Stereotactic Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Rationale, Feasibility, and Early Experience Using the CyberKnife Radiosurgery Delivery Platform

Obayomi-Davies, Olusola; Kole, Thomas P.; Oppong, Bridget A.; Rudra, Sonali; Makariou, Erini; Campbell, L. D.; Anjum, Hozaifa M.; Collins, Sean P.; Unger, Keith; Willey, Shawna C.; Tousimis, Eleni; Collins, Brian T.

doi:10.3389/fonc.2016.00129

Cited by 43 publications

(46 citation statements)

References 28 publications

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“…Accelerated partial breast irradiation (APBI) is an effective alternative to standard whole breast irradiation (WBI) in selected early-stage breast cancer patients undergoing breast conservation therapy [ 1 – 6 ]. Recently developed stereotactic partial breast irradiation (S-PBI) allows 1–5 treatment fractions by delivering a high biologically potent dose to the target, while sparing adjacent critical organs and normal tissue [ 1 , 7 – 9 ]. With S-PBI tumoricidal doses, accurate and precise dose delivery is critical to achieve high treatment quality.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation

et al. 2017

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BackgroundRecently developed stereotactic partial breast irradiation (S-PBI) allows delivery of a high biologically potent dose to the target while sparing adjacent critical organs and normal tissue. With S-PBI tumoricidal doses, accurate and precise dose delivery is critical to achieve high treatment quality. This study is to investigate both rigid and non-rigid components of target geometric error and their corresponding margins in S-PBI and identify correlated clinical factors.MethodsForty-three early-stage breast cancer patients with implanted gold fiducial markers were enrolled in the study. Fiducial positions recorded on the orthogonal kV images on a Cyberknife system during treatment were used to estimate intra-fraction errors and composite errors (including intra-fraction errors and residual errors after patient setup). Both rigid and non-rigid components of intra-fraction and composite errors were analyzed and used to estimate rigid and non-rigid margins, respectively. Univariate and multivariate linear regressions were conducted to evaluate correlations between clinical factors and errors.ResultsFor the study group, the intra-fraction rigid and non-rigid errors are 2.0 ± 0.6 mm and 0.3 ± 0.2 mm, respectively. The composite rigid and non-rigid errors are 2.3 ± 0.5 mm and 1.3 ± 0.8 mm, respectively. The rigid margins in the left-right, anterior-posterior, and superior-inferior directions are estimated as 2.1, 2.4, and 2.3 mm, respectively. The estimated non-rigid margin, assumed to be isotropic, is 1.7 mm. The outer breast quadrants are more susceptible to composite errors occurrence than the inner breast quadrants. The target to chest wall distance is the clinical factor correlated with target geometric errors.ConclusionsThis is the first comprehensive analysis of breast target geometric rigid and non-rigid errors in S-PBI. Upon the estimation, the non-rigid margin is comparable to rigid margin, and therefore should be included in planning target volume as it cannot be accounted for by the Cyberknife system. Treatment margins selection also need to consider the impact of relevant clinical factor.Electronic supplementary materialThe online version of this article (10.1186/s13014-017-0889-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation

et al. 2017

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“…XACT imaging can also be applied to different radiotherapy machine, for example, CyberKnife treatments are nonisocentric, where beams can be directed from any desired angle. 6 At present, when applying XACT to practical clinical in vivo dose measurements, the image resolution we can achieve is still a challenging problem. The LINAC pulse duration in clinic is usually between 3 and 4 µs, the corresponding in-water spatial resolution is 4.4-5.9 mm.…”

Section: Discussionmentioning

confidence: 99%

“…4 In recent years, SBRT has been investigated to apply for early-stage breast cancer, that is, stereotactic partial breast irradiation (SPBI). [5][6][7][8] It is essential for SPBI to deliver accurate radiation dose to tumor; however, traditional radiotherapy workflow cannot meet this requirement. 5 In addition, the occurrence of lumpectomy shrinkage and radiation-induced breast swelling leads to large interfraction geometric uncertainties.…”

