The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity

Moody, A.M.; Mayles, W. P. M.; Bliss, J; A’Hern, Roger; Owen, John R.; Regan, John D.; Broad, B.; Yarnold, John

doi:10.1016/0958-3947(94)01443-r

Cited by 38 publications

(46 citation statements)

References 16 publications

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“…Relevant portions of the irradiated breast may receive doses exceeding 105% or even 110% of the reference dose (V 105% and V 110% ), which may negatively impact acute side effects and long-term cosmetic outcome [4,8,11,20,21]. Women with larger breast sizes are reported to have worse cosmetic outcome due to an inferior dose distribution [13,19]. Dose inhomogeneity occurs particularly at the level of the inframammary fold and other areas of the breast where substantial deviation from the tangential geometry such as scarce, retraction and dose build-up effect is found [2,17].…”

Section: Discussionmentioning

confidence: 99%

“…The most important determinant of dose distribution in WBI is breast size [19] with moist desquamations being more frequent in full-breasted women [20]. An inhomogeneous dose distribution in wedged tangential fields predominantly occurs at the most cranial and caudal parts of the breast resulting in hot spots with increased risk of adverse effects and inferior cosmetic outcome [26].…”

Section: Introductionmentioning

confidence: 99%

“…Beyond homogeneity of dose distribution several confounding factors exist, e.g., neoadjuvant or adjuvant systemic therapy including antihormonal therapy, and variations in intrinsic radiosensitivity [25]. Both, quality of life and psychological distress are related to patients' ratings of cosmetic outcome [9,22,24].The most important determinant of dose distribution in WBI is breast size [19] with moist desquamations being more frequent in full-breasted women [20]. An inhomogeneous dose distribution in wedged tangential fields predominantly occurs at the most cranial and caudal parts of the breast resulting in hot spots with increased risk of adverse effects and inferior cosmetic outcome [26].…”

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Partial-Volume Segmentation for Dose Optimization in Whole-Breast Radiotherapy

et al. 2009

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Purpose: To analyze the dosimetric and clinical benefit of a forward planned technique to optimize dose distribution in whole-breast irradation (WBI) using additional partial-volume segments (PVSeg). Patients and Methods: In two separate treatment periods, 265 breast cancer patients received tangential-field WBI and were retrospectively analyzed. Between 02/2004 and 03/2006, 96 patients were treated with one to two additional low-weighted PVSeg to reduce dose peaks within the target volume. 169 patients treated between 01/2000 and 12/2001 before implementation of this PVSeg technique served as comparison group. Total dose was 50-50.4 Gy (single dose, 1.8-2 Gy). The planning target volume (PTV) receiving at least 95%, 105% and 110% of the reference dose (V 95-110% ) and frequency of moist skin desquamation during radiotherapy were compared uni-and multivariately with patient-and treatment-related variables. Results: The mean PTV was 1,144 ml (range, 235-2,365 ml). Moist skin desquamations developed in 16 patients (17%) with PVSeg compared to 30 patients (18%) without PVSeg (p = 0.482). In breast volumes > 1,100 ml, the corresponding figures were 19% versus 29% (p = 0.133). V 105% was significantly reduced by the use of PVSeg (82 ± 51 ml vs. 143 ± 129 ml; p < 0.0001). In univariate analysis, the following variables had significant influence on the development of moist skin desquamation: V 95% (p < 0.0001), V 105% (p < 0.001), V 110% (p = 0.012) adjuvant chemotherapy (p = 0.02), and single dose (p = 0.009). In multivariate analysis, only V 95% (p = 0.002) remained significant. Conclusion: The use of PVSeg in WBI reduced dose peaks within the PTV while breast volumes > 1,100 ml benefited most. V 95% was strongly correlated to the risk of developing moist skin desquamations. Partialvolumensegmentierung zurOptimierung der Dosisverteilung bei Ganzbrustbestrahlung. Eine vergleichende dosimetrische und klinische Analyse Ziel: Untersuchung des Nutzens einer einfachen vorwärts geplanten Bestrahlungstechnik mit Partialvolumensegmenten (PVSeg) bei der Ganzbrustbestrahlung. Patienten und Methodik: Es wurden 265 Brustkrebspatientinnen aus zwei Behandlungszeiträumen analysiert, die nach brusterhaltender Therapie eine Ganzbrustbestrahlung mit tangentialen Feldern erhielten. Von 02/2004 bis 03/2006 erhielten 96 Patientinnen ein bis zwei zusätzliche, niedriggewichtete PVSeg zur Reduzierung von Dosisspitzen im Zielvolumen. Als Vergleich dienten 169 Patientinnen im Zeitraum von 01/2000 bis 12/2001 vor Einführung der PVSeg-Technik. Die Gesamtdosis betrug 50-50,4 Gy (Einzeldosis: 1,8-2 Gy). Das Planungszielvolumen (PTV), welches mindestens 95%, 105% und 110% der Referenzdosis (V 95-110% ) erhielt, und die Häufigkeit feuchter Epitheliolysen während der Bestrahlung wurden mittels uni-und multivariater Analyse mit Patienten-und Behandlungsparametern verglichen. Ergebnisse: Das mittlere PTV betrug 1 144 ml (Streubreite: 235-2 365 ml). Feuchte Epitheliolysen traten bei 16 Patientinnen (17%) mit PVSeg versus 30 Patientinnen (18%) ohne PVSeg ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Partial-Volume Segmentation for Dose Optimization in Whole-Breast Radiotherapy

