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Huang K, Das P, Olanrewaju AM, Cardenas C, Fuentes D, Zhang L, Hancock D, Simonds H, Rhee DJ, Beddar S, Briere TM, Court L. Automation of radiation treatment planning for rectal cancer. J Appl Clin Med Phys 2022; 23:e13712. [PMID: 35808871 PMCID: PMC9512348 DOI: 10.1002/acm2.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To develop an automated workflow for rectal cancer three‐dimensional conformal radiotherapy (3DCRT) treatment planning that combines deep learning (DL) aperture predictions and forward‐planning algorithms. Methods We designed an algorithm to automate the clinical workflow for 3DCRT planning with field aperture creations and field‐in‐field (FIF) planning. DL models (DeepLabV3+ architecture) were trained, validated, and tested on 555 patients to automatically generate aperture shapes for primary (posterior–anterior [PA] and opposed laterals) and boost fields. Network inputs were digitally reconstructed radiographs, gross tumor volume (GTV), and nodal GTV. A physician scored each aperture for 20 patients on a 5‐point scale (>3 is acceptable). A planning algorithm was then developed to create a homogeneous dose using a combination of wedges and subfields. The algorithm iteratively identifies a hotspot volume, creates a subfield, calculates dose, and optimizes beam weight all without user intervention. The algorithm was tested on 20 patients using clinical apertures with varying wedge angles and definitions of hotspots, and the resulting plans were scored by a physician. The end‐to‐end workflow was tested and scored by a physician on another 39 patients. Results The predicted apertures had Dice scores of 0.95, 0.94, and 0.90 for PA, laterals, and boost fields, respectively. Overall, 100%, 95%, and 87.5% of the PA, laterals, and boost apertures were scored as clinically acceptable, respectively. At least one auto‐plan was clinically acceptable for all patients. Wedged and non‐wedged plans were clinically acceptable for 85% and 50% of patients, respectively. The hotspot dose percentage was reduced from 121% (σ = 14%) to 109% (σ = 5%) of prescription dose for all plans. The integrated end‐to‐end workflow of automatically generated apertures and optimized FIF planning gave clinically acceptable plans for 38/39 (97%) of patients. Conclusion We have successfully automated the clinical workflow for generating radiotherapy plans for rectal cancer for our institution.
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Affiliation(s)
- Kai Huang
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA.,Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adenike M Olanrewaju
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donald Hancock
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hannah Simonds
- Department of Radiation Oncology, Tygerberg Hospital Stellenbosch University, Stellenbosch, South Africa
| | - Dong Joo Rhee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sam Beddar
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tina M Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Fadavi P, Ahmadi HK, Diba AAY, Jafari F, Alamolhoda M. Dosimetric comparison of left sided whole breast irradiation with Tangential wedge beam, electron boosted Tangential wedged beam and asymmetric technique. J Family Med Prim Care 2020; 9:6135-6139. [PMID: 33681053 PMCID: PMC7928138 DOI: 10.4103/jfmpc.jfmpc_1476_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/15/2020] [Accepted: 11/03/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Irradiation of the adjacent critical structures is inevitable in breast cancer radiotherapy (RT). Our purpose is to assess the dose distribution across the breast tissue and adjacent organs with our institutional asymmetric technique for left-sided breast cancer compared to the standard tangential wedged beam (TWB) and electron-boosted TWB techniques. Materials and Methods: The three RT planning were created for 30 consecutive patients with a focus on proper coverage of the planning target volume (PTV). The irritated doses into the heart, ipsilateral lung, and left anterior descending artery (LAD) were evaluated. Results: No significant difference was found in the mean values of relative PTV irradiated to 47.5 Gy, PTV dose and the volume of PTV, and critical organs between the treatments. The mean dose (Dmean) irradiated to the heart and LAD was lowest with the electron-boosted TWB. The Dmean to the heart was comparable between the TWB and asymmetric RT techniques, while the Dmean to LAD was significantly reduced with asymmetric technique versus TWB. The heart volume receiving ≥25 Gy and the Dmean to the left lung were significantly decreased with the asymmetric technique compared with TWB. The mean relative lung volume irradiated to ≥20 Gy was comparable between all techniques. The mean central lung distance was also significantly increased from 18.03 ± 4.5 cm with asymmetric RT to 37.47 ± 5.6 cm with TWB and to 27.67 ± 3.8 cm with electron-boosted TWB techniques. Conclusion: The asymmetric technique is useful for patients with breast cancer on the left side, having acceptable PTV coverage and considerably reduced cardiopulmonary doses.
