Evaluation of compensation in breast radiotherapy: a planning study using multiple static fields

Donovan, Ellen M.; Johnson, U.; Shentall, Glyn; Evans, Philip; Neal, Anthony; Yarnold, John

doi:10.1016/s0360-3016(99)00388-0

Cited by 68 publications

(21 citation statements)

References 18 publications

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“…All participating centres used 3D dose compensations in their breast planning as required in the FAST protocol, and forward-planned treatments using MLC segments were the most common technique used. In agreement with conclusions of previous studies, this compensation method is an efficient and effective way of achieving uniform dose distribution throughout the breast [19][20][21][22][23]. 37 out of 672 plans (6%) failed to fulfil the maximum dose requirement.…”

Section: Discussionsupporting

confidence: 90%

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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Section: Discussionsupporting

confidence: 90%

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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“…While performing IMRT of the breast (25)(26)(27)(28)(29), clinical benefits associated with skin toxicity reduction have been reported. Furthermore, it has also been reported that IMRT is beneficial in reducing chronic breast edema (27) and the incidence of change in breast appearance (30).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric comparison of left-sided whole breast irradiation with 3D-CRT, IP-IMRT and hybrid IMRT

et al. 2014

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Abstract. The aim of this study was to compare the dosimetric characteristics of left-sided whole breast irradiation among 3-dimensional conformal radiotherapy (3D-CRT), 4-field inverse-planned intensity-modulated radiotherapy (IP-IMRT) and hybrid IMRT technique (combining 3D-CRT beams and IP-IMRT beams) with respect to target coverage and irradiation of organs at risk. The 3 different planning techniques were analyzed for 8 patients with left-sided breast conserving surgery. Plans were compared on the basis of planning target volume (PTV) dose conformity, homogeneity and the volumes of normal tissues treated based on dose-volume histograms (DVHs). DVHs were calculated for the PTV, heart, and the bilateral lungs, contralateral breast, and soft tissue surrounding the breast PTV (V OB ) volume. IP-IMRT and hybrid IMRT techniques comparably improved the PTV dose homogeneity and conformity (CI) significantly, compared to the conventional 3D-CRT technique (P<0.017); the IP-IMRT technique only could additionally benefit patients by decreasing the high-dose (40 Gy) volume for heart and ipsilateral lung compared with the hybrid IMRT technique (P<0.017); the hybrid IMRT plans achieved a further improvement by compromising the increase of low-dose volume (total lung V13, contralateral lung V5, heart V10 and soft tissue surrounding the breast V5) compared with IP-IMRT plans (P<0.017). Hybrid IMRT plans achieved equivalent PTV dose uniformity to IP-IMRT plans and compromised the low-dose volume and requirement of clinic resource between IP-IMRT and 3D-CRT plans, promoting it as a standard practice of left-sided breast irradiation for patients in good-ordered cardiopulmonary health.

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“…Dose homogeneity complied with ICRU 50 recommendations. Full-dose compensation was delivered using multiple static fields [8] if the maximum dose was O105%. Megavoltage 6 or 10 MV photons were used in all patients.…”

Section: Radiotherapymentioning

confidence: 99%

Acute Toxicity and 2-year Adverse Effects of 30 Gy in Five Fractions over 15 Days to Whole Breast after Local Excision of Early Breast Cancer

et al. 2008

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ABSTRACT:Aims: A pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer. Materials and methods: Thirty women with early invasive breast cancer aged R 50 years with a pathological tumour size !3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6e10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0 [ none, 1 [ mild, 2 [ moderate, 3 [ severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years. Results: Nine patients (30%, 95% confidence interval 14.7e49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95% confidence interval 3.7e30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95% confidence interval 9.9e42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1e3.9 years) there have been no ipsilateral local tumour relapses. Conclusions: Further evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days. Martin, S. et al.

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Evaluation of compensation in breast radiotherapy: a planning study using multiple static fields

Cited by 68 publications

References 18 publications

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

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

Dosimetric comparison of left-sided whole breast irradiation with 3D-CRT, IP-IMRT and hybrid IMRT

Acute Toxicity and 2-year Adverse Effects of 30 Gy in Five Fractions over 15 Days to Whole Breast after Local Excision of Early Breast Cancer

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