HALFMOON TomoTherapy (Helical ALtered Fractionation for iMplant partial OmissiON): implant-sparing post-mastectomy radiotherapy reshaping the clinical target volume in the reconstructed breast

Leonardi, Maria Cristina; Spoto, Ruggero; Miglietta, E.; Trivellato, S.; Rocca, Eliana La; Luraschi, R.; Grosso, P.; Lorenzi, Francesca De; Fodor, C.; Dell’Acqua, V.; Gerardi, Marianna Alessandra; Morra, Anna; Francia, C.; Rietjens, Mario; Galimberti, Viviana; Veronesi, Giulia; Orecchia, Roberto; Cattani, Federica; Jereczek‐Fossa, Barbara Alicja

doi:10.1007/s00432-019-02938-8

Cited by 10 publications

(13 citation statements)

References 32 publications

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“…We also note that the patients in this study were scanned using deep-inspiration breath-hold, which is not feasible with all helicoidal tomotherapy techniques. Our results with helicoidal tomotherapy are similar to those reported in the HALF-MOON helicoidal tomotherapy publication by Leonardi et al [19], in which the HALFMOON helicoidal tomotherapy plans are shaped around the CTV but had more dose to the heart (MHD 4.5 Gy compared with conventional FiF 2.5 Gy), lungs and contralateral breast, compared with three-dimensional conformal radiation therapy planning.…”

Section: Discussionsupporting

confidence: 88%

Postmastectomy Radiation Therapy Planning After Immediate Implant-based Reconstruction Using the European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice Consensus Guidelines for Target Volume Delineation

et al. 2021

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Aims: To evaluate how common radiation therapy techniques perform in the setting of the new European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) delineation recommendations for immediate breast reconstruction (IBR). Materials and methods: Seven Danish radiation therapy centres and six international European centres participated in this project. Two breast cancer cases (one left-sided and one right-sided) with a retropectoral implant were chosen for radiation therapy planning using deep-inspiration breath-hold. Target volumes were delineated according to ESTRO-ACROP delineation recommendations. The centres were asked to plan the cases using any radiation therapy technique according to the Danish Breast Cancer Group plan objectives.

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Section: Discussionsupporting

confidence: 88%

Postmastectomy Radiation Therapy Planning After Immediate Implant-based Reconstruction Using the European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice Consensus Guidelines for Target Volume Delineation

et al. 2021

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“…The results were evaluated within the 95% confidence interval and the significance was evaluated under p < 0.05. Accurate sample size was calculated by a method developed by Cohen (d-value) based on the study by Leonardi et al G-power program (version 3.1) was used to calculate the sample size of 16 with 95% confidence interval (1 − α), 90% power (1 − β) with an estimated mean difference of 4.5 between two groups [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines

et al. 2022

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Background The ESTRO-ACROP Consensus Guideline (EACG) recommends implant excluded clinical target volume (CTVp) definitions for post-mastectomy radiation therapy after implant-based immediate breast reconstruction (IBR). The purpose of this study is to investigate the effectiveness of Helical Tomotherapy (HTp) and Volumetric Modulated Arc Therapy (VMATp) treatment techniques in terms of CTVp coverage and reduced organ at risk (OAR), normal tissue and implant doses when CTVp was used for treatment planning as the target structure instead of conventional CTV. Methods Eight left-sided and eight right-sided breast cancer patients who underwent IBR after mastectomy were included in this study. Planning CT data sets were acquired during free breathing and patients were treated with HT technique targeted to conventional CTV. Retrospectively, CTVp was delineated based on EACG by the same radiation oncologist, and treatment plans with HTp and VMATp techniques were generated based on CTVp. For each patient, relevant dosimetric parameters were obtained from three different treatment plans. Results There was no statistically significant difference on target coverage in terms of, PTVp-D95, PTVp-Vpres, homogeneity index (p > 0.05) between HTp and VMATp plans. But, the conformity numbers were significantly higher (HTp vs VMATp, 0.69 ± 0.15 vs 0.79 ± 0.12) for VMATp (Z = − 2.17, p = 0.030). While HTp significantly lowered Dmax and Dmean for LAD (LAD-Dmax: χ2 = 12.25, p = 0.002 and LAD-Dmean: χ2 = 12.30, p = 0.002), neither HTp nor VMATp could reduce maximum and mean dose to heart (p > 0.05). Furthermore, heart volume receiving 5 Gy was significantly higher for VMATp when compared to HTp (21.2 ± 9.8 vs 42.7 ± 24.8, p: 0.004). Both techniques succeeded in reducing the mean dose to implant (HTp vs HT, p < 0.001; VMATp vs HT, p < 0.001; VMATp vs HTp, p = 0.005). Conclusion Both HTp and VMATp techniques succeeded to obtain conformal and homogeneous dose distributions within CTVp while reducing the mean implant dose. HTp was found to be superior to VMATp with regards to lowering all OAR doses except for CB.

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“…This is also a challenge for radiation oncologists and medical physicists. Prospective trials are necessary to ensure that these new techniques do not compromise oncologic outcomes [13][14][15][16].…”

Section: Effect Of the Calculation Grid On The Results Of The Dose Distributionmentioning

confidence: 99%

Radiotherapy treatment planning for breast cancer patients after a subcutaneous mastectomy with the use of a prosthesis or expander

Kędzierawski

Buliński

Kuszewski

et al. 2021

Nowotwory. Journal of Oncology

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Introduction. Medical physicists planning radiation treatment are increasingly confronted with situations that require special attention. Undoubtedly, one such situation is the postoperative irradiation of a patient with breast cancer in which there is a prosthesis or an expander. In recent years, expanders have appeared in this location, which, due to the density of the device's valve makes it difficult to prepare an acceptable treatment plan. The study aims to present treatment planning in these situation in various Polish cancer centres and to compare overall patient preparation for the treatment. Material and methods. A questionnaire was prepared and sent to more than 20 radiotherapy departments, which included basic questions regarding the preparation of an irradiation plan for patients treated for breast cancer after a subcutaneous mastectomy with immediate reconstruction with a prosthesis or expander. The survey encompassed eight radiotherapy departments. Results. Not all radiotherapy departments require a manufacturer's certificate, which shows that the manufacturer does not prohibit the use of a prosthesis/expander during treatment with ionizing radiation. The X 6MV photons and the supine position, total and fraction doses: from 40 to 60 Gy and from 2 to 2.67 Gy, respectively, are the most commonly used. The way of defining them also depends on the oncological centre. The most commonly used irradiation technique is VMAT. Conclusion.The conclusion from the questionnaire -no standardisation of treatment planning -should encourage the community, at least medical physicists, to develop rules of conduct in this case. Irradiation techniques are mainly dynamic ones. The expander or prosthesis does not significantly affect the dose distributions.

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HALFMOON TomoTherapy (Helical ALtered Fractionation for iMplant partial OmissiON): implant-sparing post-mastectomy radiotherapy reshaping the clinical target volume in the reconstructed breast

Cited by 10 publications

References 32 publications

Postmastectomy Radiation Therapy Planning After Immediate Implant-based Reconstruction Using the European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice Consensus Guidelines for Target Volume Delineation

Postmastectomy Radiation Therapy Planning After Immediate Implant-based Reconstruction Using the European Society for Radiotherapy and Oncology-Advisory Committee in Radiation Oncology Practice Consensus Guidelines for Target Volume Delineation

Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines

Radiotherapy treatment planning for breast cancer patients after a subcutaneous mastectomy with the use of a prosthesis or expander

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