Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy?

Sedlmayer, Felix; Sautter-Bihl, Marie-Luise; Budach, Wilfried; Dunst, Juergen; Feyer, Petra; Fietkau, Rainer; Harms, Wolfgang; Rödel, Claus; Souchon, Rainer; Wenz, Frederik; Sauer, Rolf

doi:10.1007/s00066-012-0300-3

Cited by 27 publications

(16 citation statements)

References 23 publications

(24 reference statements)

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“…Precise and reliable treatment techniques are mandatory to provide robust dosimetry, accurate delivery, and consistent clinical results. Patients should preferably be enrolled into clinical trials in order to have prospectively collected outcomes in terms of local control, long-term toxicity profile, cosmetic result, and quality of life [46,47]. …”

Section: Boosting the Tumor Bedmentioning

confidence: 99%

Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence

et al. 2014

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Radiation therapy delivered with hypofractionation, which involves the delivery of a higher dose per fraction in fewer fractions (generally with a lower total nominal dose) over a shorter overall treatment time, is an established therapeutic option at least for a selected group of early breast cancer patients after breast-conserving surgery. Optimal delivery of the tumor bed boost dose in terms of timing, fractionation, and total dose whenever a hypofractionated schedule is employed has yet to be established. We herein present a review of the current evidence on the role of boost integration in whole breast radiotherapy.

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Section: Boosting the Tumor Bedmentioning

confidence: 99%

Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence

et al. 2014

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“…This SIB can be planned either by using 3-dimensional (3D) conventional techniques or modern modulated IMRT/VMAT techniques. The rationale is a localized dose escalation in the area most at risk for recurrence without prolonging the overall treatment duration [20]. From the published series, daily tumour bed doses between 2.1 Gy for low-risk and 2.25 Gy for high-risk settings seem to be within the therapeutic range [20].…”

Section: Boostmentioning

confidence: 99%

“…The rationale is a localized dose escalation in the area most at risk for recurrence without prolonging the overall treatment duration [20]. From the published series, daily tumour bed doses between 2.1 Gy for low-risk and 2.25 Gy for high-risk settings seem to be within the therapeutic range [20]. However, prospective data on long-term toxicity are still not available.…”

Section: Boostmentioning

confidence: 99%

Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer

et al. 2018

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Radiation therapy (RT) for breast cancer has dramatically changed over the past years, leading to individualized risk-adapted treatment strategies. Historically, the choice of RT regimen was limited to conventional fractionation protocols using standard tangential fields. Nowadays, technological and technical improvements in modern RT have added a variety of other RT modalities, different fractionation schedules, and individualised treatment volumes to the portfolio of breast RT. This review aims to give a short overview on the main topics which have recently found their way into clinical practice: hypofractionated treatment protocols, accelerated partial breast irradiation (APBI) for low-risk patients, deep inspiration breath hold (DIBH) for maximal heart protection, extent of regional nodal irradiation for high-risk patients, and the implementation of new radiation techniques such as intensity modulated RT (IMRT) and volumetric modulated RT (VMAT).

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“…An alpha to beta ratio (α/β) of 10 Gy for tumor response and α/β of 3 Gy for late-responding normal tissues were used to determine the SIB prescribed BED for the breast and the boost volumes from the traditionally used SEQ prescribed BED [12]. Recent reports suggest that healthy breast tissues as well as the tumor are sensitive to fraction size with an α/β of 5 Gy or less [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Breast Sequential and Simultaneous Integrated Boost Using the Biologically Effective Dose Volume Histogram (BEDVH)

Aly

Abo-Madyan

Jahnke

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose: A method is presented to radiobiologically compare sequential (SEQ) and simultaneously integrated boost (SIB) breast radiotherapy. Methods: The method is based on identically prescribed biologically effective dose (iso-BED) which was achieved by different prescribed doses due to different fractionation schemes. It is performed by converting the calculated three-dimensional dose distribution to the corresponding BED distribution taking into consideration the different number of fractions for generic α/β ratios. A cumulative BED volume histogram (BEDVH) is then derived from the BED distribution and is compared for the two delivery schemes. Ten breast cancer patients (4 right-sided and 6 left-sided) were investigated. Two tangential intensity modulated whole breast beams with two other oblique (with different gantry angles) beams for the boost volume were used. The boost and the breast target volumes with either α/β = 10 or 3 Gy, and ipsi-lateral and contra-lateral lungs, heart, and contra-lateral breast as organs at risk (OARs) with α/β = 3 Gy were compared.Results: Based on the BEDVH comparisons, the use of SIB reduced the biological breast mean dose by about 3 %, the ipsi-lateral lung and heart by about 10 %, and contra-lateral breast and lung by about 7 %. Conclusion: BED based comparisons should always be used in comparing plans that have different fraction sizes. SIB schemes are dosimetrically more advantageous than SEQ in breast target volume and OARs for equal prescribed BEDs for breast and boost.

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Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy?

Cited by 27 publications

References 23 publications

Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence

Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence

Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer

Comparison of Breast Sequential and Simultaneous Integrated Boost Using the Biologically Effective Dose Volume Histogram (BEDVH)

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