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Low-dose-area-constrained helical TomoTherapy-based whole breast radiotherapy and dosimetric comparison with tangential field-in-field IMRT. BIOMED RESEARCH INTERNATIONAL 2013; 2013:513708. [PMID: 24024197 PMCID: PMC3759257 DOI: 10.1155/2013/513708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 07/11/2013] [Indexed: 12/25/2022]
Abstract
Background and Purpose. To present a novel helical TomoTherapy-based method for whole breast radiotherapy that has better dosimetry and also has acceptable low-dose regions for lungs, heart, and contralateral breast compared with tangential field-in-field IMRT (FIF-IMRT). Material and Methods. Ten patients with left-side breast cancer were planned with low-dose-area-constrained helical TomoTherapy (LDC-HT) and FIF-IMRT. Dosimetry was compared for all techniques. Results. Coverage of the whole breast was adequate with both techniques. Homogeneity index (HI) and conformity index (CI) were better with LDC-HT. LDC-HT showed dosimetry advantages over FIF-IMRT for ipsilateral lung and heart in not only high-dose levels but also in low-dose levels such as V10 Gy and V5 Gy. For contralateral lung, both techniques can provide good protection, although the mean dose of LDC-HT is higher than that of FIF-IMRT. Conclusions. With LDC-HT, we obtained adequate target coverage, better HI and CI of target volume, better sparing of organs at risk, and acceptably low-dose areas compared with FIF-IMRT. LDC-HT could be a feasible method in whole breast radiotherapy. Clinical benefits of LDC-HT need further investigation.
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102
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Tsuchiya K, Kinoshita R, Shimizu S, Nishioka K, Harada K, Nishikawa N, Suzuki R, Shirato H. Dosimetric comparison between intensity-modulated radiotherapy and standard wedged tangential technique for whole-breast radiotherapy in Asian women with relatively small breast volumes. Radiol Phys Technol 2013; 7:67-72. [PMID: 23982269 DOI: 10.1007/s12194-013-0232-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
We sought to investigate whether intensity-modulated radiotherapy (IMRT) has a dosimetric advantage compared to the standard wedged tangential technique (SWT) for whole-breast radiotherapy (WBRT) in Asian women with relatively small breast volume. Computed tomography images of 25 Asian patients with early-stage breast cancer (right 15, left 10) used for WBRT planning were examined. After contouring the target volumes and bilateral lungs and, for left-side treatment, the heart, 4 plans were made for each patient: namely, SWT, tangential-field IMRT (T-IMRT), 3-field IMRT (3F-IMRT), and 4-field IMRT (4F-IMRT). The prescribed dose was 5000 cGy. The median planning target volume (PTV) for WBRT was 552.6 cc (range 288.8-1518.4 cc). Compared to SWT, (1) T-IMRT achieved significant improvement for dose homogeneity in the PTV (p < 0.001) and the dose received by 2% (D2) of the PTV (p < 0.001). T-IMRT also reduced the bilateral lung mean dose (p < 0.001) and the ipsilateral lung volume which received more than 20 Gy (V20) (p = 0.01). (2) 3F-IMRT resulted in a significant increase in the mean dose to the ipsilateral lung (p < 0.001) and to the contralateral lung (p < 0.001). (3) 4F-IMRT also resulted in a significant increase in the mean dose to the ipsilateral lung (p < 0.001) and to the contralateral lung (p < 0.001). Tangential-field IMRT provided an improved dose distribution compared with SWT for WBRT in Asian women with a relatively small breast volume.
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Affiliation(s)
- Kazuhiko Tsuchiya
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, North 15 West 7 Kita-ku, Sapporo, 060-8638, Japan
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103
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Mulliez T, Veldeman L, van Greveling A, Speleers B, Sadeghi S, Berwouts D, Decoster F, Vercauteren T, De Gersem W, Van den Broecke R, De Neve W. Hypofractionated whole breast irradiation for patients with large breasts: A randomized trial comparing prone and supine positions. Radiother Oncol 2013; 108:203-8. [DOI: 10.1016/j.radonc.2013.08.040] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/23/2013] [Accepted: 08/24/2013] [Indexed: 11/17/2022]
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104
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Lei RY, Leonard CE, Howell KT, Henkenberns PL, Johnson TK, Hobart TL, Fryman SP, Kercher JM, Widner JL, Kaske T, Carter DL. Four-year clinical update from a prospective trial of accelerated partial breast intensity-modulated radiotherapy (APBIMRT). Breast Cancer Res Treat 2013; 140:119-33. [PMID: 23824363 PMCID: PMC3706719 DOI: 10.1007/s10549-013-2623-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/22/2013] [Indexed: 01/03/2023]
Abstract
This prospective Phase II single-arm study gathered data on the use of intensity-modulated radiotherapy (IMRT) to deliver accelerated partial breast irradiation (APBI). Four-year efficacy, cosmesis, and toxicity results are presented. Between February 2004 and September 2007, 136 consecutive patients with Stage 0/I breast cancer and negative margins ≥0.2 cm were treated on protocol. Patients received 38.5 Gy in 10 equal fractions delivered twice daily. Breast pain and cosmesis were rated by patient, and cosmesis was additionally evaluated by physician per Radiation Therapy Oncology Group (RTOG) criteria. The National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v3.0) was used to grade toxicities. 136 patients (140 breasts) with median follow-up of 53.1 months (range, 8.9-83.2) were evaluated. Population characteristics included median age of 61.9 years and Tis (13.6 %), T1a (18.6 %), T1b (36.4 %), and T1c (31.4 %). Kaplan-Meier estimates at 4 years: ipsilateral breast tumor recurrence 0.7 %; contralateral breast failure 0 %; distant failure 0.9 %; overall survival 96.8 %; and cancer-specific survival 100 %. At last follow-up, patients and physicians rated cosmesis as excellent/good in 88.2 and 90.5 %, respectively; patients rated breast pain as none/mild in 97.0 %. Other observations included edema (1.4 %), telangiectasia (3.6 %), five cases of grade 1 radiation recall (3.6 %), and two cases of rib fractures (1.4 %). This analysis represents the largest cohort and longest follow-up of APBI utilizing IMRT reported to date. Four-year results continue to demonstrate excellent local control, survival, cosmetic results, and toxicity profile.
