Simultaneous irradiation of the breast and regional lymph nodes in prone position using helical tomotherapy

Kainz, K.; White, Julia; Chen, GP; Hermand, J; England, Mark; Li, XA

doi:10.1259/bjr/18685881

Cited by 11 publications

(13 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Kainz et al [ 19 ] performed a feasibility trial comparing WB + LNI in prone position to previously reported supine tomotherapy plans. In left sided breast cancer, they showed lower heart and contralateral breast doses using the prone position.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

et al. 2017

View full text Add to dashboard Cite

BackgroundProne whole breast irradiation (WBI) leads to reduced heart and lung doses in breast cancer patients receiving adjuvant radiotherapy. In this feasibility trial, we investigated the prone position for whole breast + lymph node irradiation (WB + LNI).MethodsA new support device was developed for optimal target coverage, on which patients are positioned in a position resembling a phase from the crawl swimming technique (prone crawl position). Five left sided breast cancer patients were included and simulated in supine and prone position. For each patient, a treatment plan was made in prone and supine position for WB + LNI to the whole axilla and the unoperated part of the axilla. Patients served as their own controls for comparing dosimetry of target volumes and organs at risk (OAR) in prone versus in supine position.ResultsTarget volume coverage differed only slightly between prone and supine position. Doses were significantly reduced (P < 0.05) in prone position for ipsilateral lung (Dmean, D2, V5, V10, V20, V30), contralateral lung (Dmean, D2), contralateral breast (Dmean, D2 and for total axillary WB + LNI also V5), thyroid (Dmean, D2, V5, V10, V20, V30), oesophagus (Dmean and for partial axillary WB + LNI also D2 and V5), skin (D2 and for partial axillary WB + LNI V105 and V107). There were no significant differences for heart and humeral head doses.ConclusionsProne crawl position in WB + LNI allows for good breast and nodal target coverage with better sparing of ipsilateral lung, thyroid, contralateral breast, contralateral lung and oesophagus when compared to supine position. There is no difference in heart and humeral head doses.Trial registrationNo trial registration was performed because there were no therapeutic interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Although some authors report dosimetrical data on regional nodal irradiation in prone position [ 18 , 19 ], this indication has not seen the same shift towards prone irradiation as in WBI, and few data are available for clinical implementation [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

et al. 2017

View full text Add to dashboard Cite

show abstract

“…An air space margin of 2 cm is normally applied in breast tissue [ 11 – 13 ]. However, the PTV contour was defined only inside the breast tissue in TomoTherapy [ 14 , 15 ]. TomoDirect can be used for breast radiation treatment not only because it uses fixed angles, but also because it can include a PTV margin using Flash.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Flash effect in breast irradiation using TomoDirect: an investigational study

Kang

Park

Kim

et al. 2015

Journal of Radiation Research

View full text Add to dashboard Cite

Flash is a specified function in TomoDirect that enables beam expansion by opening additional leaves to the target. This study assessed the theoretical dose distribution resulting from Flash in breast irradiation using TomoDirect. A cylindrical phantom that enabled dose distribution of the breast was used for verifying the effect of planning target volume (PTV) contouring and Flash. A total of 18 Gy in 10 fractions were prescribed to the PTV. Five PTVs were then created by Contracting this contour by 0, 1, 2, 3, 4 and 5 mm, giving PTV-x. Flash ±x is defined by opening x (number) of the leaves. The Flash effect in the air was compared with each set-up error of 5, 10 and 15 mm, respectively. The minimum PTV dose from PTV-1 to PTV-3 increased from 13.88 Gy to 15.86 Gy. In contrast, Dmin in PTV-4 and PTV-5 was 17.80 Gy in 98.88% of the prescription dose. Without Flash, when 5-, 10- and 15-mm set-up errors applied in the PTV, relative doses of 87.88, 23.73 and 7.94% were observed, respectively. However, in Flash 3, which was equal to the usual air margin of 1.875 cm, a relative dose of 104.24% ± 0.30% was observed, irrespective of set-up errors (5 mm to 15 mm). Flash opening is useful for countervailing set-up errors in breast cancer patients who receive breast irradiation with TomoDirect.

show abstract

“…The results of the present study and other analyses 21 – 26 demonstrate that when irradiation of any of the axillary lymph-node levels or the IM lymph nodes is required, special attention should be paid to the doses to these target volumes; in most cases, the conventional tangential fields must be modified to meet the dosimetric need. Although prone radiotherapy is traditionally limited to the operated breast, efforts have been made to extend prone radiotherapy to patients who need irradiation of the axillary and supraclavicular lymph-node regions, through the use of conformal radiotherapy, 30 helical tomotherapy, 31 or intensity-modulated radiation therapy. 32 Therefore, in order to maintain the advantages of prone positioning, the target volume could be extended to the lymph nodes; nevertheless, the feasibility and repositioning accuracy of the method need to be investigated.…”

Section: Discussionmentioning

confidence: 99%

Radiation dose to the nodal regions during prone versus supine breast irradiation

Csenki¹,

Újhidy²,

Cserháti³

et al. 2014

TCRM

View full text Add to dashboard Cite

BackgroundProne positioning for breast radiotherapy is preferable when the aim is a reduction of the dose to the ipsilateral lung or the heart in certain left-sided cases.Materials and methodsIn 100 breast cancer cases awaiting postoperative whole-breast radiotherapy, conformal radiotherapy plans were prospectively generated in both prone and supine positions. The axillary nodal region (levels I–III) and internal mammary (IM) lymph-node region in the upper three intercostal spaces were retrospectively contoured. The mean doses to the nodal regions and the volume receiving 25 Gy (V25Gy), V45Gy, and V47.5Gy were compared between the two treatment positions.ResultsIn most cases, the doses to axillary levels I–III and the IM lymph nodes were inadequate, regardless of the treatment position. The nodal doses were significantly lower in the prone than in the supine position. The radiation doses to levels II–III and IM nodes were especially low. The V45Gy and V47.5Gy of the level I axillary lymph nodes were 54.6% and 40.2%, respectively, in the supine, and 3.0% and 1.7%, respectively, in the prone position. In the supine position, only 17 patients (17%) received a mean dose of 45 Gy to the axillary level I nodes.ConclusionThe radiation dose to the axillary and IM lymph nodes during breast radiotherapy is therapeutically insufficient in most cases, and is significantly lower in the prone position than in the supine position.

show abstract

Simultaneous irradiation of the breast and regional lymph nodes in prone position using helical tomotherapy

Cited by 11 publications

References 27 publications

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

Evaluation of the Flash effect in breast irradiation using TomoDirect: an investigational study

Radiation dose to the nodal regions during prone versus supine breast irradiation

Contact Info

Product

Resources

About