et al. 2009

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“…However, the ICRU recommendations [13] are frequently violated, if the full three-dimensional (3-D) dose distribution is analyzed [1]. Overdosages occur mainly in the lower anatomic quadrants of the breast and may lead to adverse cosmetic outcome [10,18,27]. The need for improved dose distributions was discussed in review articles [20,30].…”

Section: Introductionmentioning

confidence: 99%

Automatic Generation of a Plan Optimization Volume for Tangential Field Breast Cancer Radiation Therapy

Vaerenbergh

Gersem²,

Vakaet³

et al. 2005

Strahlenther Onkol

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“…Nach den aktuellen Daten der Early Breast Cancer Trialists' Collaborative Group muss jedoch vermutet werden, dass eine Verbesserung des rezidivfreien Überlebens durch Strahlentherapie bei brusterhaltender Therapie durch eine Erhöhung der nicht tumorbedingten Mortalität bei Langzeitüberlebenden vor allem mit linksseitigem Mammakarzinom erkauft zu sein scheint [7]. Darüber hinaus können Dosisinhomogenitäten von 15-20% auftreten, die insbesondere bei großen Brüsten zu Einbußen hinsichtlich des kosmetischen Ergebnisses führen können [10,16,21]. Bei großen Brüs-ten lässt sich mittels konventioneller 3-D-Planung bei Verwendung tangentialer Felder die Dosishomogenität nicht wesentlich steigern [19].…”

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Virtueller Bolus zur inversen Bestrahlungsplanung bei intensitätsmodulierter Radiotherapie des Mammakarzinoms im Rahmen der adjuvanten Therapie

Thilmann

Grosser

Rhein

et al. 2002

Strahlentherapie und Onkologie

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The realization of inverse optimization for IMRT of the breast requires the use of a virtual bolus. Thereby, IMRT in accordance to the consensus recommendations of the EORTC, BCCG and EUSOMA is possible. Especially, the same target definition as in conventional technique may be used. IMRT techniques with a conventional beam arrangement of two tangential fields or multiple beam techniques can be realized.

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The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity

Cited by 38 publications

References 16 publications

Partial-Volume Segmentation for Dose Optimization in Whole-Breast Radiotherapy

Partial-Volume Segmentation for Dose Optimization in Whole-Breast Radiotherapy

Automatic Generation of a Plan Optimization Volume for Tangential Field Breast Cancer Radiation Therapy

Virtueller Bolus zur inversen Bestrahlungsplanung bei intensitätsmodulierter Radiotherapie des Mammakarzinoms im Rahmen der adjuvanten Therapie

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