Breast radiotherapy in women with pectus excavatum (funnel chest): is the lateral decubitus technique an answer? A dosimetric study

Ma, Bollet; Campana, F.; Ym, Kirova; Dendale, R.; Mg, Saliou; Jc, Rosenwald

doi:10.1259/bjr/23839243

Cited by 14 publications

(4 citation statements)

References 13 publications

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“…In order to solve this difficult clinical problem, the use of helical tomotherapy (6) or volumetric-modulated arc therapy (14), intensity-modulated radiation, and isocentric lateral decubitus technique (8) have been proposed. Our data show that excellent MHD can be obtained without resorting to resource-intensive techniques such as helical tomotherapy or intensity-modulated radiation.…”

Section: Figure 3 Failure Of Haller Index (251 In This Instance) Tomentioning

confidence: 99%

“…Classically, PE has been measured on computed tomography (CT) by the Haller index (HI), which is used to determine which patients might benefit from surgical correction. PE is well recognized as a condition which may increase MHD during left-sided breast radiation, prompting the investigation of several radiotherapy techniques to address this clinical problem, including intensity-modulated radiation therapy (6), deep inspiration breath-hold technique (DIBH) (7), and lateral decubitus positioning (8).…”

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Chest Wall Deformity in the Radiation Oncology Clinic

Stahl

Hong

Lester-Coll

et al. 2016

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Abstract. Background Adjuvant radiation therapy for women with breast cancer is associated with a reduction in local recurrence and, in many patients, a survival benefit (1, 2). As risk of cardiac events is correlated with the mean heart radiation dose (MHD), radiation oncological planning often focuses on techniques to reduce the MHD in women with left-sided breast cancer (3). Individual anatomic variation, including breast size, breast ptosis, tumor bed location, heart position and chest wall shape, all impact the ability of the radiation oncologist to achieve optimal MHD. In particular, pectus excavatum (PE) has been identified as a challenging situation for treatment planning in breast cancer.PE is a congenital deformity of the chest wall associated with sternal depression. It accounts for about 90% of anterior chest wall disorders and has an incidence of one in 400 to one in 1,000 births (4). PE is about four times more prevalent in males than females (5). Classically, PE has been measured on computed tomography (CT) by the Haller index (HI), which is used to determine which patients might benefit from surgical correction. PE is well recognized as a condition which may increase MHD during left-sided breast radiation, prompting the investigation of several radiotherapy techniques to address this clinical problem, including intensity-modulated radiation therapy (6), deep inspiration breath-hold technique (DIBH) (7), and lateral decubitus positioning (8).The purpose of this analysis was to determine the incidence of PE in women treated with radiation therapy for breast cancer at our Institution and to define anatomical chest wall metrics predictive of elevated MHD in patients undergoing breast radiotherapy. Patients and MethodsData source and study cohort. We retrospectively reviewed the records of 273 patients consecutively simulated for left-sided breast cancer or at our Institution between January 2013 and December 2014. The Yale Institutional Review Board approved this study (#150301553). Patients underwent 3-dimensionsal conformal planning, with either forward planned fixed gantry field-in-field technique or wedges as indicated by individual patient geometry. Cardiac segmentation included both cardiac muscle and the pericardium, starting at the branch point of the pulmonary arteries and continuing inferiorly to the cardiac apex. The MHD was recorded from the treatment planning system using heterogeneity corrections (Eclipse Version 13.6; Varian, Palo Alto, CA, USA). Contribution to MHD from supraclavicular, axillary, or boost fields was not considered in the measurement of MHD. Patients with PE who were treated with DIBH were also retrospectively re-planned on their free breathing (FB) CT scan for comparison.Variables. Patients were classified as having PE based on physical examination at the time of consult, which was confirmed upon review of axial imaging (Figure 1). Thoracic surgeons initially developed the HI to quantify the degree of the pectus deformity by 5295 This article is freely accessible onli...

