Biological equivalent dose assessment of the consequences of hypofractionated radiotherapy

Jones, Bleddyn; Dale, Roger G.; Finst, P; Khaksar, S.

doi:10.1016/s0360-3016(00)00571-x

Cited by 63 publications

(44 citation statements)

References 10 publications

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“…This study aimed to investigate the impact of dose inhomogeneity on late adverse effects when hypofractionated schedules are introduced, since partial volumes absorbing >100% of prescribed dose suffer an increase in both total dose and dose per fraction, so-called double trouble [18]. Based on the linear-quadratic (LQ) formulation, hot spots are penalised more severely in a hypofractionated treatment, the so-called treble trouble effect [18,19].…”

Section: Discussionmentioning

confidence: 99%

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The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Tsang

Haviland

Venables

et al. 2012

Radiotherapy and Oncology

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a b s t r a c tBackground and purpose: Linear quadratic models predict that hypofractionation increases the biological effect of physical dose inhomogeneity. The clinical significance of this effect was tested retrospectively in a trial of adjuvant breast hypofractionation. Methods: The UK FAST trial randomised 915 women after breast conservation surgery between standard fractionation and two dose levels of a 5-fraction regimen delivering 5.7 or 6.0 Gy fractions in 5 weeks, using 3D dosimetry. Logistic regression tested for association between the absolute volumes receiving different isodose level >100% of prescribed dose (hotspots) and the risk of change in 2-year photographic breast appearance. The strength of this association was compared between control and hypofractionated groups. Results: Three hundred and ninety datasets from 11 participating centres were available for analysis. At 2 years post-randomisation, 81 (20.8%) had mild change and 24 (6.2%) had marked change in photographic breast appearance. After adjusting for breast size and surgical deficit, there was no statistically significant association between the risk of 2-year change in breast appearance and dose inhomogeneity in either the control or hypofractionated schedules, according to the various definitions of hotspots analysed. The magnitude of the effect of dosimetry on 2-year change in breast appearance did not vary significantly between control and hypofractionated schedules for any of the dosimetry parameters (p > 0.05 for all heterogeneity tests). Conclusion: Dose inhomogeneity had no greater impact on the risk of 2-year change in photographic breast appearance after hypofractionated breast radiotherapy than after standard fractionation.Ó 2012 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 104 (2012) 143-147The routine use of hypofractionation in breast radiotherapy is supported by outcome data of four large randomised clinical trials in women with early breast cancer [1][2][3][4][5][6][7]. Residual concerns include the impact of dose inhomogeneity on the risk of adverse effects after hypofractionated schedules, so-called 'treble trouble' [8][9][10]. A causal association between breast dose inhomogeneity and the risk of late tissue complications is suggested by the 5 years follow up results of a UK randomised trial (N = 306) comparing 2D versus 3D breast dosimetry [11]. Assuming dose distribution matters, it is not known if residual dose inhomogeneity in patients treated using 3D dose compensation contributes to a higher risk of adverse effects after hypofractionated radiotherapy than after standard regimens. Against this background, a retrospective analysis of a UK hypofractionation trial, which recently published its 2 years follow-up results [12], has been undertaken to test the hypothesis that residual dose inhomogeneity has a greater impact on late adverse effect in women prescribed hypofractionated whole breast radiotherapy, even when delivered in conformity with the International Commission on Radiation Units...

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Section: Discussionmentioning

confidence: 99%

“…Based on the linear-quadratic (LQ) formulation, hot spots are penalised more severely in a hypofractionated treatment, the so-called treble trouble effect [18,19]. In theory, the clinical effect is expected to be very small, but there is a lingering concern that it might matter in practice, especially if dosimetry is suboptimal.…”

Section: Discussionmentioning

confidence: 99%

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Tsang

Haviland

Venables

et al. 2012

Radiotherapy and Oncology

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“…When fraction size is increased, the total dose needs to be reduced, as already described. However, due to the mathematical form of the linear-quadratic dose-effect relationship, hot spots will be penalized more severely in a hypofractionated treatment, a phenomenon called triple-trouble (30). One way to look at this is by noticing that the steepness of the dose-response curve increases with increasing dose per fraction (31) and that this will tighten the required dose uniformity.…”

Section: Concern Relating To ''Triple-trouble''mentioning

confidence: 99%

Hypofractionated Whole-Breast Radiotherapy for Women With Early Breast Cancer: Myths and Realities

Yarnold

Bentzen

Coles

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

148

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“…''Hotspots'' cause more tissue damage than expected owing to the ''double trouble effect'', which describes the significance of a higher total dose and a higher dose per fraction, and this effect might be more important in a hypofractionated schedule, so-called ''triple trouble'' [27]. Turesson and Thames [28] suggested that the a/b for skin telangiectasia in breast radiotherapy was 2.8-4.3 Gy.…”

Section: Discussionmentioning

confidence: 99%

Quality assurance analysis of participating centres’ protocol compliance to a UK multicentre hypofractionated breast (FAST) trial

Tsang

Venables²,

Yarnold³

2012

BJR

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Objectives: The FAST (FASTer radiotherapy for breast radiotherapy) trial is a UK Phase 2 multicentre randomised clinical trial evaluating a five-fraction schedule of wholebreast radiotherapy following local excision of early breast cancer. The purpose of this quality assurance study was to analyse the radiotherapy planning data in order to confirm compliance with the trial protocol. Methods: 915 patients were recruited between 2004 and 2007 from 18 centres. The protocol required that all centres should use three-dimensional dose compensations to optimise radiotherapy plans. Planning techniques, maximum dose (D max ) and dosevolume histograms from treatment plans were evaluated and compared between centres. The homogeneity of plans was tested by creating a cut-off value of 5% for the percentage of breast volume receiving .105% of the prescribed dose. Results: 672 data sets from 15 centres were available. 93% (624/672) of plans were treated using forward-planned multileaf collimator (MLC) segments, 6% with breast compensators and 1% with inverse-planned MLC segments. 94% (635/672) of patients had a D max #107% of the prescribed dose. 11% (74/672) of plans delivered .105% of the prescribed dose to .5% of the breast volume. Conclusion: Reviewing the data in this study, 95% of plans submitted by centres complied with the protocol. With the improved breast radiotherapy standards shown in FAST centres, the following recommendations were suggested for future UK breast radiotherapy trials: (i) the minimum, mean and maximum dose to the whole-breast planning target volume (PTV) should be recorded and assessed; (ii) apart from having a D max #107% of the prescribed dose, #5% of PTV should a receive dose .105% of the prescription dose.

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Biological equivalent dose assessment of the consequences of hypofractionated radiotherapy

Cited by 63 publications

References 10 publications

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

The impact of dose heterogeneity on late normal tissue complication risk after hypofractionated whole breast radiotherapy

Hypofractionated Whole-Breast Radiotherapy for Women With Early Breast Cancer: Myths and Realities

Quality assurance analysis of participating centres’ protocol compliance to a UK multicentre hypofractionated breast (FAST) trial

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