in normal organ exposure and potential toxicity, VMAT is the optimal technique for patients receiving RNI when deep inspiration breath-hold is not available.
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Affiliation(s)
- Pei-Yu Hou
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Chen-Hsi Hsieh
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Le-Jung Wu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Chen-Xiong Hsu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Deng-Yu Kuo
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Yueh-Feng Lu
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Hui-Ju Tien
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Hsiu-Wen Hsiao
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
| | - Pei-Wei Shueng
- Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei 220, Taiwan; (P.-Y.H.); (C.-H.H.); (L.-J.W.); (C.-X.H.); (D.-Y.K.); (Y.-F.L.); (H.-J.T.); (H.-W.H.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Correspondence: (P.-W.S.); (S.-M.H.); Tel.: +886-2-8966-7000 (ext. 1031) (P.-W.S.); +886-2-2826-5858 (S.-M.H.); Fax: +886-2-2820-1095 (S.-M.H.)
| | - Shih-Ming Hsu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
- Correspondence: (P.-W.S.); (S.-M.H.); Tel.: +886-2-8966-7000 (ext. 1031) (P.-W.S.); +886-2-2826-5858 (S.-M.H.); Fax: +886-2-2820-1095 (S.-M.H.)
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11
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Zhang Y, Huang Y, Ding S, Yuan X, Shu Y, Liang J, Mao Q, Jiang C, Li J. A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer. Radiat Oncol 2021; 16:171. [PMID: 34488817 PMCID: PMC8422660 DOI: 10.1186/s13014-021-01895-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background To compare the dosimetric, normal tissue complication probability (NTCP), secondary cancer complication probabilities (SCCP), and excess absolute risk (EAR) differences of volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for left-sided breast cancer after mastectomy. Methods and materials Thirty patients with left-sided breast cancer treated with post-mastectomy radiation therapy (PMRT) were randomly enrolled in this study. Both IMRT and VMAT treatment plans were created for each patient. Planning target volume (PTV) doses for the chest wall and internal mammary nodes, PTV1, and PTV of the supraclavicular nodes, PTV2, of 50 Gy were prescribed in 25 fractions. The plans were evaluated based on PTV1 and PTV2 coverage, homogeneity index (HI), conformity index, conformity number (CN), dose to organs at risk, NTCP, SCCP, EAR, number of monitors units, and beam delivery time. Results VMAT resulted in more homogeneous chest wall coverage than did IMRT. The percent volume of PTV1 that received the prescribed dose of VMRT and IMRT was 95.9 ± 1.2% and 94.5 ± 1.6%, respectively (p < 0.001). The HI was 0.11 ± 0.01 for VMAT and 0.12 ± 0.02 for IMRT, respectively (p = 0.001). The VMAT plan had better conformity (CN: 0.84 ± 0.02 vs. 0.78 ± 0.04, p < 0.001) in PTV compared with IMRT. As opposed to IMRT plans, VMAT delivered a lower mean dose to the ipsilateral lung (11.5 Gy vs 12.6 Gy) and heart (5.2 Gy vs 6.0 Gy) and significantly reduced the V5, V10, V20, V30, and V40 of the ipsilateral lung and heart; only the differences in V5 of the ipsilateral lung did not reach statistical significance (p = 0.409). Although the volume of the ipsilateral lung and heart encompassed by the 2.5 Gy isodose line (V2.5) was increased by 6.7% and 7.7% (p < 0.001, p = 0.002), the NTCP was decreased by 0.8% and 0.6%, and SCCP and EAR were decreased by 1.9% and 0.1% for the ipsilateral lung. No significant differences were observed in the contralateral lung/breast V2.5, V5, V10, V20, mean dose, SCCP, and EAR. Finally, VMAT reduced the number of monitor units by 31.5% and the treatment time by 71.4%, as compared with IMRT. Conclusions Compared with IMRT, VMAT is the optimal technique for PMRT patients with left-sided breast cancer due to better target coverage, a lower dose delivered, NTCP, SCCP, and EAR to the ipsilateral lung and heart, similar doses delivered to the contralateral lung and breast, fewer monitor units and a shorter delivery time.
