Improving Dose Homogeneity in Large Breasts by IMRT

Abo-Madyan, Yasser; Poledník, Martin; Rahn, A.; Schneider, Frank; Dobler, Barbara; Wenz, Frederik; Lohr, Frank

doi:10.1007/s00066-008-1730-9

Cited by 27 publications

(7 citation statements)

References 34 publications

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“…In a previous report from our group we worked with a cohort of patients selected because of their unfavorable anatomy, which is probably comparable to their group with the greatest NTCP. Using multifield IMRT a similar order of magnitude of NTCP reduction (3-4% to 0.05% for their sample patient and 6.03% to 0.25% for our patients) could be achieved [48,50,52]. …”

Section: Discussionmentioning

confidence: 66%

“…Considering this, it is of interest to notice that APBI delivers a higher maximal dose to parts of the heart as compared to IORT and EBRT. A significantly better sparing of the high-dose volume of the heart in selected early breast cancer patients with unfavourable thoracic geometry has been reported by the use of multifield IMRT [48-50]. Compared to three dimensional conformal radiotherapy (3DCRT), multifield IMRT reduced the heart volume receiving ≥ 30 Gy by 87% [48], or ≥ 35 Gy by 81% [49].…”

Section: Discussionmentioning

confidence: 99%

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Can the risk of secondary cancer induction after breast conserving therapy be reduced using intraoperative radiotherapy (IORT) with low-energy x-rays?

et al. 2011

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BackgroundRadiation induced secondary cancers are a rare but severe late effect after breast conserving therapy. Intraoperative radiotherapy (IORT) is increasingly used during breast conserving surgery. The purpose of this analysis was to estimate secondary cancer risks after IORT compared to other modalities of breast radiotherapy (APBI - accelerated partial breast irradiation, EBRT - external beam radiotherapy).MethodsComputer-tomography scans of an anthropomorphic phantom were acquired with an INTRABEAM IORT applicator (diameter 4 cm) in the outer quadrant of the breast and transferred via DICOM to the treatment planning system. Ipsilateral breast, contralateral breast, ipsilateral lung, contralateral lung, spine and heart were contoured. An INTRABEAM source (50 kV) was defined with the tip of the drift tube at the center of the spherical applicator. A dose of 20 Gy at 0 mm depth from the applicator surface was prescribed for IORT and 34 Gy (5 days × 2 × 3.4 Gy) at 10 mm depth for APBI. For EBRT a total dose of 50 Gy in 2 Gy fractions was planned using two tangential fields with wedges. The mean and maximal doses, DVHs and volumes receiving more than 0.1 Gy and 4 Gy of organs at risk (OAR) were calculated and compared. The life time risk for secondary cancers was estimated according to NCRP report 116.ResultsIORT delivered the lowest maximal doses to contralateral breast (< 0.3 Gy), ipsilateral (1.8 Gy) and contralateral lung (< 0.3 Gy), heart (1 Gy) and spine (< 0.3 Gy). In comparison, maximal doses for APBI were 2-5 times higher. EBRT delivered a maximal dose of 10.4 Gy to the contralateral breast and 53 Gy to the ipsilateral lung. OAR volumes receiving more than 4 Gy were 0% for IORT, < 2% for APBI and up to 10% for EBRT (ipsilateral lung). The estimated risk for secondary cancer in the respective OAR is considerably lower after IORT and/or APBI as compared to EBRT.ConclusionsThe calculations for maximal doses and volumes of OAR suggest that the risk of secondary cancer induction after IORT is lower than compared to APBI and EBRT.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Can the risk of secondary cancer induction after breast conserving therapy be reduced using intraoperative radiotherapy (IORT) with low-energy x-rays?

et al. 2011

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“…They found lower overall areas of hot spots and lower maximum dose with IMRT. Abo-Madyan et al 23 evaluated intensity-modulated irradiation and other techniques by comparing dose homogeneity, target coverage, feasibility, and dosimetric reliability in patients with large breasts. They observed that aperture-based IMRT using 2 tangential beams with inverse optimization provides a better alternative to the standard wedged tangential beams for patients with large breasts while maintaining the efficiency of the treatment planning and delivery process.…”

Section: Heart Dose Evaluationmentioning

confidence: 99%

“…3 Other researchers have investigated the use of IMRT and hybrid ("open" beams plus optimized beams) techniques for the treatment of breast cancer. [12][13][14][15][16][17][18][19][22][23][24][25][26][27][28] The hybrid treatment planning uses "open" and optimized beams to produce a homogeneous dose distribution, and to decrease the effect of respiratory motion, the "open" beams are usually assigned weights that are as high as possible, and the tangential posterior field edges are matched to spare lung dose. 20,21 There is a lack of consistency among institutions or individuals on what is considered an acceptable treatment plan: target coverage vis-à-vis dose to OAR.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric evaluation of whole-breast radiation therapy: Clinical experience

et al. 2015

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“…The most common and traditional whole breast radiotherapy technique uses two tangential fields due to its efficiency in terms of sparing nearby organs at risk (OARs) as well as technical simplicity in which wedge filters are used to compensate patient’s surface irregularity and reach a homogenous dose distribution. This technique has evolved over the last decade with the introduction of multi-leaf collimators (MLC) to deliver field-in-field (FIF) three-dimensional conformal (3D-CRT) [ 3 – 6 ] or intensity modulated radiation therapy (IMRT) variants [ 7 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of breast simultaneous integrated boost (SIB) radiotherapy techniques

et al. 2015

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PurposeTo dosimetrically evaluate different breast SIB techniques with respect to target coverage and organs at risk (OARs) doses.MethodsFour IMRT techniques were compared in 12 patients. Three techniques employ tangential whole breast irradiation with either two coplanar fields (T-2F), or four non-coplanar fields (T-NC), or one Volumetric Modulated Arc Therapy (T-VMAT) for the boost volume. The fourth technique is a fully-modulated VMAT technique (f-VMAT). Dosimetric parameters were compared for the boost and breast target volumes as well as OARs. Delivery efficiency was analysed based on number of monitor units (MUs) and estimated delivery time.ResultsT-VMAT and f-VMAT ranked highest with respect to integral assessment of boost and breast treatment quality measures. T-VMAT significantly outperformed f-VMAT with respect to ipsi-lateral lung and left-sided patients’ heart volumes ≥ 5 Gy (35 % ± 5 % vs. 52 % ± 6 % and 11 % ± 5 % vs. 22 % ± 6 %, respectively). f-VMAT significantly outperformed T-VMAT with respect to ipsi-lateral lung volume ≥ 20 Gy (13 % ± 2 % vs. 15 % ± 3 %) and heart volume ≥ 30 Gy in left breast cancer (0 % ± 0 % vs. 1 % ± 1 %). T-VMAT and f-VMAT needed 442 ± 58 and 1016 ± 152 MUs, respectively.ConclusionsThe hybrid T-VMAT is considered the technique of choice due to its balance of quality, efficiency and dose to OARs.

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Improving Dose Homogeneity in Large Breasts by IMRT

Cited by 27 publications

References 34 publications

Can the risk of secondary cancer induction after breast conserving therapy be reduced using intraoperative radiotherapy (IORT) with low-energy x-rays?

Can the risk of secondary cancer induction after breast conserving therapy be reduced using intraoperative radiotherapy (IORT) with low-energy x-rays?

Dosimetric evaluation of whole-breast radiation therapy: Clinical experience

Comparison of breast simultaneous integrated boost (SIB) radiotherapy techniques

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