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Lauche O, Kirova YM. Helical tomotherapy in breast cancer treatment. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Tumor bed segmentation: first step for partial breast irradiation. Clin Transl Oncol 2012; 15:39-45. [PMID: 22855170 DOI: 10.1007/s12094-012-0884-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In breast IMRT simultaneous integrated boost (SIB) treatment and accelerated partial breast irradiation (APBI), proper delineation of the tumor bed is necessary. Conservative oncoplastic surgery causes changes in peritumoral breast tissue that complicates locating the site of the tumor. Nevertheless, there are still centers that do not use surgical clips to delineate the site. This study aims to show how the lack of clips affects the techniques of SIB and APBI in terms of dose distribution and safety margins in the tumor bed. MATERIALS AND METHODS On 30 patients, the defining of the tumor bed obtained from the pre-surgery CT scan to that outlined on the basis of clips on the post-surgery CT was compared. Tumor bed deviation from the original tumor site was quantified. In addition, the margins to the original tumor site necessary to guarantee the coverage of the tumor bed were calculated. RESULTS Variations were detected in the distances between geometric centers of the PTV (minimum 0.5-maximum 3 cm). The maximum margin necessary to include the entire tumor bed was 4.5 cm. Lesions located in the upper outer quadrant required the widest margins. If margins are not added, the tumor bed volume defined with clips will be underdosed. CONCLUSIONS The definition of the tumor bed based on studies before surgery does not have the necessary accuracy. Clips need to be placed in the surgical bed to identify the changes occurring after the restorative mammoplasty. Without clips, SIB and APBI are not safe.
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Acevedo-Henao CM, Heymann S, Rossier C, Garbay JR, Arnedos M, Balleyguier C, Ferchiou M, Marsiglia H, Bourgier C. [Conformal accelerated partial breast irradiation: state of the art]. Cancer Radiother 2012; 16:641-9. [PMID: 22727723 DOI: 10.1016/j.canrad.2012.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 03/09/2012] [Accepted: 03/27/2012] [Indexed: 11/26/2022]
Abstract
Breast conserving treatment (breast conserving surgery followed by whole breast irradiation) has commonly been used in early breast cancer since many years. New radiation modalities have been recently developed in early breast cancers, particularly accelerated partial breast irradiation. Three-dimensional conformal accelerated partial breast irradiation is the most commonly used modality of radiotherapy. Other techniques are currently being developed, such as intensity-modulated radiotherapy, arctherapy, and tomotherapy. The present article reviews the indications, treatment modalities and side effects of accelerated partial breast irradiation.
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Affiliation(s)
- C-M Acevedo-Henao
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, Villejuif cedex, France
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Bissonnette JP, Balter PA, Dong L, Langen KM, Lovelock DM, Miften M, Moseley DJ, Pouliot J, Sonke JJ, Yoo S. Quality assurance for image-guided radiation therapy utilizing CT-based technologies: A report of the AAPM TG-179. Med Phys 2012; 39:1946-63. [PMID: 22482616 DOI: 10.1118/1.3690466] [Citation(s) in RCA: 194] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Palma BA, Sánchez AU, Salguero FJ, Arráns R, Sánchez CM, Zurita AW, Hermida MIR, Leal A. Combined modulated electron and photon beams planned by a Monte-Carlo-based optimization procedure for accelerated partial breast irradiation. Phys Med Biol 2012; 57:1191-202. [DOI: 10.1088/0031-9155/57/5/1191] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Breast cancer and funnel chest. Strahlenther Onkol 2012; 188:127-35. [DOI: 10.1007/s00066-011-0022-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 10/04/2011] [Indexed: 02/02/2023]
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Njeh CF, Saunders MW, Langton CM. Accelerated partial breast irradiation using external beam conformal radiation therapy: A review. Crit Rev Oncol Hematol 2012; 81:1-20. [PMID: 21376625 DOI: 10.1016/j.critrevonc.2011.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Revised: 01/03/2011] [Accepted: 01/25/2011] [Indexed: 01/03/2023] Open
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Ji YS, Dong KR, Kim CB, Choi SK, Chung WK, Lee JW. Comparison of dose-volume histograms for Tomo therapy, linear accelerator-based 3D conformal radiation therapy, and intensity-modulated radiation therapy. ANN NUCL ENERGY 2011. [DOI: 10.1016/j.anucene.2011.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Jones R, Yang W, Read P, Sheng K. Radiation therapy of post-mastectomy patients with positive nodes using fixed beam tomotherapy. Radiother Oncol 2011; 100:247-52. [DOI: 10.1016/j.radonc.2011.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 11/26/2022]
