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Moradi S, Hashemi B, Bakhshandeh M, Banaei A, Mofid B. Introducing new plan evaluation indices for prostate dose painting IMRT plans based on apparent diffusion coefficient images. Radiat Oncol 2022; 17:193. [PMID: 36419067 PMCID: PMC9685857 DOI: 10.1186/s13014-022-02163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dose painting planning would be more complicated due to different levels of prescribed doses and more complex evaluation with conventional plan quality indices considering uniform dose prescription. Therefore, we tried to introduce new indices for evaluating the dose distribution conformity and homogeneity of treatment volumes based on the tumoral cell density and relative volumes of each lesion in prostate IMRT. METHODS CT and MRI scans of 20 male patients having local prostate cancer were used for IMRT DP planning. Apparent diffusion coefficient (ADC) images were imported to a MATLAB program to identify lesion regions based on ADC values automatically. Regions with ADC values lower than 750 mm2/s and regions with ADC values higher than 750 and less than 1500 mm2/s were considered CTV70Gy (clinical tumor volume with 70 Gy prescribed dose), and CTV60Gy, respectively. Other regions of the prostate were considered as CTV53Gy. New plan evaluation indices based on evaluating the homogeneity (IOE(H)), and conformity (IOE(C)) were introduced, considering the relative volume of each lesion and cellular density obtained from ADC images. These indices were compared with conventional homogeneity and conformity indices and IOEs without considering cellular density. Furthermore, tumor control probability (TCP) was calculated for each patient, and the relationship of the assessed indices were evaluated with TCP values. RESULTS IOE (H) and IOE (C) with considering cellular density had significantly lower values compared to conventional indices and IOEs without considering cellular density. (P < 0.05). TCP values had a stronger relationship with IOE(H) considering cell density (R2 = -0.415), and IOE(C) without considering cell density (R2 = 0.624). CONCLUSION IOE plan evaluation indices proposed in this study can be used for evaluating prostate IMRT dose painting plans. We suggested to consider cell densities in the IOE(H) calculation formula and it's appropriate to calculate IOE(C) without considering cell density values.
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Affiliation(s)
- Saman Moradi
- grid.412266.50000 0001 1781 3962Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 1411713116 Iran
| | - Bijan Hashemi
- grid.412266.50000 0001 1781 3962Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 1411713116 Iran
| | - Mohsen Bakhshandeh
- grid.411600.2Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, 1985717443 Iran
| | - Amin Banaei
- grid.412266.50000 0001 1781 3962Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, 1411713116 Iran
| | - Bahram Mofid
- grid.411600.2Department of Radiation Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 1985717443 Iran
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Li Y, Liu H, Huang N, Wang Z, Zhang C. Using Cherenkov imaging to monitor the match line between photon and electron radiation therapy fields on biological tissue phantoms. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200268RR. [PMID: 33300317 PMCID: PMC7725107 DOI: 10.1117/1.jbo.25.12.125001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
SIGNIFICANCE Due to patients' respiratory movement or involuntary body movements during breast cancer radiotherapy, the mismatched adjacent fields in surface exposure regions could result in insufficient dosage or overdose in these regions, which would lead to tissue injury, excessive skin burns, and potential death. Cherenkov luminescence imaging (CLI) could be used to effectively detect the matching information of adjacent radiation fields without extra radiation or invasive imaging. AIM Our objective was to provide a biological experimental basis for monitoring matching of adjacent radiation fields between photon and electron fields due to introduced shifts during radiotherapy by CLI technique. APPROACH A medical accelerator was used to generate photon and electron fields. An industrial camera system was adopted to image the excited CLI signal during irradiation of chicken tissue with yellow (group A and group C experiments) or black color (group B experiment). The following introduced shifts were tested: 10, 5, 2, and 0 mm toward superior or inferior direction. A model was introduced to deal with matching error analysis of adjacent radiation fields due to introduced shifts with adapted plans used to treat neoplasms of the right breast with supraclavicular nodes or internal mammary lymph node. RESULTS The matching values between photon and electron fields were consistent with the tested introduced shifts during yellow chicken irradiation. In group A, average discrepancies were 0.59 ± 0.35 mm and 0.68 ± 0.37 mm for photon fields and electron fields in anterior/posterior (AP) direction, with 87% and 75% of measurement within 1 mm, respectively. In group C, average discrepancies were 0.80 ± 0.65 mm and 1.07 ± 0.57 mm for oblique photon field with gantry angles of 330 deg and 150 deg, with 66% and 65% of measurement within 1 mm, respectively. The average discrepancies were 0.44 ± 0.30 mm for electron field in the AP direction, with 94% of measurement within 1 mm. The matching error introduced by the proposed method was less than 1.5 mm for AP fields and 2 mm for oblique incidence fields. However, the field matching could not be monitored with black chicken tissue irradiation due to a weak CLI signal that could hardly be extracted from background noise in group B. CONCLUSIONS CLI is demonstrated for the quantitative monitoring of the field match line on light biological tissue phantoms and has potential for monitoring of field matching in surface tissue during breast cancer radiotherapy.
