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Onal C, Bozca R, Dolek Y, Elmali A, Guler OC. A Comparative Analysis of Implant-sparing Plan Versus Conventional Plans Utilizing Helical Tomotherapy in Breast Cancer Patients Undergoing Breast Reconstruction. In Vivo 2024; 38:1412-1420. [PMID: 38688603 PMCID: PMC11059874 DOI: 10.21873/invivo.13583] [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] [Received: 01/06/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM To compare implant sparing irradiation with conventional radiotherapy (RT) using helical (H) and TomoDirect (TD) techniques in breast cancer patients undergoing immediate breast reconstruction (IBR). PATIENTS AND METHODS The dosimetric parameters of 40 patients with retropectoral implants receiving 50.4 Gy delivered in 28 fractions were analyzed. Three plans were created: H plan using conventional planning target volume (PTV) that included the chest wall, skin, and implant; TD plan using conventional PTV; and Hs plan using implant-sparing PTV. The H, TD, and Hs plans were compared for PTV doses, organ-at-risk (OAR) doses, and treatment times. RESULTS Dose distribution in the Hs plan was less homogeneous and uniform than that in the H and TD plans. The TD plan had lower lung, heart, contralateral breast, spinal cord, liver, and esophagus doses than the Hs plan. Compared to the Hs plan, the H plan had lower lung volume receiving 5Gy (V5) (39.1±3.9 vs. 41.2±3.9 Gy; p<0.001), higher V20 (12.3±1.3 vs. 11.5±2.6 Gy; p=0.02), and higher V30 (7.5±1.6 vs. 4.4±1.7 Gy; p<0.001). H plan outperformed Hs plan in heart dosimetric parameters except V20. The Hs plan had significantly lower mean implant doses (43.4±2.1 Gy) than the H plan (51.4±0.5 Gy; p<0.001) and the TD plan (51.9±0.6 Gy; p<0.001). Implementing an implant sparing technique for silicone dose reduction decreases lung doses. CONCLUSION Conventional H and TD plans outperform the implant sparing helical plan dosimetrically. Because capsular contracture during RT is unpredictable, long-term clinical outcomes are required to determine whether silicon should be spared.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey;
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Recep Bozca
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Yemliha Dolek
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
| | - Aysenur Elmali
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
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Oki Y, Akasaka H, Uehara K, Mizonobe K, Sawada M, Nagata J, Harada A, Mayahara H. Evaluation of robustness of optimization methods in breast intensity-modulated radiation therapy using TomoTherapy. Phys Eng Sci Med 2024:10.1007/s13246-023-01377-7. [PMID: 38265521 DOI: 10.1007/s13246-023-01377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Intensity-modulated radiation therapy (IMRT) has become a popular choice for breast cancer treatment. We aimed to evaluate and compare the robustness of each optimization method used for breast IMRT using TomoTherapy. A retrospective analysis was performed on 10 patients with left breast cancer. For each optimization method (clipping, virtual bolus, and skin flash), a corresponding 50 Gy/25 fr plan was created in the helical and direct TomoTherapy modes. The dose-volume histogram parameters were compared after shifting the patients anteriorly and posteriorly. In the helical mode, when the patient was not shifted, the median D1cc (minimum dose delivered to 1 cc of the organ volume) of the breast skin for the clipping and virtual bolus plans was 52.2 (interquartile range: 51.9-52.6) and 50.4 (50.1-50.8) Gy, respectively. After an anterior shift, D1cc of the breast skin for the clipping and virtual bolus plans was 56.0 (55.6-56.8) and 50.9 (50.5-51.3) Gy, respectively. When the direct mode was used without shifting the patient, D1cc of the breast skin for the clipping, virtual bolus, and skin flash plans was 52.6 (51.9-53.1), 53.4 (52.6-53.9), and 52.3 (51.7-53.0) Gy, respectively. After shifting anteriorly, D1cc of the breast skin for the clipping, virtual bolus, and skin flash plans was 55.6 (54.1-56.4), 52.4 (52.0-53.0), and 53.6 (52.6-54.6) Gy, respectively. The clipping method is not sufficient for breast IMRT. The virtual bolus and skin flash methods were more robust optimization methods according to our analyses.
