Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT)

Baglan, Kathy; Sharpe, Michael B.; Jaffray, David A.; Frazier, Robert C.; Fayad, Julie; Kestin, Larry L.; Remouchamps, Vincent; Martínez, Álvaro; Wong, John W.; Vicini, Frank A.

doi:10.1016/s0360-3016(02)03811-7

Cited by 268 publications

(72 citation statements)

References 53 publications

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“…The issue of combining respiratory motion with setup uncertainties was not explicitly addressed in this work, as PBI margins are typically separated into setup (5 mm) and respiratory (5 mm) margin components. 8 Focusing on respiratory motion alone, van Herk et al 3 derived respiratory margin formulas in the craniocaudal direction using an ideal dose profile and periodic sin 6 respiratory motion, both symmetric and asymmetric. They found that the required margins were ∼0.3A in the caudal direction and ∼0.5A in the cranial direction.…”

Section: Discussionmentioning

confidence: 99%

“…The widely used 5 mm respiratory margin was originally suggested in the seminal PBI paper by Baglan et al 8 The margin was based on a study monitoring surgical clip motion in 16 PBI patients, where a conservative symmetric respiratory margin of 5 mm was chosen based on the observed mean range of motion of 6 mm (range: 3-9 mm), allowing for a geometric extent of motion of 10 mm. A recent review of the respiratory motion literature in PBI (Ref.…”

Section: Discussionmentioning

confidence: 99%

“…This margin was conservatively determined from a small number of patients to cover the full extent of respiratory motion. 8 Subsequent studies have found that for most patients, the extent of respiratory motion is less than 5 mm (Ref. 9) and some authors have suggested that the PBI respiratory margin size could be decreased to facilitate increased normal tissue sparing.…”

Section: Introductionmentioning

confidence: 99%

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Realistic respiratory motion margins for external beam partial breast irradiation

2015

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A methodology for determining population-based respiratory margins using real respiratory motion patterns and dose profiles in the AP direction was described. It was found that the currently used respiratory margin of 5 mm in partial breast irradiation may be overly conservative for many 3DCRT PBI patients. Amplitude alone was found to be insufficient to determine patient-specific margins: individual respiratory trace shape and baseline drift both contributed to the dosimetric target coverage. With respiratory coaching, individualized respiratory margins smaller than the full extent of motion could reduce planning target volumes while ensuring adequate coverage under respiratory motion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Realistic respiratory motion margins for external beam partial breast irradiation

2015

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“…Baglan KL et al [21] presented a 3D-CRT technique for partial breast irradiation in supine position. The prescribed dose was 34 Gy in 5 patients and 38.5 Gy in 4 patients, delivered in 10 fractions twice daily over 5 consecutive days.…”

Section: Discussionmentioning

confidence: 99%

“…Recent prospective studies have thus explored the techniques of only treating the tumor bed of the breast, i.e. partial breast irradiation (PBI), for patients with early-stage breast cancer using different technical approaches [16][17][18][19][20][21][22][23][24]. These studies have investigated the use of low-dose-rate and high-doserate brachytherapy and the use of External-Beam Radiotherapy (EBRT) for partial breast irradiation.…”

Section: Introductionmentioning

confidence: 99%

Hypofractioned Radiation Therapy in the Treatment of Partial Breast: 30 Gy in Five Consecutive Fractions