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Donovan EM, Ciurlionis L, Fairfoul J, James H, Mayles H, Manktelow S, Raj S, Tsang Y, Tywman N, Yarnold J, Coles C. Planning With Intensity-Modulated Radiotherapy and Tomotherapy to Modulate Dose Across Breast to Reflect Recurrence Risk (IMPORT High Trial). Int J Radiat Oncol Biol Phys 2011; 79:1064-72. [DOI: 10.1016/j.ijrobp.2009.12.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 11/25/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
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Willis DJ, Kron T, Chua B. An optimized online verification imaging procedure for external beam partial breast irradiation. Med Dosim 2010; 36:171-7. [PMID: 20510600 DOI: 10.1016/j.meddos.2010.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 02/08/2010] [Accepted: 02/26/2010] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the capabilities of a kilovoltage (kV) on-board imager (OBI)-equipped linear accelerator in the setting of on-line verification imaging for external-beam partial breast irradiation. Available imaging techniques were optimized and assessed for image quality using a modified anthropomorphic phantom. Imaging dose was also assessed. Imaging techniques were assessed for physical clearance between patient and treatment machine using a volunteer. Nonorthogonal kV image pairs were identified as optimal in terms of image quality, clearance, and dose. After institutional review board approval, this approach was used for 17 patients receiving accelerated partial breast irradiation. Imaging was performed before every fraction verification with online correction of setup deviations >5 mm (total image sessions = 170). Treatment staff rated risk of collision and visibility of tumor bed surgical clips where present. Image session duration and detected setup deviations were recorded. For all cases, both image projections (n = 34) had low collision risk. Surgical clips were rated as well as visualized in all cases where they were present (n = 5). The average imaging session time was 6 min, 16 sec, and a reduction in duration was observed as staff became familiar with the technique. Setup deviations of up to 1.3 cm were detected before treatment and subsequently confirmed offline. Nonorthogonal kV image pairs allowed effective and efficient online verification for partial breast irradiation. It has yet to be tested in a multicenter study to determine whether it is dependent on skilled treatment staff.
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Affiliation(s)
- David J Willis
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
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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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Kim LH, DeCesare S, Vicini F, Yan D. Effect of lumpectomy cavity volume change on the clinical target volume for accelerated partial breast irradiation: a deformable registration study. Int J Radiat Oncol Biol Phys 2010; 78:1121-6. [PMID: 20207493 DOI: 10.1016/j.ijrobp.2009.09.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Previous studies have shown that lumpectomy cavity volumes can change significantly in the weeks following surgery. The effect of this volume change on the surrounding tissue that constitutes the clinical target volume (CTV) for accelerated partial breast irradiation and boost treatment after whole breast irradiation has not been previously studied. In the present study, we used deformable registration to estimate the effect of lumpectomy cavity volume changes on the CTV for accelerated partial breast irradiation and discuss the implications for target construction. METHODS AND MATERIALS The data from 13 accelerated partial breast irradiation patients were retrospectively analyzed. Deformable registration was used to propagate contours from the initial planning computed tomography scan to a later computed tomography scan acquired at the start of treatment. The changes in cavity volume and CTV, distance between cavity and CTV contours (i.e., CTV margin), and CTV localization error after cavity registration were determined. RESULTS The mean ± standard deviation change in cavity volume and CTV between the two computed tomography scans was -35% ± 23% and -14% ± 12%, respectively. An increase in the cavity-to-CTV margin of 2 ± 2 mm was required to encompass the CTV, and this increase correlated with the cavity volume change. Because changes in the cavity and CTV were not identical, a localization error of 2-3 mm in the CTV center of mass occurred when the cavity was used as the reference for image guidance. CONCLUSION Deformable registration suggested that CTV margins do not remain constant as the cavity volume changes. This finding has implications for planning target volume and CTV construction.
