High-dose simultaneously integrated breast boost using intensity-modulated radiotherapy and inverse optimization

Hurkmans, Coen; Meijer, G.; Vliet-Vroegindeweij, Corine van; Sangen, M.J.C. van der; Cassee, J.

doi:10.1016/j.ijrobp.2006.05.041

Cited by 85 publications

(49 citation statements)

References 28 publications

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“…A further Dutch institution reported a similar experience, with a cohort comprising 1274 patients treated between 2007 and 2009 (28 fractions of 1.8 Gy WBRT, 2.3 Gy SIB; [14]). To date, there has been no information published on toxicities and tumor-related parameters.…”

Section: Clinical Evidence Of Sib Techniques For Breast Cancermentioning

confidence: 93%

Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy?

et al. 2013

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Section: Clinical Evidence Of Sib Techniques For Breast Cancermentioning

confidence: 93%

Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy?

et al. 2013

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“…Technological improvements in radiotherapy delivery and imaging are being used to achieve dose inhomogeneity [1] complex planning within trials [2], and for cases requiring extensive nodal irradiation [3]. These complex treatments require the use of advanced verification imaging i.e.…”

Section: Contextmentioning

confidence: 99%

The IMPORT HIGH Image-guided Radiotherapy Study: A Model for Assessing Image-guided Radiotherapy

et al. 2015

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“…Also the volume that received ≥95% of the prescribed total dose (V patient, 95%(total-dose) ) was determined. Furthermore, the undesired volume (outside PTV boost ) that received ≥95% of the total dose (V outside PTVboost, 95%(total-dose) ) [14,18] was determined. In addition, maximum physical dose to the absolute heart volume (HD max ) and mean physical lung dose (MLD) were investigated.…”

Section: Analysis Of Coverage Dose Distribution and Normal Tissuesmentioning

confidence: 99%

“…On the one hand, since boost planning for SEQ is actually performed on CT 5 , and our patients demonstrate significant seroma reduction during RT, this provided an advantage for SEQ planning when compared to SIB(-ART). On the other hand, the combination of the slightly lower physical dose (to obtain biologically equivalent plans) with inherently tighter total planned dose distributions [14,18] provided an advantage for SIB(-ART). In this study, these features were deliberately maintained to provide a fair clinical comparison.…”

Section: Comparing Seq Sib and Sib-artmentioning

confidence: 99%

“…A large seroma reduction is primarily to be expected in patients with a large initial seroma volume [8,9], suggesting that a sequential boost will minimize irradiation overdose in this patient group. On the other hand, simultaneous integrated boost [12,13], with or without re-planning halfway through RT, can provide the benefit of improved dose distribution and shorter overall treatment course [14,15]. To ultimately decide upon an optimal technique for patients with seroma, we need to know which plan results in the smallest excess breast dose outside the boost planning target volume (PTV boost ).…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric impact of post-operative seroma reduction during radiotherapy after breast-conserving surgery

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Hollander

Yang

et al. 2011

Radiotherapy and Oncology

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Purpose: Three boost radiotherapy (RT) techniques were compared to evaluate the dosimetric effect of seroma reduction during RT after breast-conserving surgery (BCS). Materials and methods: Twenty-one patients who developed seroma after BCS were included. Each patient underwent three CT scans: one week before RT (CT -1 ), in the third (CT 3 ) and fifth (CT 5 ) week of RT. For each patient, three plans were generated. 1) SEQ: whole breast irradiation planned on CT -1, sequential boost planned on CT 5 , 2) SIB: simultaneous integrated boost planned on CT -1 , 3) SIB adaptive radiation therapy (SIB-ART): planned on CT -1 and re-planned on CT 3 . Irradiated volumes, mean lung (MLD) and maximum heart dose (HD max ) were projected and compared on CT 5 . Results: On average 62% seroma reduction during RT was observed. Volumes receiving ≥107% of prescribed whole breast dose were significantly smaller with SIB-ART compared to SEQ and SIB. The undesired volume receiving ≥95% of prescribed total dose was also significantly smaller with SIB-ART. For SEQ, SIB-ART and SIB respectively, small but significant differences were found in MLD (4.2 vs. 4.6 vs. 4.7Gy) and in HD max for patients with left-sided breast cancer (39.9 vs. 35.8 vs. 36.9Gy). Conclusions: This study demonstrates a dosimetric advantage for patients with seroma when simultaneous integrated boost is used with re-planning halfway through treatment. IntroductionRadiotherapy (RT) following breast-conserving surgery (BCS) has been proven to be effective in improving local control and long-term survival [1]. Following whole breast irradiation (WBI), an additional boost to the tumor bed was found to further decrease local recurrence [2]. In case the boost target volume (TV boost ) on the initial planning CT includes post-operative seroma, it is frequently assumed that it does not change significantly during RT. However, prior studies have demonstrated 36% to 50% seroma reduction prior to RT [3,4], and 22% to 62% during RT [5][6][7][8][9]. Due to seroma reduction, the volume of breast tissue not intended to receive boost RT will become excessive towards the end of treatment, with increasing risk of fibrosis and additional worsening of cosmetic outcome [10,11].Though we now know that TV boost is dynamic during RT and the irradiated volume should be kept as small as possible to optimize cosmetic results, no investigation has addressed the dosimetric consequences of different planning techniques specifically for boost volumes including seroma. Boost irradiation can be planned and delivered separately from or integrated with WBI. Planning of boost irradiation after WBI has the advantage of obtaining a second CT scan specifically for boost planning prior to boost irradiation, thereby accounting for seroma reduction during WBI. A large seroma reduction is primarily to be expected in patients with a large initial seroma volume [8,9], suggesting that a sequential boost will minimize irradiation overdose in this patient group. On the other hand, simultaneous integrated...

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High-dose simultaneously integrated breast boost using intensity-modulated radiotherapy and inverse optimization

Cited by 85 publications

References 28 publications

Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy?

Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy?

The IMPORT HIGH Image-guided Radiotherapy Study: A Model for Assessing Image-guided Radiotherapy

Dosimetric impact of post-operative seroma reduction during radiotherapy after breast-conserving surgery

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