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Affiliation(s)
- Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Xingxing Yuan
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Yuxian Shu
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Jinhui Liang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Qingfeng Mao
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Chunling Jiang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China. .,Medical College of Nanchang University, Nanchang, Jangxi, 330031, People's Republic of China. .,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Jiangxi, 330029, People's Republic of China.
| | - Jingao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China.,Medical College of Nanchang University, Nanchang, Jangxi, 330031, People's Republic of China.,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Jiangxi, 330029, People's Republic of China
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12
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Zhang C, Hu W, Zhou Q, He J, Wang H, Qiu K, Wang L, Li X. The possibility of developing customized 3D-printed silicone hydrogel bolus for post-mastectomy radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2021. [DOI: 10.1080/16878507.2021.1962629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Caixun Zhang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Weiguo Hu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Qing Zhou
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Junxiang He
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Hao Wang
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Kehu Qiu
- Department of Oncology Center, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Luzhou Wang
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
| | - Xiangpan Li
- Department of Radiotherapy, Renmin Hospital of Wuhan University, Wuhan, P .R. China
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13
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Chen SN, Ramachandran P, Deb P. Dosimetric comparative study of 3DCRT, IMRT, VMAT, Ecomp, and Hybrid techniques for breast radiation therapy. Radiat Oncol J 2021; 38:270-281. [PMID: 33389982 PMCID: PMC7785843 DOI: 10.3857/roj.2020.00619] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess and compare the dosimetric parameters obtained between three-dimensional conformal radiotherapy (3DCRT), three-dimensional field-in-field (3DFIF), 5-field intensity-modulated radiotherapy (IMRT MF5), tangential IMRT (tIMRT), tangential volumetric modulated arc therapy (tVMAT), electronic tissue compensation (Ecomp), and Hybrid treatment plans. Material and Methods Thirty planning computed tomography datasets obtained from patients previously treated with whole breast radiation therapy (WBRT) were utilized in this study. Treatment plans were created for 3DCRT, 3DFIF, IMRT MF5, tIMRT, tVMAT, Ecomp, and Hybrid techniques using Eclipse Treatment Planning System (version 13.6) with a prescribed dose of 42.5 Gy in 16 fractions. Results Techniques with tangential beams produced statistically significantly better organs-at-risk (OARs) dosimetry (p < 0.001). Planning target volume Homogeneity Index (HI) was found to be significantly different among all techniques (p < 0.001), with Ecomp resulting in better HI (1.061 ± 0.029). Ecomp was also observed to require relatively shorter planning time (p < 0.001). Conclusions Techniques using tangential fields arrangements produced improved OARs dosimetry. Of all the treatment planning techniques employed in this study, Ecomp was found to be relatively easy to plan and produce acceptable dosimetry for WBRT in a short time.
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Affiliation(s)
- Semaya Natalia Chen
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Prabhakar Ramachandran
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Princess Alexandra Hospital, Queensland, Australia
| | - Pradip Deb
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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14
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Chen CH, Hsieh CC, Chang CS, Chen MF. A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy. Cancer Manag Res 2020; 12:9173-9182. [PMID: 33061609 PMCID: PMC7532038 DOI: 10.2147/cmar.s269893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background A better understanding of the organs-at-risk (OAR) dose metrics and the related toxicity induced by radiotherapy (RT) for left breast cancer (BC) will improve the quality of life. This study addressed the issue for left-BC patients treated with intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT). Patients and Methods Between 2012 and 2018, 308 left-BC patients underwent adjuvant RT at our hospital. Before June 2015, 134 patients were treated with 3D-CRT. Thereafter, 174 patients underwent IMRT. The patient’s characteristics in the IMRT group did not significantly different compared to those in the 3D-CRT group. Results Among the total study population, the incidence of ≥grade 2 radiation dermatitis (RID) was 17.3%. Higher volumes receiving 105% (≥5.7%) and 107% (≥1%) of prescribed dose and 3D-CRT technique were associated with a higher risk of RID. Regarding lung toxicity, the mean lung dose (≥10.2Gy) and V20 (≥20%) of ipsilateral lung were significantly associated with the incidence of RT-induced pulmonary changes. By dosimetry analysis, IMRT achieved better dose conformity and delivered lower mean doses to heart and ipsilateral lung compared to 3D-CRT. Furthermore, propensity sore and multivariate analysis showed that IMRT technique helped to reduce RT-induced dermatitis and lung toxicity. Conclusion Our data suggest that the volume of OAR exposed to higher doses is a predictor of RT-induced toxicity. Adjuvant RT with IMRT technique offered better dose conformity and spared high-dose levels to OARs to reduce radiation-related morbidity for BC patients.