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Affiliation(s)
- Rachel Y. Lei
- Rocky Mountain Cancer Centers, 22 W. Dry Creek Circle, Littleton, CO 80120 USA
- Rocky Mountain Cancer Center, 1700 S. Potomac Street, Aurora, CO 80012 USA
| | - Charles E. Leonard
- Rocky Mountain Cancer Centers, 22 W. Dry Creek Circle, Littleton, CO 80120 USA
| | - Kathryn T. Howell
- Rocky Mountain Cancer Centers, 22 W. Dry Creek Circle, Littleton, CO 80120 USA
| | | | - Timothy K. Johnson
- Rocky Mountain Cancer Centers, 22 W. Dry Creek Circle, Littleton, CO 80120 USA
| | - Tracy L. Hobart
- Rocky Mountain Cancer Centers, 22 W. Dry Creek Circle, Littleton, CO 80120 USA
| | - Shannon P. Fryman
- Rocky Mountain Cancer Centers, 22 W. Dry Creek Circle, Littleton, CO 80120 USA
- Rocky Mountain Cancer Center, 1700 S. Potomac Street, Aurora, CO 80012 USA
| | | | | | - Terese Kaske
- Sally Jobe Diagnostic Breast Center, Greenwood Village, CO USA
| | - Dennis L. Carter
- Rocky Mountain Cancer Center, 1700 S. Potomac Street, Aurora, CO 80012 USA
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105
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Mulliez T, Speleers B, Madani I, De Gersem W, Veldeman L, De Neve W. Whole breast radiotherapy in prone and supine position: is there a place for multi-beam IMRT? Radiat Oncol 2013; 8:151. [PMID: 23800109 PMCID: PMC3702403 DOI: 10.1186/1748-717x-8-151] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Early stage breast cancer patients are long-term survivors and finding techniques that may lower acute and late radiotherapy-induced toxicity is crucial. We compared dosimetry of wedged tangential fields (W-TF), tangential field intensity-modulated radiotherapy (TF-IMRT) and multi-beam IMRT (MB-IMRT) in prone and supine positions for whole-breast irradiation (WBI). Methods MB-IMRT, TF-IMRT and W-TF treatment plans in prone and supine positions were generated for 18 unselected breast cancer patients. The median prescription dose to the optimized planning target volume (PTVoptim) was 50 Gy in 25 fractions. Dose-volume parameters and indices of conformity were calculated for the PTVoptim and organs-at-risk. Results Prone MB-IMRT achieved (p<0.01) the best dose homogeneity compared to WTF in the prone position and WTF and MB-IMRT in the supine position. Prone IMRT scored better for all dose indices. MB-IMRT lowered lung and heart dose (p<0.05) in supine position, however the lowest ipsilateral lung doses (p<0.001) were in prone position. In left-sided breast cancer patients population averages for heart sparing by radiation dose was better in prone position; though non-significant. For patients with a PTVoptim volume ≥600 cc heart dose was consistently lower in prone position; while for patients with smaller breasts heart dose metrics were comparable or worse compared to supine MB-IMRT. Doses to the contralateral breast were similar regardless of position or technique. Dosimetry of prone MB-IMRT and prone TF-IMRT differed slightly. Conclusions MB-IMRT is the treatment of choice in supine position. Prone IMRT is superior to any supine treatment for right-sided breast cancer patients and left-sided breast cancer patients with larger breasts by obtaining better conformity indices, target dose distribution and sparing of the organs-at-risk. The influence of treatment techniques in prone position is less pronounced; moreover dosimetric differences between TF-IMRT and MB-IMRT are rather small.
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Affiliation(s)
- Thomas Mulliez
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium.
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106
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Borges C, Cunha G, Monteiro-Grillo I, Vaz P, Teixeira N. Comparison of different breast planning techniques and algorithms for radiation therapy treatment. Phys Med 2013; 30:160-70. [PMID: 23735838 DOI: 10.1016/j.ejmp.2013.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/23/2013] [Accepted: 04/30/2013] [Indexed: 12/25/2022] Open
Abstract
This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques--forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT--and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques--f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART - were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose-volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.
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Affiliation(s)
- C Borges
- Medicalconsult SA, Campo Grande, n° 56 - 8° A, 1700-093 Lisboa, Portugal.
| | - G Cunha
- Escola Superior de Tecnologias da Saúde, Avenida Dom João II, 1900-096 Lisboa, Portugal
| | - I Monteiro-Grillo
- Departamento de Radioterapia, Hospital de Santa Maria, Centro Hospitalar Lisboa, Norte, EPE, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal
| | - P Vaz
- Instituto Superior Técnico, Campus Tecnológico e Nuclear, Unidade de Protecção e Segurança Radiológica, Estrada Nacional 10 (ao km 139,7), 2695-066 Bobadela LRS, Portugal
| | - N Teixeira
- Escola Superior de Tecnologias da Saúde, Avenida Dom João II, 1900-096 Lisboa, Portugal
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107
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Tortorelli G, Di Murro L, Barbarino R, Cicchetti S, di Cristino D, Falco MD, Fedele D, Ingrosso G, Janniello D, Morelli P, Murgia A, Ponti E, Terenzi S, Tolu B, Santoni R. Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities. BMC Cancer 2013; 13:230. [PMID: 23651532 PMCID: PMC3660202 DOI: 10.1186/1471-2407-13-230] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 04/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify predictive factors of radiation-induced skin toxicity in breast cancer patients by the analysis of dosimetric and clinical factors. METHODS 339 patients treated between January 2007 and December 2010 are included in the present analysis. Whole breast irradiation was delivered with Conventional Fractionation (CF) (50 Gy, 2.0/day, 25 fractions) and moderate Hypofractionated Schedule (HS) (44 Gy, 2.75 Gy/day, 16 fractions) followed by tumour bed boost. The impact of patient clinical features, systemic treatments and, in particular, dose inhomogeneities on the occurrence of different levels of skin reaction has been retrospectively evaluated. RESULTS G2 and G3 acute skin toxicity were 42% and 13% in CF patients and 30% and 7.5% in HS patients respectively. The retrieval and revaluation of 200 treatment plans showed a strong correlation between areas close to the skin surface, with inhomogeneities >107% of the prescribed dose, and the desquamation areas as described in the clinical records. CONCLUSIONS In our experience dose inhomogeneity underneath G2 - G3 skin reactions seems to be the most important predictor for acute skin damage and in these patients more complex treatment techniques should be considered to avoid skin damage. Genetic polymorphisms too have to be investigated as possible promising candidates for predicting acute skin reactions.
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Affiliation(s)
- Grazia Tortorelli
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Viale Oxford 81, Rome 00133, Italy
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108
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Small K, Kelly C, Beldham-Collins R, Gebski V. Whole breast and excision cavity radiotherapy plan comparison: Conformal radiotherapy with sequential boost versus intensity-modulated radiation therapy with a simultaneously integrated boost. J Med Radiat Sci 2013; 60:16-24. [PMID: 26229603 PMCID: PMC4175795 DOI: 10.1002/jmrs.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 11/29/2012] [Accepted: 12/05/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction A comparative study was conducted comparing the difference between (1) conformal radiotherapy (CRT) to the whole breast with sequential boost excision cavity plans and (2) intensity-modulated radiation therapy (IMRT) to the whole breast with simultaneously integrated boost to the excision cavity. The computed tomography (CT) data sets of 25 breast cancer patients were used and the results analysed to determine if either planning method produced superior plans. Methods CT data sets from 25 past breast cancer patients were planned using (1) CRT prescribed to 50 Gy in 25 fractions (Fx) to the whole-breast planning target volume (PTV) and 10 Gy in 5Fx to the excision cavity and (2) IMRT prescribed to 60 Gy in 25Fx, with 60 Gy delivered to the excision cavity PTV and 50 Gy delivered to the whole-breast PTV, treated simultaneously. In total, 50 plans were created, with each plan evaluated by PTV coverage using conformity indices, plan maximum dose, lung dose, and heart maximum dose for patients with left-side lesions. Results CRT plans delivered the lowest plan maximum doses in 56% of cases (average CRT = 6314.34 cGy, IMRT = 6371.52 cGy). They also delivered the lowest mean lung dose in 68% of cases (average CRT = 1206.64 cGy, IMRT = 1288.37 cGy) and V20 in 88% of cases (average CRT = 20.03%, IMRT = 21.73%) and V30 doses in 92% of cases (average CRT = 16.82%, IMRT = 17.97%). IMRT created more conformal plans, using both conformity index and conformation number, in every instance, and lower heart maximum doses in 78.6% of cases (average CRT = 5295.26 cGy, IMRT = 5209.87 cGy). Conclusion IMRT plans produced superior dose conformity and shorter treatment duration, but a slightly higher planning maximum and increased lung doses. IMRT plans are also faster to treat on a daily basis, with shorter fractionation.
