Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

Wen, Bo; Hsu, Heng-Shou; Formenti-Ujlaki, G.F.; Lymberis, S.; Magnolfi, C.; Zhao, Xuan; Chang, Jenghwa; DeWyngaert, J. Keith; Jozsef, Gabor; Formenti, Silvia C.

doi:10.1016/j.ijrobp.2012.01.055

Cited by 12 publications

(11 citation statements)

References 20 publications

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“…External beam studies have shown mean heart doses of 1.2 Gy and V5 of 1% ( 82 , 83 ). RTOG 0413 showed external partial breast irradiation with a mean V5 value at 1.1% for left-sided patients ( 84 ).…”

Section: Resultsmentioning

confidence: 99%

Treatment Techniques to Reduce Cardiac Irradiation for Breast Cancer Patients Treated with Breast-Conserving Surgery and Radiation Therapy: A Review

Beck

Kim²,

Yue³

et al. 2014

Front. Oncol.

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Thousands of women diagnosed with breast cancer each year receive breast-conserving surgery followed by adjuvant radiation therapy. For women with left-sided breast cancer, there is risk of potential cardiotoxicity from the radiation therapy. As data have become available to quantify the risk of cardiotoxicity from radiation, strategies have also developed to reduce the dose of radiation to the heart without compromising radiation dose to the breast. Several broad categories of techniques to reduce cardiac radiation doses include breath hold techniques, prone positioning, intensity-modulated radiation therapy, and accelerated partial breast irradiation, as well as many small techniques to improve traditional three-dimensional conformal radiation therapy. This review summarizes the published scientific literature on the various techniques to decrease cardiac irradiation in women treated to the left breast for breast cancer after breast-conserving surgery.

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Section: Resultsmentioning

confidence: 99%

Treatment Techniques to Reduce Cardiac Irradiation for Breast Cancer Patients Treated with Breast-Conserving Surgery and Radiation Therapy: A Review

Beck

Kim²,

Yue³

et al. 2014

Front. Oncol.

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“…Indeed, our study included PTV with the average volume and the maximum volume 30% and 60%–70% smaller, respectively, than those from the postoperative single‐fraction radiotherapy studies (9,10) . In addition, our study showed

V_{50 %}

and

V_{100 %}

of ILB about 15% and 5%, respectively, whereas postoperative prone APBI studies (28‐30) showed about a

V_{50}

of approximately 40%–50% and

V_{100}

\sim 20 % - 30 %

. Similarly, postoperative supine APBI studies, which reported acceptable cosmetic outcome, showed a

V_{50}

\sim 35 % - 40 %

and

V_{100}

\sim 10 % - 15 %

(4,31) .…”

Section: Discussionmentioning

confidence: 60%

Dosimetric comparison of preoperative single‐fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT

Yoo

Blitzblau

Yin

et al. 2015

J Applied Clin Med Phys

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The purpose of this study was to compare dosimetric parameters of treatment plans among four techniques for preoperative single-fraction partial breast radiotherapy in order to select an optimal treatment technique. The techniques evaluated were noncoplanar 3D conformal radiation therapy (3D CRT), noncoplanar intensity-modulated radiation therapy (IMRTNC), coplanar IMRT (IMRTCO), and volumetric-modulated arc therapy (VMAT). The planning CT scans of 16 patients in the prone position were used in this study, with the single-fraction prescription doses of 15 Gy for the first eight patients and 18 Gy for the remaining eight patients. Six (6) MV photon beams were designed to avoid the heart and contralateral breast. Optimization for IMRT and VMAT was performed to reduce the dose to the skin and normal breast. All plans were normalized such that 100% of the prescribed dose covered greater than 95% of the clinical target volume (CTV) consisting of gross tumor volume (GTV) plus 1.5 cm margin. Mean homogeneity index (HI) was the lowest (1.05 ± 0.02) for 3D CRT and the highest (1.11 ± 0.04) for VMAT. Mean conformity index (CI) was the lowest (1.42 ± 0.32) for IMRTNC and the highest (1.60 ± 0.32) for VMAT. Mean of the maximum point dose to skin was the lowest (73.7 ± 11.5%) for IMRTNC and the highest (86.5 ± 6.68%) for 3D CRT. IMRTCO showed very similar HI, CI, and maximum skin dose to IMRTNC (differences <1%). The estimated mean treatment delivery time, excluding the time spent for patient positioning and imaging, was 7.0 ± 1.0, 8.3 ± 1.1, 9.7 ± 1.0, and 11.0 ± 1.5min for VMAT, IMRTCO, IMRTNC and 3D CRT, respectively. In comparison of all four techniques for preoperative single-fraction partial breast radiotherapy, we can conclude that noncoplanar or coplanar IMRT were optimal in this study as IMRT plans provided homogeneous and conformal target coverage, skin sparing, and relatively short treatment delivery time.

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“…Prospective trials have demonstrated that EB-APBI is compliant to dosimetric requirements. 89 , 90 However, Formenti et al found that prone EB-APBI resulted in an increase in cardiac dose in 19 of 30 plans compared to a decrease in cardiac dose in seven of 30 plans. 89 …”

Section: Resultsmentioning

confidence: 99%

Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment

Chan¹,

Tang²,

Tan³

et al. 2018

CMAR

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Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.

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Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

Cited by 12 publications

References 20 publications

Treatment Techniques to Reduce Cardiac Irradiation for Breast Cancer Patients Treated with Breast-Conserving Surgery and Radiation Therapy: A Review

Treatment Techniques to Reduce Cardiac Irradiation for Breast Cancer Patients Treated with Breast-Conserving Surgery and Radiation Therapy: A Review

Dosimetric comparison of preoperative single‐fraction partial breast radiotherapy techniques: 3D CRT, noncoplanar IMRT, coplanar IMRT, and VMAT

Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment

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