Breast conserving treatment for breast cancer: dosimetric comparison of different non-invasive techniques for additional boost delivery

Parijs, Hilde Van; Reynders, Truus; Heuninckx, K.; Verellen, Dirk; Storme, Guy; Ridder, Mark De

doi:10.1186/1748-717x-9-36

Cited by 24 publications

(29 citation statements)

References 25 publications

(21 reference statements)

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“…Thus, more volume of normal breast tissue underwent high-dose irradiation, thereby affecting the cosmetic results. The following dosimetric studies on the photon beam and electron beam boost found results opposite to those of the CI of the photon beam [ 15 , 16 ]. Currently, the electron beam is a widely adopted tumor bed boost technique because its dosimetric characteristics are more suitable for superficial tumor bed; however, boost for deeper tumor bed requires increased electron beam energy, which will further increase the radiation dose to the heart, lung and normal breast tissue.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of the Simultaneous Integrated Boost in Whole-Breast Irradiation after Breast-Conserving Surgery: IMRT, IMRT plus an Electron Boost and VMAT

Lai

et al. 2015

PLoS ONE

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ObjectivesTo compare the target volume coverage and doses to organs at risks (OARs) using three techniques that simultaneous integrated boost (SIB) in whole-breast irradiation (WBI) after breast-conserving surgery, including intensity-modulated radiation therapy (IMRT), IMRT plus an electron boost (IMRT-EB), and volumetric-modulated arc therapy (VMAT).MethodsA total of 10 patients with early-stage left-sided breast cancer after breast-conserving surgery were included in this study. IMRT, IMRT-EB and VMAT plans were generated for each patient.ResultsThe conformity index (CI) of the planning target volumes evaluation (PTV-Eval) of VMAT was significantly superior to those of IMRT and IMRT-EB (P < 0.05). The CI of the PTV Eval-boost of VMAT was better than that of IMRT (P = 0.018) and IMRT-EB (P < 0.001), while the CI of the PTV Eval-boost of IMRT was better than that of IMRT-EB (P = 0.002). The V5, V10 and Dmean in ipsilateral lung with VMAT were significantly higher than IMRT (P < 0.05) and IMRT-EB (P < 0.05). The Dmean, V5 and V10 in heart with VMAT were significantly greater than those of IMRT and IMRT-EB (P < 0.05). There was no significant difference in the OARs between IMRT and IMRT-EB (P > 0.05).ConclusionsConsidered the target volume coverage and radiation dose delivered to the OARs (especially the heart and lung), IMRT may be more suitable for the SIB in WBI than IMRT-EB and VMAT. Additional clinical studies with a larger sample size will be needed to assess the long-term feasibility and efficacy of SIB using different radiotherapy techniques.

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Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of the Simultaneous Integrated Boost in Whole-Breast Irradiation after Breast-Conserving Surgery: IMRT, IMRT plus an Electron Boost and VMAT

Lai

et al. 2015

PLoS ONE

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“…Previous dosimetric studies demonstrated feasibility of SIB with 3D-CRT, IMRT, and VMAT (7,11,12,(15)(16)(17). Furthermore, the dosimetric advantages of SIB over SB have been previously demonstrated (14, 15,22). Compared to the most widely used sequential electron boost, (23,24).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Onal