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Affiliation(s)
- Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan.
| | - Hiroaki Akasaka
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, Australia
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuou-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Masanobu Sawada
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
- Division of Radiological Technology, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo, 669-1321, Japan
| | - Junya Nagata
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
- Section of Medical Physics and Engineering, Kanagawa Cancer Center, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, 8-5-1 Minatojima-nakamachi, Chuo-ku, Kobe, Hyogo, 650-0046, Japan
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Onal C, Bozca R, Oymak E, Guler OC. Comparison of helical and TomoDirect techniques with simultaneous integrated boost in early breast cancer patients. Rep Pract Oncol Radiother 2023; 28:541-550. [PMID: 37795226 PMCID: PMC10547420 DOI: 10.5603/rpor.a2023.0058] [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: 02/27/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023] Open
Abstract
Background The aim of the study was to perform dosimetric comparisons of helical (H) and TomoDirect (TD) plans for whole-breast irradiation (WBI) with simultaneous integrated boost (SIB) in early-stage breast cancer patients undergoing breast conserving surgery. Materials and methods Fifty patients, 25 with left-side and 25 with right-side tumors, were determined for a treatment planning system for a total dose of 50.4Gy in 1.8Gy per fraction to WBI, with a SIB of 2.3Gy per fraction delivered to the tumor bed. The planning target volume (PTV) doses and the conformity (CI) and homogeneity indices (HI) for PTVbreast and PTVboost, as well as organ-at-risk (OAR) doses and treatment times, were compared between the H and TD plans. Results All plans met the PTV coverage criteria for the H plan, except for mean V107 of PTVbreast for TD plan. The H plan yielded better homogeneity and conformity of dose distribution compared to the TD plan. The ipsilateral mean lung doses were not significantly different between the two plans. The TD plans is advantageous for mean doses to the heart, contralateral breast and lung, spinal cord, and esophagus than the H plans. In both the H and TD plans, the right-sided breast patients had lower heart dose parameters than the left-sided breast patients. The TD plan is superior to the H plan in sparing the contralateral breast and lung by decreasing low-dose volumes. Conclusions While the OAR dose advantages of TD are appealing, shorter treatment times or improved dose homogeneity and conformity for target volume may be advantageous for H plan.
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Affiliation(s)
- Cem Onal
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Türkiye
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Türkiye
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Ankara, Türkiye
| | - Recep Bozca
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Türkiye
| | - Ezgi Oymak
- Division of Radiation Oncology, Iskenderun Gelisim Hospital, Hatay, Türkiye
| | - Ozan Cem Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine Adana Dr Turgut Noyan Research and Treatment Center, Adana, Türkiye
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Wang Y, Shen J, Gu P, Wang Z. Recent advances progress in radiotherapy for breast cancer after breast-conserving surgery: a review. Front Oncol 2023; 13:1195266. [PMID: 37671064 PMCID: PMC10475720 DOI: 10.3389/fonc.2023.1195266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Adjuvant radiotherapy after breast-conserving surgery has become an integral part of the treatment of breast cancer. In recent years, the development of radiotherapy technology has made great progress in this field, including the comparison of the curative effects of various radiotherapy techniques and the performance of the segmentation times. The choice of radiotherapy technology needs to be co-determined by clinical evidence practice and evaluated for each individual patient to achieve precision radiotherapy. This article discusses the treatment effects of different radiotherapy, techniques, the risk of second cancers and short-range radiation therapy techniques after breast-conserving surgery such as hypo fractionated whole breast irradiation and accelerated partial breast irradiation. The choice of radiotherapy regimen needs to be based on the individual condition of the patient, and the general principle is to focus on the target area and reduce the irradiation of the normal tissues and organs. Short-range radiotherapy and hypofractionated are superior to conventional radiotherapy and are expected to become the mainstream treatment after breast-conserving surgery.
