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Arbab M, Frame R, Alluri P, Parsons D, Lin MH, Cleaton J, Rahimi A. Master Breast Radiation Planning: Simple Guide for Radiation Oncology Residents. Adv Radiat Oncol 2024; 9:101476. [PMID: 38690296 PMCID: PMC11059315 DOI: 10.1016/j.adro.2024.101476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/04/2024] [Indexed: 05/02/2024] Open
Abstract
This article focuses on various aspects of breast radiation treatment planning, from simulation to field design. It covers the most common techniques including tangents, mono isocentric, dual isocentric, electron-photon match, and VMAT. This can serve as a guide for radiation oncology residents and medical students to advance their understanding of key aspects of breast radiation treatment and planning processes.
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Affiliation(s)
- Mona Arbab
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Romona Frame
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Prasanna Alluri
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - David Parsons
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Mu-Han Lin
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Jennifer Cleaton
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Asal Rahimi
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
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Takabi FS, Broomand MA, Nickfarjam A, Asadi A, Namiranian N. Determination and comparison of dosimetric parameters of three-dimensional conformal radiotherapy, field in field, and intensity-modulated radiotherapy techniques in radiotherapy of breast conserving patients. J Cancer Res Ther 2023; 19:624-632. [PMID: 37470585 DOI: 10.4103/jcrt.jcrt_234_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Purpose Three radiation therapy techniques for breast are common, namely three-dimensional conformal radiotherapy (3D-CRT), Field-in-Field (FIF), and Intensıty-Modulated Radıotherapy (IMRT). The purpose of this study was to determine and compare dosimetric parameters of three different treatment planning planning types; 3D-CRT, FIF, and IMRT in target and normal tissues after breast-conserving surgery. Methods One hundred patients with left or right breast cancer cooperated in this study. They were divided into three categories (small, medium, and large size) based on breast volume. Three treatment planning techniques were carried out by planner for each patient in Prowess® 5.2 Treatment Planning System. The dosimetric parameters were obtained from dose-volume histograms using the CERR software (MATLAB Company, Washington, USA), which runs as an add-on in MATLAB software. Results 3D-CRT technique with the highest value of Dmax creates more hot spots than the other techniques in the tumor region (P = 0.013). IMRT and FIF showed the best uniformity compared to 3D-CRT in all groups with respect to the values of the parameters D98 and D2. IMRT provided the best coverage in the tumor compared to other methods (P < 0.001). 3D-CRT technique yielded a high volume receiving ≥107% of the prescription dose (P < 0.001). Among the three methods, the FIF method results in a lower dose to the lung for treatment based on the V5 and V20 parameters (P < 0.001). Homogeneity index for IMRT was better than FIF, as well as, conformity index (CI) for IMRT and FIF was better than 3D-CRT. Conclusion IMRT and FIF plans offered excellent target coverage and uniformity, whereas FIF had better protection of healthy tissues. Thus FIF method is an efficient method to improve the quality of treatment for breast cancer patients.
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Affiliation(s)
- Fatemeh Shirani Takabi
- Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Broomand
- Department of Radiotherapy, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Abolfazl Nickfarjam
- Department of Medical Physics; Department of Radiotherapy, School of Medicine; Radiotherapy Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amin Asadi
- Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Gortman A, Aherne NJ, Westhuyzen J, Amalaseelan JV, Dwyer PM, Hoffmann M, Last AT, Shakespeare TP. Metaplastic carcinoma of the breast: Clinicopathological features and treatment outcomes with long-term follow up. Mol Clin Oncol 2021; 15:178. [PMID: 34276997 DOI: 10.3892/mco.2021.2340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Metaplastic breast carcinoma is an uncommon subtype of invasive ductal carcinoma with a tendency towards poorer clinical outcomes. Following ethical approval, the current study reviewed the institutional records of ~2,500 women with breast cancer. A total of 14 cases of metaplastic breast cancer were reviewed for management and treatment outcomes. The results demonstrated that patients had median follow up of 30 months, a 5-year disease-free survival of 57.1% and 5-year overall survival of 57.1%. The majority of patients had at least T2 disease and all tumours were high grade. Additionally, most patients were triple negative and nodal metastases were uncommon. Metaplastic breast cancer is an aggressive variant of invasive breast cancer. Most patients can be treated with breast conservation and survival parameters tend to be worse than more common breast cancer subtypes.
