Helical tomotherapy for bilateral breast cancer: Clinical experience

Kaidar‐Person, Orit; Kostich, M.; Zagar, Timothy M.; Jones, Ellen; Gupta, Gaorav P.; Mavroidis, Panayiotis; Das, Shiva K.; Marks, Lawrence B.

doi:10.1016/j.breast.2016.05.004

Cited by 27 publications

(31 citation statements)

References 20 publications

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“…Synchronous bilateral breast irradiation is challenging due to the large and complex target volume and the need to minimize the dose to the heart and lungs. IMRT, VMAT, and HT techniques have been reported to improve dosimetry in SBBC patients, and past dosimetric studies have shown that IMPT can reduce the cardiac dose significantly in unilateral breast cancer (11)(12)(13)(14)(15)(16)(17)(18)(19). Previous studies have not compared dosimetric differences between IMRT, VMAT, and HT in SBBC.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to 3D-CRT, intensitymodulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT), or tomotherapy can improve the target dose coverage and can achieve acceptable cosmetic effects and cardiopulmonary sparing. Thus, the use of VMAT, IMRT, or tomotherapy was strongly suggested for SBBC (11)(12)(13)(14)(15). However, few studies have compared dosimetric differences between the three techniques of IMRT, VMAT, and tomotherapy in SBBC.…”

Section: Introductionmentioning

confidence: 99%

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Heart and Cardiac Substructure Dose Sparing in Synchronous Bilateral Breast Radiotherapy: A Dosimetric Study of Proton and Photon Radiation Therapy

et al. 2020

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Background: Synchronous bilateral breast cancer (SBBC) is rare. The purpose of this study was to compare the dosimetric differences in intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT), helical tomotherapy (HT), and intensity-modulated proton therapy (IMPT) to find an optimal radiotherapy technique for bilateral breast cancer radiotherapy. Methods: For 11 patients who received synchronous bilateral whole-breast irradiation without local lymph nodal regions, six plans were designed for each patient: IMRT with a single isocenter (IMRT-ISO1), IMRT with two isocenters (IMRT-ISO2), VMAT with a single isocenter (VMAT-ISO1), VMAT with two isocenters (VMAT-ISO2), HT, and IMPT. The differences between the single-and dual-isocentric plans for IMRT and VMAT were compared, and the plan with the better quality was selected for further dosimetric comparisons with IMPT and HT. The plan aimed for a target coverage of at least 95% with the prescription dose of 50 Gy [relative biological effectiveness (RBE)] while minimizing the dose of organs at risk (OARs). Results: IMRT-ISO1 and VMAT-ISO2 plans were adopted for further dosimetric comparisons because of the reduced dose of the heart and/or lungs compared to IMRT-ISO2 and VMAT-ISO1 plans. The dose coverage of the planning target volume (PTV) was significantly higher in IMPT plans than that in all other plans. VMAT and IMPT plans showed the best conformity, whereas IMRT plans showed the worst conformity. Compared to IMRT and VMAT plans, IMPT and HT plans achieved significantly higher dose homogeneity. IMPT plans reduced the mean dose and low dose volume (V 5 , V 10 , and V 20) of the heart, left anterior descending artery (LAD), and left ventricle (LV). In high-dose volumes of the heart and cardiac substructures, the IMPT, VMAT, and HT techniques showed similar advantages, and IMRT plans increased the values more than other techniques. IMPT plans had the maximal lung and normal tissue sparing but increased the skin dose compared to IMRT and VMAT plans. Sun et al. Photon vs. Proton in SBBC Conclusions: IMPT plans improve both the target coverage and the OARs sparing, especially for the heart, cardiac substructures (LAD and LV), lungs and normal tissue, in synchronous bilateral breast radiotherapy. VMAT and HT could be selected as suboptimal techniques for SBBC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart and Cardiac Substructure Dose Sparing in Synchronous Bilateral Breast Radiotherapy: A Dosimetric Study of Proton and Photon Radiation Therapy

et al. 2020

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“…Irradiating only the breast may account for the lack of dysphagia and nausea in our case [ 8 ]. A recently published study in nine patients with bilateral breast cancer has shown that tomotherapy to the breast or chest wall and draining lymph nodes was associated with a high toxicity rate [ 9 ]. Furthermore, the patient in this report did not develop radiation skin changes, confirming the observed clinical experience of our center that skin reactions are not an issue with helical tomotherapy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Helical Tomotherapy and Direct Tomotherapy in Bilateral Whole Breast Irradiation in a Case of Bilateral Synchronous Grade 1 and Stage 1 Breast Cancer