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Affiliation(s)
- Yun Wang
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Jingjing Shen
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Peihua Gu
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Zhongming Wang
- Department of Radiation Oncology, Shidong Hospital, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
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Ke S, Wang W, Li B, Feng X, Yan D, Liu J. Superior survival for breast-conserving therapy over mastectomy in patients with breast cancer: A population-based SEER database analysis across 30 years. Front Oncol 2023; 12:1032063. [PMID: 36686746 PMCID: PMC9846313 DOI: 10.3389/fonc.2022.1032063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction It has been believed that breast-conserving therapy (lumpectomy plus adjuvant radiation, Lum + RT) and mastectomy without radiation (Mast + NoRT) have equivalent survival outcomes. However, there is a need to re-evaluate the role of lumpectomy plus adjuvant radiation due to changed breast cancer management over time. This study aimed to conduct a population-based study that compare long-term oncologic survival outcomes after Lum + RT vs Mast + NoRT. Methods The Surveillance, Epidemiology and End Results database was used to identify female breast cancer patients with a primary localized breast cancer diagnosis from 1988 to 2018. The standardized incidence/mortality ratio (SIR/SMR) for breast cancer recurrence (BCR) and breast cancer-specific death (BSD) was estimated by the SEER*Stat program. Cumulative incidences of BCR and BSD were assessed using Gray's method. We evaluated the effects of Lum + RT vs. Mast + NoRT on breast cancer recurrence-free survival (BRFS) and breast cancer-specific survival (BCSS). Fine-Gray competing risk model analyses, propensity score-adjusted Kaplan-Meier analyses and Cox proportional hazards model analyses were applied. Results A total of 205,788 women were included in the study. Patients who underwent Lum + RT had higher SIR of BCR (4.14 [95% confidence interval, CI: 3.94-4.34] vs. 1.11 [95% CI: 1.07-1.14]) and lower SMR (9.89 [95% CI: 9.71-10.08] vs. 17.07 [95% CI: 16.82-17.33]) than patients who underwent Mast + NoRT. Lum + RT was associated with higher competing risk of BCR (adjusted hazard ratio [HR]: 1.996, 95% CI: 1.925-2.069, p < 0.001) and lower competing risk of BSD when compared to Mast + RT (adjusted HR: 0.584, 95% CI: 0.572-0.597, p < 0.001). Multivariate Cox regression analysis revealed similar results (adjusted HR after PSW for BRFS: 1.792, 95% CI 1.716-1.871, p < 0.001; adjusted HR after PSW for BCSS: 0.706, 95% CI 0.688-0.725, p < 0.001). These findings persisted in the sensitivity and subgroup analyses. Discussion The present study further confirmed superior long-term survival with lumpectomy plus adjuvant radiation over mastectomy independent of patient characteristics including age, race, time period, historic subtype, tumor size, historic grade and stage, indicating that this benefit may result from the treatment itself.
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Affiliation(s)
- Shanbao Ke
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Wei Wang
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Baiyu Li
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Xiao Feng
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Danfang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianbo Liu
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China,*Correspondence: Jianbo Liu,
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Zhao R, Wei W, Zhen L. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients. Open Med (Wars) 2023; 18:20230651. [PMID: 36896338 PMCID: PMC9990777 DOI: 10.1515/med-2023-0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/07/2022] [Accepted: 01/04/2023] [Indexed: 03/08/2023] Open
Abstract
Locally advanced breast cancer patients have a poor prognosis; however, the relationship between potential targets and the response to treatment is still unclear. The gene expression profiles of breast cancer patients with stages from IIB to IIIC were downloaded from The Cancer Genome Atlas. We applied weighted gene co-expression network analysis and differentially expressed gene analysis to identify the primary genes involved in treatment response. The disease-free survival between low- and high-expression groups was analyzed using Kaplan-Meier analysis. Gene set enrichment analysis was applied to identify hub genes-related pathways. Additionally, the CIBERSORT algorithm was employed to evaluate the correlation between the hub gene expression and immune cell types. A total of 16 genes were identified to be related to radiotherapy response, and low expression of SVOPL, EDAR, GSTA1, and ABCA13 was associated with poor overall survival and progression-free survival in breast cancer cases. Correlation analysis revealed that the four genes negatively related to some specific immune cell types. The four genes were downregulated in H group compared with the L group. Four hub genes associated with the immune cell infiltration of breast cancer were identified; these genes might be used as a promising biomarker to test the treatment in breast cancer patients.