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Affiliation(s)
- Chia-Hsin Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Chuan Hsieh
- Department of General Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Shen Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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15
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Nithya L, Goel V, Sharma D, Vittal K, Marjara N. Dosimetric Comparison of Different Planning Techniques in Left-sided Whole-Breast Irradiation: A Planning Study. J Med Phys 2020; 45:148-155. [PMID: 33487927 PMCID: PMC7810142 DOI: 10.4103/jmp.jmp_49_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose: This planning study compared the various dosimetric parameters of different types of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques for left-sided breast cancer radiotherapy. Materials and Methods: Treatment of 22 left-sided breast cases was planned using two IMRT and VMAT techniques for the prescription of 40 Gy in 15 fractions. For tangential IMRT (Tan_IMRT), five beams were placed as conventional tangential beams. For equally spaced IMRT (Equi_IMRT), six beams were placed equidistantly at 40° interval from 300° to 140°. For tangential VMAT (Tan_VMAT), two arcs were used with the avoidance sector in such a way that the beam covered like tangential fields. For full-arc VMAT (Full_VMAT), similar arcs as Tan_VMAT were used, without avoidance sector. All treatment plans were generated using Eclipse planning system for TrueBeam STx linear accelerator. For planning target volume (PTV), dose parameters including D95%, D99%, V105% homogeneity index (HI), and conformity index (CI) were analyzed. Different dose parameters for the left lung, heart, left anterior descending artery (LAD), right lung, and right breast were also analyzed. In addition, low-dose spillage in the normal tissues and the number of monitor units (MUs) required for the treatment were compared. Results: IMRT technique exhibited superior D95% and D99% for PTV compared with VMAT techniques. VMAT plans provided more V105% (6%) compared with that of IMRT plans (approximately 1%). HI was better in IMRT plans (Tan_IMRT, 0.085 ± 0.015; Equi_IMRT, 0.094 ± 0.011) than in VMAT plans. CI was better in VMAT plans. The mean lung dose (7.7 Gy ± 1.788 Gy) and V5Gy (34.99% ± 6.799%) were better achieved in Tan_IMRT plan than other plans. Right lung, heart, and right breast sparing were better achieved in Tan_IMRT plan. Moreover, low-dose spillage was very less in the Tan_IMRT compared with all other techniques. Conclusion: Dosimetric comparison in this study showed that tangential IMRT technique is superior in terms of target coverage, sparing of lung, heart, and right breast, and low-dose spillage control in the left-sided breast-only radiotherapy.
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Affiliation(s)
- L Nithya
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
| | - Vineeta Goel
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
| | - Deepti Sharma
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India.,Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karthik Vittal
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
| | - Nidhi Marjara
- Department of Radiation Oncology, Max Super Speciality Hospital, Shalimarbagh, New Delhi, India
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16
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Torres MA, Horst KC, Freedman GM. Postmastectomy and Regional Nodal Radiation for Breast Cancer. J Clin Oncol 2020; 38:2299-2309. [PMID: 32442076 DOI: 10.1200/jco.19.02908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mylin A Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kathleen C Horst
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, CA
| | - Gary M Freedman
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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17
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Kumawat N, Shrotriya AK, Heigrujam MS, Kumar S, Semwal MK, Bansal AK, Munjal RK, Mittal DK, Garg C, Anand AK. The Composite Planning Technique in Left Sided Breast Cancer Radiotherapy: A Dosimetric Study. Eur J Breast Health 2020; 16:137-145. [PMID: 32285036 DOI: 10.5152/ejbh.2020.5370] [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: 01/05/2020] [Accepted: 02/09/2020] [Indexed: 11/22/2022]
Abstract
Objective The aim of this retrospective study is to reduce the dose of heart, both lung and opposite breast and left anterior descending artery (LAD) and avoid long term complication and radiation induced secondary malignancies in radiotherapy left breast/chest wall without losing homogeneity and conformity of the Planning Target Volume (PTV), contoured using Radiotherapy Oncology Group (RTOG 1005) guideline. Materials and Methods The treatment plans were generated retrospectively by TFIF, VMAT and Composite techniques for 30 patients. Dose-Volume Histograms (DVHs) were evaluated for PTV and organs at risk (OAR's) and analyzed in two groups BCS and MRM using Wilcoxon signed rank test. Results The homogeneity index (HI) was improved in Composite technique by 32.72% and 21.81% of VMAT, 50.66% and 49.41% of TFIF in BCS and MRM group respectively. The Conformity Index (CI) for composite plan was statistically same as VMAT and superior by 27.94% and 41.37% of TFIF in BCS and MRM group respectively. The low dose volume V5Gy and V10Gy of the heart were improved in Composite plan by 47.9% and 26.1% of VMAT respectively in BCS group and in MRM group, improved by 21.2% and 45.6% of VMAT. The V5Gy and V10Gy of ipsilateral lung were improved in Composite plan by 16% and 13.7% of VMAT respectively in BCS and 8.4% and 3% of VMAT respectively in MRM group. Conclusion The Composite plan consisting of VMAT and TFIF plan with an optimum selection of fractions can achieve lower low dose exposure to the OAR's without compromising coverage compared to VMAT.
