Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience Abstract Background: 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Radiotherapy in Practice Cambridge University Press

Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

Download PDF
15 pages

Loading next page...
 
/lp/cambridge-university-press/dosimetric-evaluation-of-3-and-or-4-field-radiation-therapy-of-breast-Er2N8hJTPE

References

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Cambridge University Press
Copyright
© The Author(s), 2020. Published by Cambridge University Press
ISSN
1467-1131
eISSN
1460-3969
DOI
10.1017/S1460396920000503
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: 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.

Journal

Journal of Radiotherapy in Practice – Cambridge University Press

Published: Dec 1, 2021

Keywords: breast radiotherapy; chest-wall radiotherapy; DIBH; heart dose; lung dose

References

  • for the Canadian Cancer Statistics Advisory Committee. Projected estimates of cancer in Canada in 2020
    Brenner, DR; Weir, HK; Demers, AA
  • Review of the three-field techniques in breast cancer radiotherapy
    Kagkiouzis, J; Platoni, K; Kantzou, I
  • The choice of multi-beam IMRT for whole breast radiotherapy in early-stage right breast cancer
    Haciislamoglu, E; Colak, F; Canyilmaz, E.
  • Dosimetric evaluation of 3-D conformal and intensity-modulated radiotherapy for breast cancer after conservative surgery
    Mansouri, S; Naim, A; Glaria, L
  • A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, field-in-field, tangential-IMRT, multi-beam IMRT and VMAT
    Jin, GH; Chen, LX; Deng, XW
  • Dosimetric trade-offs in breast treatment with VMAT technique
    Fogliata, A; Seppälä, J; Reggiori, G
  • Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique
    Bahrainy, M; Kretschmer, M; Jöst, V
  • Comparison of dosimetric parameters between field in field and conformal radiation therapy techniques in early stage of left breast cancer patients
    Nokhasteh, S; Nazemi, H; Hejazi, P
  • Dosimetric comparison of three intensity-modulated radiation therapies for left breast cancer after breast-conserving surgery
    Zhang, HW; Hu, B; Xie, C
  • Hybrid intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) technique versus three-dimensional (3D) conformal radiotherapy with SIB for breast radiotherapy: a planning comparison
    Smith, SK; Estoesta, RP; Kader, JA
  • Dosimetric comparison of left-sided whole breast irradiation with 3D-CRT, IP-IMRT and hybrid IMRT
    Xie, X; Ouyang, S; Wang, H
  • High tangent radiation therapy with field-in-field technique for breast cancer
    Tanaka, H; Ito, M; Yamaguchi, T
  • Dosimetric comparison and evaluation of three radiotherapy techniques for use after modified radical mastectomy for locally advanced left-sided breast cancer
    Ma, C; Zhang, W; Lu, J
  • Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index
    Yim, J; Suttie, C; Bromley, R
  • Evaluation of the field-in-field technique with lung blocks for breast tangential radiotherapy
    Tanaka, H; Hayashi, S; Kajiura, Y
  • Dosimetric outcomes of the breast field-in-field (FIF) radiotherapy technique in patients with mastectomy and lumpectomy surgeries
    Ghadimi, B; Jabbari, N; Karimkhani, L
  • Dosimetric evaluation of whole-breast radiation therapy: clinical experience
    Osei, E; Darko, J; Fleck, A
  • Internal mammary and medial supraclavicular irradiation in breast cancer
    Poortmans, PM; Collette, S; Kirkove, C
  • Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-, supraclavicular-and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk
    Hjelstuen, MH; Mjaaland, I; Vikström, J
  • Radiation dose to the nodal regions during prone versus supine breast irradiation
    Csenki, M; Újhidy, D; Cserháti, A
  • Comparing the monoisocentric and dual isocentric techniques in chest wall radiotherapy of mastectomy patients
    Banaei, A; Hashemi, B; Bakhshandeh, M.
  • Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer
    Deseyne, P; Speleers, B; De Neve, W
  • Clinical significance of lymph-node ratio in determining supraclavicular lymph-node radiation therapy in pN1 breast cancer patients who received breast-conserving treatment (KROG 14-18): A Multicenter Study
    Kim, J; Park, W; Kim, JH
  • Elective breast radiotherapy including level i and ii lymph nodes: a planning study with the humeral head as planning risk volume
    Surmann, K; van der Leer, J; Branje, T
  • A hybrid conformal planning technique with solitary dynamic portal for postmastectomy radiotherapy with regional nodes
    Rafic, KM; Peace, BT; Babu, SE
  • A comparative dosimetric study of seven radiation techniques for breast cancer after mastectomy and immediate breast reconstruction
    Zheng, H; Lai, YQ; Zhou, Y
  • Ten years results of the Canadian breast intensity modulated radiation therapy (IMRT) randomized controlled trial
    Pignol, JP; Truong, P; Rakovitch, E
  • Optimized dose coverage of regional lymph nodes in breast cancer: the role of intensity-modulated radiotherapy
    Dogan, N; Cuttino, L; Lloyd, R
  • Deep inspiration breath hold: techniques and advantages for cardiac sparing during breast cancer irradiation
    Bergom, C; Currey, A; Desai, N
  • 163. Field-in-Field versus 3D standard techniques for breast cancer: dosimetric and reproducibility study
    D’Avenia, P; Nigro, R; Camarda, M
  • A dosimetric planning study for hypofractionated whole breast irradiation with concurrent boost (RTOG 1005) for early stage breast cancer
    Chen, G; White, J; Vicini, FA
  • NSABP B-51/RTOG 1304: Randomized phase III clinical trial evaluating the role of postmastectomy chest wall and regional nodal XRT (CWRNRT) and post-lumpectomy RNRT in patients (pts) with documented positive axillary (Ax) nodes before neoadjuvant chemotherapy (NC) who convert to pathologically negative Ax nodes after NC
    Mamounas, EP; White, JR; Bandos, H
  • Cctg MA.39 tailor RT: A randomized trial of regional radiotherapy in biomarker low-risk node-positive breast cancer (NCT03488693)
    Parulekar, WR; Berrang, T; Kong, I; Rakovitch, E
  • Intensity-modulated radiation therapy using TomoDirect for postoperative radiation of left-sided breast cancer including lymph node area: comparison with TomoHelical and three-dimensional conformal radiation therapy
    Takano, S; Omura, M; Suzuki, R
  • Tolerance of normal tissue to therapeutic radiation
    Emami, B.
  • A multicenter randomized trial of breast intensity modulated radiation therapy to reduce acute radiation dermatitis
    Pignol, JP; Olivotto, I; Rakovitch, E