ACR Appropriateness Criteria® on Postmastectomy Radiotherapy

Taylor, Marie E.; Haffty, Bruce G.; Rabinovitch, Rachel; Arthur, Douglas W.; Halberg, F.; Strom, Eric A.; White, Julia; Cobleigh, Melody A.; Edge, Stephen B.

doi:10.1016/j.ijrobp.2008.10.080

Cited by 113 publications

(52 citation statements)

References 46 publications

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“…The CTVevl in EBRT is cropped to lie 5 mm from the skin level for better dose coverage in IMRT or VMAT planning. The HDR surface mould dose was limited to 7.5 Gy in 3 fractions which is less than the recommended 10 Gy in 5 fractions by ACR guidelines [11]. This was done because the surface mould usually delivers higher dose to the skin overlying the CTVhdr_evl (D 90 ≥ 120%) when compared to dose by enface electrons along with bolus.…”

Section: Dose Prescriptionmentioning

confidence: 99%

“…This is in expected lines as the skin lies between the source and the CTVhdr_evl. Moreover this is the reason for limiting the scar boost dose to 7.5 Gy in 3 fractions, although dose recommended is 10 Gy in 5 fractions [11]. Higher skin dose is desirable during scar boost and it is the standard feature in surface mould brachytherapy.…”

Section: Dose To Skinmentioning

confidence: 99%

“…Recent studies have suggested that when more than one of the adverse risk factors viz., young age, premenopausal status, tumour size, tumour grade, lymphovascular invasion, margin status, nodal ration, estrogen receptor status, tumour subtype, 21-gene recurrence score, and the genomic predictive index are present in the setting of nodal involvement, more aggressive locoregional management is warranted [11,12]. Even as the debate continues, the technological development in External Beam Radiotherapy (EBRT) like Intensity Modulated Radiotherapy (IMRT), Respiratory Gated Radiotherapy, and Volumetric Modulated Radiotherapy (VMAT), and Image-Guided Radiotherapy (IGRT), has made it now possible to deliver radiation to Planned Target Volumes (PTV) with minimal setup errors and with acceptable dose coverage, while sparing the organs at risk (OARs).…”

Section: Introductionmentioning

confidence: 99%

“…In this study, an attempt is made to reduce this complexity by introducing HDR surface mould for the chest wall boost (CWB). While boost treatment during adjunct radiotherapy following breast conservation surgery is documented [11], not many data are available about effective methods for CWB during PMRT. A new method for CWB during PMRT using Catheter Flap TM (Varian Medical Systems, USA) surface mold HDR brachytherapy was introduced and its efficacy in dose coverage to tumour volume and sparing the underlying critical organs is evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Postmastectomy Scar Boost Irradiation Using HDR Surface Mould Brachytherapy by 3D Image-Based Volume Optimization

Neelakandan¹,

Karunanithi²,

Nagarajan³

et al. 2013

IJMPCERO

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Introduction: During postmastectomy radiotherapy (PMRT), it is recommended to boost the postmastectomy surgical scar with additional 10 Gy in 5 fractions in the patients with close or positive surgical margins. The electron beam therapy, though cumbersome, is usually preferred since it has the desired rapid fall of a dose beyond R 85 . An alternative but easier and reproducible treatment method for PMRT surgical scar boost using 3D CT image-based HDR surface mould brachytherapy is introduced and analyses of the target coverage and dose nearby organs-at-risk (OARs) using this method are evaluated in this study. Methods and Materials: This study includes twelve patients (five left-sided and seven right-sided chest wall), who were planned and treated with CT-image based surface mould HDR brachytherapy for chest wall scar boost (CWB) using Catheter Flap Set TM (Varian Medical Systems, USA) that were given concurrently during external beam radiotherapy (EBRT) treatments. Since no guidelines are available for delineating clinical target volume (CTV) structure to be used for postmastectomy scar boost, the CTV in this study was a uniform 5-mm thick volume drawn at 5 mm beneath the skin (CTVhdr_evl) and its extent was made conforming to the boost area marked on the skin and made visible in CT images by radiopaque wires. Results: Prescribed dose (PD) to CTVhdr_evl is 7.5 Gy in 3 fractions, and 2.5 Gy per fraction. The CTVhdr_evl volume receives the PD with mean V 100% , V 98% and V 95% values which are 98.57%, 99.63% and 100% respectively. The mean dose for heart (MHD) is 2.71 Gy in left-sided CWB and 1.80 Gy in right-sided CWB plans. Mean lung dose (MLD) is 2.48 Gy for ipsilateral lung and 0.76 Gy for contralateral lung. Maximum dose to contralateral breast is 4.93 Gy and the mean dose is 0.79 Gy. The mean percent dose to the skin volume overlying the CTVhdr_evl is 138.6% and 3.7% of skin volume received 200% of the PD. Conclusion: The 3D image-based HDR surface mould achieved good CTV coverage with acceptable doses to OARs. Patient preparation, treatment planning, and execution in this method are less cumbersome and reproducible. Thus surface mould using flap applicator can be used whenever postmastectomy surgical scar boost is required.

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Section: Dose Prescriptionmentioning

confidence: 99%

Section: Dose To Skinmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Postmastectomy Scar Boost Irradiation Using HDR Surface Mould Brachytherapy by 3D Image-Based Volume Optimization

Neelakandan¹,

Karunanithi²,

Nagarajan³

et al. 2013

IJMPCERO

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“…Adjuvant whole breast radiotherapy has been shown to improve local control (LC) and overall survival, with a 70% reduction in recurrence risk [2,3] and a 9-12% reduction in risk of death [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of weekly concomitant tumor bed boost with three-week hypofractionated whole breast irradiation in early breast cancer

et al. 2017

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Objectives: A prospective study was conducted to assess the acute and late toxicity of hypofractionated whole breast irradiation with a weekly concomitant boost for women with early breast cancer (EBC). Methods:Women with EBC who underwent breast-conserving surgery were eligible. A dose of 40Gy in 15 fractions over 3 weeks was delivered to the whole breast with a concomitant weekly boost to the post-operative cavity of 3Gy in 3 fractions. Toxicity was graded using the RTOG acute toxicity and RTOG/EORTC late toxicity scales.Results: A total of 67 women were enrolled with a median age of 49 years (range 31Ð69). Median follow up was 25 months (range 11-34). Acute skin reactions included grade (G) 1 (n=47, 70%), G2 (n=10, 13%) and G3 (n=1, 1.5%). Late skin toxicity was observed in 13 patients (19%), all of whom experienced G1 toxicity only. On multivariable analysis, diabetes mellitus was predictive of acute skin toxicity (p=0.003), while age less than 50 years (p=0.029) and diabetes mellitus (p=0.013) were predictive of late skin toxicity. Conclusions:Whole breast irradiation with concomitant weekly boost appears feasible and safe. Further investigation is required to fully evaluate this schedule as an alternative to conventional whole breast irradiation with a sequential boost.

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