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Affiliation(s)
- Pedram Fadavi
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Helaleh Khoshbakht Ahmadi
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Asghar Yousefi Diba
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jafari
- Radiation Oncology Research Center, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Radiation Oncology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Alamolhoda
- Department of Radiation Oncology, Shohadaye 7 Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
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Gustafson NR, Burrier T, Butler B, Hunzeker A, Lenards N, Culp L. Correlation of hot spot to breast separation in patients treated with postlumpectomy tangent 3D-CRT using field-in-field technique and mixed photon energies. Med Dosim 2019; 45:134-139. [PMID: 31521451 DOI: 10.1016/j.meddos.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/02/2019] [Accepted: 08/18/2019] [Indexed: 11/26/2022]
Abstract
Radiotherapy to an intact breast was previously determined to have a positive correlation between breast separation measurement and hot spot dose. As breast separation measurement increased, hot spot dose increased. The purpose of this retrospective study was to determine if this correlation persisted despite current techniques including field-in-field (FiF) blocking and mixed photon energies. Radiation treatment plans on unilateral intact breasts from 90 female, early stage breast cancer patients treated with lumpectomy were analyzed. Plans were created using 3-dimensional conformal radiation therapy (3D-CRT) nondivergent opposing tangent beams, FiF technique, and 6 MV with or without higher energy photons. Data collected included breast separation measurement, hot spot point dose and location, number of beams, photon energy, clinical target volume (CTV) coverage and breast volume coverage. Correlations between breast separation measurement and each of these values were determined. The positive correlation between breast separation measurement and hot spot dose persisted despite incorporating FiF and mixed photon energies. Correlations were also found between breast separation and the number of beams as well as breast separation and photon energy. Larger breast separations tended to be treated with additional beams of higher photon energy. There were no correlations found between breast separation and CTV or breast volume coverage. The data in this study suggested the medical dosimetrist should expect hot spots above prescription dose of 106%, 107%, and 108% for small, medium and large breast separation sizes respectively. Additionally, adding a high energy photon bean may be indicated with medium and large breast separations.
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Affiliation(s)
- Nancy R Gustafson
- Department of Health Professions, University of Wisconsin - La Crosse, La Crosse, Wisconsin, USA.
| | - Teri Burrier
- Department of Health Professions, University of Wisconsin - La Crosse, La Crosse, Wisconsin, USA
| | - Brittany Butler
- Department of Health Professions, University of Wisconsin - La Crosse, La Crosse, Wisconsin, USA
| | - Ashley Hunzeker
- Department of Health Professions, University of Wisconsin - La Crosse, La Crosse, Wisconsin, USA
| | - Nishele Lenards
- Department of Health Professions, University of Wisconsin - La Crosse, La Crosse, Wisconsin, USA
| | - Lee Culp
- Department of Health Professions, University of Wisconsin - La Crosse, La Crosse, Wisconsin, USA
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Kim H, Kwak J, Jung J, Jeong C, Yoon K, Lee SW, Ahn SD, Choi EK, Kim SS, Cho B. Automated Field-In-Field (FIF) Plan Framework Combining Scripting Application Programming Interface and User-Executed Program for Breast Forward IMRT. Technol Cancer Res Treat 2019; 17:1533033818810391. [PMID: 30384804 PMCID: PMC6259058 DOI: 10.1177/1533033818810391] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: To develop an one-click option on treatment planning system that enables for the
automated breast FIF planning by combining the Eclipse Scripting application programming
interfaces and user-executed programming in Windows. Methods: Scripting application programming interfaces were designed to promote automation in
clinical workflow associated with radiation oncology. However, scripting cannot provide
all functions that users want to perform. Thus, a new framework proposes to integrate
the benefits of the scripting application and user-executed programming for the
automated field-in-field technique. We adopted the Eclipse Scripting applications, which
provide an interface between treatment planning system server and client and enable for
running the executed program to create dose clouds and adjust the planning parameters
such as multi-leaf collimator placements and monitor unit values. Importantly, all tasks
are designed to perform with one-click option on treatment planning system, including
the automated pushback of the proposed plan to the treatment planning system. Results: The plans produced from the proposed framework were validated against the manual
field-in-field plans with 40 retrospective breast patient cases in planning efficiency
and plan quality. The elapsed time for running the framework was less than 1 minute,
which significantly reduced the manual multi-leaf collimator/monitor unit adjustment
time. It decreased the total planning time by more than 50%, relative to the manual
field-in-field planning. In dosimetric aspects, the mean and maximum dose of the heart,
lung, and whole breast did not exceed 1% deviation from the manual plans in most patient
cases, while maintaining the target dose coverage and homogeneity index inside the
target volume. From numerical analysis, the automated plans were demonstrated to be
sufficiently close to the manual plans. Conclusion: The combination of scripting applications and user-executed programming for automated
breast field-in-field planning accomplished a significant enhancement in planning
efficiency without degrading the plan quality, relative to the manual field-in-field
procedure.
