Purpose Breast cancer is the most common cancer in women globally and radiation therapy is a cornerstone of its treatment. However, there is an enormous shortage of radiotherapy staff, especially in low‐ and middle‐income countries. This shortage could be ameliorated through increased automation in the radiation treatment planning process, which may reduce the workload on radiotherapy staff and improve efficiency in preparing radiotherapy treatments for patients. To this end, we sought to create an automated treatment planning tool for postmastectomy radiotherapy (PMRT). Methods Algorithms to automate every step of PMRT planning were developed and integrated into a commercial treatment planning system. The only required inputs for automated PMRT planning are a planning computed tomography scan, a plan directive, and selection of the inferior border of the tangential fields. With no other human input, the planning tool automatically creates a treatment plan and presents it for review. The major automated steps are (a) segmentation of relevant structures (targets, normal tissues, and other planning structures), (b) setup of the beams (tangential fields matched with a supraclavicular field), and (c) optimization of the dose distribution by using a mix of high‐ and low‐energy photon beams and field‐in‐field modulation for the tangential fields. This automated PMRT planning tool was tested with ten computed tomography scans of patients with breast cancer who had received irradiation of the left chest wall. These plans were assessed quantitatively using their dose distributions and were reviewed by two physicians who rated them on a three‐tiered scale: use as is, minor changes, or major changes. The accuracy of the automated segmentation of the heart and ipsilateral lung was also assessed. Finally, a plan quality verification tool was tested to alert the user to any possible deviations in the quality of the automatically created treatment plans. Results The automatically created PMRT plans met the acceptable dose objectives, including target coverage, maximum plan dose, and dose to organs at risk, for all but one patient for whom the heart objectives were exceeded. Physicians accepted 50% of the treatment plans as is and required only minor changes for the remaining 50%, which included the one patient whose plan had a high heart dose. Furthermore, the automatically segmented contours of the heart and ipsilateral lung agreed well with manually edited contours. Finally, the automated plan quality verification tool detected 92% of the changes requested by physicians in this review. Conclusions We developed a new tool for automatically planning PMRT for breast cancer, including irradiation of the chest wall and ipsilateral lymph nodes (supraclavicular and level III axillary). In this initial testing, we found that the plans created by this tool are clinically viable, and the tool can alert the user to possible deviations in plan quality. The next step is to subject this tool to prospective testing, in which automatically p...
Breast cancer is one of the major healthcare challenges in South Africa (SA). Data published by the National Cancer Registry [1] in 2014 showed that breast cancer represented 22% of all cancers affecting women in SA, making it the most prevalent cancer affecting women in this country. Understanding the total cost of care for breast cancer is important from a health funder perspective, i.e. policymakers and hospital administration, in budget allocation and in decision-making [2] in a resource-constrained environment. Objectives To develop a method to determine the cost of breast cancer treatment with chemotherapy per episode of care and to quantify the associated costs relating to chemotherapy at Groote Schuur Hospital (GSH), a tertiary government hospital in Western Cape Province, SA. These costs included costs associated with the management of adverse events arising from chemotherapy. Methods Study design A retrospective cohort analysis was performed to determine the cost of an episode of care for treatment of breast cancer with chemotherapy. Cost estimates for an episode of care were obtained for each stage of breast cancer. The episode of care was defined as the care provided from 2 months prior to the date of commencing chemotherapy (pre-chemotherapy phase), during chemotherapy (treatment phase) and until 6 months after the date when the last cycle of chemotherapy was administered (follow-up phase). The episode of care was on average a period of 10-12 months per patient. Participants A total of 1 024 patients were extracted from the electronic database. Two hundred patients were randomly selected using a random number generator. Patients were included in the study based on the following criteria: (i) a diagnosis of breast cancer; (ii) registration date at the oncology department from 1 April 2013 to 31 March 2015; (iii) evidence of receipt of chemotherapy with two or more health encounters [3] related to breast cancer, e.g. doctor consultation in oncology ward and a mammogram; and (iv) age ≥18 years. Patients were excluded from the study based on the following criteria: (i) male; (ii) initiated on hormone therapy but not chemotherapy; (iii) enrolled in a clinical trial; and (iv) a primary diagnosis of cancer that was not breast cancer. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.