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Affiliation(s)
- Katherine Small
- Nepean Cancer Care Centre Penrith, New South Wales 2750, Australia
| | - Chris Kelly
- Nepean Cancer Care Centre Penrith, New South Wales 2750, Australia ; The Crown Princess Mary Cancer Centre Westmead, New South Wales 2145, Australia
| | - Rachael Beldham-Collins
- Nepean Cancer Care Centre Penrith, New South Wales 2750, Australia ; The Crown Princess Mary Cancer Centre Westmead, New South Wales 2145, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney Sydney, New South Wales 2050, Australia
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109
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Effect of Bra Use during Radiotherapy for Large-Breasted Women: Acute Toxicity and Treated Heart and Lung Volumes. Pract Radiat Oncol 2013; 3:9-15. [PMID: 23459714 DOI: 10.1016/j.prro.2012.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE Large breast size presents special problems during radiation simulation, planning and patient treatment, including increased skin toxicity, in women undergoing breast-conserving surgery and radiotherapy (BCT). We report our experience using a bra during radiation in large-breasted women and its effect on acute toxicity and heart and lung dosimetry. MATERIALS AND METHODS From 2001 to 2006, 246 consecutive large-breasted women (bra size ≥ 38 and/or ≥ D cup) were treated with BCT using either 3D conformal (3D-CRT) or Intensity Modulated Radiation (IMRT). In 58 cases, at the physicians' discretion, a custom-fit bra was used during simulation and treatment. Endpoints were acute radiation dermatitis, and dosimetric comparison of heart and lung volumes in a subgroup of 12 left-sided breast cancer patients planned with and without a bra. RESULTS The majority of acute skin toxicities were grade 2 and were experienced by 90% of patients in a bra compared to 70% of patients not in a bra (p=0.003). On multivariate analysis significant predictors of grade 2/3 skin toxicity included 3D-CRT instead of IMRT (OR=3.9, 95% CI:1.8-8.5) and the use of a bra (OR=5.5, 95% CI:1.6-18.8). For left-sided patients, use of a bra was associated with a volume of heart in the treatment fields decreased by 63.4% (p=0.002), a volume of left lung decreased by 18.5% (p=0.25), and chest wall separation decreased by a mean of 1 cm (p=0.03). CONCLUSIONS The use of a bra to augment breast shape and position in large-breasted women is an alternative to prone positioning and associated with reduced chest wall separation and reduced heart volume within the treatment field.
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Furuya T, Sugimoto S, Kurokawa C, Ozawa S, Karasawa K, Sasai K. The dosimetric impact of respiratory breast movement and daily setup error on tangential whole breast irradiation using conventional wedge, field-in-field and irregular surface compensator techniques. JOURNAL OF RADIATION RESEARCH 2013; 54:157-165. [PMID: 22859565 PMCID: PMC3534267 DOI: 10.1093/jrr/rrs064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 06/01/2023]
Abstract
To evaluate the dosimetric impact of respiratory breast motion and daily setup error on whole breast irradiation (WBI) using three irradiation techniques; conventional wedge (CW), field-in-field (FIF) and irregular surface compensator (ISC). WBI was planned for 16 breast cancer patients. The dose indices for evaluated clinical target volume (CTV(evl)), lung, and body were evaluated. For the anterior-posterior (AP) respiratory motion and setup error of a single fraction, the isocenter was moved according to a sine function, and the dose indices were averaged over one period. Furthermore, the dose indices were weighted according to setup error frequencies that have a normal distribution to model systematic and random setup error for the entire treatment course. In all irradiation techniques, AP movement has a significant impact on dose distribution. CTV(evl)D(95) (the minimum relative dose that covers 95 % volume) and V(95) (the relative volume receiving 95 % of the prescribed dose) were observed to significantly decrease from the original ISC plan when simulated for the entire treatment course. In contrast, the D(95), V(95) and dose homogeneity index did not significantly differ from those of the original plans for FIF and CW. With regard to lung dose, the effect of motion was very similar among all three techniques. The dosimetric impact of AP respiratory breast motion and setup error was largest for the ISC technique, and the second greatest effect was observed with the FIF technique. However, these variations are relatively small.
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Affiliation(s)
- Tomohisa Furuya
- Department of Radiology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
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111
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Kraus-Tiefenbacher U, Sfintizky A, Welzel G, Simeonova A, Sperk E, Siebenlist K, Mai S, Wenz F. Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS). Radiat Oncol 2012; 7:217. [PMID: 23249653 PMCID: PMC3598440 DOI: 10.1186/1748-717x-7-217] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 11/21/2012] [Indexed: 01/03/2023] Open
Abstract
PURPOSE/OBJECTIVES Standard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy. MATERIALS/METHODS Between 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24-77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19. RESULTS After 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema.In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005).Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate analysis, factors associated with higher grade skin toxicity were larger breast target volume (p=0,003), smoking (p=0,034) and absence of allergies (p=0,002). CONCLUSION Patients treated in this study showed less objectively documented skin toxicity after 50 Gy 3D-CRT compared to similar patient cohorts. Factors associated with higher grade skin toxicity were smoking during 3D-CRT, absence of allergies and larger breast volumes.
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MESH Headings
- Adult
- Aged
- Body Mass Index
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Combined Modality Therapy
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Prognosis
- Radiodermatitis/diagnosis
- Radiodermatitis/etiology
- Radiotherapy, Conformal/adverse effects
- Risk Factors
- Smoking/adverse effects
- Young Adult
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Affiliation(s)
- Uta Kraus-Tiefenbacher
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Andreas Sfintizky
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Anna Simeonova
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Kerstin Siebenlist
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Sabine Mai
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, 68167, Mannheim, Germany
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112
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Use of intensity modulated radiation therapy to reduce acute and chronic toxicities of breast cancer patients treated with traditional and accelerated whole breast irradiation. Pract Radiat Oncol 2012; 2:e45-e51. [DOI: 10.1016/j.prro.2012.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 01/20/2012] [Accepted: 01/25/2012] [Indexed: 11/18/2022]
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113
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Michalski A, Atyeo J, Cox J, Rinks M. Inter- and intra-fraction motion during radiation therapy to the whole breast in the supine position: A systematic review. J Med Imaging Radiat Oncol 2012; 56:499-509. [DOI: 10.1111/j.1754-9485.2012.02434.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/25/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - John Atyeo
- Faculty of Health Science (MRS) Radiation Therapy; The University of Sydney
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Dayes I, Rumble R, Bowen J, Dixon P, Warde P. Intensity-modulated Radiotherapy in the Treatment of Breast Cancer. Clin Oncol (R Coll Radiol) 2012; 24:488-98. [DOI: 10.1016/j.clon.2012.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 04/13/2012] [Accepted: 05/11/2012] [Indexed: 02/09/2023]
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Planning Hybrid Intensity Modulated Radiation Therapy for Whole-breast Irradiation. Int J Radiat Oncol Biol Phys 2012; 84:e115-22. [DOI: 10.1016/j.ijrobp.2012.02.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 02/10/2012] [Accepted: 02/10/2012] [Indexed: 12/25/2022]
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Keller LMM, Sopka DM, Li T, Klayton T, Li J, Anderson PR, Bleicher RJ, Sigurdson ER, Freedman GM. Five-year results of whole breast intensity modulated radiation therapy for the treatment of early stage breast cancer: the Fox Chase Cancer Center experience. Int J Radiat Oncol Biol Phys 2012; 84:881-7. [PMID: 22909414 DOI: 10.1016/j.ijrobp.2012.01.069] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/17/2012] [Accepted: 01/21/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the 5-year outcomes using whole-breast intensity-modulated radiation therapy (IMRT) for the treatment of early-stage-breast cancer at the Fox Chase Cancer Center. METHODS AND MATERIALS A total of 946 women with early-stage breast cancer (stage 0, I, or II) were treated with IMRT after surgery with or without systemic therapy from 2003-2010. Whole-breast radiation was delivered via an IMRT technique with a median whole-breast radiation dose of 46 Gy and median tumor bed boost of 14 Gy. Endpoints included local-regional recurrence, cosmesis, and late complications. RESULTS With a median follow-up of 31 months (range, 1-97 months), there were 12 ipsilateral breast tumor recurrences (IBTR) and one locoregional recurrence. The 5-year actuarial IBTR and locoregional recurrence rates were 2.0% and 2.4%. Physician-reported cosmestic outcomes were available for 645 patients: 63% were considered "excellent", 33% "good", and <1.5% "fair/poor". For physician-reported cosmesis, boost doses≥16 Gy, breast size>900 cc, or boost volumes>34 cc were significantly associated with a "fair/poor" cosmetic outcome. Fibrosis, edema, erythema, and telangectasia were also associated with "fair/poor" physician-reported cosmesis; erythema and telangectasia remained significant on multivariate analysis. Patient-reported cosmesis was available for 548 patients, and 33%, 50%, and 17% of patients reported "excellent", "good", and "fair/poor" cosmesis, respectively. The use of a boost and increased boost volume: breast volume ratio were significantly associated with "fair/poor" outcomes. No parameter for patient-reported cosmesis was significant on multivariate analysis. The chances of experiencing a treatment related effect was significantly associated with a boost dose≥16 Gy, receipt of chemotherapy and endocrine therapy, large breast size, and electron boost energy. CONCLUSIONS Whole-breast IMRT is associated with very low rates of local recurrence at 5 years, 83%-98% "good/excellent" cosmetic outcomes, and minimal chronic toxicity, including late fibrosis.