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Affiliation(s)
- Naveen Kumawat
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | | | | | - Satendra Kumar
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Manoj Kumar Semwal
- Department of Radiotherapy, Radiotherapy Army Hospital (Research and Referral), New Delhi, India
| | - Anil Kumar Bansal
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Ram Kishan Munjal
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Deepak Kumar Mittal
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Charu Garg
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
| | - Anil Kumar Anand
- Department of Radiation Oncology; Max Super Speciality Hospital, New Delhi, India
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18
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Dosimetric Comparison of Three Radiotherapy Techniques in Irradiation of Left-Sided Breast Cancer Patients after Radical Mastectomy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7131590. [PMID: 32258140 PMCID: PMC7085359 DOI: 10.1155/2020/7131590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/18/2020] [Accepted: 02/12/2020] [Indexed: 11/17/2022]
Abstract
Results The VMAT plans showed superior to PTV dose conformity index (CI), homogeneity index (HI), protection of the ipsilateral lung, monitor units (MUs), and maximum dose (Dmax) to the contralateral breast compared with TSP and 9FIMRT plans. The TSP provided better protection for Dmean of the heart and left ventricle (p < 0.05). A dose for left anterior descending artery from the three techniques had no significant difference. Compared with the 9FIMRT plans, the V5Gy (%) and V10Gy (%) for the ipsilateral lung were significantly reduced with TSP and VMAT (p < 0.05). The V5Gy (%) and V10Gy (%) for the ipsilateral lung turned out to be similar between VMAT and TSP techniques. Conclusions Our study indicates that VMAT should be a better choice of radiotherapy for left-sided breast cancer patients after radical mastectomy. If VMAT is unavailable, 9FIMRT can achieve better CI and HI values and be more MU-efficient compared with TSP; however, TSP can effectively reduce the low dose volume of the ipsilateral lungs and heart.
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19
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Flores-Martinez E, Kim GY, Yashar CM, Cerviño LI. Dosimetric study of the plan quality and dose to organs at risk on tangential breast treatments using the Halcyon linac. J Appl Clin Med Phys 2019; 20:58-67. [PMID: 31183967 PMCID: PMC6612683 DOI: 10.1002/acm2.12655] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/13/2018] [Accepted: 05/13/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the plan quality and doses to the heart, contralateral breast (CB), ipsilateral lung (IL), and contralateral lung (CL) in tangential breast treatments using the Halcyon linac with megavoltage setup fields. Methods Radiotherapy treatment plans with tangential beams from 25 breast cancer patients previously treated on a C‐arm linac were replanned for Halcyon. Thirteen corresponded to right‐sided breasts and 12 to left‐sided breasts, all with a dose prescription of 50 Gy in 25 fractions. Plans were created with the following setup imaging techniques: low‐dose (LD) MVCBCT, high‐quality (HQ) MVCBCT, LD‐MV and HQ‐MV pairs and the imaging dose was included in the plans. Plan quality metric values for the lumpectomy cavity, whole‐breast and doses to the organs at risk (OARs) were measured and compared with those from the original plans. Results No significant differences in plan quality were observed between the original and Halcyon plans. An increase in the mean dose (Mean) for all the organs was observed for the Halcyon plans. For right‐sided plans, the accumulated Mean over the 25 fractions in the C‐arm plans was 0.4 ± 0.3, 0.2 ± 0.2, 5.4 ± 1.3, and 0.1 ± 0.1 Gy for the heart, CB, IL, and CL, respectively, while values in the MVCBCT‐LD Halcyon plans were 1.2 ± 0.2, 0.6 ± 0.1, 6.5 ± 1.4, and 0.4 ± 0.1 Gy, respectively. For left‐sided treatments, Mean in the original plans was 0.9 ± 0.2, 0.1 ± 0.0, 4.2 ± 1.2, and 0.0 ± 0.0 Gy, while for the MVCBCT‐LD Halcyon plans values were 1.9 ± 0.2, 0.6 ± 0.2, 5.1 ± 1.2, and 0.5 ± 0.2 Gy, respectively. Conclusions Plan quality for breast treatments using Halcyon is similar to the quality for a 6 MV, C‐arm plan. For treatments using megavoltage setup fields, the dose contribution to OARs from the imaging fields can be equal or higher than the dose from treatment fields.
