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Mast M, Leong A, Korreman S, Lee G, Probst H, Scherer P, Tsang Y. ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation. Tech Innov Patient Support Radiat Oncol 2023; 28:100219. [PMID: 37745181 PMCID: PMC10511493 DOI: 10.1016/j.tipsro.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- M.E. Mast
- Department of Radiation Oncology, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - A. Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
- Bowen Icon Cancer Centre, Wellington, New Zealand
| | - S.S. Korreman
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Oncology, Aarhus University Hospital, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - G. Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - H. Probst
- Sheffield Hallam University, Sheffield, United Kingdom
| | - P. Scherer
- Department of Radiotherapy and Radio-Oncology, LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - Y. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Duzenli C, Koulis T, Menna T, Carpentier E, Arora T, Coope R, Gill B, Lim P, Aquino-Parsons C, Nichol A, Singer J, Ingledew PA, Grahame S, Chan EK. Reduction in Doses to Organs at Risk and Normal Tissue During Breast Radiation Therapy With a Carbon-Fiber Adjustable Reusable Accessory. Pract Radiat Oncol 2021; 11:470-479. [PMID: 34303034 DOI: 10.1016/j.prro.2021.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/05/2021] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the breast, remove the inframammary fold, and reduce dose to organs at risk for whole breast radiation therapy in the supine position. METHODS AND MATERIALS Thirty patients with inframammary folds ≥1 cm or lateral ptosis in supine treatment position were planned with standard positioning and with a carbon-fiber Adjustable Reusable Accessory (CARA) breast support. Twenty patients received whole breast with or without regional nodal irradiation with 42.5 Gy in 16 fractions or 50 Gy in 25 fractions using CARA. Median body mass index was 32 in this study. RESULTS CARA removed all inframammary folds and reduced V20Gyipsilateral lung, V105%breast, and V50% body, without compromising target coverage. Median (range) V20Gyipsilateral lung for whole breast radiation therapy was 12.3% (1.4%-28.7%) with standard of care versus 10.9% (1.2%-17.3%) with CARA (Wilcoxon P = .005). Median V105% breast was 8.0% (0.0%-29%) with standard of care versus 4.0% (0.0%-23%) with CARA (P = .006) and median V50% body was 3056 mL (1476-5285 mL) versus 2780 mL (1415-5123 mL) with CARA (P = .001). CARA was compatible with deep inspiration breath hold and achieved median V25Gyheart = 0.1% (range 0%-1.9%) for all patients with left breast cancer. Skin reactions with CARA were consistent with historical data and daily variation in treatment setup was consistent with standard supine positioning. CONCLUSIONS CARA can reduce V105%breast, lung and normal tissue dose, and remove the inframammary fold for breast patients with large or pendulous breasts and high body mass index treated in the supine position, without compromising target coverage. CARA will undergo further study in a randomized controlled trial.
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Affiliation(s)
- Cheryl Duzenli
- Department of Medical Physics, BC Cancer, Vancouver, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada.
| | - Theodora Koulis
- Department of Radiation Oncology, BC Cancer, Kelowna, Canada
| | - Tara Menna
- Department of Radiation Therapy, BC Cancer, Vancouver, Canada
| | - Emilie Carpentier
- Department of Medical Physics, BC Cancer, Vancouver, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Tania Arora
- Department of Radiation Therapy, BC Cancer, Vancouver, Canada
| | - Robin Coope
- BC Cancer Genome Sciences Centre, Vancouver, Canada
| | - Bradford Gill
- Department of Medical Physics, BC Cancer, Vancouver, Canada
| | - Peter Lim
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Christina Aquino-Parsons
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Joel Singer
- University of British Columbia, School of Population and Public Health, Vancouver, Canada
| | - Paris-Anne Ingledew
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Sheri Grahame
- Department of Radiation Therapy, BC Cancer, Vancouver, Canada
| | - Elisa K Chan
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada
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Radiation dose to the heart with hypofractionation in patients with left breast cancer. EXPERIMENTAL RESULTS 2021. [DOI: 10.1017/exp.2021.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction
In this study we compared radiation dose received by organs at risk (OARs) after breast conservation surgery(BCS) and mastectomy in patients with left breast cancer.