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Affiliation(s)
- Yi Li
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
- Xi’an Jiaotong University, School of Physics, Xi’an, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Hongjun Liu
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
- Shanxi University, Collaborative Innovation Center of Extreme Optics, Taiyuan, China
| | - Nan Huang
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
| | - Zhaolu Wang
- Chinese Academy of Sciences, Xi’an Institute of Optics and Precision Mechanics, State Key Laboratory of Transient Optics and Photonics, Xi’an, China
| | - Chunmin Zhang
- Xi’an Jiaotong University, School of Physics, Xi’an, China
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La radiothérapie externe guidée par l’imagerie dans le cancer de la prostate ; comment, quand et pourquoi ? Cancer Radiother 2018; 22:586-592. [DOI: 10.1016/j.canrad.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 06/29/2018] [Indexed: 12/14/2022]
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The Use of Ultrasound Imaging in the External Beam Radiotherapy Workflow of Prostate Cancer Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7569590. [PMID: 29619375 PMCID: PMC5829356 DOI: 10.1155/2018/7569590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/13/2017] [Accepted: 12/28/2017] [Indexed: 12/16/2022]
Abstract
External beam radiotherapy (EBRT) is one of the curative treatment options for prostate cancer patients. The aim of this treatment option is to irradiate tumor tissue, while sparing normal tissue as much as possible. Frequent imaging during the course of the treatment (image guided radiotherapy) allows for determination of the location and shape of the prostate (target) and of the organs at risk. This information is used to increase accuracy in radiation dose delivery resulting in better tumor control and lower toxicity. Ultrasound imaging is harmless for the patient, it is cost-effective, and it allows for real-time volumetric organ tracking. For these reasons, it is an ideal technique for image guidance during EBRT workflows. Review papers have been published in which the use of ultrasound imaging in EBRT workflows for different cancer sites (prostate, breast, etc.) was extensively covered. This new review paper aims at providing the readers with an update on the current status for prostate cancer ultrasound guided EBRT treatments.
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Yu AS, Najafi M, Hristov DH, Phillips T. Intrafractional Tracking Accuracy of a Transperineal Ultrasound Image Guidance System for Prostate Radiotherapy. Technol Cancer Res Treat 2017; 16:1067-1078. [PMID: 29332454 PMCID: PMC5762073 DOI: 10.1177/1533034617728643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the tracking accuracy of a commercial ultrasound system under relevant treatment conditions and demonstrate its clinical utility for detecting significant treatment deviations arising from inadvertent intrafractional target motion. METHODS A multimodality male pelvic phantom was used to simulate prostate image-guided radiotherapy with the system under evaluation. Target motion was simulated by placing the phantom on a motion platform. The tracking accuracy of the ultrasound system was evaluated using an independent optical tracking system under the conditions of beam-on, beam-off, poor image quality with an acoustic shadow introduced, and different phantom motion cycles. The time delay between the ultrasound-detected and actual phantom motion was investigated. A clinical case example of prostate treatment is presented as a demonstration of the utility of the system in practice. RESULTS Time delay between the motion phantom and ultrasound tracking system is 223 ± 45.2 milliseconds including video and optical tracking system frame rates. The tracking accuracy and precision were better with a longer period. The precision of ultrasound tracking performance in the axial (superior-inferior) direction was better than that in the lateral (left-right) direction (root mean square errors are 0.18 and 0.25 mm, respectively). The accuracy of ultrasound tracking performance in the lateral direction was better than that in the axial direction (the mean position errors are 0.23 and 0.45 mm, respectively). Interference by radiation and image quality do not affect tracking ability significantly. Further, utilizing the tracking system as part of a clinical study for prostate treatment further verified the accuracy and clinical appropriateness. CONCLUSIONS It is feasible to use transperineal ultrasound daily to monitor prostate motion during treatment. Our results verify the accuracy and precision of an ultrasound system under typical external beam treatment conditions and further demonstrate that the tracking system was able to identify important prostate shifts in a clinical case.
