Wide Tangential Fields Including the Internal Mammary Lymph Nodes in Patients with Left-Sided Breast Cancer

Stranzl, Heidi; Zurl, B.; Langsenlehner, Tanja; Kapp, Karin S.

doi:10.1007/s00066-009-1939-2

Cited by 51 publications

(37 citation statements)

References 24 publications

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“…The DEGRO expert panel also strongly discourages the use of these selection criteria to treat patients with radiation techniques being fundamentally different from the proven standard [1,5,7,8,15,27,28] outside of clinical trials. By contrast, the DEGRO expert panel recommends treating these patients exclusively in the framework of clinical studies to avoid compromising the high cure rates in these low risk patients and to enable progress in medicine based on solid clinical data rather than on assumptions and hypotheses.…”

Section: Strahlentherapie Und Onkologiementioning

confidence: 99%

Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

et al. 2009

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EditorialBreast cancer has the highest incidence among all cancer types in females with one in every eight to ten women being affected during her lifetime. The 5 year survival rate averaged over all tumor stages is reaching 90% according to the American Cancer Society [3]. Breast cancer therapy has become more and more risk adapted over the last 3 decades and especially the extent of surgery was reduced without compromising outcome. Breast conserving surgery (BCS) and sentinel node biopsy have replaced radical mastectomy and radical axillary resection in appropriately selected patients based on risk factors.There is no doubt, that adjuvant whole breast radiotherapy (WBRT) after BCS decreases the risk of in breast tumor recurrence (IBTR) from about 30-40% after 10 years to about 5-10% and thus improves overall survival by about 5% after 15 years [20,25,29,30]. Moreover, it has been demonstrated in a large randomized trial that a group of patients benefited from an additional focal dose escalation -the tumor bed boost (review in [29]). Although the results were expected founded on theoretical considerations, this change in practice had to be based on a large prospective randomized trial from the EORTC to exactly document risks and benefits.Like every other adjuvant therapy, WBRT after BCS is an overtreatment for some patients and reducing the intensity of WBRT is currently one of the most fervidly and controversially discussed issues with regard to breast cancer therapy [21][22][23][24]. Although the idea of a risk adapted reduction of breast cancer radiotherapy either in radiation dose and/or in treatment volume is intriguing, it is strongly recommended not to base such a fundamental change in clinical practice on theoretical assumptions alone rather than on solid data from properly designed and conducted trials.There are important lessons learned from the history of breast cancer treatment. 15 years ago, it was hypothesized, that there is a certain percentage of patients with so called low risk features (old age, small tumor, receptor positivity, etc.) who would not benefit from WBRT after BCS at all. Several trials were performed lasting several years, and in parallel, thousands of patients were treated according to the "expected results" outside of these trials. Up to 30% of the patients in the respective age group did not receive the proper treatment [10]. However, in none of these prospective trials any subgroup could be identified which did not benefit from WBRT in terms of a reduced rate of IBTR in all age and risk groups. Moreover, it seems important, that the relative risk reduction was almost constant in all patient groups. This experience should remind us that even though hypotheses are a prerequisite for progress in medicine, any such advancement can only Key Words: Breast cancer · Radiotherapy · Breast-conserving therapy · Partial-breast irradiation Schlüsselwörter: Mammakarzinom · Radiotherapie · Brusterhaltende Therapie · Teilbrustbestrahlung

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Section: Strahlentherapie Und Onkologiementioning

confidence: 99%

Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

et al. 2009

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“…Voluntary DIBH is a process where the patient's breathing is verbally coached and is simultaneously tracked by an external surrogate (ie, Real-Time Position Management [RPM] system from Varian Medical Systems, Palo Alto, California). [15][16][17] The RPM system uses the vertical displacement of the 6-dot infrared tracker placed on the patient (ie, sternum or abdomen) and provides a relative position value with respect to the patient's breathing cycle. 18 The alternate method, termed moderate DIBH, includes limiting the patient's inspiration to a predefined lung volume determined by the user (usually 75% of the maximum inspiration).…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Considerations in Respiratory-Gated Deep Inspiration Breath-Hold for Left Breast Irradiation

Walston

Quick

Kuhn

et al. 2016

Technol Cancer Res Treat

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Purpose: To present our clinical workflow of incorporating AlignRT for left breast deep inspiration breath-hold treatments and the dosimetric considerations with the deep inspiration breath-hold protocol. Material and Methods: Patients with stage I to III left-sided breast cancer who underwent lumpectomy or mastectomy were considered candidates for deep inspiration breathhold technique for their external beam radiation therapy. Treatment plans were created on both free-breathing and deep inspiration breath-hold computed tomography for each patient to determine whether deep inspiration breath-hold was beneficial based on dosimetric comparison. The AlignRT system was used for patient setup and monitoring. Dosimetric measurements and their correlation with chest wall excursion and increase in left lung volume were studied for free-breathing and deep inspiration breath-hold plans. Results: Deep inspiration breath-hold plans had significantly increased chest wall excursion when compared with free breathing. This change in geometry resulted in reduced mean and maximum heart dose but did not impact lung V 20 or mean dose. The correlation between chest wall excursion and absolute reduction in heart or lung dose was found to be nonsignificant, but correlation between left lung volume and heart dose showed a linear association. It was also identified that higher levels of chest wall excursion may paradoxically increase heart or lung dose. Conclusion: Reduction in heart dose can be achieved for many left-sided breast and chest wall patients using deep inspiration breath-hold. Chest wall excursion as well as left lung volume did not correlate with reduction in heart dose, and it remains to be determined what metric will provide the most optimal and reliable dosimetric advantage.

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“…These new techniques allow a reduction of safety margins, thereby, providing more homogeneous irradiation of the tumor target volume and a decreased risk of OAR complications [31,33].…”

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confidence: 99%

Dosimetric comparison of free-breathing and deep inspiration breath-hold radiotherapy for lung cancer

et al. 2012

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Wide Tangential Fields Including the Internal Mammary Lymph Nodes in Patients with Left-Sided Breast Cancer

Abstract: Radiation exposure of organs at risk can significantly be reduced for breast cancer patients using the DIBH technique. If radiotherapy of the internal mammary lymph nodes is considered necessary, DIBH may be the preferable technique.

Cited by 51 publications

References 24 publications

Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

Accelerated Partial-Breast Irradiation (APBI) – Ready for Prime Time?

Dosimetric Considerations in Respiratory-Gated Deep Inspiration Breath-Hold for Left Breast Irradiation

Dosimetric comparison of free-breathing and deep inspiration breath-hold radiotherapy for lung cancer

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