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Affiliation(s)
- Lanea M M Keller
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Yang DS, Lee JA, Yoon WS, Chung SY, Lee S, Kim CY, Park YJ, Son GS. Whole breast irradiation for small-sized breasts after conserving surgery: is the field-in-field technique optimal? Breast Cancer 2012; 21:162-9. [PMID: 22535568 DOI: 10.1007/s12282-012-0365-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 03/26/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND To determine the optimal whole breast irradiation technique in patients with small-sized breasts, tangential and field-in-field IMRT (FIF) techniques were compared. METHODS Sixteen patients with ≤3 cm breast height and ≤350 cc volume were included. Seven patients had 4D CTs performed. The planning target volumes (PTV), editing 5 and 2 mm from the surface on the whole breast, were delineated and called PTV(5) and PTV(2), respectively. Dose-volume histograms of tangential techniques with open beam (OT) and wedge filter (WT), conventional FIF (cFIF), and modified FIF (mFIF) blocking out the lung were produced. Various dose-volume parameters, the dose heterogeneity index (DHtrI), dose homogeneity index (DHmI), and PTV dose improvement (PDI) were calculated. RESULTS OT compared with WT showed a significantly favorable V 90 of the heart and lung, and PTV(5)-dose distribution. Comparing OT and cFIF, OT showed significant improvement in the V 95 of PTV(2), whereas cFIF showed significant improvement in the V 95, DHtrI, DHmI, and PDI of the PTV(5). In comparing cFIF and mFIF, mFIF showed improved dose distributions of the heart and lung, while cFIF presented the better V 95, DHtrI, DHmI, and PDI of the PTV(5). Respiratory influences on the absolute dose were mostly within 1 %. The ratio of free breathing and each respiratory phase was similar among OT, cFIF, and mFIF. CONCLUSIONS cFIF has favorable dose conformity and is suggested to be an optimal method for small-sized breasts. However, OT for dose coverage close to the skin and mFIF for normal tissue may also be potential alternatives. Respiratory effects are minimal.
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Affiliation(s)
- Dae Sik Yang
- Department of Radiation Oncology, Guro Hospital, Korea University Medical Center, Gurodong-gil 97, Guro-gu, Seoul, 152-703, Republic of Korea
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Algara M, Arenas M, De Las Peñas Eloisa Bayo D, Muñoz J, Carceller JA, Salinas J, Moreno F, Martínez F, González E, Montero A. Radiation techniques used in patients with breast cancer: Results of a survey in Spain. Rep Pract Oncol Radiother 2012; 17:122-8. [PMID: 24377012 DOI: 10.1016/j.rpor.2012.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/05/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022] Open
Abstract
AIM To evaluate the resources and techniques used in the irradiation of patients with breast cancer after lumpectomy or mastectomy and the status of implementation of new techniques and therapeutic schedules in our country. BACKGROUND The demand for cancer care has increased among the Spanish population, as long as cancer treatment innovations have proliferated. Radiation therapy in breast cancer has evolved exponentially in recent years with the implementation of three-dimensional conformal radiotherapy, intensity modulated radiotherapy, image guided radiotherapy and hypofractionation. MATERIAL AND METHODS An original survey questionnaire was sent to institutions participating in the SEOR-Mama group (GEORM). In total, the standards of practice in 969 patients with breast cancer after surgery were evaluated. RESULTS The response rate was 70% (28/40 centers). In 98.5% of cases 3D conformal treatment was used. All the institutions employed CT-based planning treatment. Boost was performed in 56.4% of patients: electrons in 59.8%, photons in 23.7% and HDR brachytherapy in 8.8%. Fractionation was standard in 93.1% of patients. Supine position was the most frequent. Only 3 centers used prone position. The common organs of risk delimited were: homolateral lung (80.8%) and heart (80.8%). In 84% histograms were used. An 80.8% of the centers used isocentric technique. In 62.5% asymmetric fields were employed. CTV was delimited in 46.2%, PTV in 65% and both in 38.5%. A 65% of the centers checked with portal films. IMRT and hypofractionation were used in 1% and in 5.5% respectively. CONCLUSION In most of centers, 3D conformal treatment and CT-based planning treatment were used. IMRT and hypofractionation are currently poorly implemented in Spain.
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Affiliation(s)
- Manuel Algara
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | | | | | - Julia Muñoz
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | | | - Juan Salinas
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | - Ferran Moreno
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | | | | | - Angel Montero
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
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Tan W, Liu D, Xue C, Xu J, Li B, Chen Z, Hu D, Wang X. Anterior Myocardial Territory May Replace the Heart as Organ at Risk in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer. Int J Radiat Oncol Biol Phys 2012; 82:1689-97. [DOI: 10.1016/j.ijrobp.2011.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 03/04/2011] [Accepted: 03/10/2011] [Indexed: 12/25/2022]
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Hardee ME, Raza S, Becker SJ, Jozsef G, Lymberis SC, Hochman T, Goldberg JD, DeWyngaert KJ, Formenti SC. Prone Hypofractionated Whole-Breast Radiotherapy Without a Boost to the Tumor Bed: Comparable Toxicity of IMRT Versus a 3D Conformal Technique. Int J Radiat Oncol Biol Phys 2012; 82:e415-23. [DOI: 10.1016/j.ijrobp.2011.06.1950] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/31/2011] [Accepted: 06/03/2011] [Indexed: 11/25/2022]
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Harris R, Probst H, Beardmore C, James S, Dumbleton C, Bolderston A, Faithfull S, Wells M, Southgate E. Radiotherapy skin care: A survey of practice in the UK. Radiography (Lond) 2012. [DOI: 10.1016/j.radi.2011.10.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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122
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Forward Intensity-Modulated Radiotherapy Planning in Breast Cancer to Improve Dose Homogeneity: Feasibility of Class Solutions. Int J Radiat Oncol Biol Phys 2012; 82:394-400. [DOI: 10.1016/j.ijrobp.2010.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 06/14/2010] [Accepted: 09/14/2010] [Indexed: 01/02/2023]
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Heymann S, Verstraet R, Pichenot C, Vergne E, Lefkopoulos D, Husson F, Kafrouni H, Mahe J, Kandalaft B, Bourhis J, Marsiglia H, Bourgier C. Modulation d’intensité en radiothérapie mammaire : développement d’une méthode innovante de champ dans le champ à l’institut Gustave-Roussy. Cancer Radiother 2011; 15:663-9. [DOI: 10.1016/j.canrad.2011.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 02/06/2011] [Accepted: 03/04/2011] [Indexed: 10/18/2022]
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Cosmetic Outcome 1–5 Years After Breast Conservative Surgery, Irradiation and Systemic Therapy. Pathol Oncol Res 2011; 18:421-7. [DOI: 10.1007/s12253-011-9462-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 09/09/2011] [Indexed: 01/03/2023]
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125
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Automated Planning of Tangential Breast Intensity-Modulated Radiotherapy Using Heuristic Optimization. Int J Radiat Oncol Biol Phys 2011; 81:575-83. [DOI: 10.1016/j.ijrobp.2010.11.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 11/12/2010] [Accepted: 11/18/2010] [Indexed: 11/20/2022]
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Hoover S, Bloom E, Patel S. Review of breast conservation therapy: then and now. ISRN ONCOLOGY 2011; 2011:617593. [PMID: 22229101 PMCID: PMC3200284 DOI: 10.5402/2011/617593] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/11/2011] [Indexed: 01/03/2023]
Abstract
Breast conservation therapy (BCT), which is the marriage of breast conserving surgery and radiation therapy to the breast, has revolutionized the treatment of breast cancer over the last few decades. Surgical direction had seen a heightened interest in the performance of cosmetically superior partial and segmental resections in breast conservation as well as increased demand by patients for breast preservation. The broadening of approaches to delivery of breast irradiation from whole breast to accelerated partial breast has allowed more patients to opt for breast conservation and allowed for what appears to be comparable measurable outcomes in emerging data. As well, the addition of state-of-the-art chemotherapeutic and hormonal therapies has allowed improved outcomes of patients from both local regional recurrence and overall survival standpoints. This paper will provide an overview of BCT and review some of the newest developments in optimizing this therapy for patients with breast cancer from a surgical-, medical-, and radiation-oncology standpoint.