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Affiliation(s)
- Ruipeng Zhao
- Department of Thyroid and Breast Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Wan Wei
- Department of Thyroid and Breast Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Linlin Zhen
- Department of Thyroid and Breast Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
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Kim H, Jung J, Jung H, Jeong J, Lee D, Jeong HW, Lee Y. Comparison of Jaw Mode and Field Width for Left-Breast Cancer Using TomoDirect Three-Dimensional Conformal Radiation Therapy: A Phantom Study. Healthcare (Basel) 2022; 10:healthcare10122431. [PMID: 36553955 PMCID: PMC9777817 DOI: 10.3390/healthcare10122431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
It is very important to use effective parameters in the treatment plan of breast cancer patients in TomoDirect (TD)-three-dimensional conformal radiation therapy (TD-3DCRT). The objective of this study was to compare the radiation treatment plans to the parameters (jaw width and jaw mode) of TD-3DCRT for left-breast cancer. This study was conducted using the phantom, the jaw mode (fixed and dynamic) and field width (2.5 cm and 5.0 cm) were controlled to compare the TD-3DCRT treatment plans. There was small difference in the conformity index (CI) and homogeneity index (HI) values for target according to the jaw mode for each field width. As a result of observation in terms of dose, treatment time and unnecessary damage to surrounding normal organs could be minimized when dynamic jaw with a field width of 5.0 cm was used. In conclusion, we verified that the use of dynamic jaws and 5.0 cm field width was effective in left-breast cancer radiotherapy plan using TD-3DCRT.
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Affiliation(s)
- Haneul Kim
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Jaehong Jung
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaruro, Bucheon-si 14584, Republic of Korea
| | - Hyunseo Jung
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Jibeom Jeong
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Dohwa Lee
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Hyun-Woo Jeong
- Department of Biomedical Engineering, Eulji University, 553, Sanseong-daero, Sujeong-gu, Seongnam-si 13135, Republic of Korea
- Correspondence: (H.-W.J.); (Y.L.); Tel.: +82-31-740-7135 (H.-W.J.); +82-32-820-4362 (Y.L.)
| | - Youngjin Lee
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
- Correspondence: (H.-W.J.); (Y.L.); Tel.: +82-31-740-7135 (H.-W.J.); +82-32-820-4362 (Y.L.)
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Gupte A, Sasidharan A, Kunheri B, Kumar AN, Reddy S, Nair H, Pushpaja KU, Anoop R, Dutta D. Dosimetric Comparison of Four Different Radiotherapy Planning Techniques for Adjuvant Radiotherapy of Left-Sided Breast, Axilla, and Supraclavicular Fossa. J Med Phys 2021; 46:308-314. [PMID: 35261501 PMCID: PMC8853459 DOI: 10.4103/jmp.jmp_54_21] [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: 04/09/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose/Aim: Forward planned intensity-modulated radiotherapy (forward IMRT) with breath-hold (BH) technique is considered optimal by most practitioners for treating left-sided breast cancer. Regional nodal irradiation including axilla and supraclavicular fossa (SCF) increases can increase dose-to-organs at risk (OAR) especially lung. This study was done to assess the potential of inverse planned IMRT (inverse IMRT) to achieve significant reduction in dose to OAR. Materials and Methods: Ten patients with left-sided breast cancer treated with Active Breath Co-ordinator BH technique were included in the study. Forward IMRT plans were generated in both BH and free breathing (FB) scans. Inverse IMRT plans were generated in FB scan using Tomotherapy-Direct and Tomotherapy-Helical techniques. Contouring was done as per the ESTRO consensus contouring guidelines. The dose prescribed was 40 Gy in 15 fractions. Statistical significance was tested using one-way ANOVA for parametric data and Kruskall–Wallis test for nonparametric data. Multiple comparison tests were done by using Bonferroni test. P <0.05 was considered to denote statistical significance. Results: Inverse IMRT plans achieved superior homogeneity index compared to forward IMRT with BH. Tomotherapy-Direct reduced dose to ipsilateral lung, compared to the forward IMRT with BH while achieving similar doses to other OAR. Tomotherapy-Helical plans achieved significantly better conformity index and reduced maximum dose to left anterior descending artery compared to forward IMRT plans, but low dose to other OAR was significantly worse. Conclusion: For left-sided breast, axilla, and SCF radiotherapy, inverse IMRT with Tomotherapy-Direct plan achieved better homogeneity index and reduced dose to ipsilateral lung compared to forward IMRT with BH.
