Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study

Maier, Johannes; Knott, Bernadette; Maerz, Manuel; Loeschel, Rainer; Koelbl, Oliver; Dobler, Barbara

doi:10.1186/s13014-016-0687-6

Cited by 13 publications

(16 citation statements)

References 34 publications

(42 reference statements)

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“…The SIB approach was discussed at various levels in [ 19 , 21 , 23 , 25 , 29 , 38 , 47 , 48 , 50 , 63 , 67 , 70 ]. Altered patient positioning and bilateral breast : …”

Section: Resultsmentioning

confidence: 99%

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Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

et al. 2017

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Background: The aim of this review is the critical appraisal of the current use of volumetric modulated arc therapy for the radiation therapy management of breast cancer. Both clinical and treatment planning studies were investigated. Material and methods: A Pubmed/MEDLINE search of the National Library of Medicine was performed to identify VMAT and breast related articles. After a first order rejection of the irrelevant findings, the remaining articles were grouped according to two main categories: clinical vs. planning studies and to some sub-categories (pointing to significant technical features). Main areas of application, dosimetric and clinical findings as well as areas of innovations were defined.

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“…The SIB approach was discussed at various levels in [ 19 , 21 , 23 , 25 , 29 , 38 , 47 , 48 , 50 , 63 , 67 , 70 ]. Altered patient positioning and bilateral breast : …”

Section: Resultsmentioning

confidence: 99%

“…The use of high intensity photon beams was addressed in 6 studies [ 21 , 25 , 40 , 47 , 61 , 62 ] plus the two clinical reports from the Humanitas Cancer Center group [ 11 , 12 ]. The treatment of the whole breast or of the chest wall, as well as the use of conventional or of SIB fractionation schemes were appraised.…”

Section: Resultsmentioning

confidence: 99%

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

et al. 2017

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“…There is no standard technique for SIB in WBI after BCS, because of conflicting results due to different RT techniques, treatment planning systems, and dose constraints for OARs used in these studies. Maier et al (25) have evaluated IMRT, VMAT, and tangential arc VMAC using Monaco treatment planning for right-sided BC patients using SIB technique. The authors found that best target coverage and homogeneity was observed with VMAT, and lowest doses to the contralateral lung and breast were observed with tangential arc VMAT.…”

Section: Discussionmentioning

confidence: 99%

“…Michalski et al (12) have compared HT, IMRT, and 3D-CRT for left-sided breast tumors with SIB technique, and found that HT offered superior target-volume doses and lower doses to ipsilateral lung and heart, compared to 3D-CRT and IMRT. In dosimetric studies with more conformal techniques, VMAT (16,25) and HT (11,12) provide better target-volume coverage and lower lung and heart doses. In the current study comparing VMAT and HT technologies with the SIB technique, we found that HT had better target-volume coverage and provided lower doses to contralateral breast and lung compared to VMAT.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Onal