Efe

Güler

et al. 2019

In Vivo

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Background/Aim: To compare simultaneousintegrated boost (SIB) versus sequential-boost (SB) delivered in the context of whole-breast irradiation (WBI) via volumetricmodulated arc therapy (VMAT) and helical-tomotherapy (HT). Materials and Methods: Planning target-volume (PTV) dosimetric parameters and organs at risk (OAR) were analyzed for SB plan (50 Gy plus 16 Gy boost) and SIB plan (50.4 Gy WBI and 64.4 Gy tumor bed boost) in VMAT and HT techniques. Results: Conformity and homogeneity for targetvolume doses were better in HT plans compared to VMAT plans. There were no significant differences in ipsilateral lung doses between VMAT and HT plans for SB/SIB techniques, except for a significantly higher lung V5 value with VMAT-SB, and lung V13 value with HT-SIB technique. HT provided a statistically significant decrease in contralateral lung mean V5. Conclusion: The SIB technique showed better target-volume dose distribution in both HT and VMAT plans, and better sparing heart in HT compared to the SB technique. Breast cancer (BC) is the most common cancer and is a major cause of cancer-related death in women (1). Currently, adjuvant radiotherapy (RT), especially whole-breast irradiation (WBI) after breast-conserving surgery (BCS), is accepted as standard-of-care for early BC patients as this multimodal treatment increases local control and improves overall survival in early BC (2, 3). Additional tumor-bed boost after WBI has also been shown to reduce local recurrence (4); however, a long-term follow-up study found that inhomogeneous radiation in tumor-bed boosts, and use of photon beam boosts led to poorer cosmetic outcomes in patients (5). Therefore, in the past few decades, a lot of attention has focused on the development of new techniques to achieve a homogeneous dose distribution, better local control, and improve cosmetic outcomes for WBI after BCS. Breast RT techniques range from conventional tangential field RT, field-in-field conformal RT (CRT), intensity modulated RT (IMRT), volumetric arc therapy (VMAT) to helical tomotherapy (6-11). For tumor-bed boost, relatively simple electron or hybrid techniques (i.e., a combination of different techniques for WBI and boosts), have been used. Recent dosimetric studies have demonstrated that multi-field 3D-CRT, IMRT, or VMAT are superior to electron therapy with respect to the target-volume coverage and sparing normal tissues (12-15). Moreover, simultaneous-integrated boost (SIB), which is a technique wherein a boost is delivered to the tumor bed concurrently with WBI, has been reported to be technically and dosimetrically feasible (11-13, 15-17). The rationale underlying the SIB technique is to escalate radiation doses in the area at highest risk without prolonging treatment duration. This dose escalation provides improved patient comfort while shortening the duration of RT, and also exploits the higher sensitivity of breast tumor cells to larger single doses. However, more advanced techniques are required to increase the uniformity of the radiation dose to improve p...

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“…In performed trials, this boost dose has decreased local recurrence (1)(2)(3). Although most radiation oncologists are in agreement with the boost treatment, especially in patients with higher risks of recurrence, they have different ideas about the method to be used in terms of the type of beam (electron or photon) and the method of radiation delivery (4)(5)(6)(7). Delivering the 10 -20 Gy boost dose necessitates the accurate determina-tion of the area and depth of the tumor bed.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the normal tissue of the breast is less exposed to radiation when the tumor bed is determined more accurately, and thus fewer consequent side effects appear. Different methods have been used to determine the tumor bed, including scar surgery, asking the patient to remember the mass, radiography, ultrasound, CT scan, and surgical clips (7)(8)(9)(10). The accuracy of the aforementioned methods has been studied.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Accuracy in Determining the Tumor Depth for Boost Field Radiotherapy in Breast Cancer in Comparison With CT Scan Plus Clips

Aghili

Tahmtan

Samiee

et al. 2015

Rep Radiother Oncol

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Background: There are miscellaneous methods of boost field determination with different levels of accuracy. One of the important parameters in boost field planning is the tumor bed depth, as it is important for determining electron energy. Objectives: The purpose of present research was the determination of ultrasound accuracy to estimate the appropriate depth for the tumor bed. Patients and Methods: Patients who were undergone breast conservative surgery with placing of 5 clips in the tumor bed (lower, upper, medial, lateral, and posterior) were included. The depth and location of the tumor bed were determined using ultrasonography. The optimum field boost was planned with an appropriate 2.5 cm margin. After putting the marker on the field boost, the CT simulation was done and then the obtained depth of the ultrasound report and that of the CT scan-clips were compared. Results: Twenty five patients were included. The average depth reported by the ultrasound was about 18 mm ± 3 mm (range 10-26 mm), and the average obtained from the CT scan-clips was about 48 mm ± 13 mm (range 24-80 mm), (P Value = 0.001). In almost all cases, the depth obtained from the ultrasound was less than that obtained from the CT scan-clips. Conclusions: Ultrasound is not an accurate method to determine the appropriate depth and field for determination of breast field boost. Thus, it is better not to use ultrasound to estimate the tumor cavity depth; the CT scan images with surgical clips should be used instead.

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Breast conserving treatment for breast cancer: dosimetric comparison of different non-invasive techniques for additional boost delivery

Cited by 24 publications

References 25 publications

Dosimetric Comparison of the Simultaneous Integrated Boost in Whole-Breast Irradiation after Breast-Conserving Surgery: IMRT, IMRT plus an Electron Boost and VMAT

Dosimetric Comparison of the Simultaneous Integrated Boost in Whole-Breast Irradiation after Breast-Conserving Surgery: IMRT, IMRT plus an Electron Boost and VMAT

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Ultrasound Accuracy in Determining the Tumor Depth for Boost Field Radiotherapy in Breast Cancer in Comparison With CT Scan Plus Clips

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