Section: Introductionmentioning

confidence: 99%

X‐ray‐induced acoustic computed tomography for guiding prone stereotactic partial breast irradiation: a simulation study

et al. 2020

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The aim of this study is to investigate the feasibility of x-ray-induced acoustic computed tomography (XACT) as an image guidance tool for tracking x-ray beam location and monitoring radiation dose delivered to the patient during stereotactic partial breast irradiation (SPBI). Methods: An in-house simulation workflow was developed to assess the ability of XACT to act as an in vivo dosimetry tool for SPBI. To evaluate this simulation workflow, a three-dimensional (3D) digital breast phantom was created by a series of two-dimensional (2D) breast CT slices from a patient. Three different tissue types (skin, adipose tissue, and glandular tissue) were segmented and the postlumpectomy seroma was simulated inside the digital breast phantom. A treatment plan was made with three beam angles to deliver radiation dose to the seroma in breast to simulate SPBI. The three beam angles for 2D simulations were 17°, 90°and 159°(couch angles were 0 degrees) while the angles were 90 degrees (couch angles were 0°, 27°, 90°) in 3D simulation. A multi-step simulation platform capable of modelling XACT was developed. First, the dose distribution was converted to an initial pressure distribution. The propagation of this pressure disturbance in the form of induced acoustic waves was then modeled using the k-wave MATLAB toolbox. The waves were then detected by a hemispherical-shaped ultrasound transducer array (6320 transducer locations distributed on the surface of the breast). Finally, the time-varying pressure signals detected at each transducer location were used to reconstruct an image of the initial pressure distribution using a 3D time-reversal reconstruction algorithm. Finally, the reconstructed XACT images of the radiation beams were overlaid onto the structure breast CT. Results: It was found that XACT was able to reconstruct the dose distribution of SPBI in 3D. In the reconstructed 3D volumetric dose distribution, the average doses in the GTV (Gross Target Volume) and PTV (Planning Target Volume) were 86.15% and 80.89%, respectively. When compared to the treatment plan, the XACT reconstructed dose distribution in the GTV and PTV had a RMSE (root mean square error) of 2.408 % and 2.299 % over all pixels. The 3D breast XACT imaging reconstruction with time-reversal reconstruction algorithm can be finished within several minutes. Conclusions: This work explores the feasibility of using the novel imaging modality of XACT as an in vivo dosimeter for SPBI radiotherapy. It shows that XACT imaging can provide the x-ray beam location and dose information in deep tissue during the treatment in real time in 3D. This study lays the groundwork for a variety of future studies related to the use of XACT as a dosimeter at different cancer sites.

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“…This technique, in the context of adjuvant therapy, was evaluated in an early feasibility study. 19 The MultiPlan 5.2.1 nonisocentric inverse-planning algorithm was used to create conformal treatment plans utilizing the Monte Carlo method.…”

Section: Methodsmentioning

confidence: 99%

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

Lischalk

Chen

Repka

et al. 2018

Advances in Radiation Oncology

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PurposeFew definitive treatment options exist for elderly patients diagnosed with early stage breast cancer who are medically inoperable or refuse surgery. Historical data suggest very poor local control with hormone therapy alone. We examined the dosimetric feasibility of hypofractionated radiation therapy using stereotactic ablative radiotherapy (SABR) and proton beam therapy (PBT) as a means of definitive treatment for early stage breast cancer.Methods and MaterialsFifteen patients with biopsy-proven early stage breast cancer with a clinically visible tumor on preoperative computed tomography scans were identified. Gross tumor volumes were contoured and correlated with known biopsy-proven malignancy on prior imaging. Treatment margins were created on the basis of set-up uncertainty and image guidance capabilities of the three radiation modalities analyzed (3-dimensional conformal radiation therapy [3D-CRT], SABR, and PBT) to deliver a total dose of 50 Gy in 5 fractions. Dose volume histograms were analyzed and compared between treatment techniques.ResultsThe median planning target volume (PTV) for SABR, PBT, and 3-dimensional CRT was 11.91, 21.03, and 45.08 cm3, respectively, and were significantly different (P < .0001) between treatment modalities. Overall target coverage of gross tumor and clinical target volumes was excellent with all three modalities. Both SABR and PBT demonstrated significant dosimetric improvements, each in its own unique manner, relative to 3D-CRT. Dose constraints to normal structures including ipsilateral/contralateral breast, bilateral lungs, and heart were all consistently achieved using SABR and PBT. However, skin or chest wall dose constraints were exceeded in some cases for both SABR and PBT plans and was dictated by the anatomic location of the tumor.ConclusionsDefinitive hypofractionated radiation therapy using SABR and PBT appears to be dosimetrically feasible for the treatment of early stage breast cancer. The anatomical location of the tumor relative to the skin and chest wall appears to be the primary limiting dosimetric factor.

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Stereotactic Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Rationale, Feasibility, and Early Experience Using the CyberKnife Radiosurgery Delivery Platform

Cited by 43 publications

References 28 publications

Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation

Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation

X‐ray‐induced acoustic computed tomography for guiding prone stereotactic partial breast irradiation: a simulation study

Definitive hypofractionated radiation therapy for early stage breast cancer: Dosimetric feasibility of stereotactic ablative radiotherapy and proton beam therapy for intact breast tumors

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