Minimising contralateral breast dose in post-mastectomy intensity-modulated radiotherapy by incorporating conformal electron irradiation

Laan, Hans Paul van der; Korevaar, Erik W; Dolsma, W.V.; Maduro, John H.; Langendijk, Johannes A.

doi:10.1016/j.radonc.2009.12.015

Cited by 26 publications

(22 citation statements)

References 43 publications

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“…Therefore, it is critical to limit the heart dose in patients, especially those with left-sided breast cancer. It has been reported that the heart V30 of IMRT was significantly lower than 3D-CRT levels for patients underwent left- sided mastectomy 14. Rudat et al have found that IMRT significantly reduced the ipsilateral lung dose and heart dose in 20 subsequent post mastectomy breast cancer patients 34.…”

Section: Discussionmentioning

confidence: 99%

“…reported that the IMRT technique improved the chest wall (CW) and IMN dose coverage and reduced the cardiac dose. Previously, we conducted a similar study in 30 patients with left-sided post-mastectomy breast cancer, and the results showed that the conformity index of IMRT was better than that of 3D-CRT and IMRT increased the low-dose volume of normal tissue 14,15…”

Section: Introductionmentioning

confidence: 94%

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Dosimetric comparison for volumetric modulated arc therapy and intensitymodulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer

Zhang

et al. 2015

Radiology and Oncology

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BackgroundThe aim of the study was to evaluate the dosimetric benefit of applying volumetric modulated arc therapy (VMAT) on the post-mastectomy left-sided breast cancer patients, with the involvement of internal mammary nodes (IMN).Patients and methodsThe prescription dose was 50 Gy delivered in 25 fractions, and the clinical target volume included the left chest wall (CW) and IMN. VMAT plans were created and compared with intensity-modulated radiotherapy (IMRT) plans on Pinnacle treatment planning system. Comparative endpoints were dose homogeneity within planning target volume (PTV), target dose coverage, doses to the critical structures including heart, lungs and the contralateral breast, number of monitor units and treatment delivery time.ResultsVMAT and IMRT plans showed similar PTV dose homogeneity, but, VMAT provided a better dose coverage for IMN than IMRT (p = 0.017). The mean dose (Gy), V30 (%) and V10 (%) for the heart were 13.5 ± 5.0 Gy, 9.9% ± 5.9% and 50.2% ± 29.0% by VMAT, and 14.0 ± 5.4 Gy, 10.6% ± 5.8% and 55.7% ± 29.6% by IMRT, respectively. The left lung mean dose (Gy), V20 (%), V10 (%) and the right lung V5 (%) were significantly reduced from 14.1 ± 2.3 Gy, 24.2% ± 5.9%, 42.4% ± 11.9% and 41.2% ± 12.3% with IMRT to 12.8 ± 1.9 Gy, 21.0% ± 3.8%, 37.1% ± 8.4% and 32.1% ± 18.2% with VMAT, respectively. The mean dose to the contralateral breast was 1.7 ± 1.2 Gy with VMAT and 2.3 ± 1.6 Gy with IMRT. Finally, VMAT reduced the number of monitor units by 24% and the treatment time by 53%, as compared to IMRT.ConclusionsCompared to 5-be am step-and-shot IMRT, VMAT achieves similar or superior target coverage and a better normal tissue sparing, with fewer monitor units and shorter delivery time.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Dosimetric comparison for volumetric modulated arc therapy and intensitymodulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer

Zhang

et al. 2015

Radiology and Oncology

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“…Data on the effect of IMRT of the chest wall in post-mastectomy breast cancer patients are scarce in the literature [49-51]. There are distinct differences between the target volume of the chest wall and the whole breast.…”

Section: Introductionmentioning

confidence: 99%

Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: A dosimetric comparison

et al. 2011

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BackgroundThis study evaluates the dose distribution of reversed planned tangential beam intensity modulated radiotherapy (IMRT) compared to standard wedged tangential beam three-dimensionally planned conformal radiotherapy (3D-CRT) of the chest wall in unselected postmastectomy breast cancer patientsMethodsFor 20 unselected subsequent postmastectomy breast cancer patients tangential beam IMRT and tangential beam 3D-CRT plans were generated for the radiotherapy of the chest wall. The prescribed dose was 50 Gy in 25 fractions. Dose-volume histograms were evaluated for the PTV and organs at risk. Parameters of the dose distribution were compared using the Wilcoxon matched pairs test.ResultsTangential beam IMRT statistically significantly reduced the ipsilateral mean lung dose by an average of 21% (1129 cGy versus 1437 cGy). In all patients treated on the left side, the heart volume encompassed by the 70% isodose line (V70%; 35 Gy) was reduced by an average of 43% (5.7% versus 10.6%), and the mean heart dose by an average of 20% (704 cGy versus 877 cGy). The PTV showed a significantly better conformity index with IMRT; the homogeneity index was not significantly different.ConclusionsTangential beam IMRT significantly reduced the dose-volume of the ipsilateral lung and heart in unselected postmastectomy breast cancer patients.

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“…Van Der Laan et al . [36] found the volume of the mammaria interna irradiated to be 98.5% in the 3D planning system, 98.5% in photon IMRT and 98.6% in photon electron IMRT in their study which they performed using advanced technology devices. In our study, marked reductions were observed in MI volume irradiated at higher doses compared to the reference dose of 40 Gy with PE and OE techniques and this can be attributed to rapid energy loss of electron beams in deep tissues.…”

Section: Discussionmentioning

confidence: 99%

Research on different techniques in breast cancer radiotherapy

Doğan¹,

Zincircioglu²,

Aydinol³

2013

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In breast cancer radiotherapy, the internal mammary lymphatic chain is treated in the target volume in a group of patients with high risk criteria. There are a number of different techniques in breast radiotherapy because of the variability of the anatomic region, structures and risk criteria in the irradiation field. When irradiating the target volume we also consider homogeneity of dose distribution and minimizing the dose to critical structures such as the heart and lung. In this study, we have evaluated the dose distribution of different radiotherapy techniques in twelve patients with left breast cancer who had breast conserving surgery or mastectomy. A two-dimensional computerized planning system (2-DCPS) was used for each patient to compare wide-field, oblique photon-electron, perpendicular photon-electron and oblique-electron techniques in terms of dose homogeneities in the target volume, the doses received by the heart and lung, and the coverage of the internal mammary chain. Critical structures were irradiated with acceptable dose percentages besides the internal mammary chain with both wide-field, photon-electron and oblique-electron techniques. The wide-field technique was easy to perform and exposed the heart to a smaller radiation dose than photon-electron techniques. The oblique electron techniques provide a minimal radiation dose to critical structures. In oblique electron techniques, if the internal mammary chain was not covered in the target volume, the heart dose was minimized. In conclusion, we suggest using oblique-electron techniques in breast irradiation where the internal mammary is in the target volume.

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Minimising contralateral breast dose in post-mastectomy intensity-modulated radiotherapy by incorporating conformal electron irradiation

Cited by 26 publications

References 43 publications

Dosimetric comparison for volumetric modulated arc therapy and intensitymodulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer

Dosimetric comparison for volumetric modulated arc therapy and intensitymodulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer

Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: A dosimetric comparison

Research on different techniques in breast cancer radiotherapy

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