Body radiation exposure in breast cancer radiotherapy: Impact of breast IMRT and virtual wedge compensation techniques

Woo, Tony; Pignol, Jean-Philippe; Rakovitch, Eileen; Vu, Toni; Hicks, D.A.; O’Brien, Peter C.; Pritchard, Kathleen I.

doi:10.1016/j.ijrobp.2005.11.023

Cited by 67 publications

(46 citation statements)

References 35 publications

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“…Multiple dosimetric studies have reported improved homogeneity of dose distribution with the use of IMRT which result in reduced dose to the heart and lungs, and contralateral breast [20][21][22][23]. A feasibility study on the use of Simultaneous Boost Radiotherapy with IMRT improved boost coverage and decreased OAR doses, compared with sequential boost [18].…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Moorthy¹,

Elhateer²,

Majumdar³

et al. 2012

J Nucl Med Radiat Ther

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Purpose: Whole breast irradiation is part of breast conservative management for early breast cancer; addition of boost dose to tumor bed improves local recurrence rates and is currently the standard of care. Randomized trials reported low a/b ratio for breast cancer that predict a radiobiological advantage for hypofractionation. Simultaneous boost radiation as a method of hypofractionation proved safe and effective for head and neck tumors. In this study we attempt to compare and analyze the dosimetric aspects of adding Simultaneous Integrated Boost (SIB) over Sequential Boost (SB) to a hypofractionated treatment schedule in breast cancer patients after BCS. Materials and methods:CT simulation data sets for 23 patients were selected for this planning study; Targets and OAR were delineated as per RTOG guidelines. Multiple dynamic field IMRT plans were generated for each patient. The prescribed dose was 40 Gy/15 fractions to whole breast (2.67 Gy/fraction) and 48 Gy/15fractions to lumpectomy cavity (3.2 Gy/fraction) for SIB, and 40 Gy/15 fractions followed by 10Gy/5 fractions for SB. Generated Treatment plans were evaluated by experienced radiation oncologist, and the best plan was selected for the dosimetric analysis. Results:The pre specified target coverage criteria were met for the lumpectomy cavity as well as whole breast in all plans. All quality indices for PTV coverage showed to be significantly improved with SIB for both whole breast and tumor bed volumes. SB technique showed more dose spillage outside the boost volume. SIB-IMRT was better in sparing OAR ,the volume of the ipsilateral lung V20 Gy was 19.8 % compared to 22.8 % (p = 0.04), maximum dose to LAD was 17.6 Gy Vs. 21.6 (p= 0.01) and contralateral breast mean dose was 0.36 Gy Vs. 1.27 Gy (p = 0.01) for SIB and SB respectively. Conclusions:Hypofractionated breast SIB is feasible with better PTV coverage and OAR. Along with further reduction of the overall period which may increase patient convenience and resource utilization benefit.

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Section: Discussionmentioning

confidence: 99%

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Moorthy¹,

Elhateer²,

Majumdar³

et al. 2012

J Nucl Med Radiat Ther

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“…There have been recent changes in the direction of 3D-CRT with wedges, MLCs, compensators [13,43] or field-in-field techniques [26]. Breast IMRT is a further step toward an ideal solution [24].…”

Section: Planning Proceduresmentioning

confidence: 99%

Multisegmented Tangential Breast Fields: a Rational Way to Treat Breast Cancer

et al. 2008

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“…The multileaf collimator is used instead of wedges for field in field technique. The use of multileaf collimator decreasing scattered doses to OARs when compared to conventional tangential field technique with wedges (19)(20). Moreover, some hot inhomgenities may stay after the use of wedge because of extreme tissue geometric extremes, this can be avoided by adopting the field in field technique (12).…”

Section: Discussion:-mentioning

confidence: 99%

A Dosimetric Study of Conformal Radiotherapy Plan With Wedge and Field-in-Field-Forward-Planned Radiotherapy in Left Sided Breast Cancer.

Abdelgawad¹,

Elwan²,

mostafa³

2017

IJAR

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Key words:- Dosimetric, ,Breast cancer, conformal RT, field in field planPurpose: To perform a dosimetric comparison of field in field forward planned radiotherapy (FiF-FP) and (3D-CRT) with wedge which are used in whole breast irradiation. Method: In thirty patients, two techniques per patient were done (3D-CRT )with wedge and (FiF-FP).A comparison of treatment plans was done, using dose volume histograms for (PTV) and organs at risk. Volumes: V95, V105, D mean, D max, D min V20, V30 and V5 were chosen for the comparison. Results: The 2 plans, revealed a comparable good dose coverage, V95 >95% of PTV. V105% of doses were observed in less than 10% of the (PTV). D max. > 110% of prescribed doses in FiF-FP and > 110% for 3D-CRT. D mean of PTVs were 101.1% for 3D-CRT versus 100.1% for FiF-FP ,all values were less than the tolerance doses of OARs , the two plans were equivalent in sparing (OARs) , V20 Gy and V30 Gy for heart and ipsilateral lung in the 3D-CRT had an edge over FiF-FP. D max of the heart and ipsilateral lung were higher in 3D-CRT than FiF-FP , D max was lower in 3D-CRT than FiF-FP for contralateral breast. (MUs ) needed to deliver 3D-CRT with wedge plan were more than the values needed to deliver FiF-FP. Conclusion: FiF-FP had better dose homogeneity in (PTV) than (3D-CRT) with wedge and with less dose to OARs. (MUs) were less in (FiF-FP) with less time on the machine and less machine consumption. This technique lead to good expected breast irradiation outcome and encourages breast conservative surgery in developing countries Copy Right, IJAR, 2017,. All rights reserved.

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Body radiation exposure in breast cancer radiotherapy: Impact of breast IMRT and virtual wedge compensation techniques

Cited by 67 publications

References 35 publications

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Multisegmented Tangential Breast Fields: a Rational Way to Treat Breast Cancer

A Dosimetric Study of Conformal Radiotherapy Plan With Wedge and Field-in-Field-Forward-Planned Radiotherapy in Left Sided Breast Cancer.

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