Optimized Dose Coverage of Regional Lymph Nodes in Breast Cancer: The Role of Intensity-Modulated Radiotherapy

Dogan, Nesrin; Cuttino, L.W.; Lloyd, R V; Bump, Edward A.; Arthur, Douglas W.

doi:10.1016/j.ijrobp.2007.03.059

Cited by 89 publications

(85 citation statements)

References 40 publications

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“…SNB in place of ALND decreases morbidity but does not eliminate it as demonstrated by ALMANAC randomized trial comparing quality of life outcomes between SNB alone and standard axillary treatment group (ALND or Axillary RT). The patients receiving only SNB as axillary treatment had lymphedema in 5% of cases and sensory loss in 11% cases versus 13% and 31% in patients receiving axillary radiation/ ALND [7]. Studies have been conducted on increased pulmonary toxicity as a complication of radiation to internal mammary node.…”

Section: Discussionmentioning

confidence: 99%

“…They include part of the anterior thoracic cavity which in turn leads to significant radiation to heart and lung leading to the risk of long-term pulmonary and cardiac complications [5]. The conformal radiation therapy like three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) leads to favorable dose distribution and less dose to these critical organs [6,7]. All above data are basically on breast conservative cases.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Incidental Radiation Dose to Axilla and Internal Mammary Nodal Area by Conventional, 3DCRT, and IMRT Technique in Carcinoma of Breast

Hb¹,

Thimmaiah²,

Ia³

et al. 2017

J Nucl Med Radiat Ther

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Purpose: To quantify the incidental radiation dose delivered to axilla and internal mammary nodal (IMN) area by Conventional Tangential Radiation Therapy (CRT), 3 Dimensional Conformal Radiation Therapy (3DCRT) and Intensity Modulated Radiation Therapy (IMRT). Methods and Materials:We prospectively evaluated incidental radiation to axilla in twenty cases of breast cancer treated with adjuvant radiation therapy. Three plans were generated for each case, comprising CRT, 3DCRT and IMRT tangents. Radiation doses to axillary levels I, II, III, and IMN areas were evaluated for mean dose, V95, V80 and V50. Comparisons were made using ANOVA. Results:The mean volume and range of the axillary level I, II, III, and IMN were 61.1 cc and 142-57 cc; 42.6 cc and 61-21cc; 19.5 cc and 34-15 cc; 13.2 cc and 21-9 cc respectively. The mean dose to axilla by 3 techniques (by IMRT, 3DCRT and CRT) to Level I, II, III, and IMN were 75%, 53%, 38%, and 61% vs. 81%, 64%, 44% and 77% vs. 92%, 86%, 53% and 92% respectively (p<0.05). The V95 values (volume receiving 95% of dose) for the three techniques were 43%, 39%, 17% and 49% by IMRT: 40%, 45%, 21% and 59% by 3DCRT; 72%, 61%, 24% and 65% by CRT (IMRT vs. 3DCRT for level II axilla, IMRT vs. CRT and 3DCRT vs. CRT-p<0.05) The V80 were 49%, 53%, 29%, and 57% by IMRT; 55%, 47%, 34% and 68% by 3DCRT; 85%, 77%, 44% and 69% by CT (IMRT vs. 3DCRT for level III axilla and IMN, IMRT vs. CRT and 3DCRT vs. CRT -p<0.05). The V50 values were 75%, 65%, 41% and 66% by IMRT; 82%, 53%, 57% and 84% by 3DCRT; 94%, 89%, 42% and 90% by CRT (IMRT vs. 3DCRT, IMRT vs. CRT, and 3DCRT vs. CRP-p<0.05). Conclusion:Axillary and internal mammary nodal areas receive substantial amount of incidental radiation doses with all the three techniques; however, conformal techniques (IMRT, 3DCRT) deliver significantly lesser incidental radiation to lower axilla than CRT technique.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Incidental Radiation Dose to Axilla and Internal Mammary Nodal Area by Conventional, 3DCRT, and IMRT Technique in Carcinoma of Breast

