Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

Ratoša, Ivica; Jenko, A.; Šljivić, Ž.; Pirnat, Maja; Oblak, Irena

doi:10.2478/raon-2020-0050

Cited by 6 publications

(4 citation statements)

References 60 publications

(119 reference statements)

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“…Typically, dosimetry analysis, aimed at comparing the OAR dose values, relies on generating new proton treatment plans based on the previous ones planned for the photon beam. It is crucial to start comparing the real dosimetry doses and to design a new methodology in order to check the dosimetry values when carrying out radiotherapy for protons and photons [ 79 ].…”

Section: Discussionmentioning

confidence: 99%

Future Perspectives of Proton Therapy in Minimizing the Toxicity of Breast Cancer Radiotherapy

Musielak

Suchorska

Fundowicz

et al. 2021

JPM

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The toxicity of radiotherapy is a key issue when analyzing the eligibility criteria for patients with breast cancer. In order to obtain better results, proton therapy is proposed because of the more favorable distribution of the dose in the patient’s body compared with photon radiotherapy. Scientific groups have conducted extensive research into the improved efficacy and lower toxicity of proton therapy for breast cancer. Unfortunately, there is no complete insight into the potential reasons and prospects for avoiding undesirable results. Cardiotoxicity is considered challenging; however, researchers have not presented any realistic prospects for preventing them. We compared the clinical evidence collected over the last 20 years, providing the rationale for the consideration of proton therapy as an effective solution to reduce cardiotoxicity. We analyzed the parameters of the dose distribution (mean dose, Dmax, V5, and V20) in organs at risk, such as the heart, blood vessels, and lungs, using the following two irradiation techniques: whole breast irradiation and accelerated partial breast irradiation. Moreover, we presented the possible causes of side effects, taking into account biological and technical issues. Finally, we collected potential improvements in higher quality predictions of toxic cardiac effects, like biomarkers, and model-based approaches to give the full background of this complex issue.

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Section: Discussionmentioning

confidence: 99%

Future Perspectives of Proton Therapy in Minimizing the Toxicity of Breast Cancer Radiotherapy

Musielak

Suchorska

Fundowicz

et al. 2021

JPM

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“…Because our institution has applied DIBH since October 2019, 15 patients consecutive from November 2019 to February 2020 were selected for the DIBH group. To minimize the effect of OARs by the different characteristics of body contour between DIBH and FB groups, FB group was selected based on clinical target volume (CTV) of breast [ 12 ]. Of 33 patients from October 2017 to May 2018, 15 patients for the FB group were paired with the DIBH group considering the approximate CTV.…”

Section: Methodsmentioning

confidence: 99%

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

2021

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Purpose Breast radiotherapy set-up is often uncertain. Actual dose distribution to normal tissues could be different from planned dose distribution. The objective of this study was to investigate such difference in dose distribution according to the extent of set-up error in breast radiotherapy. Materials and methods A total of 50 Gy with fraction size of 2 Gy was given to 30 left breasts with different set-ups applying a deep inspiration breath holding (DIBH) or a free breathing (FB) technique. Under the assumption that errors might come from translational axes of deep or caudal directions, the isocenter was shifted from the original tangential alignment every 2.5 mm to simulate uncertainty of deep and caudal tangential set-up in DIBH and FB. Changes were evaluated for dosimetric parameters for the heart, the left ventricle (LV), the left anterior descending coronary artery (LAD), and the ipsilateral lung. Results On the original plan, mean doses of heart and ipsilateral lung were 2.0 ± 1.1 Gy and 3.7 ± 1.4 Gy in DIBH and 8.4 ± 1.3 Gy and 7.8 ± 1.5 Gy in FB, respectively. The change of dose distribution for the heart in DIBH was milder than that in FB. The deeper the tangential set-up, the worse the heart, LV, LAD, and ipsilateral lung doses, showing as much as 49.4%, 56.4%, 90.3%, and 26.1% shifts, respectively, in 5 mm DIBH setup. The caudal set-up did not show significant dose difference. In multiple comparison of DIBH, differences of mean dose occurred in all 7.5 mm deep set-ups for the heart (p = 0.025), the LV (p = 0.049), and LAD (p = 0.025) in DIBH. Conclusions To correct set-up error over indicated limitation for deep tangential set-up in DIBH at 5 mm action level, mean heart and ipsilateral lung doses are expected to increase approximately 50% and 25%, respectively.

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“…The same dosimetric parameters for the LAD and LV structures have previously been used in studies dealing with radiotherapy for breast carcinomas [32][33][34].…”

Section: Treatment Planningmentioning

confidence: 99%

Radiation Dose to Critical Cardiac Structures from Three-Dimensional Conformal Radiation Therapy (3D-CRT), Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques for Left-Sided Breast Cancer

Konstantinou,

Varveris,

Solomou

et al. 2024

JPM

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A comparison of the radiation exposure to the left anterior descending artery (LAD) and left ventricle (LV) was performed for twenty-three left breast cancer patients. For each participant, two tangential fields 3D-CRT, two- and seven-field IMRT and two and four partial arcs VMAT plans were created. Dose constraints for CTV, ipsilateral lung and heart were followed. The V40Gy, V30Gy, Dav of LAD and V23Gy, V5Gy, Dav of LV were calculated and extracted from the plans. Parametric and non-parametric tests were applied to compare the parameters derived from the five treatment techniques. All generated plans fulfilled the dose constraints. The Dav ranges of the LAD and LV from all examined techniques were 11.77–14.73 Gy and 5.37–6.40 Gy, respectively. The V40Gy and V30Gy ranges of the LAD were 2.90–12.91% and 10.80–18.51%, respectively. The V23Gy and V5Gy of the LV were 4.29–7.43% and 18.24–30.05%, respectively. The VMAT plans and seven-field IMRT significantly reduced the V40Gy, V30Gy of LAD and V23Gy of LV compared with the two-field treatments (p < 0.05). However, 3D-CRT plans provided statistically lower values for V5Gy of LV over the other techniques (p < 0.05). The presented results provide a detailed dataset of the radiation burden of two critical cardiac structures from five radiotherapy techniques.

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Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

Cited by 6 publications

References 60 publications

Future Perspectives of Proton Therapy in Minimizing the Toxicity of Breast Cancer Radiotherapy

Future Perspectives of Proton Therapy in Minimizing the Toxicity of Breast Cancer Radiotherapy

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

Radiation Dose to Critical Cardiac Structures from Three-Dimensional Conformal Radiation Therapy (3D-CRT), Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) Techniques for Left-Sided Breast Cancer

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