Materials and methods
Total 30 patients, 15 each of BCS and mastectomy were included in this study. Planning Computerised Tomography (CT) was done for each patient. Chest wall, whole breast, heart, lungs, LAD, proximal and distal LAD, and contra lateral breast was contoured for each patient. Radiotherapy plans were made by standard tangent field. Dose prescribed was 40Gy/16#/3 weeks. Mean heart dose, LAD, proximal and distal LAD, mean and V5 of right lung, and mean, V5, V10 and V20 of left lung, mean dose and V2 of contra lateral breast were calculated for each patient and compared between BCS and mastectomy patients using student’s T test.
Results
Mean doses to the heart, LAD, proximal LAD and distal LAD were 3.364Gy, 16.06Gy, 2.7Gy, 27.5Gy; and 4.219Gy, 14.653Gy, 4.306Gy, 24.6Gy, respectively for mastectomy and BCS patients. Left lung mean dose, V5, V10 and V20 were 5.96Gy, 16%, 14%, 12.4%; and 7.69Gy, 21%, 18% and 16% in mastectomy and BCS patients, respectively. There was no statistical significant difference in the doses to the heart and left lung between mastectomy and BCS. Mean dose to the right lung was significantly less in mastectomy as compared to BCS, 0.29Gy vs. 0.51Gy, respectively (p = 0.007). Mean dose to the opposite breast was significantly lower in patients with mastectomy than BCS (0.54Gy Vs 0.37Gy, p = 0.007). The dose to the distal LAD was significantly higher than proximal LAD both in BCS (24.6Gy Vs 4.3Gy, p = <0.0001) and mastectomy (27.5Gy Vs 2.7Gy, p = <0.0001) patients.
Conclusion
There was no difference in doses received by heart and left lung between BCS and mastectomy patients. Mean doses to the right lung and breast were significantly less in mastectomy patients.
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A service evaluation of the immobilisation techniques adopted for breast cancer patients with large and/or pendulous breasts, receiving external beam radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Breast cancer patients referred for external beam radiotherapy and who have large and/or pendulous breasts can present positioning and immobilisation challenges. Deep infra-mammary and/or lateral wrap skin folds can occur that can lead to unwanted radiation-induced skin toxicity. The purpose of the study was to evaluate the immobilisation techniques adopted for this subgroup of patients in order to inform best practice.Method:A survey aimed to identify the current clinical practice in radiotherapy centres throughout the United Kingdom and Ireland was undertaken. The email survey was distributed with support of the Radiotherapy Services Managers group.Results:Twenty-six of the 74 radiotherapy centres responded to the survey. Responses demonstrated that supine positioning with or without additional immobilisation was preferable. Of the eight different immobilisation techniques identified, patients positioned supine on a breast board wearing a bra was the most common. Only two of the centres reported using a prone technique.Conclusions:Immobilisation and reproducibility are key for successful external beam radiotherapy particularly when advanced treatment techniques are being employed. No single technique gained widespread acceptance as the optimum for the effective immobilisation of patients with large and/or pendulous breasts. Further evaluative research in the form of a multi-centre trial is warranted in order to clearly establish the most effective immobilisation methods/devices for this ever expanding, subgroup of cancer patients.
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Sabater S, Pastor-Juan M, Berenguer R, Lozano-Setien E, Andres I, Tercero-Azorin M, Sevillano M, Jimenez-Jimenez E, Rovirosa A, Korte E, Arenas M. An MRI comparative image evaluation under diagnostic and radiotherapy planning set-ups using a carbon fibre tabletop for pelvic radiotherapy. Cancer Radiother 2019; 23:296-303. [DOI: 10.1016/j.canrad.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 01/31/2023]
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Patients' view of the differences in topical creams for radiation dermatitis prevention. A pilot study of cosmetic properties. Rep Pract Oncol Radiother 2019; 24:347-354. [PMID: 31198411 DOI: 10.1016/j.rpor.2019.03.006] [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: 03/16/2018] [Revised: 12/18/2018] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Aim To investigate the feasibility of including patients' reports on the cosmetic properties of topical formulations for acute radiation dermatitis (ARD). Background No topical agent tested for acute radiation dermatitis (ARD) has proven to be better than any other, all achieving similar objective outcomes. No clear guidelines have therefore been established in clinics. Because the vehicle for such creams has shown to be an important factor in patient adherence to treatments in other dermatological diseases, patients' opinions are evaluated. Material and methods Seventy breast cancer patients referred for postoperative radiotherapy after conservative surgery were enrolled. Patients were assigned to use one of the 7 topical agents that are most-commonly used in the prevention of ARD. Patients' reports were assessed using continuous visual analogue scales (VAS), objective signs and symptoms produced by ARD, and were rated using the RTOG and RISRAS scales. Results The creams tested differed in their cosmetic properties significantly (p = 0.044). The performance of the agent, their absorption and any residue left over were also significantly different (p = 0.022, 0.014 and 0.02, respectively). Conclusions Topical agents for preventive ARD are reported by patients to show different cosmetic properties. Cosmetic properties are important when choosing topical agents for ARD prevention. Recommending those with better cosmetic profiles would improve patient adherence to treatments.
