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Chirilă ME, Kraja F, Marta GN, Neves Junior WFP, de Arruda GV, Gouveia AG, Franco P, Poortmans P, Ratosa I. Organ-sparing techniques and dose-volume constrains used in breast cancer radiation therapy - Results from European and Latin American surveys. Clin Transl Radiat Oncol 2024; 46:100752. [PMID: 38425691 PMCID: PMC10900109 DOI: 10.1016/j.ctro.2024.100752] [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: 12/31/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Advances in local and systemic therapies have improved the outcomes of patients with breast cancer (BC), leading to a possible increased risk for postoperative radiation therapy (RT) late adverse events. The most adequate technologies and dose constraints for organs at risk (OAR) in BC RT have yet to be defined. Methods An online survey was distributed to radiation oncologists (ROs) practicing in Europe and Latin America including the Caribbean (LAC) through personal contacts, RO and BC professional groups' networks. Demographic data and clinical practice information were collected. Results The study included 585 responses from ROs practicing in 57 different countries. The most frequently contoured OAR by European and LAC participants were the whole heart (96.6 % and 97.7 %), the ipsilateral (84.3 % and 90.8 %), and contralateral lung (71.3 % and 77.4 %), whole lung (69.8 % and 72.9 %), and the contralateral breast (66.4 % and. 83.2 %). ESTRO guidelines were preferred in Europe (33.3 %) and the RTOG contouring guideline was the most popular in LAC (62.2 %), while some participants used both recommendations (13.2 % and 19.2 %). IMRT (68.6 % and 59.1 %) and VMAT (65.6 % and 60.2 %) were the preferred modalities used in heart sparing strategies, followed by deep inspiration breath-hold (DIBH) (54.8 % and 37.4 %) and partial breast irradiation (PBI) (41.6 % and 24.6 %). Only a small percentage of all ROs reported the dose-volume constraints for OAR used in routine clinical practice. A mean heart dose (Heart-Dmean) between 4 and 5 Gy was the most frequently reported parameter (17.2 % and 39.3 %). Conclusion The delineation approaches and sparing techniques for OAR in BC RT vary between ROs worldwide. The low response rate to the dose constraints subset of queries reflects the uncertainty surrounding this topic and supports the need for detailed consensus recommendations in the clinical practice.
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Affiliation(s)
- Monica-Emila Chirilă
- Radiation Oncology Department, Amethyst Radiotherapy Centre, Cluj-Napoca, Romania
- Department of Clinical Development, MVision AI, Helsinki, Finland
| | - Fatjona Kraja
- Surgery Department, Faculty of Medicine, University of Medicine Tirana, Albania
- Department of Oncology, University Hospital Centre Mother Teresa, Tirana, Albania
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
- Post-Graduation Program, Radiology and Oncology Department, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Wellington Furtado Pimenta Neves Junior
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
- Post-Graduation Program, Radiology and Oncology Department, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gustavo Viani de Arruda
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - André Guimarães Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Pierfrancesco Franco
- Department of Translational Sciences (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Faculty of Medicine and Health Sciences, University of Antwerp, Iridium Netwerk, Wilrijk-Antwerp, Belgium
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
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Doses delivered to small and large breasts and adjacent organs in left breast cancer patients utilizing 3D and IM radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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McConnell K, Kirby N, Rasmussen K, Gutierrez AN, Papanikolaou N, Stanley D. Variability of Breast Surface Positioning Using an Active Breathing Coordinator for a Deep Inspiration Breath Hold Technique. Cureus 2021; 13:e15649. [PMID: 34306859 PMCID: PMC8279697 DOI: 10.7759/cureus.15649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose The Elekta Active Breathing CoordinatorTM (ABC) is used to control breathing and guide deep inspiration breath hold (DIBH). It has been shown to be accurate in lung cancers, but limited analysis has been performed on the spatial accuracy and reproducibility of the breast surface. The use of optical surface-image guidance for patient positioning has grown in popularity and is an alternative solution for breast DIBH. This study aims to evaluate the breast surface variability of an ABC-guided DIBH by using a three-dimensional (3D) surface imaging system to record surface position. Methods Ten participants were placed in the treatment position, and breathing baselines and inhalation volume threshold baselines were monitored and recorded using the ABC. Over 60 minutes, the breathing patterns were recorded by the ABC and CatalystHDTM (C-RAD, Uppsala, Sweden). For each breath hold, the valve of the ABC closed at the baseline inhalation threshold and a 3D surface image was acquired. For each point on the baseline breast surface, a 3D vector was calculated to the subsequent breath hold surface as well as a root mean square (RMS) vector magnitude for the entire surface. Results The average and standard deviation for the RMS difference between the baseline and subsequent evaluated images were 7.12 ± 2.70 mm. Conclusion This study shows that while the ABC-guided inhalation volume is kept constant, a non-negligible variability of the breast surface position exists. Special considerations should be used in clinical situations, where the positioning of the surface is considered more important than inhalation volume.
