A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

Yu, Ting; Li, Yankang; Sun, Tao; Xu, Min; Wang, Wei; Shao, Qing; Zhang, Yingjie; Li, Jianbin; J, Yu

doi:10.1038/s41598-021-97520-z

Cited by 4 publications

(5 citation statements)

References 42 publications

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“…As a pioneering study utilizing H-VMAT when comparing dosimetric parameters between SEQ-HFWBI and SIB-HFWBI, we found the CI value for both plans was close to 1, aligning with the ideal value as suggested by previous studies. Additionally, the HI analysis indicated that the SIB plans exhibited better dose homogeneity for the tumor bed (PTVtb) and the whole breast excluding the tumor bed (PTVwb-tb) compared to the SEQ plans, consistent with ndings from Yu et al [17].…”

Section: Dosimetric Evaluationsupporting

confidence: 84%

Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment

Dong,

Lin,

Qiu

et al. 2024

Preprint

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Background This study aimed to compare dosimetry of the target region and organ at risk (OAR) according to two different radiation plans for patients after breast-conserving surgery (BCS), hypofractionated whole breast irradiation (HFWBI) combined with an additional sequential boost (SEQ) versus simultaneous integrated boost (SIB), and further explore better radiotherapy after breast-conserving surgery. Methods We included 56 patients with early-stage left-sided breast cancer. Hybrid volumetric modulated arc therapy (H-VMAT) plus sentinel lymph node biopsy was given to all participants. The following SIB and SEQ treatments were planned for each patient. The radiation doses delivered to OAR and dose-volume histogram were analyzed. The comparison of the max dose (Dmax), the mean dose (Dmean), the min dose (Dmin), and the volume of each organ that received x Gy (Vx) was accomplished. Results The V5, V10, and V20 of the heart and the ipsilateral lung were lower in the SIB plan than SEQ, while among patients receiving the SIB plan, the V5 and V10 of the right and the left ventricle were lower. The Dmean for the heart, left anterior descending (LAD), right ventricle, left ventricle and the ipsilateral lung was lower for the SIB plan (heart: 5.24 ± 0.75 Gy vs. 6.92 ± 0.92Gy, p < 0.001; lad: 9.27 ± 1.07Gy vs. 11.86 ± 1.40Gy, p < 0.001; right ventricle 6.39 ± 1.54Gy vs. 8.39 ± 1.88Gy, left ventricle 6.10 ± 1.33Gy vs. 8.54 ± 1.80Gy, p < 0.001; lung: 9.28 ± 1.07Gy vs. 11.86 ± 1.41Gy, p < 0.001). Conclusions Regarding the dosimetry among the heart, LAD, ventricle, and left lung, SIB radiotherapy achieved better results, suggesting that the SIB plan might be more suitable for postoperative radiotherapy after BCS for early-stage breast cancer patients. We also witnessed that large daily radiation doses could be safe and effective when combined with the radiobiology of breast cancer.

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Section: Dosimetric Evaluationsupporting

confidence: 84%

Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment

Dong,

Lin,

Qiu

et al. 2024

Preprint

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“…Few reports are available on the dosimetric feasibility of HF-SIB, which has not yet been widely adopted clinically for breast cancer. Yu T et al [ 28 ] dosimetrically compared HF-WBI with SEQ versus SIB in the supine and prone positions using three-dimensional conformal RT with the field-in-field technique. The dose prescribed for WBI was 40.05 Gy in 15 fractions, while that of the tumor bed was 9.6 Gy in 3 fractions for SEQ and 48 Gy in 15 fractions for SIB.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Heart and Lung Doses According to Tumor Bed Boost Techniques in Early-Stage Left-Sided Breast Cancer: Simultaneous Integrated Boost versus Sequential Boost