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Affiliation(s)
- Susan Hoover
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Moon SK, Kim YS, Kim SY, Lee MJ, Keum HS, Kim SJ, Youn SM. A Dosimetric Analysis of IMRT and Multistatic Fields Techniques for Left Breast Radiotherapy. Med Dosim 2011; 36:276-83. [DOI: 10.1016/j.meddos.2010.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/20/2010] [Accepted: 05/27/2010] [Indexed: 10/18/2022]
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Abstract
OBJECTIVES To present a clinical update on the available evidence for the prevention and management of radiation skin reactions (radiodermatitis). DATA SOURCES Research studies, review articles, and clinical practice guidelines. CONCLUSION In the past 4 years since the publication of the original article, there has been minimal change in the evidence available to guide decisions and practice in the management of radiation skin reactions. There continues to be insufficient evidence in the literature to recommend a variety of topical or oral agents in the prevention of skin reactions. There have been some recent studies that have impacted decision making and recommendations in the management of skin reactions. Radiation treatment techniques are the most promising intervention in reducing the degree of skin reaction. The use of calendula cream may reduce the incidence of grade 2 or 3 reactions in women with breast cancer. The controversy related to the use of deodorant in the treatment field unfortunately continues in clinical settings, but deodorant use as part of routine hygiene is now recommended for practice. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses need to be aware of the evidence and lack of evidence when recommending interventions to their patients and avoid undue marketing influence when suggesting interventions for the management of skin reactions. Further research is required to evaluate specific interventions in both the prevention and management of radiation dermatitis.
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Affiliation(s)
- Maurene McQuestion
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada.
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Abstract
PURPOSE To describe early clinical results of tomotherapy treatment in patients with breast cancer and complex treatment volumes. METHODS AND MATERIALS Ten patients were treated with tomotherapy between January 2009 and March 2010. Treatment planning objectives were to cover at least 95% of the planning target volume with the 95% isodose; to have a minimum dose of 90% and a maximum dose of 105%. All treatments included daily CT/megavoltage image guidance. Acute toxicity was recorded weekly. RESULTS Six patients were treated because constraints were not accomplished for heart, lung or contralateral breast in a previous three-dimensional conformal plan; two for preexisting cardiac or pulmonary disease, and two more for bilateral breast irradiation. Treatment volumes included the whole breast in the majority of patients, as well as the supraclavicular and the internal mammary chain nodes when indicated. Most patients were older than 50 years, and had an early breast cancer, with positive oestrogen receptors, negative HER2 expression and a poorly differentiated, infiltrating ductal carcinoma. The majority of patients had received neoadjuvant chemotherapy associated to breast-conserving surgery and adjuvant hormonotherapy. Median homogeneity index was 1.09; median coverage index was 0.81. Median V20Gy and V10Gy for ipsilateral lung was 20% and 37.1% respectively. Median V25 and V35 for heart was 15% and 4% respectively. Median dose for contralateral breast was 7 Gy. Skin acute toxicity was grade 1 in 41.7% and grade 2 in 58.3%. CONCLUSION Tomotherapy is a technique capable of delivering a well tolerated treatment with high homogeneity and coverage indexes and high capabilities for sparing the organs at risk in patients with anatomically complex breast cancer, bilateral breast cancer, indication for internal mammary chain node irradiation, cardiac toxicity derived from chemotherapy, or preexisting cardiac or pulmonary disease. Further studies are required to evaluate local control and late toxicity.
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Schubert LK, Gondi V, Sengbusch E, Westerly DC, Soisson ET, Paliwal BR, Mackie TR, Mehta MP, Patel RR, Tomé WA, Cannon GM. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother Oncol 2011; 100:241-6. [DOI: 10.1016/j.radonc.2011.01.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 01/05/2011] [Accepted: 01/12/2011] [Indexed: 01/08/2023]
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Das IJ, Cheville AL, Scheuermann J, Srinivas SM, Alavi A, Solin LJ. Use of lymphoscintigraphy in radiation treatment of primary breast cancer in the context of lymphedema risk reduction. Radiother Oncol 2011; 100:293-8. [DOI: 10.1016/j.radonc.2010.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 09/07/2010] [Accepted: 09/20/2010] [Indexed: 11/28/2022]
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132
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Topical Use of a Silymarin-Based Preparation to Prevent Radiodermatitis. Strahlenther Onkol 2011; 187:485-91. [DOI: 10.1007/s00066-011-2204-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
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Stillie AL, Kron T, Herschtal A, Hornby C, Cramb J, Sullivan K, Chua B. Does inverse-planned intensity-modulated radiation therapy have a role in the treatment of patients with left-sided breast cancer? J Med Imaging Radiat Oncol 2011; 55:311-9. [DOI: 10.1111/j.1754-9485.2011.02273.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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134
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Askoxylakis V, Jensen AD, Häfner MF, Fetzner L, Sterzing F, Heil J, Sohn C, Hüsing J, Tiefenbacher U, Wenz F, Debus J, Hof H. Simultaneous integrated boost for adjuvant treatment of breast cancer--intensity modulated vs. conventional radiotherapy: the IMRT-MC2 trial. BMC Cancer 2011; 11:249. [PMID: 21676232 PMCID: PMC3150341 DOI: 10.1186/1471-2407-11-249] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 06/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiation therapy is an essential modality in the treatment of breast cancer. Addition of radiotherapy to surgery has significantly increased local control and survival rates of the disease. However, radiotherapy is also associated with side effects, such as tissue fibrosis or enhanced vascular morbidity. Modern radiotherapy strategies, such as intensity modulated radiotherapy (IMRT), can shorten the overall treatment time by integration of the additional tumor bed boost significantly. To what extent this might be possible without impairing treatment outcome and cosmetic results remains to be clarified. METHODS/DESIGN The IMRT-MC2 study is a prospective, two armed, multicenter, randomized phase-III-trial comparing intensity modulated radiotherapy with integrated boost to conventional radiotherapy with consecutive boost in patients with breast cancer after breast conserving surgery. 502 patients will be recruited and randomized into two arms: patients in arm A will receive IMRT in 28 fractions delivering 50.4 Gy to the breast and 64.4 Gy to the tumor bed by integrated boost, while patients in arm B will receive conventional radiotherapy of the breast in 28 fractions to a dose of 50.4 Gy and consecutive boost in 8 fractions to a total dose of 66.4 Gy. DISCUSSION Primary objectives of the study are the evaluation of the cosmetic results 6 weeks and 2 years post treatment and the 2- and 5-year local recurrence rates for the two different radiotherapy strategies. Secondary objectives are long term overall survival, disease free survival and quality of life. TRIAL REGISTRATION ClinicalTrials.gov Protocol ID: NCT01322854.