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Affiliation(s)
- Ajinkya Gupte
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ajay Sasidharan
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Beena Kunheri
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Amala N Kumar
- Department of Medical Physics, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Sruthi Reddy
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Haridas Nair
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - K U Pushpaja
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - R Anoop
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Debnarayan Dutta
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Hongo H, Tokuue K, Sakae T, Mase M, Omura M. Robust Treatment Planning in Intrafraction Motion Using TomoDirect™ Intensity-modulated Radiotherapy for Breast Cancer. In Vivo 2021; 35:2655-2659. [PMID: 34410953 DOI: 10.21873/invivo.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To evaluate the robustness of radiotherapy treatment planning optimization for respiratory-moving breast cancer using fixed-angle beams planning TomoDirect™ intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS A minimax optimisation algorithm was applied to 10 breast cancer patients. Two sets of treatment plans with or without robust techniques were prepared considering anterior-posterior and head-tail movements due to respiration. Parameters were compared between treatment plans: 95% planned target volume (PTV) dose, conformal index and homogeneity index (HI), and organs at risk (OAR) parameters including the lung volume receiving 20 Gy or more (V20) and 5 Gy (V5). RESULTS Robust planning significantly improved parameters of 95% PTV dose and HI, without deteriorating V20 or V5 in the anterior-posterior movement, while it slightly improved 95% PTV and slightly deteriorated V20 in the head-tail movement. CONCLUSION Robust treatment planning improves coverage of targets moving because of respiration in the treatment of breast cancer using TomoDirect; however, normal lung doses should be cautiously evaluated on a case-by-case basis.
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Affiliation(s)
- Hideyuki Hongo
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa, Japan; .,Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Koichi Tokuue
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Misato Mase
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Motoko Omura
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kanagawa, Japan
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Manabe Y, Miyakawa A, Kondo T, Yamada Y, Hashimoto S, Ishikura S, Shibamoto Y. Stereotactic body radiotherapy using the forward-planned static-port tomotherapy for lung cancer: a novel planning technique with the newly-developed mode. JOURNAL OF RADIATION RESEARCH 2020; 61:993-998. [PMID: 33210148 PMCID: PMC7674681 DOI: 10.1093/jrr/rraa092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/18/2020] [Indexed: 06/11/2023]
Abstract
With the newly-developed static-port forward-planning (FP) mode of tomotherapy, the ratio of the dose of the planning target volume (PTV) periphery to the maximum dose can be easily adjusted by modifying leaf margins when planning stereotactic body radiotherapy (SBRT). The purpose of this study was to evaluate the characteristics of FP plans compared to helical intensity-modulated radiotherapy (IMRT) and helical 3D conformal radiotherapy (3DCRT) plans of SBRT for lung tumors. The three plans were created for 14 tumors in 11 patients. For 13 tumors, 60 Gy in 7.5-Gy fractions was prescribed for a minimum coverage dose of 95% of the PTV (D95). The prescribed isodose line (PIL) was intended to be 60-80% of the maximum dose. Nine angles were used for the FP plans. The median D98 and D50 of the internal target volume for FP, helical-IMRT and helical-3DCRT plans were 70.4, 71.4 and 60.5 Gy, respectively (P < 0.001), and 77.7, 75.7 and 62.3 Gy, respectively (P < 0.0001). The median PIL and the lung volume receiving ≥20 Gy (V20) were 73.4, 73.4 and 94.3%, respectively (P < 0.0001), and 4.7, 4.0 and 5.7%, respectively (P < 0.0001). These parameters were not significantly different between the FP and helical-IMRT plans. The median beam-on times were 238.6, 418.9 and 197.1 s, respectively (P < 0.0001). The FP plans reduced the beam-on time by 43% compared to the helical-IMRT plans. The dose distribution of the FP plans was comparable to that of the helical-IMRT plans. The helical-3DCRT plans could not adjust PIL to be 60-80%.
