Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Abstract

BackgroundBreast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size.ConclusionsInhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.

Dosimetric consequences of image guidance techniques on robust optimized intensity-modulated proton therapy for treatment of breast Cancer

“…Clinically, a smaller breast tends to flatten along the chest wall with the patient in a supine, arms up position, while a larger breast that remains pendulous in this position retains breast tissue that is can be very mobile. Larger breast size has been associated with increased acute toxicity such as breast edema [24]. Despite this tendency for higher breast error, the target coverage is well maintained (CTV D95 within 1% variation) as long as the patient's posture setup is accurate (< 2°setup error).…”

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

“…20,21 Additionally, quite a few clinical studies have reported a comparison of the clinical adverse events in regard to the three groups of breast sizes. 22 Although observed average MWHD in a population of breast cancer survivors is low, smaller fragments of the heart might have received doses exceeding 25-40 Gy. 4,10,23,24 Subclinical cardiac dysfunction was observed early after adjuvant radiotherapy for breast cancer with molecular biomarkers 25,26 , radionuclide myocardial perfusion imaging [27][28][29] , echocardiography [30][31][32] , and functional magnetic resonance imaging.…”

“… 20 , 21 Additionally, quite a few clinical studies have reported a comparison of the clinical adverse events in regard to the three groups of breast sizes. 22 …”

Aplicação tópica de creme contendo nanopartículas com vitamina E para prevenção de radiodermatite em mulheres com câncer de mama: estudo piloto randomizado

“…Durante e após a irradiação da mama, a intensidade das reações da pele à radioterapia é influenciada por fatores relacionados ao tratamento (extrínsecos) e ao paciente (intrínsecos). Os fatores relacionados ao tratamento incluem: a dose administrada em cada sessão, a dose total administrada, o volume de tecido tratado, o tipo de radiação utilizada, uso de bolus e a concomitância com quimioterapia (Censabella et al, 2017;DeHaven, 2014;Feight et al, 2011;Fernandez-Castro, Martin-Gil, 2015;Glover e Harmer, 2014;Harper et al, 2004;Kole, Kole, Moran, 2017;Leventhal, Young, 2017;McQuestion, 2011;Meghrajani et al, 2013;Pires, Segreto, Segreto, 2008;Ratosa, Jenko, Oblak, 2018;Salvo et al, 2010;Seité, Bensadoun, Mazer, 2017;Singh et al, 2016;Waghmare, 2013;Warnock, Lee, 2014). Técnicas modernas de teleterapia, como a IMRT (Intensity-modulated radiation therapy), mostram-se superiores no que concerne à incidência das reações de toxicidade da pele quando comparadas à terapia de radiação convencional (Feight et al, 2011;Fernandez-Castro, Martin-Gil, 2015;Leventhal, Young, 2017;Marta, Weltman e Ferrigno, 2018;McQuestion, 2011;Murray, Robinson, 2011;Pignol, Olivotto, Rakovitch, 2008;Ryan, 2012;Singh et al, 2016;Skliarenko, Warde, 2011;Teh, Woo, Butler, 1999;Waghmare, 2013;Warnock, Lee, 2014), porém o uso dessa tecnologia na prática diária não é considerado como tratamento padrão para pacientes com câncer de mama (Feight et al, 2011 Glover e Harmer, Harper et al, 2004;…”

“…A dermatite úmida, restrita (grau 2) ou não (grau 3) à prega cutânea foi mais incidente na região inframamária das pacientes, corroborando outros estudos que também apontam predominância de grau 3 nessa região e na axilar, por serem áreas de dobra de pele, com fricção constante e maior umidade (Pires, Segreto, Segreto, 2008;Censabella et al, 2017;Kole, Kole, Moran, 2017;Meghrajani et al, 2013;McQuestion, 2011;Salvo et al, 2010;Seité, Bensadoun, Mazer, 2017;Warnock, Lee, 2014), ou seja, com maior tendência de associação com as dermatites associadas à umidade, neste caso, intertriginosa. Portanto, mulheres obesas e com mamas volumosas possuem maior incidência dessas lesões (Harper et al, 2004;Kole, Kole, Moran, 2017;Ratosa, Jenko, Oblak, 2018 (Andrade et al, 2012;Azam et al, 2017;Leventhal, Young, 2017;McQuestion, 2011;Ryan, 2012;Warnock, Lee, 2014). (Kole, Kole, Moran, 2017;Seité, Bensadoun, Mazer, 2017;Warnock, Lee, 2014).…”