Intensity-modulated radiotherapy of the female breast

Thilmann, Christoph; Zabel, Angelika; Nill, Simeon; Rhein, B.; Hoess, Angelika; Haering, P.; Milker-Zabel, Stefanie; Harms, Wolfgang; Schlegel, Wolfgang; Wannenmacher, M; Debus, Jürgen

doi:10.1016/s0958-3947(02)00089-4

Cited by 42 publications

(15 citation statements)

References 26 publications

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“…Multiple dosimetric studies have reported improved homogeneity of dose distribution with the use of IMRT which result in reduced dose to the heart and lungs, and contralateral breast [20][21][22][23]. A feasibility study on the use of Simultaneous Boost Radiotherapy with IMRT improved boost coverage and decreased OAR doses, compared with sequential boost [18].…”

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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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%

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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“…Full IMRT has its special strength when geometrically complex treatment situations such as bilateral cancer, pectus excavatum (19), or the indication to cover the parasternal and supraclavicular/axillary lymph nodes arise (18,21,36). It yields concave dose distributions, as shown by groups from Sweden, Germany, and Canada (18,19,37) with special characteristics of the dose distribution compared with tangents, including a reduction of the volume treated to high doses and increasing the volume treated to lower doses (i.e., an increase in the mean and median heart dose).…”

Section: Discussionmentioning

confidence: 99%

Potential Effect of Robust and Simple IMRT Approach for Left-Sided Breast Cancer on Cardiac Mortality

Lohr

El-Haddad

Dobler

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

119

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“…Depending on the patient's lymph node metastasis, the axilla or supraclavicular area is included in the area to be irradiated (11,12). The total dose applied to the breast should be 45-50 Gy in 5-6 weeks.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Techniques in Breast Cancer Radiotherapy Planning

et al. 2014

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Objective: This study aimed to minimize the radiation dose to organs other than the target tissue during adjuvant therapy applied for breast cancer, by using different planning methods. Materials and Methods:30 women with T1-2 N1-3 M0 breast cancer were included in the study. Planning was performed using four different methods to the supraclavicular area, internal, and external tangential fields. All planning was done in a virtual environment by and the requested data was obtained. All patients were treated by the 1st method. Method 1: Different isocenter, complete supraclavicular area, breast half beam. Method 2: Different isocenter, half supraclavicular area, breast half beam. Method 3: Single isocenter, half supraclavicular area, breast half beam. Method 4: Different isocenter, supraclavicular area full beam, breast full beam.Results: Evaluation of PTV values showed a statistically significant reduction in D-max, 110% and 115% values by method III. Lower doses in other parameters were not statistically significant. Conclusion:Based on these results, the application of single isocenter, 3D radiotherapy in breast cancer provides significant advantages especially in PTV and pulmonary dosages.

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Intensity-modulated radiotherapy of the female breast

Cited by 42 publications

References 26 publications

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Hypofractionated IMRT Breast Treatment with Simultaneous Versus Sequential Boost Techniques

Potential Effect of Robust and Simple IMRT Approach for Left-Sided Breast Cancer on Cardiac Mortality

Comparison of Different Techniques in Breast Cancer Radiotherapy Planning

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