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Affiliation(s)
- Kristen McConnell
- Department of Radiation Oncology/Medical Physics, University of Alabama at Birmingham, Birmingham, USA
| | - Neil Kirby
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Karl Rasmussen
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | - Nikos Papanikolaou
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Dennis Stanley
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, USA
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Siavashpour Z, Moghani MM, Goharpey N, Mirzai HR, Mohammadi LK, Zayeri F. Correlation between gastric volume and organs at risk dose in adjuvant radiotherapy for left breast cancer. Rep Pract Oncol Radiother 2021; 26:367-379. [PMID: 34277090 PMCID: PMC8281909 DOI: 10.5603/rpor.a2021.0067] [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: 09/30/2020] [Accepted: 02/25/2021] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The role of the gastric volume on the dose-effect relationship for these organs has not been investigated. The aim of the study was to evaluate the correlation between gastric volume and dose-volume histogram (DVH) parameters of the heart, left lung and stomach during left breast cancer radiotherapy (RT). MATERIALS AND METHODS Ninety-nine left breast cancer patients who got adjuvant radiotherapy were included. Study was classified into two groups based on treatment field arrangements: 1) breast tangential fields only (T) and 2) breast tangential and supraclavicular fields (TS). Organs DVHs were extracted. Descriptive statistics, Pearson correlation, linear regression analyses, and receiver operating characteristic (ROC) analyses were performed. RESULTS There is a direct but not significant correlation between the gastric volume and doses to the stomach and left lung. For a 100-cc increase in the gastric volume, the stomach maximum dose and the V50 increased by 3 Gy and 4%, respectively. For the left lung, V4 and V5 increased by 1% for TS cases. Considering ROC analysis results, one can make a decision for about 74% of patients due to their left lung DVH parameters, using gastric volume as a known input data. The correlation between gastric volume and heart dose was not significant. CONCLUSIONS The gastric volume of about 170 cc or less can result in lower dose to the stomach and ipsilateral lung during left breast cancer radiotherapy, especially for TS cases. To reach this gastric volume threshold, patients should be fast for 2 hours before the procedure of CT simulation and treatment.
