A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain

Ranger, A.; Dunlop, A.; Hutchinson, Katie; Convery, H; Maclennan, M.; Chantler, H.; Twyman, N.; Rose, Carsten; McQuaid, D.; Amos, R.; Griffin, C; deSouza, N M; Donovan, Ellen M.; Harris, Emma; Coles, Charlotte E.; Kirby, Anna M.

doi:10.1016/j.clon.2018.01.017

Cited by 84 publications

(84 citation statements)

References 30 publications

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“…This reduces the dosimetric advantages offered by IMPT which nevertheless remains the technique that allows to minimize the dose to distal OARs for such patients. Interestingly, the advantages offered by IMPT seem not to be affected by the use of DIBH [6]. These results clearly indicate that the NTCP reduction expected with IMPT should also be reconsidered when comparing it to different IMXT techniques.…”

Section: Discussionmentioning

confidence: 79%

“…The results obtained in our study hold when we compare IMPT with IMXT without the use of breath-control techniques. The recent in silico study on BC with nodal involvement by Rangers et al [6] confirmed that the mean dose to heart and lung in photon RT could be reduced by the use of DIBH, especially when combined with VMAT techniques. This reduces the dosimetric advantages offered by IMPT which nevertheless remains the technique that allows to minimize the dose to distal OARs for such patients.…”

Section: Discussionmentioning

confidence: 87%

“…At the same time, regional nodal irradiation (RNI) also may lead to an increase in the complexity of the RT strategy as well as a potential increase in organs-at-risk (OARs) doses and treatment related morbidity, including pneumonitis and, in women with left-sided BC, cardiac diseases and mortality [3,4]. Different advanced RT treatment solutions, such as intensity modulated photon therapy (IMXT) with or without deep inspiration breath-hold (DIBH), for breast and RNI have been evaluated with in silico studies [5][6][7][8]. Among the different techniques, the advantages of proton beam therapy have been reported by Ranger et al [6] in a comprehensive dosimetric analysis showing high levels of conformation able to achieve the most balanced compromise between higher conformation around the target and the lowest OAR doses.…”

Section: Introductionmentioning

confidence: 99%

“…Different advanced RT treatment solutions, such as intensity modulated photon therapy (IMXT) with or without deep inspiration breath-hold (DIBH), for breast and RNI have been evaluated with in silico studies [5][6][7][8]. Among the different techniques, the advantages of proton beam therapy have been reported by Ranger et al [6] in a comprehensive dosimetric analysis showing high levels of conformation able to achieve the most balanced compromise between higher conformation around the target and the lowest OAR doses. In particular, proton therapy seems to be the best technical solution for cardiac sparing when treatment of the regional lymph nodes is indicated [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

et al. 2019

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2019) Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement, Acta Oncologica, 58:6, 934-942, ABSTRACT Background: Different modern radiation therapy treatment solutions for breast cancer (BC) and regional nodal irradiation (RNI) have been proposed. In this study, we evaluate the potential reduction in radiation-induced skin morbidity obtained by intensity modulated proton therapy (IMPT) compared with intensity modulated photon therapy (IMXT) for left-side BC and RNI. Material and Methods: Using CT scans from 10 left-side BC patients, treatment plans were generated using IMXT and IMPT techniques. A dose of 50 Gy (or Gy [RBE] for IMPT) was prescribed to the target volume (involved breast, the internal mammary, supraclavicular, and infraclavicular nodes). Two single filed optimization IMPT (IMPT 1 and IMPT 2 ) plans were calculated without and with skin optimization. For each technique, skin dose-metrics were extracted and normal tissue complication probability (NTCP) models from the literature were employed to estimate the risk of radiation-induced skin morbidity. NTCPs for relevant organs-at-risk (OARs) were also considered for reference. The non-parametric Anova (Friedman matched-pairs signed-rank test) was used for comparative analyses. Results: IMPT improved target coverage and dose homogeneity even if the skin was included into optimization strategy (HI IMPT2 ¼ 0.11 vs. HI IMXT ¼ 0.22 and CI IMPT2 ¼ 0.96 vs. CI IMXT ¼ 0.82, p < .05). A significant relative skin risk reduction (RR ¼ NTCP IMPT /NTCP IMXT ) was obtained with IMPT 2 including the skin in the optimization with a RR reduction ranging from 0.3 to 0.9 depending on the analyzed skin toxicity endpoint/model. Both IMPT plans attained significant OARs dose sparing compared with IMXT. As expected, the heart and lung doses were significantly reduced using IMPT. Accordingly, IMPT always provided lower NTCP values. Conclusions: IMPT guarantees optimal target coverage, OARs sparing, and simultaneously minimizes the risk of skin morbidity. The applied model-based approach supports the potential clinical relevance of IMPT for left-side BC and RNI and might be relevant for the setup of cost-effectiveness evaluation strategies based on NTCP predictions, as well as for establishing patient selection criteria. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

