Intensity modulation to improve dose uniformity with tangential breast radiotherapy: Initial clinical experience

Kestin, Larry L.; Sharpe, Michael B.; Frazier, Robert C.; Vicini, Frank A.; Yan, Di; Matter, Richard C.; Martínez, Álvaro; Wong, John W.

doi:10.1016/s0360-3016(00)01396-1

Cited by 292 publications

(164 citation statements)

References 32 publications

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“…This technique has been successful in improving local control 3, 4. In recent years, more highly conformal techniques have been used such as the use of mini‐beams, intensity modulated RT (IMRT) and simultaneously integrated boost, leading to improvements in three‐dimensional (3D) dose distributions 5, 6, 7. However, highly conformal techniques will only be of maximum benefit if patient setup errors can be minimised.…”

Section: Introductionmentioning

confidence: 99%

Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

et al. 2016

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IntroductionTo compare the differences in setup errors measured with electronic portal image (EPI) and cone‐beam computed tomography (CBCT) in patients undergoing tangential breast radiotherapy (RT). Relationship between setup errors, body mass index (BMI) and breast size was assessed.MethodsTwenty‐five patients undergoing postoperative RT to the breast were consented for this study. Weekly CBCT scans were acquired and retrospectively registered to the planning CT in three dimensions, first using bony anatomy for bony registration (CBCT‐B) and again using breast tissue outline for soft tissue registration (CBCT‐S). Digitally reconstructed radiographs (DRR) generated from CBCT to simulate EPI were compared to the planning DRR using bony anatomy in the V (parallel to the cranio‐caudal axis) and U (perpendicular to V) planes. The systematic (Σ) and random (σ) errors were calculated and correlated with BMI and breast size.ResultsThe systematic and random errors for EPI (Σ V = 3.7 mm, Σ U = 2.8 mm and σ V = 2.9 mm, σ U = 2.5) and CBCT‐B (Σ V = 3.5 mm, Σ U = 3.4 mm and σ V = 2.8 mm, σ U = 2.8) were of similar magnitude in the V and U planes. Similarly, the differences in setup errors for CBCT‐B and CBCT‐S in three dimensions were less than 1 mm. Only CBCT‐S setup error correlated with BMI and breast size.Conclusions CBCT and EPI show insignificant variation in their ability to detect setup error. These findings suggest no significant differences that would make one modality considered superior over the other and EPI should remain the standard of care for most patients. However, there is a correlation with breast size, BMI and setup error as detected by CBCT‐S, justifying the use of CBCT‐S for larger patients.

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Section: Introductionmentioning

confidence: 99%

Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

et al. 2016

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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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“…Fixed‐field intensity‐modulated radiation therapy (IMRT) shows significant advantages in improving irradiation dose distribution in the target region and reducing irradiation dose in surrounding normal tissues 6, 7, 8. However, IMRT expands low‐volume irradiation region of normal tissues and increases irradiation doses to the lungs and breasts at the healthy side 9, 10, 11, 12. In this study, IMRT fixed five‐field plan, IMRT fixed six‐field plan, and field‐in‐field (FIF)–direct machine parameter optimization (DMPO)–IMRT plan were designed for different patients according to the target region using the Pinnacle 3 (Philips Medical System, Andover, MA, USA) treatment plan system version 9.6.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of three intensity‐modulated radiation therapies for left breast cancer after breast‐conserving surgery

Zhang

Xie

et al. 2018

J Applied Clin Med Phys

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PurposeThis study aimed to evaluate dosimetric differences of intensity‐modulated radiation therapy (IMRT) in target and normal tissues after breast‐conserving surgery.MethodsIMRT five‐field plan I, IMRT six‐field plan II, and field‐in‐field–direct machine parameter optimization–IMRT plan III were designed for each of the 50 patients. One‐way analysis of variance was performed to compare differences, and P < 0.05 was considered statistically significant.ResultsHomogeneity index of plan III is lower than those of plans I and II. No difference was identified in conformity index of targets. Plan I exhibited difference in mean dose (D mean) for the heart (P < 0.05). Plan I featured smaller irradiation dose volumes in V 5, V 20 (P < 0.05) of the left lung than II. Plan I exhibited significantly higher V 5 in the right lung than plans II and III (P < 0.05). Under plan I, irradiation dose at V 5 in the right breast is higher than that in plans II and III. Patients in plan III presented less total monitor unit and total treatment time than those in plans I and II (P < 0.05).ConclusionIMRT six‐field plans II, and field‐in‐field–direct machine parameter optimization–IMRT plans III can reduce doses and volumes to the lungs and heart better while maintaining satisfying conformity index and homogeneity index of target. Nevertheless, plan II neglects target movements caused by respiration. In the same manner, plan III can substantially reduce MU and shorten patient treatment time. Therefore, plan III, which considers target movement caused by respiration, is a more practical radiation mode.

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Intensity modulation to improve dose uniformity with tangential breast radiotherapy: Initial clinical experience

Cited by 292 publications

References 32 publications

Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

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

Dosimetric comparison of three intensity‐modulated radiation therapies for left breast cancer after breast‐conserving surgery

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