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Affiliation(s)
- Leonard H Kim
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Hijal T, Fournier-Bidoz N, Castro-Pena P, Kirova YM, Zefkili S, Bollet MA, Dendale R, Campana F, Fourquet A. Simultaneous integrated boost in breast conserving treatment of breast cancer: a dosimetric comparison of helical tomotherapy and three-dimensional conformal radiotherapy. Radiother Oncol 2010; 94:300-6. [PMID: 20171752 DOI: 10.1016/j.radonc.2009.12.043] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 12/20/2009] [Accepted: 12/29/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the dosimetry of helical tomotherapy (HT) and three-dimensional conformal radiotherapy (3D-CRT) in breast cancer patients undergoing whole breast radiation with simultaneous integrated boost (SIB) of the tumor bed. MATERIAL AND METHODS Thirteen patients with breast cancer treated by lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned using both HT and 3D-CRT using the field-in-field technique. The whole breast and tumor bed were prescribed 50.68 Gy and 64.4 Gy, respectively, in 28 fractions. Dosimetries for both techniques were compared. RESULTS Coverage of the whole breast was adequate with both techniques (V(95%)=96.22% vs. 96.25%, with HT and 3D-CRT, respectively; p=0.64). Adequate tumor bed coverage was also achieved, although it was significantly lower with HT (V(95%)=97.18% vs. 99.72%; p<0.001). Overdose of the breast volume outside the tumor bed was significantly lower with HT (V(54.23 Gy)=12.47% vs. 30.83%; p<0.001). Ipsilateral lung V(20 Gy) (6.34% vs. 10.17%; p<0.001), V(5 Gy) (16.54% vs. 18.53%; p<0.05) and mean dose (4.05 Gy vs. 6.36 Gy; p<0.001) were significantly lower with HT. In patients with left-sided tumors, heart V(30 Gy) (0.03% vs. 1.14%; p<0.05) and mean dose (1.35 Gy vs. 2.22 Gy; p<0.01) were significantly lower with HT, but not V(5 Gy). Contralateral breast V(5 Gy) (0.27% vs. 0.00%; p<0.01) and maximum dose were significantly increased with HT. CONCLUSIONS In breast cancer treated with SIB, both HT and 3D-CRT provided adequate target volume coverage and low heart doses. Tumor bed coverage was slightly lower with HT, but HT avoided unnecessary breast overdosage while improving ipsilateral lung dosimetry.
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Affiliation(s)
- Tarek Hijal
- Department of Radiation Oncology, Institut Curie, Paris, France.
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Gierga DP, Taghian AG, Chen GT. Clinical Experience With Image-Guided Radiotherapy in an Accelerated Partial Breast Intensity-Modulated Radiotherapy Protocol: In Regard to Leonard CE et al. (Int J Radiat Oncol Biol Phys Epub May 19, 2009). Int J Radiat Oncol Biol Phys 2010; 76:315; author reply 315. [DOI: 10.1016/j.ijrobp.2009.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 08/27/2009] [Indexed: 11/26/2022]
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HARRIS EJ, SYMONDS-TAYLOR R, TREECE GM, GEE AH, PRAGER RW, BRABANTS P, EVANS PM. Evaluation of a three-dimensional ultrasound localisation system incorporating probe pressure correction for use in partial breast irradiation. Br J Radiol 2009; 82:839-46. [DOI: 10.1259/bjr/52611898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kim L. The Literature on Image-Guided Partial Breast Irradiation: In Regard to Leonard et al. (Int J Radiat Oncol Biol Phys. In Press). Int J Radiat Oncol Biol Phys 2009; 75:636; author reply 636. [DOI: 10.1016/j.ijrobp.2009.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
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Reynders T, Tournel K, De Coninck P, Heymann S, Vinh-Hung V, Van Parijs H, Duchateau M, Linthout N, Gevaert T, Verellen D, Storme G. Dosimetric assessment of static and helical TomoTherapy in the clinical implementation of breast cancer treatments. Radiother Oncol 2009; 93:71-9. [DOI: 10.1016/j.radonc.2009.07.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 06/09/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