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Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Malekzadeh Moghani
- Radiotherapy Oncology Department, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Goharpey
- Radiotherapy Oncology Department, Shohada Tajrish Hospital, Tehran, Iran
| | - Hamid Reza Mirzai
- Radiotherapy Oncology Department, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Farid Zayeri
- Proteomics Research Center and Biostatics Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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Robatjazi M, Baghani HR, Porouhan P. Dosimetric comparison between different tangential field arrangements during left-sided breast cancer radiotherapy. Radiol Phys Technol 2021; 14:226-237. [PMID: 34043155 DOI: 10.1007/s12194-021-00621-7] [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: 12/15/2020] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to evaluate variations in dose distribution within the target volume and dose received by the organs at risk (OARs) for different tangential field arrangements during three-dimensional (3D) conformal treatment planning for left-sided breast cancer. Computed tomography (CT) images of 25 breast cancer patients were included, and three different mono-isocentric half-block (MIHB) treatment plans-parallel central axis technique (PCAXT), posterior border parallel technique (PBPT), and parallel quadrant technique (PQUDT)-were considered for each patient. The dosimetric and geometric parameters related to each followed plan were then extracted for the planning target volume (PTV) and the OARs, and compared. The results showed no significant differences among the extracted dosimetric and geometric parameters of the OARs for the different plans, while the Dmax, V95%, homogeneity index (HI), and conformity index (CI) values related to the PTV were significantly different (P < 0.05). The lowest Dmax and V95% values inside the PTV were related to the PCAXT plan. The best HI was achieved with the PBPT plan, whereas the best CI was observed for the PCAXT plan. The best correlation between the geometric and dosimetric parameters of the OARs was between V5Gy-central lung distance for the ipsilateral lung and the V5Gy-maximum heart distance for the heart in all plans. These results demonstrate that variations in the tangential field arrangement at the posterior border for optimal coverage of the PTV may not considerably affect the dose received by the OARs.
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Affiliation(s)
- Mostafa Robatjazi
- Medical Physics and Radiological Sciences Department, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Pejman Porouhan
- Radiation Oncology Department, Sabzevar University of Medical Sciences, Sabzevar, Iran
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Mehta A, Kumar P, Silambarasan N, Kumar A, Kumar P. Comparison of Dosimetric Parameters of Three- Dimensional Conformal Radiotherapy and Intensity- Modulated Radiotherapy in Breast Cancer Patients Undergoing Adjuvant Radiotherapy after Modified Radical Mastectomy. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1726475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Adjuvant radiotherapy has an important role in preventing locoregional recurrences. But radiation-induced late sequelae have become an important area of concern. The ideal postmastectomy radiotherapy technique is an area of controversy. The present study was designed to compare two widely practiced conformal techniques, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT), in terms of dosimetry.
Material and Methods A total of 50 postmodified radical mastectomy patients were selected and were randomized to treatment either by 3DCRT or IMRT technique. Two opposing tangential beams were used in 3DCRT plans whereas five to seven tangential beams were used for IMRT plans. The prescribed dose was 50 Gy in 25 fractions over 5 weeks. The dosimetric parameters were compared for planning target volume (PTV), lungs, heart, and left ventricle, opposite breast and esophagus.
Results The dosimetric parameters of PTV in terms of D95%, D90%, D50%, and Dmean showed no significant difference among both techniques. The IMRT technique had significantly better mean values of Dnear-min/D98% (45.56 vs. 37.92 Gy; p = 0.01) and Dnear-max/D2% (51.47 vs. 53.65 Gy; p < 0.001). Also, conformity index (1.07 vs. 1.29; p = 0.004) and homogeneity index (0.22 vs. 0.46; p = 0.003) were significantly better in IMRT arm.The dosimetric parameters of ipsilateral lung were significantly higher in IMRT arm in terms of mean dose (19.92 vs. 14.69 Gy; p < 0.001) and low/medium dose regions (V5, V10, V13, V15, V20; p < 0.05). However, high-dose regions (V40) were significantly higher in 3DCRT arm (15.57 vs. 19.89 Gy; p = 0.02). In contralateral lung also, mean dose was significantly higher in IMRT technique (3.63 vs. 0.53 Gy; p < 0.0001) along with low-dose regions (V5, V10, V13, V15; p < 0.05) while V20 was comparable between both the arms.In left-sided patients, the heart dose favored 3DCRT technique in terms of mean dose (17.33 vs. 8.51 Gy; p = 0.003), low/medium dose regions (V5, V10, V20; p < 0.05), and doses to partial/whole volumes (D33, D67, D100). But the high-dose regions (V25, V30, V40) were comparable between both the arms. The dosimetry of left ventricle also showed significantly lesser values of mean dose and V5 in 3DCRT technique (p < 0.0001).The opposite breast also showed higher mean dose with IMRT technique (2.60 vs. 1.47 Gy; p = 0.009) along with higher V5 (11.60 vs. 3.83 Gy; p = 0.001). The dosimetric parameters of esophagus showed higher mean dose in IMRT technique (10.04 vs. 3.24 Gy; p < 0.0001) but the high-dose regions V35 and V50 were comparable between both the arms.