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Influence of body habitus on dose parameters of nodal levels III to IV irradiation for breast cancer: comparison of 3 techniques. Med Dosim 2017; 43:328-333. [PMID: 29223303 DOI: 10.1016/j.meddos.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/25/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022]
Abstract
This study aimed to investigate the effect of body habitus on supraclavicular (SC) dose-volume histogram (DVH) parameters among breast cancer patients according to 3 different techniques. Three SC irradiation plans were generated for 24 postoperative breast cancer patients: (1) direct antero-posterior field only (1fieldP), with dose prescribed to a 3-cm depth; (2) 3-cm depth plan (3cmP) using an antero-posterior field plus a posterior boost with the dose prescription defined to 3 cm; and (3) optimized plan (OptP) similar to 3cmP, with dose prescribed depending on the anatomy. The OptP plans had the least variation in DVH parameters with body habitus; 3cmP plans were the most varied. Conformity index among normal weight patients were 0.73, 0.78, and 0.87 (p = 0.02) and 0.61, 0.6, and 0.82 among overweight-obese patients for 1fieldP, 3cmP, and OptP, respectively (p < 0.001). V95% of the planning target volume among normal weight patients were 72.63%, 78.03%, and 87.18% for 1fieldP, 3cmP, and OptP, respectively (p = 0.02). The corresponding values among overweight-obese patients were 60.5%, 59.62%, and 81.62%, respectively (p = 0.001). Fixed depth dose prescriptions caused greater SC under dose than plans optimized according to patient's anatomy.
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Individualized 3D scanning and printing for non-melanoma skin cancer brachytherapy: a financial study for its integration into clinical workflow. J Contemp Brachytherapy 2017; 9:270-276. [PMID: 28725252 PMCID: PMC5509979 DOI: 10.5114/jcb.2017.68134] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/15/2017] [Indexed: 01/17/2023] Open
Abstract
Purpose Skin cancer is the most common tumor in the population. There are different therapeutic modalities. Brachytherapy is one of the techniques used, in which it is necessary to build customized moulds for some patients. Currently, these moulds are made by hand using rudimentary techniques. We present a new procedure based on 3D printing and the analysis of the clinical workflow. Material and methods Moulds can be made either by hand or by automated 3D printing. For making moulds by hand, a patient’s alginate negative is created and, from that, the gypsum cast and customized moulds are made by hand from the patient’s negative template. The new process is based on 3D printing. The first step is to take a 3D scan of the surface of the patient and then, 3D modelling software is used to obtain an accurate anatomical reconstruction of the treatment area. We present the clinical workflow using 3D scanning and printing technology, comparing its costs with the usual custom handmade mould protocol. Results The time spent for the new process is 6.25 hours, in contrast to the time spent for the conventional process, which is 9.5 hours. We found a 34% reduction in time required to create a mould for brachytherapy treatment. The labor cost of the conventional process is 211.5 vs. 152.5 hours, so the reduction is 59 hours. There is also a 49.5% reduction in the financial costs, mostly due to lack of need of a computed tomography (CT) scan of the gypsum and the mould. 3D scanning and printing offers financial benefits and reduces the clinical workload. Conclusions As the present project demonstrates, through the application of 3D printing technologies, the costs and time spent during the process in the clinical workload in brachytherapy treatment are reduced. Overall, 3D printing is a promising technique for brachytherapy that might be well received in the community.
