Using Robust Optimization for Skin Flashing in Intensity Modulated Radiation Therapy for Breast Cancer Treatment: A Feasibility Study

Liang, Xiaoying; Bradley, Julie A.; Vega, R. Mailhot; Rutenberg, M.S.; Zheng, Dandan; Getman, Nataliya; Norton, Kelly W.; Mendenhall, Nancy P.; Li, Zuofeng

doi:10.1016/j.prro.2019.09.017

Cited by 10 publications

(24 citation statements)

References 26 publications

(26 reference statements)

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“…In clinical photon treatment planning, additional postprocessing methods to improve the robustness of photon plans are commonly used. This includes extending the fluence of tangential IMRT fields into the air beyond the beams-eye-view projection of the breast surface, also known as skin flash [30]. Although not done here, the same method could be applied to the IMRT fields in a CPPT plan.…”

Section: Discussionmentioning

confidence: 99%

Combined proton–photon treatment for breast cancer

et al. 2021

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Objective. Proton therapy remains a limited resource due to gantry size and its cost. Recently, a new design without a gantry has been suggested. It may enable combined proton–photon therapy (CPPT) in conventional bunkers and allow the widespread use of protons. In this work, we explore this concept for breast cancer. Methods. The treatment room consists of a LINAC for intensity modulated radiation therapy (IMRT), a fixed proton beamline (FBL) with beam scanning and a motorized couch for treatments in lying positions with accurate patient setup. Thereby, proton and photon beams are delivered in the same fraction. Treatment planning is performed by simultaneously optimizing IMRT and IMPT plans based on the cumulative dose. The concept is investigated for three breast cancers where the goal is to minimize mean dose to the heart and lung while delivering 40.05 Gy in 15 fractions to the PTV with a SIB of 48 Gy to the tumor bed. The probabilistic approach is applied to mitigate the sensitivity to range uncertainties. Results. CPPT is particularly advantageous for irradiating concave target volumes that wrap around a curved chest wall. There, protons may deliver dose to the peripheral and medial parts of the target volume including lymph nodes. Thereby, the mean dose in normal tissues is reduced compared to single-modality IMRT. However, tangential photon beams may treat parts of the target volume near the interface to the lung. To ensure target coverage for range undershoot in an IMPT plan, proton beams have to deliberately overshoot into the lung tissue—a problem that can be mitigated via the photon component which ensures plan conformity and robustness. Conclusion. CPPT using an FBL may represent a realistic approach to make protons available to more patients. In addition, CPPT may generally improve treatment quality compared to both single-modality proton and photon treatments.

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Section: Discussionmentioning

confidence: 99%

Combined proton–photon treatment for breast cancer

et al. 2021

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“…VMAT was not used in this study because the patients were treated free‐breathing and respiratory motion would add substantial uncertainty. Such uncertainty also affects IMRT delivery, 10 but the addition of flash to tangential fields can provide some mitigation 11 . Flash was added by manually extending the fluence maps with the Eclipse skin flash tool.…”

Section: Methodsmentioning

confidence: 99%

An IMRT planning technique for treating whole breast or chest wall with regional lymph nodes on Halcyon and Ethos

Rayn,

Clark,

Hoxha

et al. 2024

J Applied Clin Med Phys

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Purpose/ObjectiveField size limitations on Halcyon and Ethos treatment machines largely preclude use of the conventional monoisocentric three‐field technique for breast/chest wall and regional lymph nodes. We present an alternative, IMRT‐based planning approach that facilitates treatment on Halcyon and Ethos while preserving plan quality.Materials/MethodsEight breast and regional node cases (four left‐sided, four right‐sided) were planned for an Ethos machine using a 15–17 field IMRT technique. Institutional plan quality metrics for CTV and PTV coverage and OAR sparing were assessed. Five plans (four right‐sided, one left‐sided) were also planned using a hybrid 3D multisocenter technique. CTV coverage and OAR sparing were compared to the IMRT plans. Eclipse scripting tools were developed to aid in beam placement and plan evaluation through a set of dosimetric scorecards, and both are shared publicly.ResultsOn average, the IMRT plans achieved breast CTV and PTV coverage at 50 Gy of 97.9% and 95.7%, respectively. Supraclavicular CTV and PTV coverages at 45 Gy were 100% and 95.5%. Axillary lymph node CTV and PTV coverages at 45 Gy were 100% and 97.1%, and IMN CTV coverage at 45 Gy was 99.2%. Mean ipsilateral lung V20 Gy was 19.3%, and average mean heart dose was 1.6 Gy for right‐sided cases and 3.0 Gy for left‐sided. In comparison to the hybrid 3D plans, IMRT plans achieved higher breast and supraclavicular CTV coverage (99.9% vs. 98.6% and 99.9% vs. 93.4%), higher IMN coverage (99.6% vs. 78.2%), and lower ipsilateral lung V20 Gy (19.6% vs. 28.2%).ConclusionInstitutional plan quality benchmarks were achieved for all eight cases using the IMRT‐based planning approach. The IMRT‐based planning approach offered superior conformity and OAR sparing than a competing hybrid 3D approach.

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“…7 Other studies have also reported benefits for head-and-neck cancer, which might be subject to important anatomical changes over the treatment course. 7 Therefore, it is now time to let our old PTV take a welldeserved retirement and move forward to robust planning.…”

Section: Opening Statementmentioning

confidence: 99%

“…For lung tumor treatment, RO plans have shown to yield better internal target volume (ITV) dose coverage, better conformity index, better OARs sparing and lower variations in mean dose to the ITV, compared with traditional ITV‐to‐PTV margin‐based plans 6 . For breast cancer, comparisons with standard skin‐flashing methods showed that RO was the only one able to meet acceptable criteria in terms of CTV coverage with the 95% isodose or maximum dose to the CTV, in both the nominal plan and when simulating geometry error scenarios 7 . Other studies have also reported benefits for head‐and‐neck cancer, which might be subject to important anatomical changes over the treatment course 7 …”

Section: For the Proposition: Marie‐claude Bistonmentioning

confidence: 99%

“…For breast cancer, comparisons with standard skin‐flashing methods showed that RO was the only one able to meet acceptable criteria in terms of CTV coverage with the 95% isodose or maximum dose to the CTV, in both the nominal plan and when simulating geometry error scenarios 7 . Other studies have also reported benefits for head‐and‐neck cancer, which might be subject to important anatomical changes over the treatment course 7 …”

Section: For the Proposition: Marie‐claude Bistonmentioning

confidence: 99%

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