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Affiliation(s)
- Vasileios Askoxylakis
- Department of Radiation Oncology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
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Almberg SS, Lindmo T, Frengen J. Superficial doses in breast cancer radiotherapy using conventional and IMRT techniques: a film-based phantom study. Radiother Oncol 2011; 100:259-64. [PMID: 21624698 DOI: 10.1016/j.radonc.2011.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 05/04/2011] [Accepted: 05/06/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Superficial doses in radiotherapy are affected by the treatment technique. The implications for breast cancer treatments were evaluated. MATERIAL AND METHODS Four treatment techniques relevant for breast cancer irradiation were evaluated; tangential standard, tangential IMRT, 7-field IMRT (arc-like field arrangement) and hybrid IMRT (an IMRT plan mixed with non-modulated fields). Only 6MV photons were used. GafChromic EBT film was used for dose measurements at the surface, in the skin (0-5mm depth) and in the superficial parts of CTV (5-10mm depth) of an anthropomorphic thorax phantom. RESULTS Only small differences in superficial doses were observed between tangential standard and tangential IMRT. Compared to the tangential standard plan, the surface and skin doses were reduced with the 7-field IMRT plan, on average by 20% and 5%, respectively, while hybrid IMRT reduced the surface and skin doses medially (by 44% and 8%, respectively) and increased the surface and skin dose laterally (by 40% and 15%, respectively). Minimum superficial CTV doses varied between regions, but were mainly between 90% and 95% of the target dose for all plans, only the hybrid IMRT plan resulted in a region with minimum dose below 90%. CONCLUSIONS Compared to tangential irradiation, skin sparing was achieved by the 7-field IMRT plan. The minimum dose in the superficial parts of the CTV was below 95% of the target dose for all plans investigated.
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Affiliation(s)
- Sigrun Saur Almberg
- Department of Physics, The Norwegian University of Science and Technology, Trondheim, Norway.
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Ayata HB, Güden M, Ceylan C, Kücük N, Engin K. Comparison of dose distributions and organs at risk (OAR) doses in conventional tangential technique (CTT) and IMRT plans with different numbers of beam in left-sided breast cancer. Rep Pract Oncol Radiother 2011; 16:95-102. [PMID: 24376964 DOI: 10.1016/j.rpor.2011.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 01/31/2011] [Accepted: 02/21/2011] [Indexed: 11/29/2022] Open
Abstract
AIM Our aim was to improve dose distribution to the left breast and to determine the dose received by the ipsilateral lung, heart, contralateral lung and contralateral breast during primary left-sided breast irradiation by using intensity modulated radiotherapy (IMRT) techniques compared to conventional tangential techniques (CTT). At the same time, different beams of IMRT plans were compared to each other in respect to CI, HI and organs at risk (OAR) dose. BACKGROUND Conventional early breast cancer treatment consists of lumpectomy followed by whole breast radiation therapy. CTT is a traditional method used for whole breast radiotherapy and includes standard wedged tangents (two opposed wedged tangential photon beams). The IMRT technique has been widely used for many treatment sites, allowing both improved sparing of normal tissues and more conformal dose distributions. IMRT is a new technique for whole breast radiotherapy. IMRT is used to improve conformity and homogeneity and used to reduce OAR doses. MATERIALS AND METHODS Thirty patients with left-sided breast carcinoma were treated between 2005 and 2008 using 6, 18 or mixed 6/18 MV photons for primary breast irradiation following breast conserving surgery (BCS). The clinical target volume [CTV] was contoured as a target volume and the contralateral breast, ipsilateral lung, contralateral lung and heart tissues as organs at risk (OAR). IMRT with seven beams (IMRT7), nine beams (IMRT9) and 11 beams (IMRT11) plans were developed and compared with CTT and among each other. The conformity index (CI), homogeneity index (HI), and doses to OAR were compared to each other. RESULTS ALL OF IMRT PLANS SIGNIFICANTLY IMPROVED CI (CTT: 0.76; IMRT7: 0.84; IMRT9: 0.84; IMRT11: 0.85), HI (CTT: 1.16; IMRT7: 1.12; IMRT9: 1.11; IMRT11: 1.11), volume of the ipsilateral lung receiving more than 20 Gy (>V20 Gy) (CTT: 14.6; IMRT7: 9.08; IMRT9: 8.10; IMRT11: 8.60), and volume of the heart receiving more than 30 Gy (>V30 Gy) (CTT: 6.7; IMRT7: 4.04; IMRT9: 2.80; IMRT11: 2.98) compared to CTT. All IMRT plans were found to significantly decrease >V20 Gy and >V30 Gy volumes compared to conformal plans. But IMRT plans increased the volume of OAR receiving low dose radiotherapy: volume of contralateral lung receiving 5 and 10 Gy (CTT: 0.0-0.0; IMRT7: 19.0-0.7; IMRT9: 17.2-0.66; IMRT11: 18.7-0.58, respectively) and volume of contralateral breast receiving 10 Gy (CTT: 0.03; IMRT7: 0.38; IMRT9: 0.60; IMRT11: 0.68). The differences among IMRT plans with increased number of beams were not statistically significant. CONCLUSION IMRT significantly improved conformity and homogeneity index for plans. Heart and lung volumes receiving high doses were decreased, but OAR receiving low doses was increased.
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Affiliation(s)
- Hande Bas Ayata
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Metin Güden
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Cemile Ceylan
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Nadir Kücük
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
| | - Kayihan Engin
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
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van Mourik A, van Kranen S, den Hollander S, Sonke JJ, van Herk M, van Vliet-Vroegindeweij C. Effects of Setup Errors and Shape Changes on Breast Radiotherapy. Int J Radiat Oncol Biol Phys 2011; 79:1557-64. [DOI: 10.1016/j.ijrobp.2010.07.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 06/18/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
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Rudat V, Alaradi AA, Mohamed A, Ai-Yahya K, Altuwaijri S. Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: a dosimetric comparison. Radiat Oncol 2011; 6:26. [PMID: 21418616 PMCID: PMC3069936 DOI: 10.1186/1748-717x-6-26] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 03/21/2011] [Indexed: 11/10/2022] Open
Abstract
Background This study evaluates the dose distribution of reversed planned tangential beam intensity modulated radiotherapy (IMRT) compared to standard wedged tangential beam three-dimensionally planned conformal radiotherapy (3D-CRT) of the chest wall in unselected postmastectomy breast cancer patients Methods For 20 unselected subsequent postmastectomy breast cancer patients tangential beam IMRT and tangential beam 3D-CRT plans were generated for the radiotherapy of the chest wall. The prescribed dose was 50 Gy in 25 fractions. Dose-volume histograms were evaluated for the PTV and organs at risk. Parameters of the dose distribution were compared using the Wilcoxon matched pairs test. Results Tangential beam IMRT statistically significantly reduced the ipsilateral mean lung dose by an average of 21% (1129 cGy versus 1437 cGy). In all patients treated on the left side, the heart volume encompassed by the 70% isodose line (V70%; 35 Gy) was reduced by an average of 43% (5.7% versus 10.6%), and the mean heart dose by an average of 20% (704 cGy versus 877 cGy). The PTV showed a significantly better conformity index with IMRT; the homogeneity index was not significantly different. Conclusions Tangential beam IMRT significantly reduced the dose-volume of the ipsilateral lung and heart in unselected postmastectomy breast cancer patients.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Saad Specialist Hospital, Saudi Arabia.