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Affiliation(s)
- Everardo Flores-Martinez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Gwe-Ya Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Catheryn M Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Laura I Cerviño
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
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20
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Tamborra P, Bettiol M, Carbonara R, Rito AD, Lioce M, Milella A, Nardone A, Necchia R, Didonna V, Massafra R. 212. RapidArc versus IMRT for postoperative irradiation of a case of recurrent breast cancer with internal mammary lymph node involvement. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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21
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Dean MK, Amestoy W, Takita C, Samuels SE. Radiographic predictors of IMRT for treating regional lymph nodes in breast cancer. Med Dosim 2018; 44:274-278. [PMID: 30396725 DOI: 10.1016/j.meddos.2018.10.002] [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: 08/08/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
Regional nodal irradiation (RNI) is an essential part of the treatment of high risk early stage (Stage IIb) and locally advanced (Stage III) breast cancer. Acceptable radiation plans can usually be achieved using 3-dimensional conformal radiation therapy with deep-inspiration breath hold to limit dose to the heart, although in some cases intensity-modulated radiation therapy produces superior results. The goal of this study is to identify radiographic parameters that predict the need for IMRT when delivering RNI. We retrospectively examined breast cancer patients treated with comprehensive RNI including internal mammary lymph nodes, supraclavicular lymph nodes, and undissected axillary lymph nodes at our institution from January 2016 to February 2018. Radiographic parameters including lung volume, internal mammary lymph nodes depth, modified central lung distance (mCLD), tangent length, and target height were recorded. Univariate and multivariate logistic regression was performed using IMRT as a binary endpoint (yes/no). A total of 46 patients were evaluated, of which 9 (20%) required IMRT. Five of the 9 (56%) IMRT patients were postmastectomy with a tissue expander in place. There was an increased likelihood of IMRT per 0.5 cm increase in mCLD (odds ratios [OR]: 3.27; 95% confidence interval [CI]: 1.39 to 9.63; p = 0.01) and per 1 cm increase in target height (OR: 1.77; 95% CI: 1.08 to 3.40; p = 0.04). A threshold value of 3.38 cm was identified for mCLD (OR 10.3; 95% CI: 2.14 to 61.4; p value = 0.005), and 25.2 cm for target height (OR 10.9; 95% CI: 2.19 to 82.7; p value = 0.007). When delivering RNI, larger values of mCLD and target height corresponded to the use of IMRT. Further investigations are warranted to confirm these findings, which may improve the efficiency of the treatment planning process and in turn patient care.
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Affiliation(s)
- Mary K Dean
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - William Amestoy
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Cristiane Takita
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Stuart E Samuels
- Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, FL, USA.
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Hwang JM, Hung JY, Tseng YH, Chang YK, Wang YN, Chang CS. Use of electronic portal images to evaluate setup error and intra-fraction motion during free-breathing breast IMRT treatment. Med Dosim 2018; 44:233-238. [PMID: 30236506 DOI: 10.1016/j.meddos.2018.08.001] [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: 06/15/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
Before delivering of intensity-modulated radiotherapy, kilo-voltage image-guidance radiotherapy is widely used in setup error correction and monitoring intra-fraction motion effectively. Accordingly, this study proposes and tests an image integration technique for observing intra-fraction motion during beam delivery, with the wider objective of reducing both image-guidance time and the dose delivered to normal breast tissue. The study sample comprised 33 female patients with breast cancer, and 241 sets of portal images acquired using a VARIAN aSi-1000 electronic portal imaging device. Motion amplitudes and vectors were collected and calculated separately by two senior therapists. The setup error in 3 axes was computed for every fraction, with average shifting for lateral, longitudinal and vertical direction was -0.3-mm ± 0.5, -0.1-mm ± 0.5 and -0.6-mm ± 1.6, with the average vector of setup error being 2.9-mm ± 1.4. The average intra-fraction motion for vertical direction was (A: -0.1-mm ± 1.0; B: -0.0 ± 1.1), for longitudinal was (A: -0.4-mm ± 1.7; B: 2.0 ± 1.1), and for lateral direction was (A: 0.3-mm ± 1.3; B: 0.2 ± 1.8). The average intra-fraction vector was 2.9-mm ± 1.3 for therapist A, and 3.4-mm ± 1.8 for therapist B. Offline Review commercial software was utilized for setup error and motion analysis, and data analysis and reliability testing were conducted with statistical package of the social sciences. Pearson correlations between the two therapists was moderate (0.59, p << 0.01), and the Cohen's kappa value for inter rater agreement between different evaluators was fair in the anterior-posterior direction (0.25, p << 0.01), with slight agreement in other two directions and vectors. The study presented efficient and dose reduction method to evaluate setup error and intra-fraction motion during breast intensity-modulated radiotherapy treatment.
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Affiliation(s)
- Jing-Min Hwang
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Jing-Yin Hung
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Yi-Han Tseng
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - You-Kang Chang
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; College of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Yu-Nong Wang
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chiou-Shiung Chang
- Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.
