The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast radiation

Kong, Feng Ming; Klein, Eric E.; Bradley, Jeffrey D.; Mansur, David B.; Taylor, Marie E.; Pérez, Carlos A.; Myerson, Robert J.; Harms, William B.

doi:10.1016/s0360-3016(02)03741-0

Cited by 99 publications

(81 citation statements)

References 18 publications

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“…It has been proven that regional radiotherapy, an integral part of breast-conserving therapy or mastectomy, can reduce the risk of local-regional recurrence of breast cancer and improve overall survival (1)(2)(3)(4)(5). Conventionally, post-mastectomy regional irradiation is planned using the two-dimensional data of the central axis of the treatment field and the wedged tangential pair treatment beams (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation

2016

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Abstract. The aim of the present study was to investigate volumetric-modulated arc therapy (VMAT) with single arc (1ARC) and dual arc (2ARC), and intensity-modulated radiation therapy (IMRT), and to evaluate the quality and delivery efficiency of post-mastectomy regional irradiation. A total of 24 female patients who required post-mastectomy regional irradiation were enrolled into the current study, and 1ARC, 2ARC and IMRT plans were designed for each individual patient. The quality of these plans was evaluated by calculating the homogeneity index (HI), conformity index (CI) and specific volume dose to the ipsilateral lung, double lungs, contralateral breast, heart and spinal cord. For the delivery efficiency of these plans, the total treatment time (TTT) and the number of monitor units (MUs) were evaluated. The 1ARC and 2ARC VMAT plans exhibited significantly better HIs and CIs than IMRT. For dose-volume histogram analysis, 1ARC and 2ARC VMAT spared a more specific volume dose to the ipsilateral lung, double lungs, contralateral breast, heart and spinal cord than IMRT (P<0.05). A lower MU per 2.0-Gy fraction was required for 1ARC (539 MU) and 2ARC (608 MU) than for IMRT (1,051 MU). Thus, TTT was correspondingly reduced in 1ARC and 2ARC compared to IMRT (P<0.05). There was no significant dose-volume difference in all the organs at risk (OARs) between the 1ARC and 2ARC plans (P>0.05), and 2ARC VMAT displayed a better HI and CI than 1ARC VMAT (P<0.05). By contrast, 1ARC VMAT was superior to 2ARC VAMT with regard to MU and TTT (P<0.05). The 1ARC and 2ARC VMAT plans demonstrated significantly better dose distribution in a shorter treatment time than IMRT for post-mastectomy regional irradiation, and spared the majority of OARs without compromising target coverage. The results of the present study suggest that 2ARC VMAT may be an alternative to 1ARC in order to obtain a more optimal HI and CI.

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Section: Introductionmentioning

confidence: 99%

Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation

2016

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“…me di al me me tek ni ği ile tan jan si yel tek ni ği kı yas la dık la rı ça lış -ma la rın da, özel lik le te da vi sa ha sın da ki gö ğüs duva rı ka lın lı ğı göz önü ne alın ma dı ğın da me di al me me tek ni ğin de yük sek doz alan ak ci ğer hac minin an lam lı de re ce de azal dı ğı nı kay det miş ler dir. 18 Oy sa BT baz lı üç bo yut lu plan la ma sis te min de ak ci ğer doz ha cim his tog ram la rı, iki bo yut lu tanjan si yel alan tek ni ğin den an lam lı fark lı bu lun mamış tır. Bu ça lış ma da 30-40 Gy alan ak ci ğer ha cim yüz de si tan jan si yel alan tek ni ği ne kı yas la sa de ce me di al me me tek ni ğin de an lam lı de re ce de da ha dü şük bu lun muş tur.…”

Section: Tar Tiş Maunclassified

“…Bu ça lış ma da 30-40 Gy alan ak ci ğer ha cim yüz de si tan jan si yel alan tek ni ği ne kı yas la sa de ce me di al me me tek ni ğin de an lam lı de re ce de da ha dü şük bu lun muş tur. 18 Bi zim ça lış ma mız da kon vansi yo nel 2D plan la ma sın da he sap la nan mak si mum ak ci ğer do zu 42.4 Gy iken, 3D plan la ma da 54.6 Gy ola rak bu lun muş tur (p=0.000).…”

Section: Tar Tiş Maunclassified

Evaluation of Conventional Radiotherapy and Conformal Radiotherapy Technique in Terms of Dose Distribution Following Breast Conserving Therapy

