Dose constraints for whole breast radiation therapy based on the quality assessment of treatment plans in the randomised Danish breast cancer group (DBCG) HYPO trial

Thomsen, M.S.; Berg, M.; Zimmermann, S.J.; Lutz, Christina; Makocki, S.; Jensen, I.; Hjelstuen, M.; Pensold, S.; Hasler, Melanie; Jensen, Maj‐Britt; Offersen, Birgitte Vrou

doi:10.1016/j.ctro.2021.03.009

Cited by 17 publications

(11 citation statements)

References 29 publications

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“…The following supporting information can be downloaded at: , Supplementary Table S1: (DVCs for emerging OaRs), Supplementary Table S2: (DVCs for RT of Hodgkin’s lymphoma), Supplementary Table S3: (DVCs for RT of breast cancers), Supplementary Table S4: (DVCs for RT of pediatric tumors), Supplementary Table S5: (DVCs for stereotactic ablative RT of ventricular arrythmia) [ 6 , 8 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 35 , 40 , 68 , 79 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 ].…”

mentioning

confidence: 99%

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

et al. 2022

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Background: The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature. Material and Methods: A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin’s lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence. Results: Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form. Conclusions: A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations.

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confidence: 99%

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

et al. 2022

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“…Since there are no established guidelines for LAD dose constraints, especially not for different regimes, the local clinical protocol follows LAD dose constraints as recommended by Danish breast cancer group-HYPO trial, advocating for LAD max < 20 Gy in 50/25 Gy regime [34]. Significant decrease in mean and maximal LAD dose in 5-fractions group of our study could implicates that this group of patients will experience less cardiac toxicity compared to patients who receive moderate hypofractionation.…”

Section: Discussionmentioning

confidence: 85%

Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic

et al. 2022

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Background and Objectives: Reducing time of treatment during COVID-19 outbreaks has been recommended by the leading Radiation Oncology societies. Still minimizing radiation induced tissue toxicity is one of the most important issues in breast cancer patients. The study aimed to investigate compliance, clinical and dosimetry normal tissue toxicity, and cosmetic results between moderated and ultra-fractionated regimes for breast cancer patients during COVID-19 pandemic. Materials and Methods: This pilot prospective randomized study included 60 patients with early breast cancer after preserving surgery, 27 patients advocated to ultra-hypofractionated whole-breast three dimensional (3D) conformal radiotherapy of 26 Gy in 5 fractions over 1 week and 33 patients with moderate fractionated breast 3D conformal radiotherapy patients between March 2020 and July 2020, during the COVID pandemic outbreak. The compliance to treatment, dosimetric parameters, acute and late skin toxicity, subcutaneous tissue toxicity, cosmetic results and clinical follow up for 18 months for the two regimes were analyzed and compared. Results: When two regimes were compared 5 fraction group had significantly lower prevalence of newly infected cases of SARS-CoV-2 and thus delayed/interrupted treatment (p = 0.05), comparable grade 1 CTCAE v5, acute skin toxicity (p = 0.18), Grade 1 Radiation Morbidity Scoring Scheme (RESS) subcutaneous tissue toxicity (p = 0.18), Grade 1 RESS late skin toxicity (p = 0.88) and cosmetic results (p = 0.46). Dosimetric results reveled that patients in 5 fraction group received significantly lower median ipsilateral lung doses (p < 0.01) in addition to left breast cancer patients that received significantly lower median heart dose (p < 0.01) and median left anterior descending artery (LAD) dose (p < 0.01). Conclusion: Ultra-hypofractionated radiotherapy for breast cancer is comparable to moderate hypofractionation regimen regarding grade 1 acute skin toxicity, grade 1 subcutaneous tissue toxicity, late skin toxicity and cosmetic results. Application of ultra-hypofractionated radiotherapy with significantly lower radiation doses for lung and heart could be crucial in reducing the risk of acute/late pulmonary and heart radiation-induced toxicity.

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“…In patients with a high BMI, surgery, delineation, and dose coverage for regional nodes may be challenging, and it is probably one of the main reasons for higher rates of locoregional failure and worse distant recurrence-free interval and overall survival in these patients [40,41]. In case of CTVp (breast or chest wall), treatment objective is that the doses in the range 95%-105% of the prescription dose and Dmax 110% [42]. The volume that receives a dose between 105% and 107% of the prescription dose should be limited to 2% of the CTV volume (V105%-V107% 2%) [43].…”

Section: Dose Coveragementioning

confidence: 99%

“…95%). Further consideration for dose coverage/planning in the setting of moderate hypofractionation for breast cancer treatment were recently published from the quality assessment of the treatment plans in the Danish Breast Cancer Group (DBCG) HYPO trial [42]. For different radiation dose protocols, example, centres using the FAST FORWARD regimen [44], we recommend reading the section for radiation planning within the trial protocol.…”

Section: Dose Coveragementioning

confidence: 99%

Tricks and tips for target volume definition and delineation in breast cancer: Lessons learned from ESTRO breast courses

Kaidar‐Person¹,

Offersen²,

Boersma³

et al. 2021

Radiotherapy and Oncology

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Dose constraints for whole breast radiation therapy based on the quality assessment of treatment plans in the randomised Danish breast cancer group (DBCG) HYPO trial

Cited by 17 publications

References 29 publications

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic

Tricks and tips for target volume definition and delineation in breast cancer: Lessons learned from ESTRO breast courses

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