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23
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Tyran M, Tallet A, Resbeut M, Ferre M, Favrel V, Fau P, Moureau-Zabotto L, Darreon J, Gonzague L, Benkemouche A, Varela-Cagetti L, Salem N, Farnault B, Acquaviva MA, Mailleux H. Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy. J Appl Clin Med Phys 2018; 19:463-472. [PMID: 29959819 PMCID: PMC6123145 DOI: 10.1002/acm2.12398] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose This study evaluates the benefit of a virtual bolus method for volumetric modulated arc therapy (VMAT) plan optimization to compensate breast modifications that may occur during breast treatment. Methods Ten files were replanned with VMAT giving 50 Gy to the breast and 47 Gy to the nodes within 25 fractions. The planning process used a virtual bolus for the first optimization, then the monitors units were reoptimized without bolus, after fixing the segments shapes. Structures and treatment planning were exported on a second scanner (CT) performed during treatment as a consequence to modifications in patient's anatomy. The comparative end‐point was clinical target volume's coverage. The first analysis compared the VMAT plans made using the virtual bolus method (VB‐VMAT) to the plans without using it (NoVB‐VMAT) on the first simulation CT. Then, the same analysis was performed on the second CT. Finally, the level of degradation of target volume coverage between the two CT using VB‐VMAT was compared to results using a standard technique of forward‐planned multisegment technique (Tan‐IMRT). Results Using a virtual bolus for VMAT does not degrade dosimetric results on the first CT. No significant result in favor of the NoVB‐VMAT plans was noted. The VB‐VMAT method led to significant better dose distribution on a second CT with modified anatomies compared to NoVB‐VMAT. The clinical target volume's coverage by 95% (V95%) of the prescribed dose was 98.9% [96.1–99.6] on the second CT for VB‐VMAT compared to 92.6% [85.2–97.7] for NoVB‐VMAT (P = 0.0002). The degradation of the target volume coverage for VB‐VMAT is not worse than for Tan‐IMRT: the median differential of V95% between the two CT was 0.9% for VMAT and 0.7% for Tan‐IMRT (P = 1). Conclusion This study confirms the safety and benefit of using a virtual bolus during the VMAT planning process to compensate potential breast shape modifications.
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Affiliation(s)
- Marguerite Tyran
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Agnes Tallet
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Michel Resbeut
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marjorie Ferre
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Veronique Favrel
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Pierre Fau
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Julien Darreon
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Laurence Gonzague
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Ahcene Benkemouche
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Naji Salem
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Bertrand Farnault
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Hugues Mailleux
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
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24
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Khullar P, Garg C, Sinha SN, Kaur I, Datta NR. An in silico comparative dosimetric study of postmastectomy locoregional irradiation using intensity-modulated vs 3-dimensional conventional radiotherapy. Med Dosim 2018; 43:370-376. [PMID: 29352629 DOI: 10.1016/j.meddos.2017.12.001] [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: 08/30/2017] [Revised: 10/27/2017] [Accepted: 12/07/2017] [Indexed: 11/15/2022]
Abstract
An in silico dosimetric evaluation of intensity-modulated radiation therapy (IMRT) vs 3-dimensional conventional radiation therapy (3D-CRT) treatment plans in postmastectomy radiation therapy (PMRT) to the chest wall and regional lymphatics was conducted. Twenty-five consecutive patients with breast cancer referred for locoregional PMRT, stages T2-4 with N1-3, were planned to receive 50 Gy in 25 fractions with IMRT. Additionally, a 3D-CRT plan was generated using identical contours for the clinical target volumes (CTV), planning target volumes (PTV), and organs at risk (OAR). Treatment plans were assessed using dose-volume histogram (DVH) parameters of D98, D95, D50, D2, and homogeneity index for individual CTVs and PTVs. OARs evaluated were ipsilateral and contralateral lungs, heart, spinal cord, and opposite breast. Most DVH parameters pertaining to CTVs and PTVs significantly favored IMRT. V20 for ipsilateral and contralateral lungs, D33 of heart and maximum dose to spinal cord favored IMRT (all p < 0.001). The mean dose to the opposite breast was significantly lesser with 3D-CRT (5.8 ± 1.8 Gy vs 2.0 ± 1.0 Gy, p < 0.001). Thus, except for the mean dose to the opposite breast, the compliance to DVH constraints applied to PTV and OARs were significantly better with IMRT. At a median follow-up of 76 months (7-91), none had locoregional failure or pulmonary or cardiac morbidity. For PMRT, requiring comprehensive irradiation to both chest wall and regional lymphatics, IMRT offers superior dosimetric advantages over 3D-CRT. This was also corroborated by long-term outcomes in these patients treated with IMRT.
