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Bogers S, Petoukhova A, Penninkhof J, Mast M, Poortmans P, Hoogeman M, Struikmans H. Target Volume Coverage and Organ at Risk Doses for Left-sided Whole-breast Irradiation With or Without Internal Mammary Chain Irradiation: A Comparison Between Three Techniques Representing the Past and the Present. Clin Oncol (R Coll Radiol) 2022; 34:537-544. [DOI: 10.1016/j.clon.2022.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/03/2022]
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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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CHANG CS, CHEN CH, LIU KC, HO CS, CHEN MF. Selection of patients with left breast cancer for IMRT with deep inspiration breath-hold technique. JOURNAL OF RADIATION RESEARCH 2020; 61:431-439. [PMID: 32123912 PMCID: PMC7299258 DOI: 10.1093/jrr/rraa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/09/2019] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
The deep inspiration breath-hold (DIBH) technique has been utilized to reduce the cardiac dose in left-sided breast cancer (BC) patients undergoing radiotherapy. Further investigation of the parameters for selecting which patients will benefit most from DIBH is essential. We performed dosimetric comparisons for 21 patients with left-sided BC who had both computed tomography (CT)-based free-breathing (FB) and DIBH plans. The doses to the heart and left anterior descending artery (LAD) and any reduction due to the DIBH technique were analysed. Based on CTFB plans, dosimetric analysis revealed that the irradiation doses to the heart and LAD were significantly correlated with the target volume, the ipsilateral lung volume (ILV) and the total lung volume (TLV). When patients had an ILV ≥ 950 cm3 or a TLV ≥ 2200 cm3, the irradiation doses to the heart and LAD were significantly decreased. Furthermore, the reduction in the mean heart dose (MHD) was correlated to the difference in lung volume between FB and DIBH. The difference in ILV between DIBH and FB of 1.8 indicated that the patients obtained more benefit from the DIBH technique. The data suggest that lung volume (ILV and TLV) measured on a CT-simulation scan and the difference between FB and DIBH could be utilized to help select patients for DIBH.
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Affiliation(s)
- Chih-Shen CHANG
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Chia-Hsin CHEN
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Kuo-Chi LIU
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Chia-Sheng HO
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Miao-Fen CHEN
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
- College of Medicine, Chang Gung University College of Medicine, Taiwan
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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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Poulsen PR, Thomsen MS, Hansen R, Worm E, Spejlborg H, Offersen B. Fully automated detection of heart irradiation in cine MV images acquired during breast cancer radiotherapy. Radiother Oncol 2019; 152:189-195. [PMID: 31787350 DOI: 10.1016/j.radonc.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/31/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop robust automated detection of heart irradiation in continuous portal images (cine MV images) of tangential breast cancer treatments. METHODS Cine MV images of 302 tangential field deliveries were recorded for ten left-sided breast cancer patients receiving deep-inspiration breath-hold radiotherapy. An algorithm for fully automated heart edge detection in cine MV images was developed and tested for all images. The algorithm first enhances the heart edge contrast greatly by exploiting that pixels on the heart edge change their intensity cyclically, and highly correlated, at 1-3 Hz due to heartbeat. The algorithm then detects the heart edge in the enhanced image and calculates the exposed heart area within the field aperture. RESULTS The algorithm correctly identified the heart edge in all cine MV series with heart exposure (169 of 302 field deliveries). With conservative selection criteria the algorithm on average identified 70 heart edge pixels in the heart-including field deliveries (range: 10-230) without false positives. With less strict criteria 106 heart edge pixels were identified on average (range: 13-262) with 0.6% being false positives. The heart edge bordering the lung was segmented highly reliably even a few millimeters outside the field edge. For six patients with frequent heart irradiation, the exposed heart area showed large interfraction variations and smaller intrafraction variations. CONCLUSIONS Automated heart edge detection in cine MV images was proposed, developed and shown to be highly efficient for heart exposure detection in tangential breast fields. It may allow unsupervised surveillance of heart exposure at all tangential breast cancer treatments in a clinic.