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Affiliation(s)
- Hojin Kim
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungwon Kwak
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinhong Jung
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chiyoung Jeong
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungjun Yoon
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyung Choi
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su Ssan Kim
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungchul Cho
- 1 Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Dose prescription point in forward intensity-modulated radiotherapy of breast and head/neck cancers. Radiol Phys Technol 2018; 11:382-391. [DOI: 10.1007/s12194-018-0475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Allaveisi F, Moghadam AN. Comparison between the four-field box and field-in-field techniques for conformal radiotherapy of the esophagus using dose-volume histograms and normal tissue complication probabilities. Jpn J Radiol 2017; 35:327-334. [PMID: 28421397 DOI: 10.1007/s11604-017-0637-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/27/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE We evaluated and compared the performance of the field-in-field (FIF) to that of the four-field box (4FB) technique regarding dosimetric and radiobiological parameters for radiotherapy of esophageal carcinoma. MATERIALS AND METHODS Twenty patients with esophageal cancer were selected. For each patient, two treatment plans were created: 4FB and FIF. The parameters compared included the conformity index (CI), homogeneity index (HI), D mean, D max, tumor control probability (TCP), V 20Gy and V 30Gy of the heart and lungs, normal tissue complication probability (NTCP), and monitor units per fraction (MU/fr). RESULTS A paired t-test analysis did not show any significant differences (p > 0.05) between the two techniques in terms of the CI and TCP. However, the HI significantly improved when the FIF was applied. D max of the PTV, lung, and spinal cord were also significantly better with the FIF. Moreover, the lung V 20Gy as well as the NTCPs of the lung and spinal cord significantly reduced when the FIF was used, and the MU/fr was significantly decreased. CONCLUSIONS The FIF showed evident advantages over 4FB: a more homogeneous dose distribution, lower D max values, and fewer required MUs, while it also retained PTV dose conformality. FIF should be considered as a simple technique to use clinically in cases with esophageal malignancies, especially in clinics with no IMRT.
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Affiliation(s)
- Farzaneh Allaveisi
- Department of Medical Physics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, PO Box 6617858-411, Iran.
| | - Amir Nami Moghadam
- Department of Medical Physics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, PO Box 6617858-411, Iran
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Kim H, Kwak J, Jeong C, Cho B. Institutional Applications of Eclipse Scripting Programming Interface to Clinical Workflows in Radiation Oncology. ACTA ACUST UNITED AC 2017. [DOI: 10.14316/pmp.2017.28.3.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hojin Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jungwon Kwak
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chiyoung Jeong
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byungchul Cho
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Hamilton DG, Bale R, Jones C, Fitzgerald E, Khor R, Knight K, Wasiak J. Impact of tumour bed boost integration on acute and late toxicity in patients with breast cancer: A systematic review. Breast 2016; 27:126-35. [PMID: 27113229 DOI: 10.1016/j.breast.2016.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/24/2016] [Accepted: 03/11/2016] [Indexed: 01/13/2023] Open
Abstract
The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle-Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques.
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Affiliation(s)
- Daniel George Hamilton
- Epworth Radiation Oncology Research Centre, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia; Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia.