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Affiliation(s)
- Pooja Khullar
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Charu Garg
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sujit Nath Sinha
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Inderjit Kaur
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Niloy Ranjan Datta
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
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25
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Robar JL, Moran K, Allan J, Clancey J, Joseph T, Chytyk-Praznik K, MacDonald RL, Lincoln J, Sadeghi P, Rutledge R. Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy. Pract Radiat Oncol 2017; 8:221-229. [PMID: 29452866 DOI: 10.1016/j.prro.2017.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE This patient study evaluated the use of 3-dimensional (3D) printed bolus for chest wall radiation therapy compared with standard sheet bolus with regard to accuracy of fit, surface dose measured in vivo, and efficiency of patient setup. By alternating bolus type over the course of therapy, each patient served as her own control. METHODS AND MATERIALS For 16 patients undergoing chest wall radiation therapy, a custom 5.0 mm thick bolus was designed based on the treatment planning computed tomography scan and 3D printed using polylactic acid. Cone beam computed tomography scanning was used to image and quantify the accuracy of fit of the 2 bolus types with regard to air gaps between the bolus and skin. As a quality assurance measure for the 3D printed bolus, optically stimulated luminescent dosimetry provided in vivo comparison of surface dose at 7 points on the chest wall. Durations of patient setup and image guidance were recorded and compared. RESULTS In 13 of 16 patients, the bolus was printed without user intervention, and the median print time was 12.6 hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus, with the frequency of air gaps 5 mm or greater reduced from 30% to 13% (P < .001) and maximum air gap dimension diminished from 0.5 ± 0.3 to 0.3 ± 0.3 mm on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76 seconds. CONCLUSIONS This study demonstrates 3D printed bolus in postmastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time needed for the 3D printing process.
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Affiliation(s)
- James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada.
| | | | - James Allan
- Nova Scotia Health Authority, Halifax, Canada
| | | | - Tami Joseph
- Nova Scotia Health Authority, Halifax, Canada
| | - Krista Chytyk-Praznik
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
| | - R Lee MacDonald
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - John Lincoln
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Parisa Sadeghi
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada; Nova Scotia Health Authority, Halifax, Canada
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26
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Cozzi L, Lohr F, Fogliata A, Franceschini D, De Rose F, Filippi AR, Guidi G, Vanoni V, Scorsetti M. Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer. Radiat Oncol 2017; 12:200. [PMID: 29258539 PMCID: PMC5735809 DOI: 10.1186/s13014-017-0935-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this review is the critical appraisal of the current use of volumetric modulated arc therapy for the radiation therapy management of breast cancer. Both clinical and treatment planning studies were investigated. Material and methods A Pubmed/MEDLINE search of the National Library of Medicine was performed to identify VMAT and breast related articles. After a first order rejection of the irrelevant findings, the remaining articles were grouped according to two main categories: clinical vs. planning studies and to some sub-categories (pointing to significant technical features). Main areas of application, dosimetric and clinical findings as well as areas of innovations were defined. Results A total of 131 articles were identified and of these, 67 passed a first order selection. Six studies reported clinical results while 61 treatment dealed with treatment planning investigations. Among the innovation lines, the use of high intensity photon beams (flattening filter free), altered fractionation schemes (simultaneous integrated boost, accelerated partial breast irradiation, single fraction), prone positioning and modification of standard VMAT (use of dynamic trajectories or hybrid VMAT methods) resulted among the main relevant fields of interest. Approximately 10% of the publications reported upon respiratory gating in conjunction with VMAT. Conclusions The role of VMAT in the radiation treatment of breast cancer seems to be consolidated in the in-silico arena while still limited evidence and only one phase II trial appeared in literature from the clinical viewpoint. More clinical reports are needed to fully proove the expected dosimetric benefits demonstrated in the planning investigations.
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Affiliation(s)
- Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
| | - Frank Lohr
- Radiation Oncology Department, Ospedaliero-Universitaria, Modena, Italy
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy
| | - Fiorenza De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy
| | - A R Filippi
- Department of Radiation Oncology, Osp. S. Luigi Gonzaga University Hospital, Torino, Italy
| | - Gabriele Guidi
- Medical Physics Department, Az. Ospedaliero-Universitaria, Modena, Italy
| | | | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano-Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
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27
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Xu LM, Kang ML, Jiang B, Liu QF, Li YX. A study of the dosimetric characteristics between different fixed-field IMRT and VMAT in early-stage primary mediastinal B-cell lymphoma. Med Dosim 2017; 43:91-99. [PMID: 28935521 DOI: 10.1016/j.meddos.2017.08.010] [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: 05/03/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
This analysis was designed to compare dosimetric parameters among different fixed-field intensity-modulated radiation therapy (IMRT) solutions and volumetric-modulated arc therapy (VMAT) to identify which can achieve the lowest risk of organs at risk (OARs) and treatment delivery efficiently. A total of 16 patients (8 male and 8 female) with early-stage primary mediastinal large B-cell lymphoma (PMBCL) were enrolled with planned gross tumor volume (PGTV) 45 Gy and planning target volume (PTV) 40 Gy. Four different plans were generated: 5-, 7, 9-field IMRT, and VMAT. The dose distributions for PGTV and PTV OARs (lungs, left ventricle, heart, thyroid gland, and breasts) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. Mean conformity index (CI) and homogeneity index (HI) for PGTV in 5F-, 7F-, 9F-IMRT, and VMAT were 1.01 and 1.10, 1.01 and 1.10, 1.01 and 1.10, and 1.01 and 1.11 (p = 0.963 and 0.843), whereas these 2 indices for PTV were 1.04 and 1.22, 1.03 and 1.19, 1.03 and 1.17, and 1.08 and 1.14 (p = 0.964 and 0.969), respectively. Dmean (Gy), V4 (%), D50 (Gy), and D80 (Gy) to the left and right breasts increased by 0.7 Gy and 0.1 Gy, 6.8% and 7.7%, 0.9 Gy and 1.7 Gy, and 1.0 Gy and 1.5 Gy in VMAT, respectively. The 9-beam IMRT plan had the highest MUs (25,762.4 MUs) and the longest treatment delivery time (10.7 minutes); whereas, the VMAT had the lowest MUs (13,345.0) and the shortest treatment delivery time (5.9 minutes). Seven- and 9-field IMRT and VMAT provide improved tumor coverage compared with 5F-IMRT, whereas VMAT shows higher treatment delivery efficiency than IMRT technique. Seven- and 9-field IMRT slightly reduce the low dose radiation exposure of breasts compared with VMAT technique. The 7- and 9-field IMRT and VMAT techniques both can be safely and efficiently delivered to patients with PMBCL.