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Affiliation(s)
- Aron Gortman
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia
| | - Noel J Aherne
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia.,Rural Clinical School, Faculty of Medicine, University of New South Wales, New South Wales 2450, Australia.,School of Health and Human Sciences, Southern Cross University, Coffs Harbour, New South Wales 2450, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia
| | - Julan V Amalaseelan
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia
| | - Patrick M Dwyer
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales 2480, Australia
| | - Matthew Hoffmann
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales 2444, Australia
| | - Andrew T Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales 2444, Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales 2450, Australia.,Rural Clinical School, Faculty of Medicine, University of New South Wales, New South Wales 2450, Australia
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Kairn T, Crowe SB. Application of retrospective data analysis to clinical protocol design: can the potential benefits of breath-hold techniques for breast radiotherapy be assessed without testing on patients? AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:227-233. [DOI: 10.1007/s13246-019-00725-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/12/2019] [Indexed: 12/25/2022]
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Squires M, Hu Y, Byrne M, Archibald‐Heeren B, Cheers S, Bosco B, Teh A, Fong A. Static beam tomotherapy as an optimisation method in whole-breast radiation therapy (WBRT). J Med Radiat Sci 2017; 64:281-289. [PMID: 28580762 PMCID: PMC5715293 DOI: 10.1002/jmrs.232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 04/10/2017] [Accepted: 04/21/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION TomoTherapy (Accuray, Sunnyvale, CA) has recently introduced a static form of tomotherapy: TomoDirect™ (TD). This study aimed to evaluate TD against a contemporary intensity modulated radiation therapy (IMRT) alternative through comparison of target and organ at risk (OAR) doses in breast cancer cases. A secondary objective was to evaluate planning efficiency by measuring optimisation times. METHODS Treatment plans of 27 whole-breast radiation therapy (WBRT) patients optimised with a tangential hybrid IMRT technique were replanned using TD. Parameters included a dynamic field width of 2.5 cm, a pitch of 0.251 and a modulation factor of 2.000; 50 Gy in 25 fractions was prescribed and planning time recorded. The planning metrics used in analysis were ICRU based, with the mean PTV minimum (D99 ) used as the point of comparison. RESULTS Both modalities met ICRU50 target heterogeneity objectives (TD D99 = 48.0 Gy vs. IMRT = 48.1 Gy, P = 0.26; TD D1 = 53.5 Gy vs. IMRT = 53.0 Gy, P = 0.02; Homogeneity index TD = 0.11 vs. IMRT = 0.10, P = 0.03), with TD plans generating higher median doses (TD D50 = 51.1 Gy vs. IMRT = 50.9 Gy, P = 0.03). No significant difference was found in prescription dose coverage (TD V50 = 85.5% vs. IMRT = 82.0%, P = 0.09). TD plans produced a statistically significant reduction in V5 ipsilateral lung doses (TD V5 = 23.2% vs. IMRT = 27.2%, P = 0.04), while other queried OARs remained comparable (TD ipsilateral lung V20 = 13.2% vs. IMRT = 14.6%, P = 0.30; TD heart V5 = 2.7% vs. IMRT = 2.8%, P = 0.47; TD heart V10 = 1.7% vs. IMRT = 1.8%, P = 0.44). TD reduced planning time considerably (TD = 9.8 m vs. IMRT = 27.6 m, P < 0.01), saving an average planning time of 17.8 min per patient. CONCLUSIONS TD represents a suitable WBRT treatment approach both in terms of plan quality metrics and planning efficiency.
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Affiliation(s)
| | - Yunfei Hu
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Mikel Byrne
- Radiation Oncology CentresWahroongaNew South WalesAustralia
| | | | - Sonja Cheers
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Bruno Bosco
- Precision Cancer CareAustralia
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Amy Teh
- Radiation Oncology CentresGosfordNew South WalesAustralia
- Radiation Oncology CentresWahroongaNew South WalesAustralia
| | - Andrew Fong
- Radiation Oncology CentresWahroongaNew South WalesAustralia
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Dean J, Hansen CJ, Westhuyzen J, Waller B, Turnbull K, Wood M, Last A. Tangential intensity modulated radiation therapy (IMRT) to the intact breast. J Med Radiat Sci 2016; 63:217-223. [PMID: 27741382 PMCID: PMC5167335 DOI: 10.1002/jmrs.185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Inverse-planned intensity modulated radiation therapy (IP-IMRT) has potential benefits over other techniques for tangential intact breast radiotherapy. Possible benefits include increased homogeneity, faster planning time, less inter-planner variability and lower doses to organs at risk (OAR). We therefore conducted a pilot study of previously treated intact breast patients to compare the current forward-planned 'field-in-field' technique (FP-IMRT) with an IP-IMRT alternative. METHODS The IP-IMRT plans of 20 patients were generated from a template created for the planning system. All patients were prescribed adjuvant whole breast radiotherapy using a hypofractionated regimen of 40.05 Gy in 15 fractions over 3 weeks. Plans were assessed based on visual inspection of coverage as well as statistical analysis and compared to the clinically acceptable FP-IMRT plans. Patients were planned retrospectively in Monaco 3.2® using a laterality-specific, tangential planning template. Minor adjustments were made as necessary to meet the planning criteria in the protocol. Dose coverage, maximums, homogeneity indices and doses to OAR were recorded. RESULTS The IP-IMRT plans provided more consistent coverage (38.18 Gy vs. 36.08 Gy of D95; P = 0.005), a comparable though higher average maximum (D2 = 42.52 Gy vs. 42.08 Gy; P = 0.0001), more homogeneous plans (homogeneity index = 0.908 vs. 0.861; P = 0.01) and somewhat lower V20 heart and lung doses (0.11% vs. 0.89% for heart; 5.4% vs. 7.52% for lung) than FP-IMRT (P > 0.05). CONCLUSION Clinically acceptable plans have been generated using the IP-IMRT templates in Monaco. Improvements in consistency and quality were seen when compared to the FP-IMRT plans. The template-based process is an efficient method to inversely plan IMRT for breast patients.
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Affiliation(s)
- Jenna Dean
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Carmen J Hansen
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Justin Westhuyzen
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Brett Waller
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Kirsty Turnbull
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Maree Wood
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour Health Campus, Coffs Harbour, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
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