Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities

Ma, Jinli; Li, Jiongyan; Xie, Juanying; Chen, Jian; Zhu, Congcong; Cai, Gang; Zhang, Zhen; Guo, Xiaomao; Chen, Jiayi

doi:10.1186/1748-717x-8-81

Cited by 50 publications

(49 citation statements)

References 24 publications

(28 reference statements)

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“…This compares favorably to rates seen with both IMRT photons (31) and conventional electrons (32) used in the postmastectomy setting. For patients who have undergone postmastectomy reconstruction and require full dose to the skin, protons may offer an advantage over photons with bolus.…”

Section: Discussionmentioning

confidence: 70%

Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

Cuaron

Chon

Tsai

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose To report dosimetry and early toxicity data in breast cancer patients treated with postoperative proton radiation therapy. Methods and Materials From March 2013 to April 2014, 30 patients with nonmetastatic breast cancer and no history of prior radiation were treated with proton therapy at a single proton center. Patient characteristics and dosimetry were obtained through chart review. Patients were seen weekly while on treatment, at 1 month after radiation therapy completion, and at 3- to 6-month intervals thereafter. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Frequencies of toxicities were tabulated. Results Median dose delivered was 50.4 Gy (relative biological equivalent [RBE]) in 5 weeks. Target volumes included the breast/chest wall and regional lymph nodes including the internal mammary lymph nodes (in 93%). No patients required a treatment break. Among patients with >3 months of follow-up (n = 28), grade 2 dermatitis occurred in 20 patients (71.4%), with 8 (28.6%) experiencing moist desquamation. Grade 2 esophagitis occurred in 8 patients (28.6%). Grade 3 reconstructive complications occurred in 1 patient. The median planning target volume V95 was 96.43% (range, 79.39%-99.60%). The median mean heart dose was 0.88 Gy (RBE) [range, 0.01–3.20 Gy (RBE)] for all patients, and 1.00 Gy (RBE) among patients with left-sided tumors. The median V20 of the ipsilateral lung was 16.50% (range, 6.1%–30.3%). The median contralateral lung V5 was 0.34% (range, 0%–5.30%). The median maximal point dose to the esophagus was 45.65 Gy (RBE) [range, 0–65.4 Gy (RBE)]. The median contralateral breast mean dose was 0.29 Gy (RBE) [range, 0.03–3.50 Gy (RBE)]. Conclusions Postoperative proton therapy is well tolerated, with acceptable rates of skin toxicity. Proton therapy favorably spares normal tissue without compromising target coverage. Further follow-up is necessary to assess for clinical outcomes and cardiopulmonary toxicities.

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Section: Discussionmentioning

confidence: 70%

Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

Cuaron

Chon

Tsai

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Typically when the depth of the involved lung is >3 cm, using a combination of photons and electrons can significantly decrease the amount of lung and heart (for left sided cases) receiving high dose [4]. IMRT and VMAT have also been more recently investigated to improve the conformity and homogeneity of plans when the IMNs were involved in addition to the breast or reconstructed chest wall [5][6][7]12]. However, this data is predominantly for left sided cases for whom it has been determined that the differences in the volume of lung included in the PWT and conventional wide tangents are small due to the presence of the heart inferiorly [8]; however, for right-sided cases this difference is found to be greater because the lung alone is the underlying organ.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Volumetric Modulated Arc Therapy, Static Field Intensity Modulated Radiation Therapy, and 3D Conformal Planning for the Treatment of a Right-Sided Reconstructed Chest Wall and Regional Nodal Case

Dumane

Hunt

Green

et al. 2014

Journal of Radiotherapy

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We compared 3D conformal planning, static field intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT) to investigate the suitable treatment plan and delivery method for a right-sided reconstructed chest wall and nodal case. The dose prescribed for the reconstructed chest wall and regional nodes was 50.4 Gy. Plans were compared for target coverage and doses of the lungs, heart, contralateral breast, and healthy tissue. All plans achieved acceptable coverage of the target and IMNs. The best right lung sparing achieved with 3D was a V20 Gy of 31.09%. Compared to it, VMAT reduced the same by 10.85% and improved the CI and HI over 3D by 18.75% and 2%, respectively. The ipsilateral lung V5 Gy to V20 Gy decreased with VMAT over IMRT by as high as 17.1%. The contralateral lung V5 Gy was also lowered with VMAT compared to IMRT by 16.22%. The MU and treatment beams were lowered with VMAT over IMRT by 30% and 10, respectively, decreasing the treatment time by >50%. VMAT was the treatment plan and delivery method of choice for this case due to a combination of improved lung sparing and reduced treatment time without compromising target coverage.

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“…2.6. Plan Optimization and Dose criteria [10,14]. In TSPs, all segmental targets were given the same objectives and cooptimized together.…”

Section: Vmat Planningmentioning

confidence: 99%

Dosimetric Comparison of Three Radiotherapy Techniques in Irradiation of Left-Sided Breast Cancer Patients after Radical Mastectomy

Hân

et al. 2020

BioMed Research International

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Introduction. This study is aimed at evaluating the dosimetric differences among target segmented planning (TSP), conventional 9-field intensity modulated radiation therapy (9FIMRT) planning, and volumetric modulated arc therapy (VMAT) planning for postmastectomy radiotherapy of left-sided breast cancer patients. Material and Methods. Fifteen left-sided breast cancer patients who underwent radical mastectomy were enrolled. In TSP, the planning target volume (PTV) was divided into four regions (supra/infraclavicular, chest wall, external mammary region, and internal mammary region), and each individual PTV region was treated with respective fixed fields. Results. The VMAT plans showed superior to PTV dose conformity index (CI), homogeneity index (HI), protection of the ipsilateral lung, monitor units (MUs), and maximum dose (Dmax) to the contralateral breast compared with TSP and 9FIMRT plans. The TSP provided better protection for Dmean of the heart and left ventricle (p<0.05). A dose for left anterior descending artery from the three techniques had no significant difference. Compared with the 9FIMRT plans, the V5Gy (%) and V10Gy (%) for the ipsilateral lung were significantly reduced with TSP and VMAT (p<0.05). The V5Gy (%) and V10Gy (%) for the ipsilateral lung turned out to be similar between VMAT and TSP techniques. Conclusions. Our study indicates that VMAT should be a better choice of radiotherapy for left-sided breast cancer patients after radical mastectomy. If VMAT is unavailable, 9FIMRT can achieve better CI and HI values and be more MU-efficient compared with TSP; however, TSP can effectively reduce the low dose volume of the ipsilateral lungs and heart.

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Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities

Cited by 50 publications

References 24 publications

Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

Dosimetric Comparison of Volumetric Modulated Arc Therapy, Static Field Intensity Modulated Radiation Therapy, and 3D Conformal Planning for the Treatment of a Right-Sided Reconstructed Chest Wall and Regional Nodal Case

Dosimetric Comparison of Three Radiotherapy Techniques in Irradiation of Left-Sided Breast Cancer Patients after Radical Mastectomy

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