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Affiliation(s)
- Li-Ming Xu
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China; Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
| | - Ming-Lei Kang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China; Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - Bo Jiang
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qing-Feng Liu
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10021, China.
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28
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Duma MN, Heinrich C, Schönknecht C, Chizzali B, Mayinger M, Devecka M, Kampfer S, Combs SE. Helical TomoTherapy for locally advanced or recurrent breast cancer. Radiat Oncol 2017; 12:31. [PMID: 28129767 PMCID: PMC5273793 DOI: 10.1186/s13014-016-0736-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose We report our experience of using helical tomotherapy (HT) to treat large and irregular shaped loco-regional advanced breast cancer target volumes embracing various organs at risk. Patients and methods We retrospectively analyzed 26 patients treated for very large, irregular shaped breast cancers. Patients were treated either with the intent to achieve local control in a primary setting (n = 14) or in a reirradiation setting (n = 12). The recurrence group was heavily pretreated with systemic therapy. Tumors were characterized by wide infiltration of the skin, encompassing mostly a complete hemithorax. The primary group underwent irradiation of supraclavicular, infraclavicular, axillary and parasternal lymphonodal region. Radiotherapy was combined with chemotherapy (n = 11). We assessed the PTV volume and its craniocaudal extension, the dose to the organs at risk, acute toxicity and survival. Results Median PTV was 2276 cm3 (1476–6837 cm3) with a median cranio-caudal extension of 28 cm (15–52 cm). The median dose to PTV was 40 Gy (32–60Gy). HT could be carried out in all patients without interruption. The acute toxicities were mild to moderate. The median LRFS and OS after radiotherapy was 21 and 57 months for the primary group versus 10 and 11 months for the recurrence group. Median PFS was 18 months (primary group) and 7 months (recurrence group). Conclusions HT is feasible for advanced thorax embracing target volumes with acceptable acute toxicity. Both curative and palliative indications can be considered good indications based on treatment volume and anatomical constellation.
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Affiliation(s)
- M N Duma
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany.
| | - C Heinrich
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Praxis für Strahlentherapie, Hausham, Germany
| | - C Schönknecht
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - B Chizzali
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Mayinger
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - M Devecka
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany
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29
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Mao X, He J, Li T, Lu Z, Sun J, Meng Y, Abliz Z, Chen J. Application of imaging mass spectrometry for the molecular diagnosis of human breast tumors. Sci Rep 2016; 6:21043. [PMID: 26868906 PMCID: PMC4751527 DOI: 10.1038/srep21043] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/15/2016] [Indexed: 01/02/2023] Open
Abstract
Distinguishing breast invasive ductal carcinoma (IDC) and breast ductal carcinoma in situ (DCIS) is a key step in breast surgery, especially to determine whether DCIS is associated with tumor cell micro-invasion. However, there is currently no reliable method to obtain molecular information for breast tumor analysis during surgery. Here, we present a novel air flow-assisted ionization (AFAI) mass spectrometry imaging method that can be used in ambient environments to differentiate breast cancer by analyzing lipids. In this study, we demonstrate that various subtypes and histological grades of IDC and DCIS can be discriminated using AFAI-MSI: phospholipids were more abundant in IDC than in DCIS, whereas fatty acids were more abundant in DCIS than in IDC. The classification of specimens in the subtype and grade validation sets showed 100% and 78.6% agreement with the histopathological diagnosis, respectively. Our work shows the rapid classification of breast cancer utilizing AFAI-MSI. This work suggests that this method could be developed to provide surgeons with nearly real-time information to guide surgical resections.
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Affiliation(s)
- Xinxin Mao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiuming He
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Tiegang Li
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Zhaohui Lu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian Sun
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yunxiao Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zeper Abliz
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Jie Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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