The choice of multi-beam IMRT for whole breast radiotherapy in early-stage right breast cancer

Haciislamoglu, Emel; Çolak, Fatma; Canyılmaz, Emine; Zengin, Ahmet; Yilmaz, Ahmet Hakan; Yöney, Adnan; Bahat, Zümrüt

doi:10.1186/s40064-016-2314-2

Cited by 23 publications

(25 citation statements)

References 29 publications

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“…The prescription dose for all patients was 50 Gy in 25 fractions. The dosimetric constraints were determined from various publications and recommendations 5–12 . The dose to OARs was divided into two dose constraints (Table 1), the patients in the first situation followed the constraint for the CW only irradiation.…”

Section: Methodsmentioning

confidence: 99%

Dosimetric comparison of TomoDirect, helical tomotherapy, and volumetric modulated arc therapy for postmastectomy treatment

Nobnop

Phakoetsuk

Chitapanarux

et al. 2020

J Applied Clin Med Phys

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Purpose To compare dose to the targets and organs at risk (OARs) in different situations for postmastectomy patients who require radiation to the chest wall with or without regional nodal irradiation when using three treatment techniques. Methods and materials Thirty postmastectomy radiotherapy (PMRT) patients previously treated by helical tomotherapy (HT) at our institution were identified for the study. The treatment targets were classified in three situations which consisted of, the chest wall (CW) only, the chest wall plus supraclavicular lymph nodes (CW + SPC), and the chest wall plus supraclavicular and whole axillary lymph nodes irradiation (CW + SPC+AXLN). The volumetric modulated arc therapy (VMAT) plans and Tomodirect (TD) plans were created for each patient and compared with HT treatment plans which had been treated. The target coverage, dose homogeneity index (HI), conformity index (CI), and dose to OARs were analyzed. The quality scores were used to evaluate the appropriate technique for each situation from multiparameter results. Results The HT and VMAT plans showed the advantage of target coverage and OARs sparing for the chest wall with regional nodal irradiation with the higher plan quality scores when compared with TD plans. However, TD plans demonstrated superiority to contralateral breast sparing for the chest wall without regional nodal situation reaching the highest of planned quality scores. HT plans showed better HI, CI, and target coverage (P < 0.01) than TD and VMAT plans for all patient situations. Volumetric modulated arc therapy plans generated better contralateral breast and heart sparing at a lower dose than HT. Conclusion The arc‐based techniques, HT and VMAT plans, provided an advantage for complex targets in terms of target coverage and OARs sparing. However, the static beam TD plan was superior for contralateral organ sparing meanwhile achieving good target coverage for the chest wall without regional node situations.

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Section: Methodsmentioning

confidence: 99%

Dosimetric comparison of TomoDirect, helical tomotherapy, and volumetric modulated arc therapy for postmastectomy treatment

Nobnop

Phakoetsuk

Chitapanarux

et al. 2020

J Applied Clin Med Phys

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“…HT, INV-IMRT, and VMAT may all increase the mean and maximum dose to contralateral breast, and mean dose to the heart and ipsilateral lung compared to F-IMRT or 3D CRT, although doses to organs at risk may also depend on the patient’s anatomy or positioning. 52 , 73 , 75 , 91 …”

Section: Discussionmentioning

confidence: 99%

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Ratoša

Jenko

Oblak

2018

Radiology and Oncology

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BackgroundBreast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size.ConclusionsInhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.

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“…In addition, in this technique, due to the healthy tissues and CTV proximity, normal tissues occur in most radiation fields. Despite the reduction in the high-dose area, the low-and medium-dose regions in the heart and lung increase [2,30] that can raise the dosimetric parameters of OARs for some patients, as reported in some studies [31][32][33][34]. However, the high-dose regions in the heart could decrease without these additional increases in the low-and medium-dose areas using DIBH [2].…”

Section: A B Cmentioning

confidence: 91%

Evaluation of the heart and lung dosimetric parameters in deep inspiration breath hold using 3D Slicer

et al. 2020

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The present study was conducted to compare dosimetric parameters for the heart and left lung between free breathing (FB) and deep inspiration breath hold (DIBH) and determine the most important potential factors associated with increasing the lung dose for left-sided breast radiotherapy using image analysis with 3D Slicer software. Materials and Methods: Computed tomography-simulation scans in FB and DIBH were obtained from 17 patients with left-sided breast cancer. After contouring, three-dimensional conformal plans were generated for them. The prescribed dose was 50 Gy to the clinical target volume. In addition to the dosimetric parameters, the irradiated volumes and both displacement magnitudes and vectors for the heart and left lung were assessed using 3D Slicer software. Results: The average of the heart mean dose (D mean) decreased from 5.97 to 3.83 Gy and V 25 from 7.60% to 3.29% using DIBH (p < 0.001). Furthermore, the average of D mean for the left lung was changed from 8.67 to 8.95 Gy (p = 0.389) and V 20 from 14.84% to 15.44% (p = 0.387). Both of the absolute and relative irradiated heart volumes decreased from 42.12 to 15.82 mL and 8.16% to 3.17%, respectively (p < 0.001); however, these parameters for the left lung increased from 124.32 to 223.27 mL (p < 0.001) and 13.33% to 13.99% (p = 0.350). In addition, the average of heart and left lung displacement magnitudes were calculated at 7.32 and 20.91 mm, respectively. Conclusion: The DIBH is an effective technique in the reduction of the heart dose for tangentially treated left sided-breast cancer patients, without a detrimental effect on the left lung.

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The choice of multi-beam IMRT for whole breast radiotherapy in early-stage right breast cancer

Cited by 23 publications

References 29 publications

Dosimetric comparison of TomoDirect, helical tomotherapy, and volumetric modulated arc therapy for postmastectomy treatment

Dosimetric comparison of TomoDirect, helical tomotherapy, and volumetric modulated arc therapy for postmastectomy treatment

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Evaluation of the heart and lung dosimetric parameters in deep inspiration breath hold using 3D Slicer

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