Postoperative radiotherapy following mastectomy for patients with left-sided breast cancer: A comparative dosimetric study

Wang, Jiahao; Li, Xiadong; Deng, Qinghua; Xia, Bing; Wu, Shixiu; Liu, Jian; Ma, Shenglin

doi:10.1016/j.meddos.2014.11.004

Cited by 28 publications

(44 citation statements)

References 17 publications

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“…However, according to literature and our previous experience, tangential PMRT could introduce large dose heterogeneities in the PTV and can induce suboptimal cosmesis after treatment. In addition, tangential PMRT would introduce higher heart dose and slightly lower lung dose than bolus electron conformal therapy without mixing with IMRT, and would introduce higher lung, heart, and coronary artery doses than VMAT …”

Section: Discussionmentioning

confidence: 99%

“…In addition, tangential PMRT would introduce higher heart dose and slightly lower lung dose than bolus electron conformal therapy without mixing with IMRT, 14 and would introduce higher lung, heart, and coronary artery doses than VMAT. 51 Potential future work for this study could be adding intensity modulated electron therapy (IMET) 16 for the chest wall into the study. This technique could potentially reduce dose spread and the magnitude of hot spots and reduce skin complications, which could remove the need for the VMAT component of our mixed beam.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of a mixed beam therapy for postmastectomy breast cancer patients: Bolus electron conformal therapy combined with intensity modulated photon radiotherapy and volumetric modulated photon arc therapy

et al. 2018

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This work has demonstrated that mixed beam therapy (BECT + IMRT:VMAT = 4:1) produces clinically acceptable plans having reduced OAR doses and risks of side effects compared with VMAT. Even though VMAT alone produces more homogenous and conformal dose distributions, mixed beam therapy remains as a viable option for treating postmastectomy patients, possibly leading to reduced normal tissue complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of a mixed beam therapy for postmastectomy breast cancer patients: Bolus electron conformal therapy combined with intensity modulated photon radiotherapy and volumetric modulated photon arc therapy

et al. 2018

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“…However, this value did not yield good agreement between measurements and TPS calculations for both 6 and 18 MV photon beams; Trombetta et al20 assigned the density of the metallic port in the Eclipse TPS to be 5 g/cm 3 which is the highest available value in the system. Except for one abstract19 in which the details and accuracy of the model were not provided, none of the previous studies created and validated a model of the metallic port with generic dimensions and density that can be applied to different beam energies, neither did they investigate the impact of the metallic port on any advanced techniques like intensity‐modulated radiotherapy (IMRT) or volumetric‐modulated arc therapy (VMAT), while these techniques have been used to treat postmastectomy patients 26…”

Section: Introductionmentioning

confidence: 99%

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Yoon

Xie

Heins

et al. 2018

J Applied Clin Med Phys

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The purpose of this study was to model the metallic port in breast tissue expanders and to improve the accuracy of dose calculations in a commercial photon treatment planning system (TPS). The density of the model was determined by comparing TPS calculations and ion chamber (IC) measurements. The model was further validated and compared with two widely used clinical models by using a simplified anthropomorphic phantom and thermoluminescent dosimeters (TLD) measurements. Dose perturbations and target coverage for a single postmastectomy radiotherapy (PMRT) patient were also evaluated. The dimensions of the metallic port model were determined to be 1.75 cm in diameter and 5 mm in thickness. The density of the port was adjusted to be 7.5 g/cm3 which minimized the differences between IC measurements and TPS calculations. Using the simplified anthropomorphic phantom, we found the TPS calculated point doses based on the new model were in agreement with TLD measurements within 5.0% and were more accurate than doses calculated based on the clinical models. Based on the photon treatment plans for a real patient, we found that the metallic port has a negligible dosimetric impact on chest wall, while the port introduced significant dose shadow in skin area. The current clinical port models either overestimate or underestimate the attenuation from the metallic port, and the dose perturbation depends on the plan and the model in a complex way. TPS calculations based on our model of the metallic port showed good agreement with measurements for all cases. This new model could improve the accuracy of dose calculations for PMRT patients who have temporary tissue expanders implanted during radiotherapy and could potentially reduce the risk of complications after the treatment.

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“…for patients with advanced disease, supraclavicular and axillary nodes are treated with additional photon fields. [2] In the past decades, many advanced technologies had been used for PMRT and shown promising results, such as intensity-modulated radiation therapy (IMRT), [3] standard volumetric modulated arc therapy (STD-VMAT), [4] non-coplanar VMAT (NC-VMAT), [5] multiple arc VMAT (MA-VMAT), [5] Tomotherapy (TOMO), [4] bolus electron conformal therapy (BECT), [6] BECT mixed with IMRT and VMAT (MIXED), [7] and proton therapy , [8] each with different degrees of sophistication and cost. Target coverage provided by most of these technologies is comparable, while the dose to surrounding normal tissues varies greatly.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Advanced Radiotherapy Techniques for Post-Mastectomy Breast Cancer Patients

Xie

Guo

Zhang

2020

Preprint

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Background: Prior cost-effectiveness studies of post-mastectomy radiotherapy (PMRT) only compared conventional radiotherapy versus no radiotherapy and only considered tumor control. The goal of this study was to perform cost-effectiveness analyses of standard of care (SOC) and advanced PMRT techniques including intensity-modulated radiotherapy (IMRT), standard volumetric modulated arc therapy (STD-VMAT), non-coplanar VMAT (NC-VMAT), multiple arc VMAT (MA-VMAT), Tomotherapy (TOMO), mixed beam therapy (MIXED), and intensity-modulated proton therapy (IMPT).Methods: Using a Markov model, we estimated the cost-effectiveness of various techniques over 15 years. A cohort of women (55-year-old) was simulated in the model, and radiogenic side effects were considered. Transition probabilities, utilities, and costs for each health state were obtained from literature and Medicare data. Model outcomes include quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER), and SOC was used as the reference.Results: For the patient cohort, IMRT is the most cost-effective technique with an ICER value of 27,310 $/QALY, and IMPT has the highest ICER of 74,564 $/QALY. One-way analysis shows that the probability of cardiac toxicity has the most significant impact on the model outcomes. The probability sensitivity analyses show that all advanced PMRT techniques are more cost-effective than SOC at a willingness-to-pay (WTP) threshold of 100,000 $/QALY, while almost none of the advanced techniques is more cost-effective than SOC at a WTP threshold of $50,000/QALY.Conclusion: Advanced PMRT techniques are more cost-effective for breast cancer patients at a WTP threshold of 100,000 $/QALY, and IMRT might be the most cost-effective option for PMRT patients.

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Postoperative radiotherapy following mastectomy for patients with left-sided breast cancer: A comparative dosimetric study

Cited by 28 publications

References 17 publications

Evaluation of a mixed beam therapy for postmastectomy breast cancer patients: Bolus electron conformal therapy combined with intensity modulated photon radiotherapy and volumetric modulated photon arc therapy

Evaluation of a mixed beam therapy for postmastectomy breast cancer patients: Bolus electron conformal therapy combined with intensity modulated photon radiotherapy and volumetric modulated photon arc therapy

Modeling of the metallic port in breast tissue expanders for photon radiotherapy

Cost-Effectiveness Analysis of Advanced Radiotherapy Techniques for Post-Mastectomy Breast Cancer Patients

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