Efe

Güler

et al. 2019

In Vivo

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Background/Aim: To compare simultaneousintegrated boost (SIB) versus sequential-boost (SB) delivered in the context of whole-breast irradiation (WBI) via volumetricmodulated arc therapy (VMAT) and helical-tomotherapy (HT). Materials and Methods: Planning target-volume (PTV) dosimetric parameters and organs at risk (OAR) were analyzed for SB plan (50 Gy plus 16 Gy boost) and SIB plan (50.4 Gy WBI and 64.4 Gy tumor bed boost) in VMAT and HT techniques. Results: Conformity and homogeneity for targetvolume doses were better in HT plans compared to VMAT plans. There were no significant differences in ipsilateral lung doses between VMAT and HT plans for SB/SIB techniques, except for a significantly higher lung V5 value with VMAT-SB, and lung V13 value with HT-SIB technique. HT provided a statistically significant decrease in contralateral lung mean V5. Conclusion: The SIB technique showed better target-volume dose distribution in both HT and VMAT plans, and better sparing heart in HT compared to the SB technique. Breast cancer (BC) is the most common cancer and is a major cause of cancer-related death in women (1). Currently, adjuvant radiotherapy (RT), especially whole-breast irradiation (WBI) after breast-conserving surgery (BCS), is accepted as standard-of-care for early BC patients as this multimodal treatment increases local control and improves overall survival in early BC (2, 3). Additional tumor-bed boost after WBI has also been shown to reduce local recurrence (4); however, a long-term follow-up study found that inhomogeneous radiation in tumor-bed boosts, and use of photon beam boosts led to poorer cosmetic outcomes in patients (5). Therefore, in the past few decades, a lot of attention has focused on the development of new techniques to achieve a homogeneous dose distribution, better local control, and improve cosmetic outcomes for WBI after BCS. Breast RT techniques range from conventional tangential field RT, field-in-field conformal RT (CRT), intensity modulated RT (IMRT), volumetric arc therapy (VMAT) to helical tomotherapy (6-11). For tumor-bed boost, relatively simple electron or hybrid techniques (i.e., a combination of different techniques for WBI and boosts), have been used. Recent dosimetric studies have demonstrated that multi-field 3D-CRT, IMRT, or VMAT are superior to electron therapy with respect to the target-volume coverage and sparing normal tissues (12-15). Moreover, simultaneous-integrated boost (SIB), which is a technique wherein a boost is delivered to the tumor bed concurrently with WBI, has been reported to be technically and dosimetrically feasible (11-13, 15-17). The rationale underlying the SIB technique is to escalate radiation doses in the area at highest risk without prolonging treatment duration. This dose escalation provides improved patient comfort while shortening the duration of RT, and also exploits the higher sensitivity of breast tumor cells to larger single doses. However, more advanced techniques are required to increase the uniformity of the radiation dose to improve p...

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“…The flatness filter has been described as the main source of photon scatter in the treatment head [11]. Additional peripheral dose resulting from this contribution has been confirmed in some publications referring to other entities [12][13][14][15][16][17][18] and increases the risk for secondary malignancies. Pituitary adenomas represent about 10% of all intracranial tumors [19].…”

Section: Introductionmentioning

confidence: 85%

The influence of radiotherapy techniques on the plan quality and on the risk of secondary tumors in patients with pituitary adenoma

Treutwein¹,

Steger²,

Loeschel

et al. 2020

BMC Cancer

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Background: This planning study compares different radiotherapy techniques for patients with pituitary adenoma, including flatness filter free mode (FFF), concerning plan quality and secondary malignancies for potentially young patients. The flatness filter has been described as main source of photon scatter.Material and methods: Eleven patients with pituitary adenoma were included. An Elekta Synergy™ linac was used in the treatment planning system Oncentra® and for the measurements. 3D plans, IMRT, and VMAT plans and noncoplanar varieties were considered. The plan quality was evaluated regarding homogeneity, conformity, delivery time and dose to the organs at risk. The secondary malignancy risk was calculated from dose volume data and from measured dose to the periphery using different models for carcinoma and sarcoma risk.Results: The homogeneity and conformity were nearly unchanged with and without flattening filter, neither was the delivery time found substantively different. VMAT plans were more homogenous, conformal and faster in delivery than IMRT plans. The secondary cancer risk was reduced with FFF both in the treated region and in the periphery. VMAT plans resulted in a higher secondary brain cancer risk than IMRT plans, but the risk for secondary peripheral cancer was reduced. Secondary sarcoma risk plays a minor role. No advantage was found for non-coplanar techniques. The FFF delivery times were not shortened due to additional monitor units needed and technical limitations. The risk for secondary brain cancer seems to depend on the irradiated volume. Secondary sarcoma risk is much smaller than carcinoma risk in accordance to the results of the atomic bomb survivors. The reduction of the peripheral dose and resulting secondary malignancy risk for FFF is statistically significant. However, it is negligible in comparison to the risk in the treated region.Conclusion: Treatments with FFF can reduce secondary malignancy risk while retaining similar quality as with flattening filter and should be preferred. VMAT plans show the best plan quality combined with lowest peripheral secondary malignancy risk, but highest level of second brain cancer risk. Taking this into account VMAT FFF seems the most advantageous technique for the treatment of pituitary adenomas with the given equipment.

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Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study

Cited by 13 publications

References 34 publications

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

The influence of radiotherapy techniques on the plan quality and on the risk of secondary tumors in patients with pituitary adenoma

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