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139
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Morganti AG, Cilla S, de Gaetano A, Panunzi S, Digesù C, Macchia G, Massaccesi M, Deodato F, Ferrandina G, Cellini N, Scambia G, Piermattei A, Valentini V. Forward planned intensity modulated radiotherapy (IMRT) for whole breast postoperative radiotherapy. Is it useful? When? J Appl Clin Med Phys 2011; 12:3451. [PMID: 21587195 PMCID: PMC5718668 DOI: 10.1120/jacmp.v12i2.3451] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/10/2010] [Accepted: 01/10/2011] [Indexed: 11/23/2022] Open
Abstract
The purpose was to compare the dosimetric results observed in 201 breast cancer patients submitted to tangential forward intensity-modulated radiation therapy (IMRT) with those observed in 131 patients treated with a standard wedged 3D technique for postoperative treatment of whole breast, according to breast size and supraclavicular node irradiation. Following dosimetric parameters were used for the comparison: D(max), D(min), D(mean), V(95%) and V(107%) for the irradiated volume; D(max), D(mean), V(80%) and V(95%) for the ipsilateral lung; D(max), D(mean), V(80%) and V(95%) for the heart. Stratification was made according to breast size and supraclavicular (SCV) nodal irradiation. As respect to irradiated volume, a significant reduction of V(107%) (mean values: 7.0 ± 6.6 versus 2.4 ± 3.7, p < 0.001) and D(max) (mean % values: 111.2 ± 2.7 versus 107.7 ± 6.3, p < 0.001), and an increase of D(min) (mean % values: 65.0 ± 17.4 versus 74.9 ± 12.9, p < 0.001) were observed with forward IMRT. The homogeneity of dose distribution to target volume significantly improved with forward IMRT in all patient groups, irrespective of breast size or supraclavicular nodal irradiation. When patients treated with supraclavicular nodal irradiation were excluded from the analysis, forward IMRT slightly reduced V(80%) (mean values: 3.7 ± 2.6 versus 3.0 ± 2.4, p = 0.03) and V(95%) (mean values 1.9 ± 1.8 versus 1.2%± 1.5; p = 0.001) of the ipsilateral lung. The dose to the heart tended to be lower with IMRT but this difference was not statistically significant. Tangential forward IMRT in postoperative treatment of whole breast improved dosimetric parameters in terms of homogeneity of dose distribution to the target in a large sample of patients, independent of breast size or supraclavicular nodal irradiation. Lung irradiation was slightly reduced in patients not undergoing to supraclavicular irradiation.
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Affiliation(s)
- Alessio G. Morganti
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Savino Cilla
- Medical Physics UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Andrea de Gaetano
- CNR‐Institute of Systems Analysis and Computer Science (IASI)BioMathLabRome
| | - Simona Panunzi
- CNR‐Institute of Systems Analysis and Computer Science (IASI)BioMathLabRome
| | - Cinzia Digesù
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Gabriella Macchia
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Mariangela Massaccesi
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Francesco Deodato
- Radiotherapy UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Gabriella Ferrandina
- Gynaecology Oncology UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Numa Cellini
- Department of RadiotherapyPoliclinico Universitario “Agostino Gemelli”, Catholic UniversityRomeItaly
| | - Giovanni Scambia
- Gynecology Oncology DepartmentPoliclinico Universitario “Agostino Gemelli”, Catholic UniversityRomeItaly
| | - Angelo Piermattei
- Medical Physics UnitDepartment of Oncology“John Paul II” Center for High Technology Research and Education in Biomedical SciencesCampobasso
| | - Vincenzo Valentini
- Department of RadiotherapyPoliclinico Universitario “Agostino Gemelli”, Catholic UniversityRomeItaly
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140
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Lemay R, Archambault M, Tremblay L, Bujold R, Lepage M, Paquette B. Irradiation of normal mouse tissue increases the invasiveness of mammary cancer cells. Int J Radiat Biol 2011; 87:472-82. [PMID: 21231833 DOI: 10.3109/09553002.2011.542541] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Treatment of breast tumours frequently involves irradiating the whole breast to reach malignant microfoci scattered throughout the breast. In this study, we determined whether irradiation of normal tissues could increase the invasiveness of breast cancer cells in a mouse model. MATERIALS AND METHODS Non-irradiated MC7-L1 mouse mammary carcinoma cells were injected subcutaneously in irradiated and non-irradiated thighs of Balb/c mice. The invasion volume, tumour volume, blood vessel permeability and interstitial volumes were monitored by magnetic resonance imaging (MRI). Slices of normal tissue invaded by cancer cells were examined by histology. Activity of matrix metalloproteinase -2 and -9 (MMP -2 and -9) in healthy and irradiated tissues was determined, and the proliferation index of the invading cancer cells was evaluated. RESULTS Three weeks after irradiation, enhancement of MC7-L1 cells invasiveness in irradiated thighs was already detected by MRI. The tumour invasion volume continued to extend 28- to 37-fold compared to the non-irradiated implantation site for the following three weeks, and it was associated with an increase of MMP-2 and -9 activities in healthy tissues. The interstitial volume associated with invading cancer cells was significantly larger in the pre-irradiated sites; while the blood vessels permeability was not altered. Cancer cells invading the healthy tissues were proliferating at a lower rate compared to non-invading cancer cells. CONCLUSION Implantation of non-irradiated mammary cancer cells in previously irradiated normal tissue enhances the invasive capacity of the mammary cancer cells and is associated with an increased activity of MMP-2 and -9 in the irradiated normal tissue.
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Affiliation(s)
- Rosalie Lemay
- Centre de Recherche en Radiothérapie, Department of Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Yoo DS, Wong TZ, Brizel DM. The Role of Adaptive and Functional Imaging Modalities in Radiation Therapy: Approach and Application from a Radiation Oncology Perspective. Semin Ultrasound CT MR 2010; 31:444-61. [DOI: 10.1053/j.sult.2010.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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142
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Jagsi R, Moran J, Marsh R, Masi K, Griffith KA, Pierce LJ. Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys 2010; 78:1594-603. [PMID: 20832186 DOI: 10.1016/j.ijrobp.2010.04.072] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 03/22/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To establish optimal intensity-modulated radiation therapy (IMRT) techniques for treating the left breast and regional nodes, using moderate deep-inspiration breath hold. METHODS AND MATERIALS We developed four IMRT plans of differing complexity for each of 10 patients following lumpectomy for left breast cancer. A dose of 60 Gy was prescribed to the boost planning target volume (PTV) and 52.2 Gy to the breast and supraclavicular, infraclavicular, and internal mammary nodes. Two plans used inverse-planned beamlet techniques: a 9-field technique, with nine equispaced axial beams, and a tangential beamlet technique, with three to five ipsilateral beams. The third plan (a segmental technique) used a forward-planned multisegment technique, and the fourth plan (a segmental blocked technique) was identical but included a block to limit heart dose. Dose--volume histograms were generated, and metrics chosen for comparison were analyzed using the paired t test. RESULTS Mean heart and left anterior descending coronary artery doses were similar with the tangential beamlet and segmental blocked techniques but higher with the segmental and 9-field techniques (mean paired difference of 15.1 Gy between segmental and tangential beamlet techniques, p < 0.001). Substantial volumes of contralateral tissue received dose with the 9-field technique (mean right breast V2, 58.9%; mean right lung V2, 75.3%). Minimum dose to ≥95% of breast PTV was, on average, 45.9 Gy with tangential beamlet, 45.0 Gy with segmental blocked, 51.4 Gy with segmental, and 50.2 Gy with 9-field techniques. Coverage of the internal mammary region was substantially better with the two beamlet techniques than with the segmental blocked technique. CONCLUSIONS Compared to the 9-field beamlet and segmental techniques, a tangential beamlet IMRT technique reduced exposure to normal tissues and maintained reasonable target coverage.