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Affiliation(s)
- Amy S Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Mohammad Najafi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Dimitre H Hristov
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Tiffany Phillips
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
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Su L, Iordachita I, Zhang Y, Lee J, Ng SK, Jackson J, Hooker T, Wong J, Herman JM, Sen HT, Kazanzides P, Lediju Bell MA, Yang C, Ding K. Feasibility study of ultrasound imaging for stereotactic body radiation therapy with active breathing coordinator in pancreatic cancer. J Appl Clin Med Phys 2017; 18:84-96. [PMID: 28574192 PMCID: PMC5529166 DOI: 10.1002/acm2.12100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/20/2016] [Accepted: 03/31/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) allows for high radiation doses to be delivered to the pancreatic tumors with limited toxicity. Nevertheless, the respiratory motion of the pancreas introduces major uncertainty during SBRT. Ultrasound imaging is a non-ionizing, non-invasive, and real-time technique for intrafraction monitoring. A configuration is not available to place the ultrasound probe during pancreas SBRT for monitoring. METHODS AND MATERIALS An arm-bridge system was designed and built. A CT scan of the bridge-held ultrasound probe was acquired and fused to ten previously treated pancreatic SBRT patient CTs as virtual simulation CTs. Both step-and-shoot intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) planning were performed on virtual simulation CT. The accuracy of our tracking algorithm was evaluated by programmed motion phantom with simulated breath-hold 3D movement. An IRB-approved volunteer study was also performed to evaluate feasibility of system setup. Three healthy subjects underwent the same patient setup required for pancreas SBRT with active breath control (ABC). 4D ultrasound images were acquired for monitoring. Ten breath-hold cycles were monitored for both phantom and volunteers. For the phantom study, the target motion tracked by ultrasound was compared with motion tracked by the infrared camera. For the volunteer study, the reproducibility of ABC breath-hold was assessed. RESULTS The volunteer study results showed that the arm-bridge system allows placement of an ultrasound probe. The ultrasound monitoring showed less than 2 mm reproducibility of ABC breath-hold in healthy volunteers. The phantom monitoring accuracy is 0.14 ± 0.08 mm, 0.04 ± 0.1 mm, and 0.25 ± 0.09 mm in three directions. On dosimetry part, 100% of virtual simulation plans passed protocol criteria. CONCLUSIONS Our ultrasound system can be potentially used for real-time monitoring during pancreas SBRT without compromising planning quality. The phantom study showed high monitoring accuracy of the system, and the volunteer study showed feasibility of the clinical workflow.
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Affiliation(s)
- Lin Su
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Iulian Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Yin Zhang
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Junghoon Lee
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Sook Kien Ng
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Juan Jackson
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Ted Hooker
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - John Wong
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph M Herman
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - H Tutkun Sen
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Kazanzides
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | | | - Chen Yang
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA.,Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Kai Ding
- School of Medicine, Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
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Pang EPP, Knight K, Baird M, Tuan JKL. Inter- and intra-observer variation of patient setup shifts derived using the 4D TPUS Clarity system for prostate radiotherapy. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa63fb] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pang EPP, Knight K, Baird M, Loh JMQ, Boo AHS, Tuan JKL. A comparison of interfraction setup error, patient comfort, and therapist acceptance for 2 different prostate radiation therapy immobilization devices. Adv Radiat Oncol 2017; 2:125-131. [PMID: 28740923 PMCID: PMC5514259 DOI: 10.1016/j.adro.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/12/2016] [Accepted: 02/08/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Our purpose was to investigate interfraction setup error of the immobilization device required to implement transperineal ultrasound compared with the current, standard immobilization device. Patient comfort and radiation therapist (RT) satisfaction were also assessed. METHODS AND MATERIALS Cone beam computed tomography images were acquired before 4069 fractions from 111 patients (control group, n = 56; intervention group, n = 55) were analyzed. The intervention group was immobilized using the Clarity Immobilization System (CIS), comprising a knee rest with autoscan probe kit and transperineal ultrasound probe (n = 55), and control group using a leg immobilizer (LI) (n = 56). Interfraction setup errors were compared for both groups. Weekly questionnaires using a 10-point visual analog scale were administered to both patient groups to measure and compare patient comfort. RT acceptance for both devices was also compared using a survey. RESULTS There was no significant difference in the magnitude of interfraction cone beam computed tomography-derived setup shifts in the lateral and anteroposterior direction between the LI and CIS (P = .878 and .690, respectively). However, a significant difference (P = .003) was observed in the superoinferior direction between the 2 groups of patients. Patient-reported level of comfort and stability demonstrated no significant difference between groups (P = .994 and .132). RT user acceptance measures for the LI and CIS were ease of handling (100% vs 53.7%), storage (100% vs 61.1%), and cleaning of the devices (100% vs 64.8%), respectively. CONCLUSIONS The CIS demonstrated stability and reproducibility in prostate treatment setup comparable to LI. The CIS device had no impact on patient comfort; however, RTs indicated a preference for LI over the CIS mainly because of its weight and bulkiness.