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Gerardina S, Edy I, Sonia S, Cristina DV, Carla Germana R, Diego G, Michele F, Lucio T, Maria DR, Sara R. A new three-dimensional conformal radiotherapy (3DCRT) technique for large breast and/or high body mass index patients: evaluation of a novel fields assessment aimed to reduce extra-target-tissue irradiation. Br J Radiol 2016; 89:20160039. [PMID: 27355127 DOI: 10.1259/bjr.20160039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To develop an alternative three-dimensional treatment plan with standardized fields class solution for whole-breast radiotherapy in patients with large/pendulous breast and/or high body mass index (BMI). METHODS Two treatment plans [tangential fields and standardized five-fields technique (S5F)] for a total dose of 50 Gy/25 fractions were generated for patients with large breasts [planning target volume (PTV) >1000 cm(3) and/or BMI >25 kg m(-2)], supine positioned. S5F plans consist of two wedged tangential beams, anteroposterior: 20° for the right breast and 340° for the left breast, and posteroanterior: 181° for the right breast and 179° for the left breast. A field in field in medial-lateral beam and additional fields were added to reduce hot spot areas and extra-target-tissue irradiation and to improve dose distribution. The percentage of PTV receiving 95% of the prescribed dose (PTV V95%), percentage of PTV receiving 105% of the prescribed dose (PTV V105%), maximal dose to PTV (PTV Dmax), homogeneity index (HI) and conformity index were recorded. V10%, V20%, V105% and V107% of a "proper" normal tissue structure (body-PTV healthy tissue) were recorded. Statistical analyses were performed using SYSTAT v.12.0 (SPSS, Chicago, IL). RESULTS In 38 patients included, S5F improved HI (8.4 vs 10.1; p ≤ 0.001) and significantly reduced PTV Dmax and PTV V105%. The extra-target-tissue irradiation was significantly reduced using S5F for V105% (cm(3)) and V107% (cm(3)) with a very high difference in tissue irradiation (46.6 vs 3.0 cm(3), p ≤ 0.001 for V105% and 12.2 vs 0.0 cm(3), p ≤ 0.001 for V107% for tangential field and S5F plans, respectively). Only a slight increase in low-dose extra-target-tissue irradiation (V10%) was observed (2.2719 vs 1.8261 cm(3), p = 0.002). CONCLUSION The S5F technique in patients with large breast or high BMI increases HI and decreases hot spots in extra-target-tissues and can therefore be easily implemented in breast cancer radiotherapy. ADVANCES IN KNOWLEDGE The treatment planning strategy proposed in this study has several advantages: (a) it is extremely reliable as the standard supine positioning is used; (b) the standardized class solution allows for widespread use;
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Affiliation(s)
| | - Ippolito Edy
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Silipigni Sonia
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | | | | | - Gaudino Diego
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Fiore Michele
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | - Trodella Lucio
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
| | | | - Ramella Sara
- Radiotherapy Unit, Campus Bio-Medico University, Rome, Italy
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Beck RE, Kim L, Yue NJ, Haffty BG, Khan AJ, Goyal S. Treatment techniques to reduce cardiac irradiation for breast cancer patients treated with breast-conserving surgery and radiation therapy: a review. Front Oncol 2014; 4:327. [PMID: 25452938 PMCID: PMC4231838 DOI: 10.3389/fonc.2014.00327] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/30/2014] [Indexed: 12/25/2022] Open
Abstract
Thousands of women diagnosed with breast cancer each year receive breast-conserving surgery followed by adjuvant radiation therapy. For women with left-sided breast cancer, there is risk of potential cardiotoxicity from the radiation therapy. As data have become available to quantify the risk of cardiotoxicity from radiation, strategies have also developed to reduce the dose of radiation to the heart without compromising radiation dose to the breast. Several broad categories of techniques to reduce cardiac radiation doses include breath hold techniques, prone positioning, intensity-modulated radiation therapy, and accelerated partial breast irradiation, as well as many small techniques to improve traditional three-dimensional conformal radiation therapy. This review summarizes the published scientific literature on the various techniques to decrease cardiac irradiation in women treated to the left breast for breast cancer after breast-conserving surgery.
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Affiliation(s)
- Robert E Beck
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Leonard Kim
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Atif J Khan
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey , New Brunswick, NJ , USA
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