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Affiliation(s)
- Per Rugaard Poulsen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
| | | | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | - Esben Worm
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | - Harald Spejlborg
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | - Birgitte Offersen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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Saini AS, Das IJ, Hwang CS, Biagioli MC, Lee WE. Biological Indices Evaluation of Various Treatment Techniques for Left-Sided Breast Treatment. Pract Radiat Oncol 2019; 9:e579-e590. [DOI: 10.1016/j.prro.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
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Dell'Oro M, Giles E, Sharkey A, Borg M, Connell C, Bezak E. A Retrospective Dosimetric Study of Radiotherapy Patients with Left-Sided Breast Cancer; Patient Selection Criteria for Deep Inspiration Breath Hold Technique. Cancers (Basel) 2019; 11:cancers11020259. [PMID: 30813346 PMCID: PMC6406815 DOI: 10.3390/cancers11020259] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Several studies have investigated cardiac dose reduction when utilizing the deep inspiration breath hold (DIBH) technique in patients undergoing radiotherapy for left-sided breast cancer. This paper aims to recommend potential selection criteria based on a retrospective single institute study of free breathing (FB) and DIBH computed tomography (CT) simulation planning scans. Methods: Dosimetric comparisons were performed retrospectively for 20 patients correlating the dose reduction and patient anatomical factors (anatomical variation of chest shape, chest wall separation, total lung volume (TLV) and others). Results: Paired t-tests demonstrated significant cardiac dose reduction for most patients but not all. Minimal cardiac dose reduction was observed for three patients using their DIBH plan, with one patient receiving a higher dose. Linear regression analysis identified a positive correlation between the patient’s TLV (on the FB CT simulation scan) and the magnitude of dosimetric benefit received (0.4045 R2). Conclusion: The TLV measured on a FB plan could potentially be utilised to predict cardiac exposure and assist with patient selection for DIBH. This is important in resource allocation, as DIBH may be unnecessarily recommended for some patients with little dosimetric benefit.
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Affiliation(s)
- Mikaela Dell'Oro
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | - Eileen Giles
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
| | | | | | | | - Eva Bezak
- Cancer Research Institute and School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia.
- Department of Physics, University of Adelaide, Adelaide, SA 5005, Australia.
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Hybrid volumetric modulated arc therapy for whole breast irradiation: a dosimetric comparison of different arc designs. Radiol Med 2019; 124:546-554. [PMID: 30701385 DOI: 10.1007/s11547-019-00994-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE To find an optimal arc design for hybrid volumetric modulated arc therapy (H-VMAT), a combination of conventional 3DCRT and VMAT plans for left-sided whole breast radiation therapy. METHODS AND MATERIALS A total of 26 left-sided early-stage breast cancer patients were selected for this study. To find the superior plan, H-VMAT with three different arc designs including, two partial arcs (2A), four partial arcs (4A) and four tangential arcs (TA) were created for each study case by combining 3DCRT and VMAT with 75% 3DCRT/25% VMAT dose proportion of prescription dose. RESULTS All H-VMAT plans achieved the expected target coverage. A higher conformity index and homogeneity index were achieved for 2A and 4A H-VMAT plans and significantly differ from TA H-VMAT (p < 0.003). The heart and ipsilateral lung dose parameters were comparable among all plans except heart V40Gy which was significantly less in 4A H-VMAT plan (p < 0.05). The contralateral lung, contralateral breast, spinal cord, normal tissue doses and MU were significantly less in TA H-VMAT (p < 0.03). The beam-on time was significantly less in 2A H-VMAT (p < 0.0001). CONCLUSION 2A and 4A H-VMAT techniques are effective in improving the PTV dosimetric parameters as well as reducing the OAR doses. Further, 2A H-VMAT delivers less MU and beam-on time compared to 4A H-VMAT.