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Section: Figure 3 Failure Of Haller Index (251 In This Instance) Tomentioning

confidence: 99%

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confidence: 99%

Chest Wall Deformity in the Radiation Oncology Clinic

Stahl

Hong

Lester-Coll

et al. 2016

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“…In particular, there is concern that the use of two tangential beams may increase the rates of pulmonary complications in patients with pectus excavatum (PE) because of the large volume of the lungs that lies within the radiation field. Accordingly, intensity modulated radiation therapy (IMRT) and the lateral decubitus set‐up technique have been developed to improve radiation delivery . However, studies in individuals with PE have estimated only the radiation dose to the lungs by constructing dose‐volume histograms (DVHs).…”

Section: Introductionmentioning

confidence: 99%

Is pectus excavatum a risk factor for radiation‐induced lung disease in patients undergoing radiation therapy following breast‐conserving surgery?

et al. 2018

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BackgroundThe relationship between radiation dose to the ipsilateral lung and subsequent radiation‐induced lung disease (RILD) in breast cancer patients with pectus excavatum (PE) undergoing radiation therapy (RT) to residual breast tissue after breast‐conserving surgery has not yet been established. The incidence of RILD in such patients with PE, meaning that a large volume of the lung is within the radiation field, has not been determined. Therefore, the aim of this study was to determine the relationship between these factors.MethodsThe study cohort comprised 133 women who underwent three‐dimensional conformal RT to residual breast tissue after breast‐conserving surgery for breast cancer. Diagnoses of PE were based on Haller's, frontosagittal, and Monden's depression indices. Radiation doses to the ipsilateral lung were established from dose‐volume histograms.ResultsFifty of the 133 participants (37.6%) were diagnosed with RILD; all were asymptomatic. Multivariate analysis revealed a significant correlation between the incidence of RILD and the administration of > 30 Gy (V30). Surprisingly, although patients with PE received higher ipsilateral lung doses, they were less likely to develop RILD than those without PE.ConclusionsOur data indicate that the incidence of RILD is correlated with the administration of > 30 Gy (V30) and that PE is not a risk factor for RILD after RT to residual breast tissue after breast‐conserving surgery for breast cancer. Surprisingly, individuals with PE may have a lower incidence of RILD than those without this condition.

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“…The standard treatment for breast cancer after breast-conserving surgery is postoperative radiotherapy. It includes the irradiation of the whole remaining breast [1][2][3][4][5][6][7] followed by a boost to the tumor bed. Patients are conventionally treated supine, although other positions, such as prone or lateral decubitus, have also been proposed [8][9][10][11][12][13][14][15][16][17][18][19][20] .…”

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confidence: 99%

Prone Breast Radiotherapy in a Patient with Early Stage Breast Cancer and a Large Pendulous Breast

Ferrari

Ivaldi

Leonardi

et al. 2009

Tumori

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In women with large and pendulous breasts postoperative radiotherapy in the supine position could represent a technical challenge because of the resulting dose inhomogeneity and the large amount of lung and heart receiving a high percentage of the prescribed dose. Breast-conserving surgery is therefore relatively contraindicated in these patients. Alternative positions for radiation therapy treatment have been proposed, and prone breast irradiation in particular has been recognized as a useful alternative to conventional treatment in the supine position. We report the case of a large-breasted patient treated in prone position in our radiation therapy division.

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Breast radiotherapy in women with pectus excavatum (funnel chest): is the lateral decubitus technique an answer? A dosimetric study

Cited by 14 publications

References 13 publications

Chest Wall Deformity in the Radiation Oncology Clinic

Chest Wall Deformity in the Radiation Oncology Clinic

Is pectus excavatum a risk factor for radiation‐induced lung disease in patients undergoing radiation therapy following breast‐conserving surgery?

Prone Breast Radiotherapy in a Patient with Early Stage Breast Cancer and a Large Pendulous Breast

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