Terenzi¹,

Barbarino²,

Falco³

et al. 2012

JCT

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Background and Purpose: Recent prospective studies have explored the partial breast irradiation (PBI) for patients with early-stage breast cancer using different technical approaches. The purpose of this study is to explore feasibility, tumor control and acute and late toxicity of a specific hypo-fractionated 3D-CRT when treating postmenopausal patients with early breast cancer with partial breast irradiation, using five fractions in five consecutive days. Materials and Methods: Ten patients, aged  70 underwent breast conservative surgery for invasive breast carcinoma with a complete microscopic resection; no lymphovascular invasion was found and negative axillary node status was assessed. Metal clips were positioned in the surgical bed at the time of surgery. All of the patients provided an informed consent for breast irradiation. Seven patients received Tamoxifen. Of the ten patients, five were treated for left breast disease, and five for right breast disease. The dose fractionation schedule was 3000 cGy delivered to the isocenter in 5 fractions (600 cGy/fr) using 6 MV photons. According to the linear quadratic model and a / ratio of 4 Gy this prescription is equivalent to 50 Gy in a standard 2-Gy fractionation schedule. Patients were treated in the supine position. A comercial breast board was used as immobilization device in order to keep the arms of the patient raised. The clinical target volume (CTV) was drawn with a uniform 1-cm three-dimensional margin around the surgical clips. The CTV was limited to 3 mm from the skin surface and 3 mm from the lung-chest wall interface. A three-dimensional margin was added to the CTV to obtain the planning target volume (PTV). The ipsilateral and controlateral breast, the ipsilateral and controlateral lung, heart and spinal cord were contoured as organs at risk (OAR). The treatment was developed using Precise Plan Treatment Planning System and four no-coplanar fields. The constraints used have been: uninvolved breast (ipsilateral breast-PTV): V 15  50%; heart: V 3  10%; ipsilateral lung: V 10  20%; controlateral lung: V 5  10% and controlateral breast: maximum dose  1 Gy. We required PTV coverage of 90%. Patient set-up was verified every day before treatment using portal images. No tumour bed boost was delivered. Clinical assessments of early normal tissue reaction were carried out every day during radiotherapy and 10 days after the end of the treatment. After radiotherapy, we visited all patients every 3 months during the first 2 years and every six month thereafter. Frontal and lateral pictures of the breast were taken on the first day of treatment (baseline), at the end of treatment, 10 days after the end of treatment and at the first follow-up. Any change in breast appearance compared with the baseline picture was scored on a four-point RTOG for acute and late radiation morbidity scoring scale. Results: No local or distant recurrences were observed and then confirmed by mammograms performed every year and breast ultrasound performed every six mont...

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Dosimetric benefits of gantry‐static couch‐motion (GsCM) technique for breast boost radiation therapy: Reduced dose to organs‐at‐risk and improved dosimetric indices

Gill

Jakubovic

Baker

et al. 2020

J Applied Clin Med Phys

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To evaluate the clinical feasibility and dosimetric benefits of a novel gantry‐static couch‐motion (GsCM) technique for external beam photon boost treatment of lumpectomy cavity in patients with early‐stage breast cancer in comparison to three‐dimensional conformal radiotherapy (3D‐CRT), wedge pair in supine position (WPS), and wedge pair in decubitus position (WPD) techniques. A retrospective review was conducted on breast patients (right breast, n = 10 and left breast, n = 10) who received 10 Gy boost after 50 Gy to whole breast. The treatment plans were generated using an isocentric‐based GsCM technique (a VMAT type planning approach) integrating couch rotational motion at static gantry positions. Static fields for each tangential side were merged using a Matlab® script and delivered automatically within the Varian TruebeamTM STx in Developer Mode application as a VMAT arc (wide‐angular medial and short‐angular lateral arcs). The dosimetric accuracy of the plan delivery was evaluated by ion chamber array measurements in phantom. For both right and left breast boost GsCM, 3D‐CRT, WPS, and WPD all provided an adequate coverage to PTV. GsCM significantly reduced the ipsilateral lung V30% for right side (mean, 80%) and left side (mean, 70%). Heart V5% reduced by 90% (mean) for right and 80% (mean) for left side. Ipsilateral breast V50% and mean dose were comparable for all techniques but for GsCM, V100% reduced by 50% (mean) for right and left side. The automated delivery of both arcs was under 2 min as compared to delivering individual fields (30 ± 5 min). The gamma analysis using 2 mm distance to agreement (DTA) and 2% dose difference (DD) was 98 ± 1.5% for all 20 plans. The GsCM technique facilitates coronal plane dose delivery appropriate for deep‐seated breast boost cavities, with sufficient dose conformity of target volume paired with sparing of the OARs.

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Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT)

Cited by 268 publications

References 53 publications

Realistic respiratory motion margins for external beam partial breast irradiation

Realistic respiratory motion margins for external beam partial breast irradiation

Hypofractioned Radiation Therapy in the Treatment of Partial Breast: 30 Gy in Five Consecutive Fractions

Dosimetric benefits of gantry‐static couch‐motion (GsCM) technique for breast boost radiation therapy: Reduced dose to organs‐at‐risk and improved dosimetric indices

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