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Ueda Y, Gerber NK, Das IJ. Model-based cardiac dose estimation in radiation treatment of left breast cancer. Br J Radiol 2018; 91:20180287. [PMID: 30044144 DOI: 10.1259/bjr.20180287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To develop a mathematical model for cardiac dose estimation for patients who have been treated for left-sided breast cancer without CT data. METHODS: After obtaining institutional review board approvals, 147 patients with left-sided breast cancer were selected that were treated supine with opposed tangents. The heart blocks from the tangential fields were removed and dose calculations were performed with 6 MV beams using an advanced algorithm. This study was performed with CT data with DRR to represent a radiographic simulator image of yesteryear treatments. The beam's eye-view images showing delineated breast, lung and heart were created to represent views on radiograph. The maximum heart distance (MHD) was recorded and irradiated heart area (AREA) was computed by combination of triangles and rectangles. Based on accurate 3D dose calculation, mean dose (Dmean) and V10 to V50 of heart were analyzed with respect to MHD and AREA for dosimetric parameters using linear and quadratic fit. RESULTS: The treatment parameters calculated by MHD and segments using 2D radiographs were within 2% of the actual dosimetric parameters computed from the 3D planning system. The MHD and AREA vs Dmean, V10, V20, V30 and V50 showed very good correlation with linear model (R2 > 0.91); however the correlation was significantly better with quadratic model (R2 > 0.92). The analysis of the dosimetric error with our linear and quadratic model is remarkable within <3% error for most cases. CONCLUSION: The proposed mathematical model for the cardiac dose estimation is accurate within ±3% using a radiograph without CT data. This provides avenues for patient pooling in future studies related to radiation dose and cardiac toxicity. These results will help in estimating cardiac dose analysis accurately from previous studies as well as in centers still using 2D planning. ADVANCES IN KNOWLEDGE: The evidence of cardiac risk following radiotherapy continues to be one of the important considerations for the management of left-sided breast cancer patients. One of the problem in the estimation of dose-risk effects is the reconstruction of heart dose for pre-CT treatments. In this study, a simple mathematical model is presented that could estimate cardiac dose within ±3% in left breast cancer treatment from 2D radiograph where CT data do not exist.
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Affiliation(s)
- Yoshihiro Ueda
- 1 Department of Radiation Oncology, Osaka International Cancer Institute , Osaka , Japan
| | - Naamit K Gerber
- 2 Department of Radiation Oncology, New York University Health & Laura and Isaac Perlmutter Cancer Center , New York, NY , USA
| | - Indra J Das
- 2 Department of Radiation Oncology, New York University Health & Laura and Isaac Perlmutter Cancer Center , New York, NY , USA
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Balaji K, Yadav P, BalajiSubramanian S, Anu Radha C, Ramasubramanian V. Hybrid volumetric modulated arc therapy for chest wall irradiation: For a good plan, get the right mixture. Phys Med 2018; 52:86-92. [PMID: 30139614 DOI: 10.1016/j.ejmp.2018.06.641] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 06/29/2018] [Accepted: 06/30/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To find the optimal dose weighting for hybrid volumetric modulated arc therapy (H-VMAT), a combination of conventional 3DCRT and VMAT plans for left sided chest wall and supraclavicular radiation therapy. METHODS & MATERIALS 20 left-sided breast cancer patients who received adjuvant radiotherapy were considered for this study. To find the optimal weighting, 5 H-VMAT plans were generated for each study case by combining different dose proportions of 3DCRT and VMAT plans including: 90% 3DCRT/10% VMAT, 80% 3DCRT/20% VMAT, 70% 3DCRT/30% VMAT, 60% 3DCRT/40% VMAT, 50% 3DCRT/50% VMAT. Further field-in-field, optimal H-VMAT and VMAT alone plans were compared. RESULTS All H-VMAT plans achieved the expected target coverage. A higher conformity index was achieved for 50% 3DCRT/50% VMAT plan, while better homogeneity index was achieved for 80% 3DCRT/20% VMAT plan. Mean and low doses were less in 90% 3DCRT/10% VMAT plan. Compared with other proportions, 80% 3DCRT/20% VMAT and 70% 3DCRT/30% VMAT weighted H-VMAT plans achieved balanced results for PTVs and OARs. CONCLUSION The optimal dose mixture for H-VMAT technique is 70% to 80% for 3DCRT and 20% to 30% for VMAT. The optimal H-VMAT achieved balanced results for the PTVs and OARs compared with field-in-field and VMAT alone plans.
