High Tangent Radiation Therapy With Field-in-Field Technique for Breast Cancer

Tanaka, Hidekazu; Ito, M.; Yamaguchi, Takahiro; Hachiya, Kae; Yajima, Takahiko; Kitahara, Masashi; Matsuyama, K.; Goshima, Satoshi; Futamura, Manabu

doi:10.1177/1178223417731297

Cited by 7 publications

(9 citation statements)

References 21 publications

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“…Adequate target coverage is associated with tumour control which leads to improve biochemical relapse-free survival, cancer progression-free survival and cancer-specific survival. Several studies [8][9][10][11][12][13][14][15][16]20,22,23,26,27,30 have reported similar PTV_eval coverage for breast cancer patients. Tanaka et al 16 investigated the FIF technique with lung blocks for breast radiotherapy and reported V 95% and V 100% of 93•2 and 62•7% for patients treated with the FB technique.…”

Section: Resultsmentioning

confidence: 99%

“…When treating the intact breast or chest-wall for low-risk early stage patients, a pair of opposed tangential fields are usually employed. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However for high-risk patients with node positive disease or are at greater risk of nodal metastasis, radiation therapy will involve treatment of the intact breast or chestwall as well as the regional lymph nodes. This is achieved using two tangential fields to treat the intact breast or chest-wall and an anterior and sometimes opposed posterior fields to treat the regional lymph nodes in the upper axillary and supraclavicular regions.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have reported that using IMRT, VMAT, FIF or the hybrid technique to treat the breast and regional lymph nodes have greater target coverage, reduced hotspots and reduced doses to the organs at risk (OAR) compared to conventional treatment with wedges. 4,6,7,10,11,14,18,23,[27][28][29][30] Some studies 6,9,[12][13][14]16,17,21,26,31 that have evaluated and compared the dosimetric parameters of three-dimensional conformal radiation therapy using FIF technique have reported significant maximum dose and hotspots reduction, improved dose coverage and a more homogenous distribution within the target. Other studies 6,8,11,12,15,18,26,27 have also used the hybrid technique for breast radiotherapy and observed similar improved dose coverage, reduced hotspots in the target and less dose to the OARs.…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

et al. 2020

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Abstract Background: Breast cancer is the most commonly diagnosed cancer among women and the second leading cause of cancer-related death in Canadian women. Surgery is often the first line of treatment for low-risk early stage patients, followed by adjuvant radiation therapy to reduce the risk of local recurrence and prevent metastasis after lumpectomy or mastectomy. For high-risk patients with node positive disease or are at greater risk of nodal metastasis, radiation therapy will involve treatment of the intact breast or chest-wall as well as the regional lymph nodes. Materials and methods: We retrospectively evaluated the treatment plans of 354 patients with breast cancer with nodes positive or were at high risk of nodal involvement treated at our cancer centre. All patients were treated with a prescription dose of 50 Gy in 25 fractions to the intact breast or chest-wall and 50 Gy in 25 fractions to the supraclavicular region and, based on patient suitability and tolerance, were treated either using the deep inspiration breath hold (DIBH) or free-breathing (FB) techniques. Results: Based on patient suitability and tolerance, 130 (36·7%) patients were treated with DIBH and 224 (63·3%) with FB techniques. There were 169 (47·7%) patients treated with intact breast, whereas 185 (52·3%) were treated for post-mastectomy chest-wall. The mean PTV_eval V92%, V95%, V100% and V105% for all patients are 99·4 ± 0·7, 97·6 ± 1·6, 74·8 ± 7·9 and 1·5 ± 3·2%, respectively. The mean ipsilateral lung V10Gy, V20Gy and V30Gy are 30·0 ± 5·3, 22·4 ± 4·7 and 18·4 ± 4·3% for intact breast and 30·9 ± 5·8, 23·5 ± 5·4 and 19·4 ± 5·0% for post-mastectomy patients with FB, respectively. The corresponding values for patients treated using DIBH are 26·3 ± 5·9, 18·9 ± 5·0 and 15·6 ± 4·7% for intact breast and 27·5 ± 6·5, 20·6 ± 5·7 and 17·1 ± 5·2% for post-mastectomy patients, respectively. The mean heart V10Gy, V20Gy, is 1·8 ± 1·7, 0·9 ± 1·0 for intact breast and 3·1 ± 2·2, 1·7 ± 1·6 for post-mastectomy patients with FB, respectively. The corresponding values with the DIBH are 0·5 ± 0·7, 0·1 ± 0·4 for intact breast and 1·1 ± 1·4, 0·4 ± 0·7 for post-mastectomy patients, respectively. Conclusion: The use of 3 and/or 4 field hybrid intensity-modulated radiation therapy technique for radiation therapy of high-risk node positive breast cancer patients provides an efficient and reliable method for achieving superior dose uniformity, conformity and homogeneity in the breast or post-mastectomy chest-wall volume with minimal doses to the organs at risk. The development and implementation of a consistent treatment plan acceptability criteria in radiotherapy programmes would establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that would reduce significant variations in the acceptability of treatment plans.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

