Concomitant intensity modulated boost during whole breast hypofractionated radiotherapy – A feasibility and toxicity study

Teh, Amy; Walsh, L.; Purdie, Thomas G.; Mosseri, Allen; Xu, Wei; Levin, Wilfred; Koch, Christine; Fyles, Anthony; Liu, Fei‐Fei; Cho, J.

doi:10.1016/j.radonc.2011.10.015

Cited by 22 publications

(18 citation statements)

References 37 publications

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“…In fact, IMRT, due to improved conformity and homogeneity of dose distribution, reduces the dose to the OAR and it has been shown to reduce rates of acute radiation dermatitis during WBI. Currently, IMRT is in widespread use by many centers worldwide [18].…”

Section: Discussionmentioning

confidence: 99%

“…A feasibility study on the use of Simultaneous Boost Radiotherapy with IMRT improved boost coverage and decreased OAR doses, compared with sequential boost [18]. Our institutional dose volume constraint for the lung in breast radiotherapy is to keep V20 at < 30% of the ipsilateral lung using conventional fractionation as the risk of radiation pneumonitis shown to be increased with increased both lungs V20 above 30% [24].…”

Section: Discussionmentioning

confidence: 99%

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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%

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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“…This is similar to the data reported by Van der Laan et al comparing conformal simultaneously integrated boost to sequential boost 11 . Other reports of simultaneous integrated boost using IMRT also report excellent data on boost coverage [33][34] .…”

Section: Discussionmentioning

confidence: 86%

Concomitant Boost Versus Sequential Boost in Breast Conservative Therapy for Early Stage Breast Cancer

El-Mesidy

Hassan

Mohamed

et al. 2013

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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To compare concomitant boost irradiation (CBI) to sequential boost irradiation (SBI) to the tumor bed by 3DCRT after breast-conserving surgery (BCS) regarding target coverage, dose homogeneity, dose to organs at risk, acute toxicity, late toxicity, local control, DFS and cosmesis. Materials/Methods: Sixty patients were randomized after BCS to receive concomitant boost irradiation for 5 weeks (for each fraction, the breast and boost planning target volumes "PTVs" received 2 Gy and 2.4 Gy, to a total dose of 50 Gy and 60 Gy respectively) or a biologically equivalent sequential boost (the breast received 2 Gy x 25 fractions followed by 2 Gy x 8 fractions boost to the tumor bed). Three-dimensional conformal beams with wedges were used. Acute toxicity was evaluated using RTOG criteria and cosmesis was evaluated using Gray score. results: Target coverage was adequate with both techniques (V45 for breast CTV = 98.5% vs 98.7% for CBI and SBI respectively, P=0.6; and D95 for boost PTV-after calculation of biologically equivalent dose "BED"= 62.9 Gy vs 63.3 Gy, respectively). There was no statistically significant difference between the two groups regarding the doses to OAR (i.e. mean heart dose, heart V40, lung V20, mean dose to contralateral breast and mean dose to the thyroid gland). The 2 groups were comparable regarding cardiac, pulmonary, neurologic and skin toxicity with 20 (33.4%) of our patients developing GII or worse skin toxicity, but with no impact on cosmetic outcome (median=7 in each arm, P=0.8). After a median follow-up of 25 months, disease free survival was 83.3% in the sequential arm versus 93.3% in the concomitant arm (P-value= 0.170). Only one patient in the study developed local recurrence; that patient was in the sequential boost arm, with loco-regional recurrence free survival (LRRFS) of 95.1% for our whole patient cohort. conclusion: Concomitant boost irradiation by 3DCRT is non-inferior to sequential boost irradiation after BCS regarding acute toxicity, cosmetic outcome, local control and DFS. It can be used to reduce the number of treatment fractions without increasing toxicity or hindering patient outcome.

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“…Gy per session compared to normofracctionated WBI and boost, achieving equivalent efficacy and less acute skin reaction after hypofractionation. A more recent approach consists of a boost given concomitantly as proposed by Meei Teh et al [18]. They carried out a prospective study in 15 patients who received 42.4 Gy of WBI with a concomitant boost of 10.08 Gy delivered in 16 fractions, showing low rate of skin toxicities.…”

Section: Discussionmentioning

confidence: 99%

“…Given that hypofractionated and normofractionated breast radiotherapy are essentially equivalent in terms of efficacy and toxicity [29], it is evident that by shortening the treatment length of treatement with hypofractionation can improve the efficiency of a radiotherapy department. Conventional irradiation schedules consisting of 50 Gy plus a boost of 16 Gy administered in 33 fractions, are equivalent to [11][12][13][14][15][16][17][18][19][20][21] hypofractionated doses (depending on the sequence and fractionation used). Thus, hypofractionation can potentially decrease the workload of radiotherapy treatment units by 45% allowing for substantial time saving.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis

et al. 2016

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Concomitant intensity modulated boost during whole breast hypofractionated radiotherapy – A feasibility and toxicity study

Abstract: CBRT using IMRT improved boost coverage and lowered OAR doses, compared with SBT. Toxicities were acceptable using a daily boost of 3.28 Gy. While resource utilization was greater, overall treatment time was reduced.

Cited by 22 publications

References 37 publications

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Concomitant Boost Versus Sequential Boost in Breast Conservative Therapy for Early Stage Breast Cancer

Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis

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