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Affiliation(s)
- Karunakaran Balaji
- Department of Radiation Oncology, Gleneagles Global Hospitals, Chennai, India; School of Advanced Sciences, Vellore Institute of Technology, Vellore, India.
| | - Poonam Yadav
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Saini AS, Hwang CS, Biagioli MC, Das IJ. Evaluation of sparing organs at risk (OARs) in left-breast irradiation in the supine and prone positions and with deep inspiration breath-hold. J Appl Clin Med Phys 2018; 19:195-204. [PMID: 29927027 PMCID: PMC6036360 DOI: 10.1002/acm2.12382] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/27/2018] [Accepted: 05/05/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose To compare doses to organs at risk (OARs) for left‐sided whole‐breast radiation therapy with comparable planning target volume (PTV) coverage using three techniques: free breathing in a supine position (SFB), deep inspirational breath‐hold in a supine position (SDIBH), and free breathing in prone position (PFB). Materials and methods Thirty‐three patients with left‐sided early‐stage breast cancer underwent CT simulation following SFB, SDIBH, and PFB protocols for whole‐breast radiation therapy. One radiation oncologist contoured the breast PTV, heart, left ventricle (LV), and left anterior descending artery (LAD). Treatment plans were optimized using field‐in‐field technique with the AAA algorithm. Each plan was optimized to provide identical coverage to the PTV such that a reasonable comparison for OAR dosimetry could be evaluated. All plans were prescribed 42.56 Gy in 16 fractions to the left‐breast PTV. Results The mean dose in SFB for the heart, LV, and LAD was 1.92, 3.19, and 21.73 Gy, respectively, which were significantly higher than the mean dose in SDIBH for the heart (1.08 Gy, P ≤ 0.0001), LV (1.50 Gy, P ≤ 0.0001), and LAD (6.3 Gy, P ≤ 0.0001) and in PFB for the heart (0.98 Gy, P ≤ 0.0001), LV (1.34 Gy, P ≤ 0.0001), and LAD (6.57 Gy, P ≤ 0.0001). Similar findings were noted for the cardiac components in SFB for V2.5, V5, V10, V20, and V30 compared with values in SDIBH and PFB. The mean dose for the left lung in PFB was 0.61 Gy that was significantly lower than in SFB (5.63 Gy, P ≤ 0.0001) and SDIBH (5.54 Gy, P ≤ 0.0001). Mean dose and dosimetric values for each OAR increased in SFB and SDIBH for patients with a large breast volume compared with values for patients with a small breast volume. Conclusions SFB results in higher heart, LAD, and LV doses than the other techniques. Both PFB and SDIBH are more advantageous for these OARs irrespective of breast volume. PFB results in significantly lower lung doses than SFB and SDIBH. PFB always provided better results than SFB for the heart, LV, LAD, and lung. This conclusion contrasts with some published studies concluding that the prone position has no benefit for heart sparing.