et al. 2020

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“…Hence the degree of incidental lymph node irradiation varied between the patients from 12.1 ± 19.2% of the prescribed dose (patient III) to 64.8 ± 17.8% of the prescribed dose (patient II). Differently from our study, most previous studies estimated the dose distribution in the lymph node areas as defined by RTOG or ESTRO guidelines [ 5 , 6 , 9 , 11 , 24 , 25 ]. However, these guidelines define a treatment volume and do not necessary reflect the whole axillary lymph node drainage system and both primary lymph node metastases and lymph node recurrences occur outside the ESTRO and RTOG margins [ 16 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of hypofractionation on the incidental axilla dose during tangential field radiotherapy in breast cancer

et al. 2020

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Objective Tangential field irradiation in breast cancer potentially treats residual tumor cells in the axilla after sentinel lymph node biopsy (SLNB). In recent years, hypofractionated radiotherapy has gained importance and currently represents the recommended standard in adjuvant breast cancer treatment for many patients. So far, the impact of hypofractionation on the effect of incidental lymph node irradiation has not be addressed. Materials and methods Biological effective dose (BED) and tumor control probability (TCP) were estimated for four different hypofractionated radiation schemes (42.50 Gy in 16 fractions [Fx]; 40.05 Gy in 15 Fx; 27 Gy in 5 Fx; and 26 in 5 Fx) and compared to conventional fractionation (50 Gy in 25 Fx). For calculation of BED and TCP, a previously published radiobiological model with an α/β ratio of 4 Gy was used. The theoretical BED and TCP for incidental irradiation between 0 and 100% of the prescribed dose were evaluated. Subsequently, we assessed BED and TCP in 431 axillary lymph node metastases. Results The extent of incidental lymph node irradiation and the fractionation scheme have a direct impact on BED and TCP. The estimated mean TCP in the axillary nodes ranged from 1.5 ± 6.4% to 57.5 ± 22.9%, depending on the patient’s anatomy and the fractionation scheme. Hypofractionation led to a significant reduction of mean TCP of lymph node metastases for all schedules. Conclusion Our data indicate that hypofractionation might affect the effectiveness of incidental radiotherapy in the axilla. This is particularly relevant for patients with positive sentinel lymph nodes who receive SLNB only.

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“…Dynamic wedge filters and/or the field in field technique were used to obtain a homogeneous dose distribution. 6 , 7 In 3DCRT, 42.4 Gy in 16 fractions of 2.65 Gy was prescribed to the isocenter. A VMAT plan used dual partial arcs of 40° to 50° with a collimator angle of 30° and treatment couch angle of 0°, rotating in opposite directions.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-Sided Breast Cancers After Breast-Conserving Surgery: A Planning Study

Tang

Ishikawa

Ito

et al. 2021

Technol Cancer Res Treat

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Background: Dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) were compared among 3 different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods: Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath-hold (DIBH) position. Three-dimensional conformal RT (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH positions. A 3DCRT plan was also created in the FB position. A dose-volume histogram (DVH) was used to analyze each evaluation index of PTV and OARs. The principal outcomes were PTV dose, heart dose, right breast dose, left anterior descending coronary artery (LADCA) dose, and left lung dose. Results: For 3DCRT plans, significant dose reductions were demonstrated in all evaluation parameters of the heart, LADCA, and left lung doses in the DIBH position compared with those in the FB position ( P < 0.05). In the DIBH position, significant dose reductions were found in the heart and LADCA in VMAT plans compared to those in 3DCRT plans ( P < 0.05). For the right breast, VMAT reduced Dmean significantly (0.32 Gy vs 0.08 Gy, P < 0.01). There were no significant differences between 3DCRT and VMAT plans for the left lung dose in the DIBH position. The indicators of PTV had no significant difference between the 3 plans. Conclusion: DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity.

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High Tangent Radiation Therapy With Field-in-Field Technique for Breast Cancer

Cited by 7 publications

References 21 publications

Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

Effect of hypofractionation on the incidental axilla dose during tangential field radiotherapy in breast cancer

Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-Sided Breast Cancers After Breast-Conserving Surgery: A Planning Study

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