Lung Dose-Volume Parameters and the Risk of Pneumonitis for Patients Treated With Accelerated Partial-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy

Recht, Abram; Ancukiewicz, Marek; El-Din, Mohamed A. Alm; Lu, Xuequan; Martin, Charles G.; Berman, Stuart M.; Hirsch, Ariel E.; Kachnic, Lisa A.; Katz, Angela; MacDonald, Shannon M.; Nedea, Elena; Stevenson, Mary Ann; Powell, Simon N.; Taghian, Alphonse G.

doi:10.1200/jco.2008.20.0121

Cited by 58 publications

(36 citation statements)

References 30 publications

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“…22 In our study, the ipsilateral lung V20Gy for IMRT (22.4%) is significantly less than that for 3DCRT (37.9%; p < 0.01). Ipsilateral lung mean dose was also higher in 3DCRT (20.29 Gy) compared to the one in IMRT (16.51Gy) (p < 0.01).…”

Section: Lung Dosementioning

confidence: 80%

Dosimetric study of SIB-IMRT versus SIB-3DCRT for breast cancer with breath-hold gated technique

Moorthy

Sakr

Hasan

et al. 2013

Int J Cancer Ther Oncol

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Background and purpose: 3-dimensional conformal therapy (3DCRT) is widely employed radiation therapy technique for breast cancer, but there is still need to minimize the doses to organ at risk (OAR) using 3DCRT. A few clinical studies have discussed using intensity modulated radiation therapy (IMRT) to address this shortfall. Simultaneous integrated boost (SIB) has been used in head and neck and prostate cancer, and there is a growing interest in using SIB for breast cancer too. This study aimed to compare SIB-IMRT versus SIB-3DCRT for breast cancer patients. Materials and Methods: SIB-3DCRT treatment plans were created for 36 consecutive patients. Dose was prescribed as 45 Gy in 25 fractions to the planning target volume (PTV)-1 and 60 Gy in 25 fractions to PTV-2. Treatment plans were normalized to 95% of PTV volume receiving 95% of the prescription dose. The conformity index (CI), homogeneity index (HI), lung dose, heart dose, left anterior descending artery(LAD) dose, and low dose volume and integral dose of normal healthy tissue were recorded and analyzed. Results: With the use of IMRT technique, there was an improvement in CI (0.14) when compared to CI of 3DCRT (0.18; p = 0.01). However, there was no significant difference in the HI (p = 0.45). On average, the V20Gy of ipsilateral lung was 37.9 % for 3DCRT and 22.4 % (p < 0.01) for IMRT, whereas the V20Gy of total lung (ipsilateral + contralateral) was 21.8% for 3DCRT and 12.14 (p < 0.01) for IMRT. Similarly, average V40Gy of heart was 7.5 % for 3DCRT and 2.13 % (p = 0.01) for IMRT. The LAD maximum dose to left side breast patients, on average, was 39.5 Gy for 3DCRT and 29.17 Gy (p = 0.03) for IMRT. The average number of monitor units was about 180 for 3DCRT and 1441 (p < 0.01) for IMRT. Conclusion: IMRT for breast cancer treatment is feasible. In comparison to 3DCRT, IMRT can reduce the maximum dose to the target volume, and dose to the OAR. However, 3DCRT technique is superior in terms of low dose volume, integral dose, and treatment time. With the use of breath-hold gated technique in IMRT, it can further improve the target coverage and reduction of doses to the heart, lung, and LAD. SIB technique could reduce the overall treatment duration by about one week.

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Section: Lung Dosementioning

confidence: 80%

Dosimetric study of SIB-IMRT versus SIB-3DCRT for breast cancer with breath-hold gated technique

Moorthy

Sakr

Hasan

et al. 2013

Int J Cancer Ther Oncol

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“…Arterial blood gases were reported infrequently, but several patients had hypoxemia and hypocapnia [14,28,36,43]. Pulmonary function test results for 13 patients most commonly showed decreased vital capacity and diffusing capacity [13,28,29,32,35,41,43] with no airflow obstruction; results were normal in 4 patients [14,31,33,34].…”

Section: Resultsmentioning

confidence: 99%

“…Types of breast cancer included ductal carcinoma in situ, invasive breast cancer, breast cancer with chest wall metastasis, and postmastectomy patients receiving adjuvant radiation therapy. Radiation treatment protocols showed that 24 women received traditional whole-breast irradiation [13, 14, 28, 30-32, 34-38, 44-46, 48, 49], 5 received chest wall irradiation [29,39,40,43], 2 received hypofractionated wholebreast irradiation [33,47], and 2 received partial-breast irradiation delivered by external beam [41]. Thirteen patients received boost treatment, and 18 received hormonal therapy.…”

Section: Resultsmentioning

confidence: 99%

“…Chest radiographs showed infiltrates with air bronchograms [13, 29- bronchograms [32,39,43,45].Migrating infiltrates werenoted in several reports [13,14,30]. Infrequent abnormalities included nodules [28,41], coin lesion [29], and reverse halo sign [45]. Although most of the 34 patients were originally diagnosed with community-acquired pneumonia and treated with antibiotics, 9 patients were initially diagnosed with postradiation pneumonitis [14, 29-31, 38, 39, 41].…”

Section: Resultsmentioning

confidence: 99%

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Systematic Review of Postradiotherapy Bronchiolitis Obliterans Organizing Pneumonia in Women With Breast Cancer

Epler

Kelly

2014

The Oncologist

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Background. Radiation therapy for breast cancer has been implicated in the development of bronchiolitis obliterans organizing pneumonia (BOOP).This inflammatory lung disorder was first noted in 1983, and there have been numerous reports of BOOPoccurring in womenwho have had radiation therapy for breast cancer since 1995.This study was undertaken to perform a systematic review of postradiotherapy BOOP to determine the occurrence, presentation, treatment, and outcome. Materials and Methods. A systematic literature review was conducted according to the guidelines provided by the Preferred ReportingItemsforSystematicReviewsandMeta-Analysesreport. Results. The literature search yielded 10 Japanese epidemiological reports with 129 women, 4 case series reports with 36

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“…Occurrence rate of complications is significantly correlated with irradiation volume and dose in lung tissues. V 5 and V 10 in lung tissues are important factors influencing occurrence of radiation pneumonitis 24, 25. Research has shown that occurrence rate of radiation pneumonitis reaches higher than 20% when V 10 of the lung measures higher than 50% 26…”

Section: Discussionmentioning

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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Lung Dose-Volume Parameters and the Risk of Pneumonitis for Patients Treated With Accelerated Partial-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy

Cited by 58 publications

References 30 publications

Dosimetric study of SIB-IMRT versus SIB-3DCRT for breast cancer with breath-hold gated technique

Dosimetric study of SIB-IMRT versus SIB-3DCRT for breast cancer with breath-hold gated technique

Systematic Review of Postradiotherapy Bronchiolitis Obliterans Organizing Pneumonia in Women With Breast Cancer

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

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