Conclusion A clear advantage could not be demonstrated with any of the techniques. The IMRT technique led to more conformal and homogenous dose distribution with reduction in high-dose regions in ipsilateral lung while the 3DCRT technique showed lesser mean dose to organs at risk (OARs). The exposure of large volumes of OARs to low doses in IMRT technique may translate to increased long-term radiation-induced complications. The shortcomings of 3DCRT technique can be overcome by using multiple subfields within tangential fields.
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Affiliation(s)
- Ankita Mehta
- Department of Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Piyush Kumar
- Department of Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - N.S. Silambarasan
- Department of Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Arvind Kumar
- Department of Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - Pavan Kumar
- Department of Radiation Oncology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
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Deep inspiration breath hold reduces the mean heart dose in left breast cancer radiotherapy. Radiol Oncol 2021; 55:212-220. [PMID: 33600676 PMCID: PMC8042816 DOI: 10.2478/raon-2021-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022] Open
Abstract
Background Patients with left breast cancer who undergo radiotherapy have a non-negligible risk of developing radiation-induced cardiovascular disease (CVD). Cardioprotection can be achieved through better treatment planning protocols and through respiratory gating techniques, including deep inspiration breath hold (DIBH). Several dosimetric studies have shown that DIBH reduces the cardiac dose, but clinical data confirming this effect is limited. The aim of the study was to compare the mean heart dose (MHD) in patients with left breast cancer who underwent radiotherapy at our institution as we transitioned from non-gated free-breathing (FB) radiotherapy to gated radiotherapy (FB-GRT), and finally to DIBH. Patients and methods Retrospective study involving 2022 breast cancer patients who underwent radiotherapy at West Pomeranian Oncology Center in Szczecin from January 1, 2014 through December 31, 2017. We compared the MHD in these patients according to year of treatment and technique. Results Overall, the MHD for patients with left breast cancer in our cohort was 3.37 Gy. MHD values in the patients treated with DIBH were significantly lower than in patients treated with non-gated FB (2.1 vs. 3.48 Gy, p < 0.0001) and gated FB (3.28 Gy, p < 0.0001). The lowest MHD values over the four-year period were observed in 2017, when nearly 85% of left breast cancer patients were treated with DIBH. The proportion of patients exposed to high (> 4 Gy) MHD values decreased every year, from 40% in 2014 to 7.9% in 2017, while the percentage of patients receiving DIBH increased. Conclusions Compared to free-breathing techniques (both gated and non-gated), DIBH reduces the mean radiation dose to the heart in patients with left breast cancer. These findings support the use of DIBH in patients with left breast cancer treated with radiotherapy.
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Zhao Y, Diao P, Zhang D, Wu J, Xin X, Fontanarosa D, Liu M, Li J, Orlandini LC. Impact of Positioning Errors on the Dosimetry of Breath-Hold-Based Volumetric Arc Modulated and Tangential Field-in-Field Left-Sided Breast Treatments. Front Oncol 2020; 10:554131. [PMID: 33194616 PMCID: PMC7658584 DOI: 10.3389/fonc.2020.554131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Heart diseases and cardiovascular events are well-known side effects in left-sided breast irradiation. Deep inspiration breath hold (BH) combined with fast delivery techniques such as volumetric modulated arc therapy (VMAT) or tangential field-in-field (TFiF) can serve as a valuable solution to reduce the dose to the heart. This study aims to compare the impact of positioning errors in VMAT and TFiF plans for BH left-sided breast treatments. Fifteen left-sided breast patients treated in BH with TFiF technique were included in this retrospective study. For each patient, a second plan with VMAT technique was optimized. Eighteen setup variations were introduced in each of these VMAT and TFiF reference plans, shifting the isocenter along six different directions by 3, 5, and 10 mm. A total of 540 perturbed plans, 270 for each technique, were recalculated and analyzed. The dose distributions on the target and organs at risk obtained in the different perturbed scenarios were compared with the reference scenarios, using as dosimetric endpoints the dose-volume histograms (DVH). The results were compared using the Wilcoxon test. Comparable plan quality was obtained for the reference VMAT and TFiF plans, except for low doses to organs at risk for which higher values (p < 0.05) were obtained for VMAT plans. For TFiF plans, perturbations of the isocenter position of 3, 5, or 10 mm produced mean deviations of the target DVH dosimetric parameters up to -0.5, -1.0, and -5.2%, respectively; VMAT plans were more sensitive to positioning errors resulting in mean deviations up to -0.5, -4.9, and -13.9%, respectively, for the same magnitude of the above mentioned perturbations. For organs at risk, only perturbations along the left, posterior, and inferior directions resulted in dose increase with a maximum deviation of +2% in the DVH dosimetric parameters. A notable exception were low doses to the left lung and heart for 10 mm isocenter shifts for which the mean differences ranged between +2.7 and +4.1%. Objective information on how external stresses affect the dosimetry of the treatment is the first step towards personalized radiotherapy.