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Affiliation(s)
- Amitpal Singh Saini
- Department of Medical Engineering, University of South Florida, Tampa, FL, USA.,Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Catherine S Hwang
- Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Matthew C Biagioli
- Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Indra J Das
- Department of Radiation Oncology, NYU Langone Medical Center, Laura and Isaac Perlmutter Cancer Center, New York, NY, USA
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Pettersson N, Johansson KA, Alsadius D, Tucker SL, Steineck G, Olsson C. A method to estimate composite doses for organs at risk in prostate cancer patients treated with EBRT in combination with HDR BT. Acta Oncol 2014; 53:815-21. [PMID: 24460070 DOI: 10.3109/0284186x.2013.870669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND When evaluating late toxicity after combined external beam radiation therapy (EBRT) and high-dose rate brachytherapy (HDR BT) prostate cancer treatments, it is important that the composite dose distribution is taken into account. This can be challenging if organ-at-risk (OAR) dose data are incomplete, i.e. due to a limited ultrasound imaging field-of-view in the HDR BT procedure. This work proposes a method that provides estimates of composite OAR doses for such situations. MATERIAL AND METHODS Original EBRT, simulated HDR BT, and composite dose-volume histograms (DVHs) for 10 pelvic OARs in 30 prostate cancer cases were used for method implementation and evaluation (EBRT: 25×2.0 Gy+BT: 2×10.0 Gy). The proposed method used information from the EBRT DVH to estimate OAR BT doses (with or without fractionation correction). Coefficients of determination (R2) were calculated for linear relationships between several EBRT DVH parameters and a BT DVH parameter of interest. The largest R2 value decided the relationship that best predicted the BT DVH parameter. The composite dose value was then calculated by adding the EBRT DVH and the estimated BT DVH parameter values and was compared to the reference composite value (in 1200 OAR/patient/parameter cases). RESULTS The linear relationships had an average R2 of 0.68 (range 0.42-0.88). Only one ninth of the 1200 estimated composite DVH values differed more than 2 Gy from their reference values. CONCLUSION Given a successful implementation, the proposed method only requires original or simulated BT plan data for a subset of patients to estimate composite doses for large study populations in a time-efficient manner. This can assist in evaluating radiation-induced late toxicity in multimodality treatments with limited OAR dose data.
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Affiliation(s)
- Niclas Pettersson
- Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital , Göteborg , Sweden
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Thorsen LBJ, Thomsen MS, Overgaard M, Overgaard J, Offersen BV. Quality assurance of conventional non-CT-based internal mammary lymph node irradiation in a prospective Danish Breast Cancer Cooperative Group trial: the DBCG-IMN study. Acta Oncol 2013; 52:1526-34. [PMID: 23957621 DOI: 10.3109/0284186x.2013.813643] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED In 2003, the Danish Breast Cancer Cooperative Group (DBCG) initiated DBCG-IMN, a prospective study on the effect of adjuvant internal mammary lymph node radiotherapy (IMN-RT) in patients with early lymph node positive breast cancer (BC). In the study, standard DBCG IMN-RT was provided only to patients with right-sided BC. We provide estimates of doses to IMNs and organs at risk (OARs) in patients treated with the non-CT-based RT techniques used during the DBCG-IMN study. MATERIAL AND METHODS Five DBCG RT regimens were simulated on planning CT scans from 50 consecutively scanned BC patients, 10 in each group. Intended target volumes were chest wall or breast and regional lymph nodes ± IMNs. Field planning was conducted in the Eclipse(TM) RT treatment planning system. Subsequently, IMN clinical target volumes (CTVs) and OARs were delineated. Estimates on doses to the IMN-CTV and OARs were made. RESULTS IMN dose coverage estimates were consistently higher in right-sided techniques where IMN treatment was intended (p < 0.0001). Estimated doses to cardiac structures were low regardless of whether IMNs were treated or not. Post-lumpectomy patients had the highest estimated lung doses. CONCLUSION Overall, simulator-based treatment using the DBCG RT techniques resulted in satisfactory coverage of IMNs and acceptable levels of OAR irradiation.
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Affiliation(s)
- Lise B J Thorsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital , Aarhus , Denmark
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