The evaluation of lung doses for radiation pneumonia risk in stereotactic body radiotherapy: A comparison of intensity modulated radiotherapy, intensity modulated arc therapy, cyberknife and helical tomotherapy

Okutan, Murat; Franko, A.; Koksal, Canan; Göksel, Evren Ozan; Karaman, Serap; Akpınar, Yunus Emre; Dağoğlu, Nergis; Demir, Bayram

doi:10.52547/ijrr.18.4.633

Cited by 2 publications

(2 citation statements)

References 16 publications

(28 reference statements)

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“…The V20 is an important metric for IL in breast radiotherapy. Ipsilateral lung volume receiving ≥ 20 Gy (V20) is a predictor of radiation pneumonitis risk, therefore it is aimed to reduce the volume receiving 20 Gy [ 25 – 27 ]. When compared with HT, HTp significantly reduced V20 for IL, while on the contrary VMATp was found to have significantly increased it.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines

et al. 2022

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Background The ESTRO-ACROP Consensus Guideline (EACG) recommends implant excluded clinical target volume (CTVp) definitions for post-mastectomy radiation therapy after implant-based immediate breast reconstruction (IBR). The purpose of this study is to investigate the effectiveness of Helical Tomotherapy (HTp) and Volumetric Modulated Arc Therapy (VMATp) treatment techniques in terms of CTVp coverage and reduced organ at risk (OAR), normal tissue and implant doses when CTVp was used for treatment planning as the target structure instead of conventional CTV. Methods Eight left-sided and eight right-sided breast cancer patients who underwent IBR after mastectomy were included in this study. Planning CT data sets were acquired during free breathing and patients were treated with HT technique targeted to conventional CTV. Retrospectively, CTVp was delineated based on EACG by the same radiation oncologist, and treatment plans with HTp and VMATp techniques were generated based on CTVp. For each patient, relevant dosimetric parameters were obtained from three different treatment plans. Results There was no statistically significant difference on target coverage in terms of, PTVp-D95, PTVp-Vpres, homogeneity index (p > 0.05) between HTp and VMATp plans. But, the conformity numbers were significantly higher (HTp vs VMATp, 0.69 ± 0.15 vs 0.79 ± 0.12) for VMATp (Z = − 2.17, p = 0.030). While HTp significantly lowered Dmax and Dmean for LAD (LAD-Dmax: χ2 = 12.25, p = 0.002 and LAD-Dmean: χ2 = 12.30, p = 0.002), neither HTp nor VMATp could reduce maximum and mean dose to heart (p > 0.05). Furthermore, heart volume receiving 5 Gy was significantly higher for VMATp when compared to HTp (21.2 ± 9.8 vs 42.7 ± 24.8, p: 0.004). Both techniques succeeded in reducing the mean dose to implant (HTp vs HT, p < 0.001; VMATp vs HT, p < 0.001; VMATp vs HTp, p = 0.005). Conclusion Both HTp and VMATp techniques succeeded to obtain conformal and homogeneous dose distributions within CTVp while reducing the mean implant dose. HTp was found to be superior to VMATp with regards to lowering all OAR doses except for CB.

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Section: Discussionmentioning

confidence: 99%

Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines

et al. 2022

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“…It was also reported in many studies that irradiated heart and lung volumes and doses are associated with long-term morbidity and mortality (4)(5)(6)(7)(8) . It has also been reported that mean lung doses in breast cancer RT are associated with radiation pneumonia (9)(10)(11) . Studies conducted on US SEER cancer registries in patients who were irradiated for breast cancer from 1970 to early 1980 by the standard RT regimens at the time reported that deaths from heart disease and lung cancer were appreciably increased 10 to 20 years afterwards (4,5) .…”

Section: Introductionmentioning

confidence: 96%

Investigation of cardiac and pulmonary doses in patients with left sided breast cancer treated by radiotherapy with deep inspiration breath hold technique

Parlar

Var²,

Cosar³

et al. 2022

Int J Radiat Res

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Background: Cardiac disease is a documented risk factor in left breast irradiation. In an attempt to reduce cardiac toxicity, different treatment techniques adapted to respiratory cycle phases have been developed. The aim of this study is to investigate the feasibility of the voluntary breath hold technique when irradiating the left breast in selected patients. Materials and Methods: The study included 20 patients with left sided breast cancer. For each patient, two computed tomography (CT) scans were acquired, one with the free breathing (FB) technique and one with the voluntary deep inspiration breath hold (DIBH) technique. Treatment plans were created using a fieldin-field intensity-modulated radiation therapy technique. A dosimetric comparison was made between the two techniques for the heart, left anterior descending (LAD) coronary artery, ipsilateral lung and contralateral breast. Results: The average of the mean dose of the heart decreased from 7.7 Gy to 5.8 Gy and V 20Gy (%) from 12.8% to 8.3% using the DIBH technique (p=0.009, p<0.001). The DIBH technique demonstrated significantly smaller maximum heart distance (2.0 cm vs. 0.9 cm, p < 0.001) and 8.0% reduction in LAD mean dose. Furthermore, D mean for the ipsilateral lung was reduced from 12.8 Gy to 12.2 Gy and V 20Gy (%) from 25.6% to 22.8%. Conclusions: In the treatment plans made using the DIBH technique, a significant reduction in the radiation dose delivered to the heart has been observed. In order to reduce long-term morbidity and mortality risks from cardiovascular disease affecting the survival of patients with left sided breast cancer, irradiation techniques such as the DIBH should be considered, especially for premenopausal patients.

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The evaluation of lung doses for radiation pneumonia risk in stereotactic body radiotherapy: A comparison of intensity modulated radiotherapy, intensity modulated arc therapy, cyberknife and helical tomotherapy

Cited by 2 publications

References 16 publications

Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines

Dosimetric evaluation of VMAT and helical tomotherapy techniques comparing conventional volumes with clinical target volumes based on new ESTRO ACROP post-mastectomy with immediate implant reconstruction contouring guidelines

Investigation of cardiac and pulmonary doses in patients with left sided breast cancer treated by radiotherapy with deep inspiration breath hold technique

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