Can we improve the dose distribution for single or multi-lumen breast balloons used for Accelerated Partial Breast Irradiation?

Skowronek, Janusz; Bielęda, Grzegorz; Łaski, Piotr; Kycler, Witold

doi:10.5114/jcb.2013.37776

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…By interactively updating dose distribution in 3D and DVH, the graphic optimization allows altering the dwell time weights by locally dragging the isodose lines to adjust the hotspot in the organ at risk and cold spot in target, until the best DHV coverage of PTV_Eval is reached without jeopardizing the other planning goals. This two-step optimization (dose point optimization followed by graphic optimization) has been tested and compared with another IPSA (inverse planning with simulated annealing) optimizations [ 16 , 17 ]. Since the results from IPSA were not optimum and needed further graphical adjustment to the iso-dose line, we decided to stay with dose optimization in 3D model for APBI brachytherapy with MLD.…”

Section: Methodsmentioning

confidence: 99%

Day to day treatment variations of accelerated partial breast brachytherapy using a multi-lumen balloon

Kuo¹,

Mehta²,

Hong³

et al. 2014

jcb

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PurposeTo evaluate the variations of multi-lumen balloon (MLB)-based brachytherapy from simulation day to treatment day and their dosimetric impacts during accelerated partial breast irradiation (APBI).Material and methodsA total of 42 CT images scanned from seven patients were evaluated with regards to daily variation due to of: 1) internal uncertainty: size and shape of balloon, seroma volume; 2) geometrical uncertainty-random: length of each catheter was measured for each fraction (total 70); 3) geometrical uncertainty-systematic: virtual systematic errors were tested by offsetting dwell positions. The original plans (as group A) had a mean value of 96.8% on V95 of the PTV_Eval. Plans were rerun (as group B) such that the mean value of the V95 was relaxed to 90.4%. By applying the reference plan to each daily CT image, variations of target coverage under different sources of error were evaluated.ResultsShape and size of the balloon had means of < 1 mm decreased in diameter and < 0.4 cm3 decreased in volume; the mean seroma volume increased by 0.2 cm3. This internal variation has a mean of < 1% difference for both V90 and V95. The geometrical uncertainty made a mean deviation of 2.7 mm per root of sum of square. It caused the degradations of V90 and V95 by mean values of 1.0% and 1.2%, respectively. A systematic error of 3 mm and 4 mm would degrade both of V90 and V95 by 4% and 6%, respectively. The degradations on target coverage of the plans in group A were statistically the same as those in group B.ConclusionsOverall, APBI treatments with MLB based brachytherapy are precise from day to day. However, minor variation due to daily treatment uncertainties can still degrade tumor bed coverage to an unacceptable coverage when V95 of the original plan is close to 90%.

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Section: Methodsmentioning

confidence: 99%

Day to day treatment variations of accelerated partial breast brachytherapy using a multi-lumen balloon

Kuo¹,

Mehta²,

Hong³

et al. 2014

jcb

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“…As a desirable effect, the heterogeneous calculations show a larger reduction D 0.2cc (maximum dose to 0.2cm 3 of tissue) for skin dose from 92.9% (water) to 81.4% (heterogeneous) due to missing backscatter. A similar reduction should apply with Ir-192 where Skowronek et al [ 45 ] find skin doses (D max ) of 81.34-85.83% of prescription dose when calculated in water. This is confirmed by measurements of skin dose by Sadeghi et al [ 47 ] who find average skin doses of 78.5% (range 56-488cGy, average 267cGy for a prescription dose of 340cGy) depending on tumor depth and size of applicator.…”

Section: Main Textmentioning

confidence: 98%

“…A study comparing Ir-192 dose distributions for single lumen and multi-strut balloons with different dose calculation algorithms shows that dose coverage of a spherical shell of target depends more on the choice of optimization algorithm than on the number of source channels. Using inverse optimization with simulated annealing (IPSA), a D 90 metric (dose to 90% of the target volume) of 99.95% vs. 102.56% of prescription dose is achieved for multi-strut vs. single lumen applicators [ 45 ]. With a simpler dose point based optimization D 90 metrics of 88.4% vs. 90.27% are achieved.…”

Section: Main Textmentioning

confidence: 99%

Present state and issues in IORT Physics

Hensley

2017

Radiat Oncol

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Literature was reviewed to assess the physical aspects governing the present and emerging technologies used in intraoperative radiation therapy (IORT). Three major technologies were identified: treatment with electrons, treatment with external generators of kV X-rays and electronic brachytherapy. Although also used in IORT, literature on brachytherapy with radioactive sources is not systematically reviewed since an extensive own body of specialized literature and reviews exists in this field. A comparison with radioactive sources is made in the use of balloon catheters for partial breast irradiation where these are applied in almost an identical applicator technique as used with kV X-ray sources. The physical constraints of adaption of the dose distribution to the extended target in breast IORT are compared. Concerning further physical issues, the literature on radiation protection, commissioning, calibration, quality assurance (QA) and in-vivo dosimetry of the three technologies was reviewed. Several issues were found in the calibration and the use of dosimetry detectors and phantoms for low energy X-rays which require further investigation. The uncertainties in the different steps of dose determination were estimated, leading to an estimated total uncertainty of around 10-15% for IORT procedures. The dose inhomogeneity caused by the prescription of electrons at 90% and by the steep dose gradient of kV X-rays causes additional deviations from prescription dose which must be considered in the assessment of dose response in IORT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0754-z) contains supplementary material, which is available to authorized users.

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“…Although most women with breast cancer are appropriate candidates for standard BCT and can be treated with lumpectomy and EBRT, only a subgroup of these women will be appropriate candidates for breast BT. However, even with strict selection criteria, it is estimated that 71,000 women each year in USA would be appropriate candidates for breast brachytherapy [ 21 , 22 , 23 ].…”

Section: Clinical Indicationsmentioning

confidence: 99%

Current status of brachytherapy in cancer treatment – short overview

Skowronek

2017

jcb

Self Cite

154

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Cancer incidence and mortality depend on a number of factors, including age, socio-economic status and geographical location, and its prevalence is growing around the world. Most of cancer treatments include external beam radiotherapy or brachytherapy. Brachytherapy, a type of radiotherapy with energy from radionuclides inserted directly into the tumor, is increasingly used in cancer treatment. For cervical and skin cancers, it has become a standard therapy for more than 100 years as well as an important part of the treatment guidelines for other malignancies, including head and neck, skin, breast, and prostate cancers. Compared to external beam radiotherapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time directly to the altered tissue area with the advantage of a rapid fall-off in dose, and consequently, sparing of adjacent organs. As a result, the patient is able to complete the treatment earlier, and the risks of occurrence of another cancer are lower than in conventional radiotherapy treatment. Brachytherapy has increased its use as a radical or palliative treatment, and become more advanced with the spread of pulsed-dose-rate and high-dose-rate afterloading machines; the use of new 3D/4D planning systems has additionally improved the quality of the treatment. The aim of the present study was to present short summaries of current studies on brachytherapy for the most frequently diagnosed tumors. Data presented in this manuscript should help especially young physicians or physicists to explore and introduce brachytherapy in cancer treatments.

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Can we improve the dose distribution for single or multi-lumen breast balloons used for Accelerated Partial Breast Irradiation?

Cited by 6 publications

References 27 publications

Day to day treatment variations of accelerated partial breast brachytherapy using a multi-lumen balloon

Day to day treatment variations of accelerated partial breast brachytherapy using a multi-lumen balloon

Present state and issues in IORT Physics

Current status of brachytherapy in cancer treatment – short overview

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