Lancellotta

Iacco

Perrucci³

et al. 2017

Am J Case Rep

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Patient: Female, 60Final Diagnosis: Complete remissionSymptoms: NoneMedication: —Clinical Procedure: RadiotherapySpecialty: OncologyObjective:Rare diseaseBackground:Synchronous bilateral breast cancer is rare. A case is presented where whole breast irradiation (WBI) was planned after breast conserving surgery in a patient with synchronous bilateral breast cancer. A comparison was made between the feasibility of helical tomotherapy and direct tomotherapy.Case Report:A 60-year-old woman was found to have bilateral breast nodules on routine mammographic screening, resulting in bilateral lumpectomy and sentinel lymph node biopsy. Histopathology showed a 6 mm diameter invasive ductal carcinoma in the right breast (Grade 1, hormone receptor positive, HER2 negative) and an 8mm diameter tubular carcinoma in the left breast (Grade 1, hormone receptor positive, HER2 negative). Lymph node biopsy and histology, chest X-ray, abdominal ultrasound scan, and bone scintigraphy were negative for metastases (both tumors were Stage 1). Adjuvant therapy with commenced with anastrozole, but no chemotherapy was given. Clinical target volumes (CTVs) were contoured on computed tomography (CT) images. For planning target volumes (PTVs), CTVs were expanded by 1 cm in all directions, except for the medial 5 mm. Since dose constraints to organs at risk (OARs) were beyond established limits, CTVs were expanded by 5 mm. For PTVs, OAR doses and homogeneity indices for helical tomotherapy and direct tomotherapy were compared. Helical tomotherapy provided better target volume coverage and OAR sparing than direct tomotherapy.Conclusions:In a case of bilateral synchronous Stage 1 and Grade 1 breast cancer, helical tomotherapy appeared more suitable than direct tomotherapy.

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“…Starting point of clinical experience of helical tomotherapy for breast cancer has been a treatment of complicated case scenarios such as bilateral breast cancer to be irradiated for the bilateral breasts/ chest wall and regional nodes. Kaidar-Person et al reviewed nine-cased treated for breast and regional nodal irradiation with Helical tomotherapy in their institute in 5 years of period [46]. The average lung V20, lung V5 and heart mean dose was 29%, 66% and 20 G, respectively.…”

Section: Tomotherapymentioning

confidence: 99%

“…The average lung V20, lung V5 and heart mean dose was 29%, 66% and 20 G, respectively. Clinical significant acute toxicity was observed such as dysphagia (5/9), fatigue (4/9), nausea and weight loss (1/9) and skin desquamation (9/9) [46]. Goddu et al also estimated the practicability of using helical tomotherapy for locally advanced left-sided breast cancer in a dosimetric planning study on 10 CT data sets comparing a multifield three-dimensional technique with the tomotherapy treatment planning for 50.4 Gy dose [47] and found tomotherapy to increase the minimal dose to the planning target volume and improve the dose homogeneity.…”

Section: Tomotherapymentioning

confidence: 99%

Modern Radiotherapy Era in Breast Cancer

Bölükbaşı¹,

Selek²

2017

Breast Cancer - From Biology to Medicine

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Radiation therapy (RT) is one of the major treatment modalities that are used in breast cancer treatment, and depending on the chest-wall anatomy, RT fields have to be customized. Techniques used in planning have been evolving since last two decades from two dimensional (2D) to three-dimensional (3D), while intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and even proton therapy have been an option in daily approach. In addition, technological hardware and software advances in delivery and planning systems, total treatment duration of breast RT have been shortened in last decades along with recent hypofractionated radiotherapy schemes or emerging partial-breast irradiation protocols. The other attractive approach-accelerated partial breast irradiation (APBI) could be a reasonable option for highly selected subpopulation of early-stage breast cancer patients out of a clinical trial. Long-term follow-up results have emerged heart and coronary sparing with maximum safety and efficacy. The most important advance could be named as cardiac sparing-deep breathhold approach-in all the modern technique improvement. Although most advanced techniques in management of breast cancer have not been verified to increase survival, we suggest recommending resource stratified advanced in order to provide best technical and clinical care in this long-term survivor candidates.

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Helical tomotherapy for bilateral breast cancer: Clinical experience

Cited by 27 publications

References 20 publications

Heart and Cardiac Substructure Dose Sparing in Synchronous Bilateral Breast Radiotherapy: A Dosimetric Study of Proton and Photon Radiation Therapy

Heart and Cardiac Substructure Dose Sparing in Synchronous Bilateral Breast Radiotherapy: A Dosimetric Study of Proton and Photon Radiation Therapy

Comparison of Helical Tomotherapy and Direct Tomotherapy in Bilateral Whole Breast Irradiation in a Case of Bilateral Synchronous Grade 1 and Stage 1 Breast Cancer

Modern Radiotherapy Era in Breast Cancer

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