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Affiliation(s)
- Yoshihiko Manabe
- Corresponding author. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mozuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. Tel: +81-52-853-8276; Fax: +81-52-852-5244;
| | - Akifumi Miyakawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Takuhito Kondo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yuki Yamada
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Seiji Hashimoto
- Department of Radiation Oncology, Nanbu Tokushukai Hospital, 171-1 Hokama, Yaese-cho, Simajiri-gun, Okinawa 901-0493, Japan
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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Choi KH, Ahn SJ, Jeong JU, Yu M, Kim JH, Jeong BK, Lee JH, Kim SH, Lee JH. Postoperative radiotherapy with intensity-modulated radiation therapy versus 3-dimensional conformal radiotherapy in early breast cancer: A randomized clinical trial of KROG 15-03. Radiother Oncol 2020; 154:179-186. [PMID: 32980384 DOI: 10.1016/j.radonc.2020.09.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the safety and efficacy of intensity-modulated radiation therapy (IMRT) for early breast cancer compared with 3-dimensional conformal radiotherapy (3D-CRT) in a prospective and randomized trial. METHODS AND MATERIALS From March 2015 to February 2018, 693 patients with pT1-2N0M0 early breast cancer who underwent breast-conserving surgery were enrolled and randomly assigned into IMRT and 3D-CRT. The primary endpoint was 3-year locoregional recurrence-free survival (LRRFS). The secondary endpoints were recurrence-free survival, overall survival, acute toxicity, target coverage index, irradiation dose to organs at risk, and fatigue inventory. The radiation dose for the 3D-CRT arm was 59.4 Gy in 33 fractions for 6.5 weeks. It was 57.4 Gy in 28 fractions with simultaneous integrated boost for 5.5 weeks for the IMRT arm. RESULTS Of 693 patients, 349 and 344 patients received 3D-CRT and IMRT, respectively. There was no significant difference in LRRFS between the two arms. Conformity index of planning target volume was significantly superior in the IMRT arm than the 3D-CRT arm (p < 0.001). The mean lung dose and V5-V50 for the ipsilateral lung were significantly lower in the IMRT arm than the 3D-CRT arm (all p < 0.05). The incidence of grade 2 or higher dermatitis was significantly lower in the IMRT arm (p = 0.009). CONCLUSION Compared to 3D-CRT, IMRT showed similar results in locoregional tumor control but superior results in planning target volume coverage. When IMRT is used in breast cancer, the irradiation dose to an ipsilateral lung and skin toxicity can be reduced.