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Affiliation(s)
- Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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143
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A review of the clinical evidence for intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol) 2010; 22:643-57. [PMID: 20673708 DOI: 10.1016/j.clon.2010.06.013] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 03/03/2010] [Accepted: 06/23/2010] [Indexed: 02/07/2023]
Abstract
AIMS Intensity-modulated radiotherapy (IMRT) is a development of three-dimensional conformal radiotherapy that offers improvements in dosimetry in many clinical scenarios. Here we review the clinical evidence for IMRT and present ongoing or unpublished randomised controlled trials (RCTs). METHODS We identified randomised and non-randomised comparative studies of IMRT and conventional radiotherapy using MEDLINE, hand-searching Radiotherapy and Oncology and the International Journal of Radiation Oncology, Biology and Physics and the proceedings of the American Society for Therapeutic Radiology and Oncology and the European Society for Therapeutic Radiology and Oncology annual meetings. The metaRegister of Controlled Trials was searched to identify completed-unpublished, ongoing and planned RCTs. RESULTS Sixty-one studies comparing IMRT and conventional radiotherapy were identified. These included three RCTs in head and neck cancer (205 patients) and three in breast cancer (664 patients) that had reported clinical outcomes; these were all powered for toxicity-related end points, which were significantly better with IMRT in each trial. There were 27 additional non-randomised studies in head and neck (1119 patients), 26 in prostate cancer (>5000 patients), four in breast cancer (875 patients) and nine in other tumour sites. The results of these studies supported those of the RCTs with benefits reported in acute and late toxicity, health-related quality of life and tumour control end points. Twenty-eight completed-unpublished, ongoing or planned RCTs incorporating IMRT were identified, including at least 12,310 patients, of which 15 compared conventional radiotherapy within IMRT as a randomisation or pre-planned stratification. DISCUSSION Inverse-planned IMRT maintains parotid saliva production and reduces acute and late xerostomia during radiotherapy for locally advanced head and neck cancer, reduces late rectal toxicity in prostate cancer patients allowing safe dose escalation and seems to reduce toxicity in several other tumour sites. Forward-planned IMRT reduces acute toxicity and improves late clinician-assessed cosmesis compared with conventional tangential breast radiotherapy.
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McDonald MW, Godette KD, Whitaker DJ, Davis LW, Johnstone PA. Three-Year Outcomes of Breast Intensity-Modulated Radiation Therapy With Simultaneous Integrated Boost. Int J Radiat Oncol Biol Phys 2010; 77:523-30. [DOI: 10.1016/j.ijrobp.2009.05.042] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 05/08/2009] [Accepted: 05/13/2009] [Indexed: 10/20/2022]
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Recommendations for research priorities in breast cancer by the coalition of cancer cooperative groups scientific leadership council: imaging and local therapy. Breast Cancer Res Treat 2010; 120:273-84. [PMID: 20024613 DOI: 10.1007/s10549-009-0655-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 11/14/2009] [Indexed: 02/03/2023]
Abstract
Imaging and local therapy are important modalities for detection and management of localized breast cancer. Improvements in screening and local therapy have contributed to reduced breast cancer-associated morbidity and mortality. The Coalition of Cancer Cooperative Groups (CCCG) convened the Scientific Leadership Council (SLC) in breast cancer, an expert panel, to identify priorities for future research and current trials with greatest practice-changing potential. Panelists formed a consensus on research priorities for breast imaging and locoregional therapy, and also identified six trials judged to be of high priority. Current high priority trials included trials determining: (1) the role of accelerated partial breast versus whole-breast radiation (B39), (2) the feasibility, safety, and local and systemic control of small localized breast cancers treated with tumor ablation (Z1072), (3) the role of removal of the primary cancer in selected patients with metastatic disease (E2108), and (4) the clinical and biological effects of pre-operative anti-HER2-directed and ER-directed therapies in localized or locally advanced breast cancer (B41, Z1031, Z1041). Ongoing and future trials will further refine optimal locoregional management, and additional research is required to develop improved screening methods and identify high risk populations most likely to benefit from targeted screening.
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146
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Strydhorst JH, Caudrelier JM, Clark BG, Montgomery LA, Fox G, MacPherson MS. Evaluation of a thermoplastic immobilization system for breast and chest wall radiation therapy. Med Dosim 2010; 36:81-4. [PMID: 20346646 DOI: 10.1016/j.meddos.2010.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 01/05/2010] [Accepted: 01/06/2010] [Indexed: 11/17/2022]
Abstract
We report on the impact of a thermoplastic immobilization system on intra- and interfraction motion for patients undergoing breast or chest wall radiation therapy. Patients for this study were treated using helical tomotherapy. All patients were immobilized using a thermoplastic shell extending from the shoulders to the ribcage. Intrafraction motion was assessed by measuring maximum displacement of the skin, heart, and chest wall on a pretreatment 4D computed tomography, while inter-fraction motion was inferred from patient shift data arising from daily image guidance procedures on tomotherapy. Using thermoplastic immobilization, the average maximum motion of the external contour was 1.3 ± 1.6 mm, whereas the chest wall was found to be 1.6 ± 1.9 mm. The day-to-day setup variation was found to be large, with random errors of 4.0, 12.0, and 4.5 mm in the left-right, superior-inferior, and anterior-posterior directions, respectively, and the standard deviations of the systematic errors were found to be 2.7, 9.8, and 4.1 mm. These errors would be expected to dominate any respiratory motion but can be mitigated by daily online image guidance. Using thermoplastic immobilization can effectively reduce respiratory motion of the chest wall and external contour, but these gains can only be realized if daily image guidance is used.
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147
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Mihailidis DN, Plants B, Farinash L, Harmon M, Whaley L, Raja P, Tomara P. Superiority of Equivalent Uniform Dose (EUD)-Based Optimization for Breast and Chest Wall*. Med Dosim 2010; 35:67-76. [DOI: 10.1016/j.meddos.2009.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 01/12/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
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148
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van Mourik AM, Elkhuizen PH, Minkema D, Duppen JC, van Vliet-Vroegindeweij C. Multiinstitutional study on target volume delineation variation in breast radiotherapy in the presence of guidelines. Radiother Oncol 2010; 94:286-91. [PMID: 20199818 DOI: 10.1016/j.radonc.2010.01.009] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 11/30/2009] [Accepted: 01/23/2010] [Indexed: 11/27/2022]
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149
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Smith W, Menon G, Wolfe N, Ploquin N, Trotter T, Pudney D. IMRT for the breast: a comparison of tangential planning techniques. Phys Med Biol 2010; 55:1231-41. [DOI: 10.1088/0031-9155/55/4/022] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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150
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van der Laan HP, Hurkmans CW, Kuten A, Westenberg HA. Current technological clinical practice in breast radiotherapy; results of a survey in EORTC-Radiation Oncology Group affiliated institutions. Radiother Oncol 2010; 94:280-5. [PMID: 20116120 DOI: 10.1016/j.radonc.2009.12.032] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 12/09/2009] [Accepted: 12/29/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the current technological clinical practice of radiation therapy of the breast in institutions participating in the EORTC-Radiation Oncology Group (EORTC-ROG). MATERIALS AND METHODS A survey was conducted between August 2008 and January 2009 on behalf of the Breast Working Party within the EORTC-ROG. The questionnaire comprised 32 questions on 4 main topics: fractionation schedules, treatment planning methods, volume definitions and position verification procedures. RESULTS Sixty-eight institutions out of 16 countries responded (a response rate of 47%). The standard fraction dose was generally 2Gy for both breast and boost treatment, although a 2.67 Gy boost fraction dose is routinely given in British institutions. The main boost modality was electrons in 55%, photons in 47% and brachytherapy in 3% of the institutions (equal use of photon and electron irradiation in 5% of the institutions). All institutions used CT-based treatment planning. Wide variations are seen in the definition of the breast and boost target volumes, with margins around the resection cavity, ranging from 0 to 30 mm. Inverse planned IMRT is available in 27% and breath-hold techniques in 19% of the institutions. The number of patients treated with IMRT and breath-hold varied per institution. Electronic portal imaging for patient set-up is used by 92% of the institutions. CONCLUSIONS This survey provides insight in the current practice of radiation technology used in the treatment of breast cancer among institutions participating in EORTC-ROG clinical trials.
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Affiliation(s)
- Hans Paul van der Laan
- Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, Groningen, The Netherlands.
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