Mayadağlı¹,

Gocen²,

Aksu³

et al. 2011

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : "Meme kanseri'' kadınlarda görülen en sık malign tümör çeşidi olup kansere bağlı ölüm nedenleri arasında ikinci sırada yer almaktadır. Meme kanserinde adjuvan radyoterapinin, lokal kontrolün yanında sağkalımı da artırdığı gösterilmiştir. Meme kanserinde erken tanı ve geliştirilen tedavi modaliteleri ile sağkalımdaki artma sonucu, tedavilere bağlı gelişen yan etki görülme sıklığı da artmıştır. Çalışmamızda meme radyoterapisinde kullanılan konvansiyonel 2 boyutlu radyoterapi (2DRT) ile 3 boyutlu konformal radyoterapi (3DRT) planlama tekniklerinde hedef meme dokusu ve çevre dokularının aldığı dozların karşılaştırılması amaçlanmıştır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Meme koruyucu cerrahi sonrası radyoterapi (RT) için başvuran 21 hastaya 2DRT planlanmıştır. Hastaların 2DRT planlama için simülatör cihazında çizimleri yapılmıştır. Hasta aynı gün bilgisayarlı tomografi (BT) simülatöre alınmıştır. 2DRT için çizilen tedavi alan girişleri ve kontür alınan kesit 3D plan üzerinde de gösterilmiştir. Hedef hacimleri belirlendikten sonra her hasta için iki RT planı yapılmıştır. 2DRT; hacmi ve dozu değiştirilmeden 3DRT'ye çevrilmiştir. B Bu ul lg gu ul la ar r: : Çalışmamızda düşük ve yüksek doz alan meme hacminin 2DRT planlama kolunda daha fazla olduğu, hedef dozu (50 Gy) alan meme hacminin ise 3DRT planlama kolunda standart verilere daha yakın olduğu görülmüştür. 3DRT kolunda hedef doz memeye daha iyi uygulanırken meme dokusundaki doz daha homojen olarak saptanmıştır. 2DRT kolunda meme doz dağılımı en belirgin konturdan alındığından doz dağılımı bu konturda normal iken memenin üst ve alt kısmında doku kalınlığının azalması nedeniyle hedef dozun üstüne toksik dozlara ulaşmaktadır. S So on nu uç ç: : 2DRT planlamada memeye uygun dozu vermek ve toksisiteyi değerlendirmek klinisyenler için zor bir karardır. Bu nedenle mümkün olduğunca meme tedavisinin 3DRT ile planlanması önerilmektedir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Radyoterapi; meme tümörleri; sağkalım oranı A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Breast cancer is the most common cancer type among women and is the second leading cause of cancer-related deaths. Adjuvant radiotherapy has been shown to improve survival as well as local control. Frequency of adverse effects related to treatment has increased as the result of early diagnosis and developing treatment modalities in breast cancer. In our study, we compared the doses received by target breat tissue and neighbouring tissues in conventional 2-dimensional radiotherapy (2DRT) and 3-dimensional conformal radiotherapy (3DRT) planning techniques used in breast radiotherapy. M Ma a--t te er ri ia al l a an nd d M Me et th ho od ds s: : 2DRT was planned for 21 patients who were admitted for radiotherapy (RT) following breast conserving surgery. Drawings were done in simulator device for 2DRT planning. The patient was taken to computed tomography (CT) simulator on the same day. Treatment region entries drawn for 2DRT and the section that ...

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“…The photon:electron ratio was determined historically, mainly to balance the skin dose, the "hot/ cold spots" along the matching plane, with the dose to the lung and heart. (6) This technique provided reasonable dose coverage to the target with a reduction of percentage volumes of the lung and heart receiving a high dose (>20 Gy). (6) However, there are two caveats in this technique: (1) a remarkably large volume of lung and heart received low dosage (<10 Gy); and (2) a mismatch of the penumbra between the electron beam of the IMF and the photon beam of the tangential fields introduced a "cold spot" within the IMF irradiated volume and a "hot spot" inside the tangential field irradiated volume.…”

Section: Introductionmentioning

confidence: 99%

“…In many cases, we also used this technique to treat the intact breast for patients with large central lung distance; in such cases, the IMF was essentially a medial breast portal. (6) A combination of electron and photon beams was used for the internal mammary field with the photon:electron ratio of 8:18. The photon beam was matched with narrowed tangential fields with the exact same gantry angle, while the electron beam was angled 5° medially compared with the tangential fields.…”

Section: Introductionmentioning

confidence: 99%

An improved internal mammary irradiation technique in radiation treatment of locally advanced breast cancers

Jin¹,

Klein²,

Kong³

et al. 2005

J. Appl. Clin. Med. Phys.

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The purpose of the present study was to compare a new internal mammary irradiation technique with traditional techniques for locally advanced breast cancers in terms of sparing ipsilateral lung and heart and reducing the "cold" and "hot spots" in breast tissue. The new technique uses wide tangential fields for the first eight fractions of treatment. A medial internal mammary field (IMF) of electrons matched with narrowed tangential fields is used for the remaining fractions. Intensity-modulated radiation therapy (IMRT) by means of segmented multileaf collimation (SMLC) is used in the narrowed tangential fields to improve the match between the electron and the photon fields. Treatment planning was performed to compare this technique to a wide-tangential-only technique and to a traditional oblique IMF technique for three patients with differing habitus. Film dosimetry was performed in a solid water phantom to confirm the planning results. For all three patients, the mean doses of the ipsilateral lung and the heart were significantly reduced with the new technique. The lung and the heart volumes were remarkably reduced at lowdose levels (≤12 Gy) compared to the traditional IMF technique, and significantly reduced at all dose levels compared to the wide tangential technique. The new technique also reduced the "cold" and "hot spots" along the match plane between the IMF and the tangential fields compared to the traditional IMF technique. In conclusion, the new IMF technique shows dosimetric improvement compared to the traditional IMF technique in terms of the critical organ sparing and target dose uniformity.PACS number: 87.53.Tf

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The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast radiation

Cited by 99 publications

References 18 publications

Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation

Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation

Evaluation of Conventional Radiotherapy and Conformal Radiotherapy Technique in Terms of Dose Distribution Following Breast Conserving Therapy

An improved internal mammary irradiation technique in radiation treatment of locally advanced breast cancers

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