Hypofractionation with simultaneous integrated boost for early breast cancer

Dellas, Kathrin; Vonthein, Reinhard; Zimmer, Jörg; Dinges, Stefan; Boicev, Alexander D.; Andreas, P; Fischer, Dorothea; Winkler, Cornelia; Ziegler, Andreas; Dunst, Jürgen

doi:10.1007/s00066-014-0658-5

Cited by 55 publications

(54 citation statements)

References 16 publications

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“…Recent clinical trials [1,5,6] were published proving the feasibility and well-tolerated toxicity of hypofractionation with SIB in early breast cancer. The comparison done here was based on the BED and hence it is important to consider the limitations of the LQ model and the BED calculations.…”

Section: Discussionmentioning

confidence: 99%

“…This limitation may be important when comparing treatment schemes differing on overall treatment time in terms of acute toxicity [10,18]. Therefore, the assumption of overall treatment time independency may become inaccurate when comparing widely different overall treatment times such as in hypofractionated schemes [1,5,6,24]. Generally, it is considered that the limitations of using the LQ model are mainly due to inaccuracies of accounting for repopulation, bi-fractionated treatments and high-dose fractions [25].…”

Section: Discussionmentioning

confidence: 99%

“…Adjuvant radiotherapy following breast conserving surgery is still usually performed by homogenous irradiation of the whole breast using doses of 1.8-2 Gy per fraction up to a total dose of about 50 Gy, although hypofractionated regimens are being used more and more often and were shown to be well tolerated [1]. Frequently, a sequential boost (SEQ) to the tumor bed follows, as it is known to be the area of highest subclinical tumor cell contamination [2].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, many authors suggested the use of simultaneously integrated boost (SIB) using doses of 2.3-2.4 Gy to the tumor bed as it showed to be dosimetrically better, more convenient due to the shorter treatment time and well tolerated [3,4]. Moreover, hypofractionation with SIB has been evaluated in a few trials and appears to be feasible with no severe adverse events [1,[3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Breast Sequential and Simultaneous Integrated Boost Using the Biologically Effective Dose Volume Histogram (BEDVH)

Aly

Abo-Madyan

Jahnke

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose: A method is presented to radiobiologically compare sequential (SEQ) and simultaneously integrated boost (SIB) breast radiotherapy. Methods: The method is based on identically prescribed biologically effective dose (iso-BED) which was achieved by different prescribed doses due to different fractionation schemes. It is performed by converting the calculated three-dimensional dose distribution to the corresponding BED distribution taking into consideration the different number of fractions for generic α/β ratios. A cumulative BED volume histogram (BEDVH) is then derived from the BED distribution and is compared for the two delivery schemes. Ten breast cancer patients (4 right-sided and 6 left-sided) were investigated. Two tangential intensity modulated whole breast beams with two other oblique (with different gantry angles) beams for the boost volume were used. The boost and the breast target volumes with either α/β = 10 or 3 Gy, and ipsi-lateral and contra-lateral lungs, heart, and contra-lateral breast as organs at risk (OARs) with α/β = 3 Gy were compared.Results: Based on the BEDVH comparisons, the use of SIB reduced the biological breast mean dose by about 3 %, the ipsi-lateral lung and heart by about 10 %, and contra-lateral breast and lung by about 7 %. Conclusion: BED based comparisons should always be used in comparing plans that have different fraction sizes. SIB schemes are dosimetrically more advantageous than SEQ in breast target volume and OARs for equal prescribed BEDs for breast and boost.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Breast Sequential and Simultaneous Integrated Boost Using the Biologically Effective Dose Volume Histogram (BEDVH)

Aly

Abo-Madyan

Jahnke

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Breast irradiation with a boost to the tumor bed provides significantly higher local recurrence rates than whole breast irradiation alone, namely, 93.8% vs. 89.8% at 10 years. In the EORTC study 22881-10882, the absolute benefit of a boost in terms of local control was most pronounced in young patients [52][53][54][55].…”

Section: Radiotherapy 130mentioning

confidence: 99%

Radiation Therapy with a Simultaneous Integrated Boost

Katsochi¹

2017

Radiotherapy

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Radiotherapy has an established role in the treatment of cancer and represents a definitive, less invasive approach for various cancer types. Its main aim is to deliver the maximum dose to the tumor with minimal toxicity on neighboring healthy tissues. Therefore, the precise determination of the target and its spatial relation to critical surrounding organs is of main importance. New imaging modalities such as the CT, MRI, and PET/CT offer more anatomical detail and facilitate the accurate delineation of the target volume and the organs at risk. The recent advances in 3D-CRT and IMRT radiation techniques offer high accuracy in tumor targeting and ensure safe dose escalation. Moreover, the introduction of IGRT offers the opportunity to safely apply a supplementary dose to the macroscopic tumor. In trials conducted, a simultaneous integrated boost (SIB) has proved to be feasible in various cancer localizations, to safely increase the total delivered dose, shorten the total treatment time and results in increased tumor control while keeping the side effects low at the same time. However, more trials need to be conducted to establish an acceptable protocol.

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