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Accelerated partial breast irradiation: what is dosimetric effect of advanced technology approaches? Int J Radiat Oncol Biol Phys 2009; 75:294-301. [PMID: 19540076 DOI: 10.1016/j.ijrobp.2009.03.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 02/03/2009] [Accepted: 03/19/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE The present treatment planning study compared whole breast radiotherapy (WBRT) to accelerated partial breast irradiation (APBI) for different external beam techniques and geometries (e.g., free breathing [FB] and deep inspiration breath hold [DIBH]). METHODS AND MATERIALS After approval by our institutional review board, a treatment planning study was performed of 10 patients with left-sided Stage 0-I breast cancer enrolled in a Phase I-II study of APBI using intensity-modulated radiotherapy (IMRT). After lumpectomy, patients underwent planning computed tomography scans during FB and using an active breathing control device at DIBH. For the FB geometry, standard WBRT and three-dimensional conformal radiotherapy (3D-CRT) APBI plans were created. For the DIBH geometry with active breathing control, WBRT, 3D-CRT, and IMRT APBI plans were created. RESULTS All APBI techniques had excellent planning target volume coverage. The maximal planning target volume dose was reduced from 116% of the prescription dose to 108% with the IMRT(DIBH) APBI plan. The maximal heart dose was >30 Gy for the WBRT techniques, 8.2 Gy for 3D-CRT(FB), and <5.0 Gy for 3D-CRT(DIBH) and IMRT(DIBH) techniques. The mean left anterior descending artery dose was significantly reduced from 11.4 Gy with WBRT(FB) to 4.2 with WBRT(DIBH) and <2.0 Gy with all APBI techniques. CONCLUSION Although planning target volume coverage was acceptable with all techniques, the plans using the DIBH geometry resulted in a marked reduction in the normal tissue dose compared with WBRT planned in the absence of cardiac blocking. Additional study is needed to determine whether these techniques result in clinical benefits.
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Moon SH, Shin KH, Kim TH, Yoon M, Park S, Lee DH, Kim JW, Kim DW, Park SY, Cho KH. Dosimetric comparison of four different external beam partial breast irradiation techniques: three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, helical tomotherapy, and proton beam therapy. Radiother Oncol 2008; 90:66-73. [PMID: 18992950 DOI: 10.1016/j.radonc.2008.09.027] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 09/11/2008] [Accepted: 09/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE As an alternative to whole breast irradiation in early breast cancer, a variety of accelerated partial breast irradiation (APBI) techniques have been investigated. The purpose of our study is to compare the dosimetry of four different external beam APBI (EB-APBI) plans: three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), helical tomotherapy (TOMO), and proton beam therapy (PBT). METHODS AND MATERIALS Thirty patients were included in the study, and plans for four techniques were developed for each patient. A total dose of 30Gy in 6Gy fractions once daily was prescribed in all treatment plans. RESULTS In the analysis of the non-PTV breast volume that was delivered 50% of the prescribed dose (PD), PBT (mean: 16.5%) was superior to TOMO (mean: 22.8%), IMRT (mean: 33.3%), and 3D-CRT (mean: 40.9%) (p<0.001). The average ipsilateral lung volume percentage receiving 20% of the PD was significantly lower in PBT (0.4%) and IMRT (2.3%) compared with 3D-CRT (6.0%) and TOMO (14.2%) (p<0.001). The average heart volume percentage receiving 20% and 10% of the PD in left-sided breast cancer (N=19) was significantly larger with TOMO (8.0%, 19.4%) compared to 3D-CRT (1.5%, 3.1%), IMRT (1.2%, 4.0%), and PBT (0%, 0%) (p<0.001). CONCLUSIONS All four EB-APBI techniques showed acceptable coverage of the PTV. However, effective non-PTV breast sparing was achieved at the cost of considerable dose exposure to the lung and heart in TOMO.
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Affiliation(s)
- Sung Ho Moon
- Proton Therapy Center, National Cancer Center, Gyeonggi-do, Republic of Korea
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