Kim

Lee

et al. 2022

Medicina

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Background and Objectives: The boost dose to the tumor bed after whole breast irradiation (WBI) can be divided into sequential boost (SEQ) and simultaneous integrated boost (SIB). SIB using modern radiation therapy (RT) techniques, such as volumetric modulated arc therapy, allow the delivery of a highly conformal dose to the target volume and has a salient ability to spare at-risk organs. This study aimed to compare the radiation dose delivered to the heart and lungs according to boost technique and tumor bed location. Materials and Methods: RT planning data of 20 patients with early-stage left-sided breast cancer were used in this study. All patients were treated with volumetric modulated arc therapy after breast-conserving surgery with a sentinel lymph node biopsy. For each patient, two different plans, whole breast irradiation with simultaneous integrated boost (WBI-SIB) and sequential boost after WBI (WBI-SEQ), were generated. To compare the dose received by each organ at risk (OAR), dose-volume histogram data were analyzed. The mean dose (Dmean) and volume of each organ that received x Gy (Vx) were calculated and compared. Results: For the heart, the V10 was lower for the WBI-SIB plan than for the WBI-SEQ plan (5.223 ± 1.947% vs. 6.409 ± 2.545%, p = 0.008). For the left lung, the V5 was lower in the WBI-SIB plan than for the WBI-SEQ plan (27.385 ± 3.871% vs. 32.092 ± 3.545%, p < 0.001). The Dmean for the heart and left lung was lower for the WBI-SIB plan than for the WBI-SEQ plan (heart: 339.745 ± 46.889 cGy vs. 413.030 ± 52.456 cGy, p < 0.001; left lung: 550.445 ± 65.094 cGy vs. 602.270 ± 55.775 cGy, p < 0.001). Conclusions: The WBI-SIB plan delivered lower radiation doses to the heart and left lung than the WBI-SEQ plan in terms of Dmean and low-dose volume in hypofractionated RT of early-stage left-sided breast cancer patients. Furthermore, a large radiation dose per day may be advantageous, considering the radiobiologic aspects of breast cancer. Long-term follow-up data are needed to determine whether the dosimetric advantages of the WBI-SIB plan can lead to clinically improved patient outcomes and reduced late side effects.

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“…Recent emphasis on the significance of preoperative MRI selection has been highlighted across various tumor radiotherapy contexts 23,24 . Prone positioning during whole‐breast radiotherapy offers advantages such as improved target conformity, dose homogeneity, reduced dose to organs at risk, and mitigation of acute radiation skin injury, 25,26 especially in patients with larger breasts 27–30 . Consequently, radiotherapy in the prone position after BCS is increasingly being used in patients with early‐stage breast cancer.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Prone positioning during whole-breast radiotherapy offers advantages such as improved target conformity, dose homogeneity, reduced dose to organs at risk, and mitigation of acute radiation skin injury, 25,26 especially in patients with larger breasts. [27][28][29][30] Consequently, radiotherapy in the prone position after BCS is increasingly being used in patients with early-stage breast cancer. This study aimed to investigate the use of preoperative MRI in guiding LC delineation in patients with BCS.…”

Section: Correlation Analysismentioning

confidence: 99%

Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast‐conserving surgery

Jin,

Zhao,

Wang

et al. 2024

Cancer Medicine

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BackgroundThis study investigated the differences in target volumes between preoperative magnetic resonance imaging (MRIpre) and postoperative MRI (MRIpost) for breast radiotherapy after breast‐conserving surgery (BCS) using deformable image registration (DIR).Methods and MaterialsSeventeen eligible patients who underwent whole‐breast irradiation in the prone position after BCS were enrolled. On MRIpre, the gross tumor volume (GTV) was delineated as GTVpre, which was then expanded by 10 mm to represent the preoperative lumpectomy cavity (LC), denoted as LCpre. The LC was expanded to the clinical target volume (CTV) and planning target volume (PTV) on the MRIpre and MRIpost, denoted as CTVpre, CTVpost, PTVpre, and PTVpost, respectively. The MIM software system was used to register the MRIpre and MRIpost using DIR. Differences were evaluated regarding target volume, distance between the centers of mass (dCOM), conformity index (CI), and degree of inclusion (DI). The relationship between CILC/CIPTV and the clinical factors was also assessed.ResultsSignificant differences were observed in LC and PTV volumes between MRIpre and MRIpost (p < 0.0001). LCpre was 0.85 cm3 larger than LCpost, while PTVpre was 29.38 cm3 smaller than PTVpost. The dCOM between LCpre and LCpost was 1.371 cm, while that between PTVpre and PTVpost reduced to 1.348 cm. There were statistically significant increases in CI and DI for LCpost–LCpre and PTVpost–PTVpre (CI = 0.221, 0.470; DI = 0.472, 0.635). No obvious linear correlations (p > 0.05) were found between CI and GTV, primary tumor volume‐to‐breast volume ratio, distance from the primary tumor to the nipple and chest wall, and body mass index.ConclusionsDespite using DIR technology, the spatial correspondence of target volumes between MRIpre and MRIpost was suboptimal. Therefore, relying solely on preoperative diagnostic MRI with DIR for postoperative LC delineation is not recommended.

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A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery

Cited by 4 publications

References 42 publications

Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment

Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment

Comparison of Heart and Lung Doses According to Tumor Bed Boost Techniques in Early-Stage Left-Sided Breast Cancer: Simultaneous Integrated Boost versus Sequential Boost

Target volumes comparison between postoperative simulation magnetic resonance imaging and preoperative diagnostic magnetic resonance imaging for prone breast radiotherapy after breast‐conserving surgery

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