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Affiliation(s)
- Kyu Hye Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Ja Ahn
- Department of Radiation Oncology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Jae Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Mina Yu
- Department of Radiation Oncology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Joo Hwan Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Breast cancer is the most commonly diagnosed cancer among women and the second leading cause of cancer-related death in Canadian women. Surgery is often the first line of treatment for low-risk early stage patients, followed by adjuvant radiation therapy to reduce the risk of local recurrence and prevent metastasis after lumpectomy or mastectomy. For high-risk patients with node positive disease or are at greater risk of nodal metastasis, radiation therapy will involve treatment of the intact breast or chest-wall as well as the regional lymph nodes.Materials and methods:We retrospectively evaluated the treatment plans of 354 patients with breast cancer with nodes positive or were at high risk of nodal involvement treated at our cancer centre. All patients were treated with a prescription dose of 50 Gy in 25 fractions to the intact breast or chest-wall and 50 Gy in 25 fractions to the supraclavicular region and, based on patient suitability and tolerance, were treated either using the deep inspiration breath hold (DIBH) or free-breathing (FB) techniques.Results:Based on patient suitability and tolerance, 130 (36·7%) patients were treated with DIBH and 224 (63·3%) with FB techniques. There were 169 (47·7%) patients treated with intact breast, whereas 185 (52·3%) were treated for post-mastectomy chest-wall. The mean PTV_eval V92%, V95%, V100% and V105% for all patients are 99·4 ± 0·7, 97·6 ± 1·6, 74·8 ± 7·9 and 1·5 ± 3·2%, respectively. The mean ipsilateral lung V10Gy, V20Gy and V30Gy are 30·0 ± 5·3, 22·4 ± 4·7 and 18·4 ± 4·3% for intact breast and 30·9 ± 5·8, 23·5 ± 5·4 and 19·4 ± 5·0% for post-mastectomy patients with FB, respectively. The corresponding values for patients treated using DIBH are 26·3 ± 5·9, 18·9 ± 5·0 and 15·6 ± 4·7% for intact breast and 27·5 ± 6·5, 20·6 ± 5·7 and 17·1 ± 5·2% for post-mastectomy patients, respectively. The mean heart V10Gy, V20Gy, is 1·8 ± 1·7, 0·9 ± 1·0 for intact breast and 3·1 ± 2·2, 1·7 ± 1·6 for post-mastectomy patients with FB, respectively. The corresponding values with the DIBH are 0·5 ± 0·7, 0·1 ± 0·4 for intact breast and 1·1 ± 1·4, 0·4 ± 0·7 for post-mastectomy patients, respectively.Conclusion:The use of 3 and/or 4 field hybrid intensity-modulated radiation therapy technique for radiation therapy of high-risk node positive breast cancer patients provides an efficient and reliable method for achieving superior dose uniformity, conformity and homogeneity in the breast or post-mastectomy chest-wall volume with minimal doses to the organs at risk. The development and implementation of a consistent treatment plan acceptability criteria in radiotherapy programmes would establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that would reduce significant variations in the acceptability of treatment plans.
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Haussmann J, Corradini S, Nestle-Kraemling C, Bölke E, Njanang FJD, Tamaskovics B, Orth K, Ruckhaeberle E, Fehm T, Mohrmann S, Simiantonakis I, Budach W, Matuschek C. Recent advances in radiotherapy of breast cancer. Radiat Oncol 2020; 15:71. [PMID: 32228654 PMCID: PMC7106718 DOI: 10.1186/s13014-020-01501-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/18/2020] [Indexed: 01/08/2023] Open
Abstract
Radiation therapy is an integral part of the multidisciplinary management of breast cancer. Regional lymph node irradiation in younger trials seems to provide superior target coverage as well as a reduction in long-term toxicity resulting in a small benefit in the overall survival rate. For partial breast irradiation there are now two large trials available which support the role of partial breast irradiation in low risk breast cancer patients. Multiple randomized trials have established that a sequentially applied dose to the tumor bed improves local control with the cost of worse cosmetic results.
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Affiliation(s)
- Jan Haussmann
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Carolin Nestle-Kraemling
- Department of Gynecologic and Obstetrics, Evanglisches Krankenhaus Dusseldorf, Dusseldorf, Germany
| | - Edwin Bölke
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany.
| | | | - Bálint Tamaskovics
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Klaus Orth
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Eugen Ruckhaeberle
- Department of Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Tanja Fehm
- Department of Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Ioannis Simiantonakis
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Wilfried Budach
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
| | - Christiane Matuschek
- Medical Faculty, Department of Radiation Oncology, Heinrich Heine University, Dusseldorf, Germany
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