| | | | - Claire Jones
- Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia
| | - Emma Fitzgerald
- Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia
| | - Richard Khor
- Austin Health, Austin Hospital, 145 Studley Road, Heidelberg VIC 3121, Australia
| | - Kellie Knight
- Department of Medical Imaging & Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton VIC 3800, Australia
| | - Jason Wasiak
- Epworth Radiation Oncology Research Centre, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Verbelen H, Gebruers N, Tjalma W. Late effects of cancer treatment in breast cancer survivors. South Asian J Cancer 2016; 4:182. [PMID: 26981510 PMCID: PMC4772396 DOI: 10.4103/2278-330x.175956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Hanne Verbelen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Multidisciplinary Breast Clinic, Gynecological Oncology Unit, Antwerp University Hospital, Wilrijkstraat 10 2650 Edegem, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium; Multidisciplinary Breast Clinic, Gynecological Oncology Unit, Antwerp University Hospital, Wilrijkstraat 10 2650 Edegem, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic, Gynecological Oncology Unit, Antwerp University Hospital, Wilrijkstraat 10 2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
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Rochlin DH, Jeong AR, Goldberg L, Harris T, Mohan K, Seal S, Canner J, Sacks JM. Postmastectomy radiation therapy and immediate autologous breast reconstruction: Integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery. J Surg Oncol 2014; 111:251-7. [DOI: 10.1002/jso.23804] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 09/05/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Danielle H. Rochlin
- Department of Plastic and Reconstructive Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Ah-Reum Jeong
- Keck School of Medicine of University of Southern California; Los Angeles California
| | - Leah Goldberg
- Department of Plastic and Reconstructive Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Timothy Harris
- Department of Radiation Oncology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Kriti Mohan
- Division of Plastic Surgery; Baylor College of Medicine; Houston Texas
| | - Stella Seal
- Welch Medical Library; Johns Hopkins University; Baltimore Maryland
| | - Joe Canner
- Center for Surgical Trials and Outcomes Research (CSTOR); Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Justin M. Sacks
- Department of Plastic and Reconstructive Surgery; Johns Hopkins University School of Medicine; Baltimore Maryland
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Breast edema in breast cancer patients following breast-conserving surgery and radiotherapy: a systematic review. Breast Cancer Res Treat 2014; 147:463-71. [PMID: 25164973 DOI: 10.1007/s10549-014-3110-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/18/2014] [Indexed: 01/13/2023]
Abstract
Breast-conserving surgery (BCS) is commonly used in breast cancer treatment. Despite its benefits, some women will be troubled by breast edema. Breast edema may cause an unsatisfactory cosmetic result, influencing the quality of life. The purpose of this systematic review is to investigate the incidence of breast edema and to identify risk factors of breast edema in breast cancer patients following BCS and radiotherapy. A systematic literature search was performed using different electronic databases (PubMed, Web of Science, Cochrane, Embase) until June 2014. Inclusion criteria were as follows: (1) research studies that included female breast cancer patients who were treated with BCS and radiotherapy and (2) studies that investigated the incidence of breast edema and/or risk factors of breast edema. Exclusion criteria were (1) reviews or case studies and (2) studies published before 1995. We identified in total 28 papers which represented 4,011 patients. There was a great variation in the incidence of breast edema (0-90.4 %). We identified several possible risk factors for breast edema namely increasing irradiated breast volume, increasing boost volume, the use of a photon boost, increasing breast separation, a higher density of the breast tissue, a large tumor, a higher specimen weight, postoperative infection, acute postoperative toxicity, and diabetes mellitus. However, their prognostic value remains uncertain. Breast edema is a common complaint after BCS and radiotherapy. A number of possible risk factors associated with breast edema were identified, but further research is warranted.
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Teh AYM, Walsh L, Purdie TG, Mosseri A, Xu W, Levin W, Koch CA, Fyles A, Liu FF, Cho BJ. Concomitant intensity modulated boost during whole breast hypofractionated radiotherapy – A feasibility and toxicity study. Radiother Oncol 2012; 102:89-95. [DOI: 10.1016/j.radonc.2011.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
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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: 30] [Impact Index Per Article: 2.3] [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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Can field-in-field technique replace wedge filter in radiotherapy treatment planning: a comparative analysis in various treatment sites. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2009; 31:317-24. [PMID: 19239058 DOI: 10.1007/bf03178601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the study was to show whether field-in-field (FIF) technique can be used to replace wedge filter in radiation treatment planning. The study was performed in cases where wedges are commonly used in radiotherapy treatment planning. Thirty patients with different malignancies who received radiotherapy were studied. This includes patients with malignancies of brain, head and neck, breast, upper and lower abdomen. All the patients underwent computed tomography scanning and the datasets were transferred to the treatment planning system. Initially, wedge based planning was performed to achieve the best possible dose distribution inside the target volume with multileaf collimators (Plan 1). Wedges were removed from a copy of the same plan and FIF plan was generated (Plan 2). The two plans were then evaluated and compared for mean dose, maximum dose, median dose, doses to 2% (D2) and 98% (D98) of the target volume, volume receiving greater than 107% of the prescribed dose (V > 107%), volume receiving less than 95% of the prescribed dose (V< 95%), conformality index (CI) and total monitor units. FIF gives equivalent dosimetric results as wedge based treatment planning. It is better than wedge planning in terms of maximum dose, D2, V >107% and CI for most of the sites with statistically significant reduction in monitor units. FIF results in better dose distribution in terms of homogeneity in most of the sites. It is feasible to replace wedge filter with FIF in radiotherapy treatment planning.