et al. 2019

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“…With the introduction of effective systemic therapy such as chemotherapy, anti-hormonal therapy, or targeted therapy, the oncologic outcomes have improved in patients with breast cancer [22,23]. In addition, advanced RT techniques enable precise targeting of the tumor, thereby allowing sufficient irradiation of the IMN region [24]. Such TNBC was defined as tumors that were negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 on immunohistochemical staining of the breast tumor 2) Radiotherapy dose was calculated using the EQD2 assuming the α/β ratio of 3.5 Gy Abbreviations: IMN Internal mammary node, DFS Disease-free survival, TNBC Triple-negative breast cancer, FNABx Fine needle aspiration biopsy, ICS Intercostal space, EQD2 Biologically equivalent dose in 2 Gy fractions advances in the treatment of breast cancer have resulted in favorable tumor control in patients with cIMN+ breast cancer.…”

Section: Discussionmentioning

confidence: 99%

Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer

et al. 2020

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Background: This study aimed to determine the optimal radiotherapy (RT) regimen for patients with clinical metastasis to the internal mammary lymph node (cIMN+) from breast cancer. Methods: We retrospectively reviewed the medical records of 84 patients with cIMN+ breast cancer treated with curative surgery, taxane-based chemotherapy, and postoperative RT between January 2009 and December 2014. Postoperative RT was administered to the whole breast or chest wall using 50 Gy in 2 Gy fractions. Boost RT to the internal mammary lymph node (IMN) was administered at the physician's discretion. We categorized patients into two groups according to the IMN dose as follows: low-dose IMN RT (50.0-63.5 Gy) and high-dose IMN RT (63.6-70.4 Gy). Results: After a median follow-up of 58 months (range, 12-111 months), IMN recurrence was observed in 2 patients (2.4%), and all IMN recurrences developed simultaneously with distant metastases. The 5-year locoregional recurrence-free survival, disease-free survival (DFS), and overall survival rates were 89.1, 72.0, and 81.2%, respectively. The triple-negative subtype, IMN size ≥1.0 cm, old age, and low-dose IMN were significantly associated with poor DFS. Among the patients with IMN size ≥1.0 cm, the 5-year DFS was significantly higher in those treated with high-dose IMN RT than in those treated with low-dose IMN RT (69.3% vs. 33.3%, p = 0.019). Conclusions: IMN RT without IMN dissection resulted in favorable outcomes in cIMN+ breast cancer. For patients with a large IMN, a higher IMN radiation dose might be needed for disease control.

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Breast Cancer

Bradley¹,

Liang²

2022

Principles and Practice of Particle Therapy

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A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain

Cited by 84 publications

References 30 publications

Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

Potential skin morbidity reduction with intensity-modulated proton therapy for breast cancer with nodal involvement

Optimal radiotherapy for patients with internal mammary lymph node metastasis from breast cancer

Breast Cancer

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