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Affiliation(s)
- Yanqun Zhao
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Peng Diao
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Da Zhang
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Juxiang Wu
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Xin Xin
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Davide Fontanarosa
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Min Liu
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Lucia Clara Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital and Research Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
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9
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Proton pencil beam scanning reduces secondary cancer risk in breast cancer patients with internal mammary chain involvement compared to photon radiotherapy. Radiat Oncol 2020; 15:228. [PMID: 33008412 PMCID: PMC7532613 DOI: 10.1186/s13014-020-01671-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose Proton pencil beam scanning (PBS) represents an interesting option for the treatment of breast cancer (BC) patients with nodal involvement. Here we compare tangential 3D-CRT and VMAT to PBS proton therapy (PT) in terms of secondary cancer risk (SCR) for the lungs and for contralateral breast. Methods Five BC patients including supraclavicular (SVC) nodes in the target (Group 1) and five including SVC plus internal-mammary-nodes (IMNs, Group 2) were considered. The Group 1 patients were planned by PT versus tangential 3D-CRT in free-breathing (FB). The Group 2 patients were planned by PT versus VMAT considering both FB and deep-inspiration breath hold (DIBH) irradiation. The prescription dose to the target volume was 50 Gy (2 Gy/fraction). A constant RBE = 1.1 was assumed for PT. The SCR was evaluated with the excess absolute risk (EAR) formalism, considering also the age dependence. A cumulative EAR was finally computed. Results According to the linear, linear-exponential and linear-plateau dose response model, the cumulative EAR for Group 1 patients after PT was equal to 45 ± 10, 17 ± 3 and 15 ± 3, respectively. The corresponding relative increase for tangential 3D-CRT was equal to a factor 2.1 ± 0.5, 2.1 ± 0.4 and 2.3 ± 0.4. Group 2 patients showed a cumulative EAR after PT in FB equal to 65 ± 3, 21 ± 1 and 20 ± 1, according to the different models; the relative risk obtained with VMAT increased by a factor 3.5 ± 0.2, 5.2 ± 0.3 and 5.1 ± 0.3. Similar values emerge from DIBH plans. Contrary to photon radiotherapy, PT appears to be not sensitive to the age dependence due to the very low delivered dose. Conclusions PBS PT is associated to significant SCR reduction in BC patients compared to photon radiotherapy. The benefits are maximized for young patients with both SVC and IMNs involvement. When combined with the improved sparing of the heart, this might contribute to the establishment of effective patient-selection criteria for proton BC treatments.
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Mittendorf EA, Bellon JR, King TA. Regional Nodal Management in Patients With Clinically Node-Negative Breast Cancer Undergoing Upfront Surgery. J Clin Oncol 2020; 38:2273-2280. [PMID: 32442075 DOI: 10.1200/jco.19.02891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Elizabeth A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Jennifer R Bellon
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA.,Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Tari A King
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
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11
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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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