Hb¹,

Thimmaiah²,

Ia³

et al. 2017

J Nucl Med Radiat Ther

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“…These techniques have been evaluated and demonstrated dosimetric advantages in many studies. [4][5][6] However, to our knowledge, presence of acute lung injury in breast cancer irradiation using HT has been investigated prospectively in very few studies, [7] although many studies [8][9][10][11][12][13][14] including different RT techniques have shown changes in pulmonary functions after breast and mostly lung cancer irradiation. The purpose of this prospective study was to investigate acute pulmonary changes that could be caused radiotherapy using pulmonary function tests (PFTs) in breast cancer patients treated with HT.…”

Section: Evaluation Of Radiation Dosesmentioning

confidence: 99%

Evaluation of Pulmonary Function After Radiotherapy Using Helical Tomotherapy for Breast Cancer Treatment: Prospective Study

Teke¹

2016

TJ Oncol

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“…Numerous other methods exist to treat these cases including electronic compensation,1, 2 where the MLCs are moved dynamically according to the tissue separation at each location. Some research3, 4, 5 has suggested that inversely optimized techniques, such as Volumetric Modulated Arc Therapy (VMAT), may improve coverage while reducing organ at risk (OAR) doses in this scenario.…”

Section: Introductionmentioning

confidence: 99%

“…This low‐dose bath to healthy organs has been associated with increased risk of secondary malignancies11, 12 and adverse cardiac events 13. A VMAT technique has been proposed that reduces this issue by using tangential VMAT partial arcs for treatment of the breast only 4, 15. This has been shown to reduce the volume of the patient receiving a low dose while maintaining good target coverage.…”

Section: Introductionmentioning

confidence: 99%

Comparison of semiautomated tangential VMAT with 3DCRT for breast or chest wall and regional nodes

Byrne

Archibald-Heeren

et al. 2018

J Applied Clin Med Phys

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Radiotherapy to the breast after surgery sometimes requires adjoining nodes to be included in the treatment volume. In these cases, the traditional approach has been a complex 3‐Dimensional Conformal Radiotherapy (3DCRT) beam arrangement which can result in significant dose heterogeneity at the beam junctions. A Volumetric Modulated Arc Therapy (VMAT) beam arrangement has previously been proposed for breast cases, where the chest wall/breast is treated with a limited angle (partial arc) tangential VMAT technique (Virén et al. [2015] Radiat Oncol. 10:79). In our study, this approach is extended to breast and chest wall cases with adjoining nodes by adding a separate conventional VMAT arc field specifically limited to the superior nodes. This VMAT method was implemented using a semiautomated approach on 27 patients, and the resultant plan compared to a monoisocentric 3DCRT plan. Plan statistics, Dose‐Volume Histogram (DVH) analysis and Radiation Oncologist (RO) preference were assessed. When compared to the 3DCRT technique, the VMAT planning method was found to result in better target volume coverage, high doses to organs at risk (OAR) were reduced but greater OAR volumes received low doses. Having said that, the volume receiving low doses with this tangential VMAT technique was less than that of other VMAT planning methods described in the literature, and the integral dose was less than the 3DCRT method. The VMAT technique also resulted in more robust junction doses that the 3DCRT method. RO review found that the VMAT technique was preferred in 81% of cases. Specifically, the VMAT plans were preferred in all categories of patients except left chest wall cases where the intermammary nodes were also treated. The VMAT technique described here is a useful addition to the treatment options available for breast/chest wall and nodal patients.

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Optimized Dose Coverage of Regional Lymph Nodes in Breast Cancer: The Role of Intensity-Modulated Radiotherapy

Cited by 89 publications

References 40 publications

Comparison of Incidental Radiation Dose to Axilla and Internal Mammary Nodal Area by Conventional, 3DCRT, and IMRT Technique in Carcinoma of Breast

Comparison of Incidental Radiation Dose to Axilla and Internal Mammary Nodal Area by Conventional, 3DCRT, and IMRT Technique in Carcinoma of Breast

Evaluation of Pulmonary Function After Radiotherapy Using Helical Tomotherapy for Breast Cancer Treatment: Prospective Study

Comparison of semiautomated tangential VMAT with 3DCRT for breast or chest wall and regional nodes

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