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Affiliation(s)
- Eric Pei Ping Pang
- Faculty of Medicine, Nursing and Health Sciences, Department of Medical Imaging and Radiation Sciences, Monash University, Wellington Road, Clayton, Victoria, Australia
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Corresponding author. Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore.Division of Radiation OncologyNational Cancer Centre Singapore11 Hospital DriveSingapore
| | - Kellie Knight
- Faculty of Medicine, Nursing and Health Sciences, Department of Medical Imaging and Radiation Sciences, Monash University, Wellington Road, Clayton, Victoria, Australia
| | - Marilyn Baird
- Faculty of Medicine, Nursing and Health Sciences, Department of Medical Imaging and Radiation Sciences, Monash University, Wellington Road, Clayton, Victoria, Australia
| | | | | | - Jeffrey Kit Loong Tuan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore
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Law G, Leung R, Lee F, Luk H, Lee KC, Wong F, Wong M, Cheung S, Lee V, Mui WH, Chan M. Effectiveness of a Patient-Specific Immobilization and Positioning System to Limit Interfractional Translation and Rotation Setup Errors in Radiotherapy of Prostate Cancers. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijmpcero.2016.53020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Three-Dimensional Ultrasound-Based Target Volume Delineation and Consequent Dose Calculation in Prostate Cancer Patients with Bilateral Hip Replacement: A Report of 4 Cases. TUMORI JOURNAL 2015; 101:e133-7. [DOI: 10.5301/tj.5000305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 01/04/2023]
Abstract
Aim To investigate the role of 3D ultrasound (3D-US) in target volume delineation in prostate cancer radiotherapy. Methods Four patients with intermediate risk prostate cancer and metal artifacts on planning computed tomography (CT) due to previous bilateral hip replacement underwent 3D-US with the Clarity platform (Clarity System, Elekta, Stockholm, Sweden) to allow for image-guided procedures. Ultrasound and CT images were coregistered to allow for better delineation of the prostate gland and organs at risk (OAR). Electron density override (EDO) and standard electron density (EDS) methods were compared for appropriate dose calculation. Results 3D-US and planning CT minimized image artifacts, providing better evidence of patient anatomy, particularly regarding soft tissue visualization. Prostate gland and seminal vesicles were better delineated, particularly in the posterior aspect. Anterior rectal wall and bladder neck were more visible. No difference was found in terms of average planning target volume dose, D15%, or D25% for rectum or D15%, D25%, or D35% of bladder between EDO and EDS. Conclusions 3D-US proved to be a viable tool for target volume and OAR visualization in patients with prostate cancer with hip prostheses.
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Hypofractionated Whole-Breast Radiotherapy and Concomitant Boost after Breast Conservation in Elderly Patients. TUMORI JOURNAL 2015; 102:196-202. [DOI: 10.5301/tj.5000402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 01/06/2023]
Abstract
Aims To report the 5- and 10-year results of accelerated hypofractionated whole-breast radiotherapy (WBRT) with concomitant boost to the tumor bed in 83 consecutive patients with early breast cancer aged >70 years. Methods All patients were treated with breast conservation and hypofractionated WBRT. The prescription dose to the whole breast was 45 Gy (2.25 Gy/20 fractions) with an additional daily concomitant boost of 0.25 Gy to the surgical cavity (2.5 Gy/20 fractions up to 50 Gy). The maximum detected toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. We considered as skin toxicity: erythema, edema, desquamation, ulceration, hemorrhage, necrosis, telangiectasia, fibrosis-induration, hyperpigmentation, retraction and atrophy. Cosmetic results were assessed as set by the Harvard criteria. Results With a median follow-up of 60 months (range 36-88), no local recurrence was observed. The maximum detected acute skin toxicity was G0 in 57% of patients, G1 in 40% and G2 in 3%. Late skin and subcutaneous toxicity was generally mild with no ≥G3 events. The cosmetic results were excellent in 69% of patients, good in 22%, fair in 5%, and poor in 4%. Conclusions The present results support the use of hypofractionation employing a concomitant boost to the lumpectomy cavity in women aged >70 years. This is a convenient treatment option for both this type of population and health-care providers.
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