<p class="abstract">A 30 year old female presented with a swelling in the back of a few weeks duration. Clinical examination revealed no other abnormalities. Fine needle aspiration cytology (FNAC) was suggestive of Rosai- Dorfman disease (RDD). The diagnosis was confirmed by biopsy and immunohistochemistry. FNA diagnosis of purely cutaneous RDD has very rarely been reported.</p>
Background and aim:
Radiation exposure to the thyroid gland during breast irradiation can lead to hypothyroidism and this can impact on the quality of life. The aim of this study was to analyse if there is any difference in the radiation dose received by the thyroid gland during supraclavicular irradiation for breast cancer, with two different neck positions—straight or when the head is turned to the contralateral side to the breast being treated, when using a conformal technique.
Materials and methods:
All patients who received chest wall/breast and supraclavicular irradiation for breast cancer in 2019 in our department were divided into two groups based on the neck position as SN (neck positioned straight) and TN (neck tilted to contralateral side). The volume of thyroid gland, the radiation dose and volume parameters for Dmax, Dmean, and V5 to V40 of the thyroid were tabulated.
Results:
There were 72 patients included in the study with a mean age of 59 years, with 39 in the SN group and 33 in the TN group. There was no significant difference in thyroid volume between the two groups. Dmean, V15, V20, V25, V30 and V35 were significantly lower in tilted neck patients as compared to straight neck patients.
Conclusion:
Neck positioned to the contralateral side of the breast primary may be recommended for conformal CT-based radiation planning.
Aim:
There are only limited studies available in literature that discuss methods to reduce the oesophageal dose and acute oesophagitis during breast cancer radiotherapy. The aim of this study is to compare dose volumetric parameters of oesophagus in radiation treatment of breast with and without oesophagus delineation.
Methods:
Treatment plans of 44 patients, who underwent chest wall and supraclavicular fossa irradiation, were selected for the study. Oesophagus was later delineated and treatment replanned using three-dimensional conformal radiotherapy (3DCRT) considering oesophagus as an organ at risk (OAR). The dose prescribed was 40 Gy/15 fractions to the planning target volume (PTV). Dose volumetric parameters of oesophagus such as maximum dose (Dmax), mean dose (Dmean), the percentage of oesophagus volume receiving ≥15Gy (V15), ≥25Gy(V25), ≥33Gy(V33) and ipsilateral lung volume parameters V4, V8 and V16 were compared with already executed plans in which oesophagus was not delineated.
Results:
Contouring the oesophagus as an OAR as a part of the radiotherapy treatment for Carcinoma Breast resulted in statistically significant reduction in dose to the oesophagus. No statistically significant change was found in the ipsilateral lung volume parameters. No compromise in plan quality was required as evident from the statistically non-significant differences in Homogeneity index and Conformity index.
Findings:
3DCRT planning with oesophagus delineation can be considered as a method to reduce oesophageal dose and the acute oesophageal toxicity during radiotherapy for carcinoma breast.
BACKGROUND Pneumonitis and lung fibrosis are some of the major toxicities of radiation in carcinoma breast, and the volume of lung included in radiation field should be as less as possible. One of the limitations of body contour based 2D (2-dimensional) planning is that we cannot assess the volume of lung included in the radiation field. Aims and Objectives-To compare the volume of lung included in the tangential radiation field in body contour-based radiation planning with CT scan based 2-dimensional radiation planning in the radiation treatment of carcinoma breast. MATERIALS AND METHODS Post modified radical mastectomy female patients were selected. For radiation planning, we followed 2D planning method by plotting body contour. A single CT scan slice at the level of centre of tangential fields was also taken. Using the treatment planning system, Greatest Perpendicular Distance (GPD) was measured. The percentage lung volume and absolute lung volume were calculated. The observed data were analysed using SPSS software. A p-value of < 0.05 was considered as significant. RESULTS It was found that the percentage lung volume and the absolute lung volume in CT based planning was less than that in contourbased planning with a difference of median 2.8332 and 79.7783 respectively. Statistical analysis with Wilcoxon signed rank test showed that this difference was significant (p < 0.0001). CONCLUSION The incidence and severity of pneumonitis increase with increasing volume of lung irradiated. GPD can predict the percentage of lung volume irradiated by tangential fields. We can assess GPD using CT scan based 2D planning. This study showed that the percentage lung volume and the absolute lung volume included in the tangential field were significantly less in CT scan based planning method. So, we can reliably use CT scan based 2D planning to reduce the volume of lung irradiated in the treatment of breast cancer in those centres lacking advanced radiation treatment facilities.
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