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Morganti AG, Cilla S, Valentini V, Digesu' C, Macchia G, Deodato F, Ferrandina G, Cece MG, Cirocco M, Garganese G, Di Lullo L, Traficante D, Scarabeo F, Panunzi S, De Gaetano A, Sallustio G, Cellini N, Sofo L, Piermattei A, Scambia G. Phase I-II studies on accelerated IMRT in breast carcinoma: technical comparison and acute toxicity in 332 patients. Radiother Oncol 2008; 90:86-92. [PMID: 19010560 DOI: 10.1016/j.radonc.2008.10.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 10/23/2008] [Accepted: 10/23/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the results in terms of dosimetric parameters and acute toxicity of two clinical studies (MARA-1 and MARA-2) on accelerated IMRT-based postoperative radiotherapy. These results are compared with historical control group (CG) of patients treated with "standard" 3D postoperative radiotherapy. MATERIALS AND METHODS Prescribed dose to the breast was 50.4Gy in the CG, 40Gy in MARA-1 (low risk of local recurrence), and 50Gy in MARA-2 (medium-high risk of recurrence). The tumor bed total dose was 60.4Gy (sequential 10Gy electron boost), 44Gy (concomitant 4Gy boost), and 60Gy (concomitant 10Gy boost) in CG, MARA-1 and MARA-2 studies, respectively. Overall treatment time was of 32 fractions for CG (6.4weeks); 16 fractions for MARA-1 study (3.2weeks) and 25 fractions for MARA-2 study (5weeks). RESULTS Three hundred and thirty two patients were included in the analysis. Dosimetric analysis showed D(max) and V(107%) reduction (p<0.001) and D(min) improvement (p<0.001) in the PTV in patients treated with IMRT. Grade 2 acute skin toxicity was 33.6%, 13.1%, and 45.1% in the CG, MARA-1, and MARA-2, respectively (p<0.001), and grade 3 acute skin toxicity was 3.1%, 1.0%, and 2.0%, respectively. Similarly, larger PTV and use of chemotherapy with anthracyclines and taxanes were associated with a greater acute toxicity. With a median follow-up of 31 months, no patients showed local or nodal relapse. CONCLUSIONS A simplified step and shoot IMRT technique allowed better PTV coverage and reduced overall treatment time (CG, 6.6weeks; MARA-1, 3.2weeks; MARA-2, 5weeks) with acceptable short-term toxicity.
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Affiliation(s)
- Alessio G Morganti
- Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
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Stelzer KJ, Bailey B, Davidson M, Dugick S, Mullins M. Determination of critical dosimetric parameters for breast radiation using forward-planned segmented fields for intensity modulation. Med Dosim 2007; 32:23-32. [PMID: 17317532 DOI: 10.1016/j.meddos.2006.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 10/16/2006] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine factors associated with acute skin toxicity from breast radiation for optimizing forward-planned intensity modulation. Treatment plans in 100 patients who received breast radiation using three-dimensional treatment planning were analyzed. Fifty-two patients were treated with tangent fields using wedges (nonsegmented), and 48 patients were treated with forward-planned fields segmented by a multileaf collimator to modulate intensity. Clinical and dosimetric variables were recorded. Acute skin toxicity was prospectively documented using a standard scale. Body weight, breast target volume, maximum body dose (encompassing 10 mL), and volume of body receiving >50 Gy and 55 Gy (V50Gy, and V55Gy) were associated with acute toxicity. Patients treated with segmented plans had significantly larger breast targets and were treated to lower prescription isodoses, confounding comparison with nonsegmented plans. Consequently, datasets from patients treated with segmented plans were used to design new nonsegmented plans for paired comparison. Segmented plans were superior with respect to dosimetric endpoints predictive of toxicity in this paired comparison. Limitations of 55 Gy for maximum body dose and 1100 mL for V50Gy appeared to be appropriate values to guide forward treatment planning of segmented fields.
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Affiliation(s)
- Keith J Stelzer
- Celilo Radiation Therapy, Mid-Columbia Medical Center, The Dalles, OR 97058, USA.
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