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Song YQ, Hong J, Wang JY, Peng J, Han JH, Luo HL. Dosimetric comparison of different intensity-modulated radiotherapy techniques for whole-breast irradiation of right-breast cancer. Cancer Radiother 2023; 27:11-16. [PMID: 35879144 DOI: 10.1016/j.canrad.2022.04.009] [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: 02/24/2022] [Revised: 04/02/2022] [Accepted: 04/11/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE This study compared the dosimetric parameters of field-in-field forward intensity-modulated radiotherapy (FIF-IMRT) and fixed-field inversely optimized intensity-modulated radiotherapy (FFIO-IMRT) for the whole-breast irradiation of patients undergoing right-breast lumpectomy. MATERIAL AND METHODS A total of 30 patients with pT1-2N0M0 right-breast invasive ductal carcinoma were enrolled in this study. Two different treatment plans, i.e., FIF-IMRT and FFIO-IMRT, were designed for each patient. The dosimetric parameters of the two treatment plans were compared including ipsilateral lung and heart, conformity index (CI), and the homogeneity index (HI) of the planning target volume (PTV). RESULTS Fixed-field inversely optimized intensity-modulated radiotherapy was found to significantly improve CI (83.302% vs. 60.146%) and HI (11.837% vs. 19.280%), and significantly reduced V25 (18.038% vs. 19.653%) and V30 (15.790% vs. 18.492%) of the ipsilateral lung. It also significantly increased V5 (69.791% vs. 32.615%) of the ipsilateral lung and V5 (61.579% vs. 3.829%), V10 (14.130% vs. 0.381%), V20 (1.843% vs. 0.051%), and Dmean (5.211Gy vs. 1.870Gy) of the heart. CONCLUSION Regardless of improving the conformity and homogeneity of PTV and reducing the ipsilateral lung irradiation volume at high doses, FFIO-IMRT significantly raised the ipsilateral lung irradiated volume at low doses, as well as the irradiation volume and mean radiation doses to the heart. This limits its use in patients with early-stage right breast cancer.
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Affiliation(s)
- Y-Q Song
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J Hong
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J-Y Wang
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J Peng
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - J-H Han
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China
| | - H-L Luo
- Department of Radiation Oncology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, 223300 Huaian Jiangsu, China.
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Chen H, Piao Y, Yang D, Kuang P, Li Z, Liao G, Zhong H. The effect of respiratory capacity for dose sparing in left-sided breast cancer irradiation with active breathing coordinator technique. Front Oncol 2022; 12:989220. [PMID: 36263201 PMCID: PMC9576200 DOI: 10.3389/fonc.2022.989220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aimA subsequent cardiac toxicity is deemed to be dose-dependent for left-sided breast cancer irradiation. This study aims to demonstrate the effect of respiratory capacity for dose sparing when the deep inspiration breath hold with Active Breathing Coordinator technique (ABC-DIBH) is used in left-sided breast cancer irradiation.Methods74 left-sided breast cancer patients, who received whole breast or post-mastectomy chest wall radiotherapy with ABC-DIBH between 2020 and 2021 in our center, were retrospectively reviewed in this study. CT scans of free breath (FB) and ABC-DIBH were done for each patient, and two treatment plans with a prescription dose of 5000 cGy/25 Fr were designed separately. The dose to heart, left anterior descending artery (LAD) and lungs was compared between FB and ABC-DIBH. The correlation between individual parameters (dose to organs at risk (OARs) and minimum heart distance (MHD)) was analyzed, and the effect of respiratory capacity for dose sparing was assessed.ResultsThe plans with ABC-DIBH achieved lower Dmean for heart (34.80%, P < 0.01) and LAD (29.33%, P < 0.01) than those with FB. Regression analysis revealed that both Dmean and D2 of heart were negatively correlated with MHD in the plans with FB and ABC-DIBH, which decreased with the increase in MHD by 37.8 cGy and 309.9 cGy per 1mm, respectively. Besides, a lower Dmean of heart was related to a larger volume of ipsilateral lung in plans with FB. With the increase in volume of ipsilateral lung, the linear correlation was getting weaker and weaker until the volume of ipsilateral lung reached 1700 cc. Meanwhile, a negative linear correlation between Dmean of LAD and MHD in plans with FB and ABC-DIBH was observed, whose slope was 162.5 and 135.9 cGy/mm, respectively. Furthermore, when the respiratory capacity of ABC-DIBH reached 1L, and the relative ratio (ABC-DIBH/FB) reached 3.6, patients could obtain the benefit of dose sparing. The larger difference in respiratory capacity had no significant effect in the larger difference of MHD, Dmean of heart and Dmean of LAD between FB and ABC-DIBH.ConclusionThis study demonstrates the sufficiently good effect of ABC-DIBH when utilizing for cardiac sparing. It also reveals the correlations among individual parameters and the effect of respiratory capacity for dose sparing. This helps take optimal advantage of the ABC-DIBH technique and predict clinical benefits.
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Affiliation(s)
| | - Ying Piao
- *Correspondence: Heli Zhong, ; Ying Piao,
| | | | | | | | | | - Heli Zhong
- *Correspondence: Heli Zhong, ; Ying Piao,
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Liu E, Guan X, Wei R, Jiang Z, Liu Z, Wang G, Chen Y, Wang X. Association Between Radiotherapy and Death From Cardiovascular Disease Among Patients With Cancer: A Large Population‐Based Cohort Study. J Am Heart Assoc 2022; 11:e023802. [PMID: 35253473 PMCID: PMC9075311 DOI: 10.1161/jaha.121.023802] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background This study aimed to investigate the association between radiotherapy for cancer and cardiovascular disease (CVD) deaths and evaluate the relative risk for CVD deaths in the general population and among patients with cancer treated with radiotherapy. Methods and Results The statistics of cancers from 16 sites were extracted from the Surveillance, Epidemiology, and End Results database and evaluated. Multivariable Cox proportional hazards regression analysis was used to analyze the association between radiotherapy and cardiovascular‐specific survival. The standardized mortality ratio for CVD deaths was estimated by comparing the observed deaths of patients with cancer treated with radiotherapy to the expected deaths of the general population. Of the 2 214 944 patients identified from the database, 292 102 (13.19%) died from CVD. Multivariable Cox proportional hazards regression analyses demonstrated that radiotherapy was an independent risk factor for cardiovascular‐specific survival among patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers. The long‐term cardiovascular‐specific survival of patients with cancer who underwent radiotherapy was significantly lower than that of patients who did not undergo radiotherapy. The incidence of CVD deaths among patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers who underwent radiotherapy was higher than that among the general population. Standardized mortality ratio significantly decreased with increasing age at cancer diagnosis, gradually decreased within 10 years of diagnosis and increased after 10 years of diagnosis. Conclusions Radiotherapy is associated with worse cardiovascular‐specific survival in patients with lung and bronchus, cervix uteri, corpus uteri, and urinary bladder cancers. Long‐term surveillance of cardiovascular conditions should be performed after radiotherapy.
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Affiliation(s)
- Enrui Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xu Guan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ran Wei
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zheng Jiang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zheng Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Guiyu Wang
- The Second Affiliated Hospital of Harbin Medical University Harbin China
- Cancer Hospital of The University of Chinese Academy of Sciences Hangzhou China
| | - Yinggang Chen
- Cancer Hospital Chinese Academy of Medical Sciences Shenzhen Center, Shenzhen China
| | - Xishan Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Chan TY, Tang JI, Tan PW, Roberts N. Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res 2018; 10:4853-4870. [PMID: 30425577 PMCID: PMC6205528 DOI: 10.2147/cmar.s172818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Neill Roberts
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Donis N, Oury C, Moonen M, Lancellotti P. Treating cardiovascular complications of radiotherapy: a role for new pharmacotherapies. Expert Opin Pharmacother 2018; 19:431-442. [DOI: 10.1080/14656566.2018.1446080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Nathalie Donis
- Laboratory of Thrombosis, Haemostasis and Valvular Heart Diseases, GIGA-Cardiovascular Sciences, Department of Cardiology, University of Liège, CHU Liège, Liège, Belgium
| | - Cécile Oury
- Laboratory of Thrombosis, Haemostasis and Valvular Heart Diseases, GIGA-Cardiovascular Sciences, Department of Cardiology, University of Liège, CHU Liège, Liège, Belgium
| | - Marie Moonen
- Laboratory of Thrombosis, Haemostasis and Valvular Heart Diseases, GIGA-Cardiovascular Sciences, Department of Cardiology, University of Liège, CHU Liège, Liège, Belgium
| | - Patrizio Lancellotti
- Laboratory of Thrombosis, Haemostasis and Valvular Heart Diseases, GIGA-Cardiovascular Sciences, Department of Cardiology, University of Liège, CHU Liège, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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Cabanne A, Schick U, Pradier O, Rivera S. [Establishing margins from CTV to PTV in breast cancer treatment]. Cancer Radiother 2016; 20:640-4. [PMID: 27614520 DOI: 10.1016/j.canrad.2016.07.083] [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: 06/27/2016] [Revised: 07/24/2016] [Accepted: 07/28/2016] [Indexed: 12/25/2022]
Abstract
The benefit of postoperative radiotherapy for breast cancer both in terms of local control and overall survival is widely acknowledged. Today, technological advances in simulation imaging and positioning control enable the definition of new margins from CTV to PTV. Improvements in mathematical modeling of random and systematic errors impact the treatment plans. However, there is no universal absolute value to consistently determine the margins from CTV to PTV. It is down to each centre to assess and correct as much as possible uncertainties due to positioning and internal movements depending on techniques and methods used for the implementation of treatment and monitoring. IMRT and respiratory gating techniques for breast radiotherapy will be considered more systematically in the years to come.
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Affiliation(s)
- A Cabanne
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29200 Brest, France.
| | - U Schick
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29200 Brest, France
| | - O Pradier
- Service de radiothérapie, CHRU Morvan, 2, avenue Foch, 29200 Brest, France
| | - S Rivera
- Service A de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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