Whole breast irradiation for small-sized breasts after conserving surgery: is the field-in-field technique optimal?

Yang, Dae Sik; Lee, Jung Ae; Yoon, Won Sup; Chung, Se Young; Lee, Suk; Kim, Chul Yong; Park, Young Je; Son, Gil Soo

doi:10.1007/s12282-012-0365-y

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…Therefore, the difference in lung doses within the used irradiation methods may not have clinical significance. Yang et al (21) compared wedge and FIF IMRT techniques in patients with small-sized breasts. The authors suggested that the conventional FIF method has favorable dose conformity and is an optimal method in patients with breast volume ≤350 cm 3 .…”

Section: Discussionmentioning

confidence: 99%

“…The authors suggested that the conventional FIF method has favorable dose conformity and is an optimal method in patients with breast volume ≤350 cm 3 . Using the conventional FIF method, the authors reported a lung V20% of 14.42±2.61% and a heart V25% of 2.44±1.07% ( 21 ). Although our patients had a mean breast volume of 493±247 cc using the FIF w/ 2RP method, our results indicated a similar value for the lung V20% of 14±5% and a lower value for the heart V20% of 1.6±1.5%.…”

Section: Discussionmentioning

confidence: 99%

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New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

et al. 2021

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The usefulness of the field-in-field with two reference points (FIF w/ 2RP) method, in which the dose reference points are set simultaneously at two positions in the irradiation field and the high-dose range is completely eliminated, was examined in the present study with the aim of decreasing acute skin toxicity in adjuvant breast radiotherapy (RT). A total of 573 patients with breast cancer who underwent postoperative whole breast RT were classified into 178 cases with wedge (W) method, 142 cases with field-in-field without 2 reference points (FIF w/o 2RP) method and 253 cases with FIF w/ 2RP method. Using the FIF w/ 2RP method, the high-dose range was the lowest among the three irradiation methods. The planning target volume (PTV) V105% and the breast PTV for evaluation (BPe) V105% decreased to 0.09 and 0.10%, respectively. The FIF w/ 2RP method vs. the FIF w/o 2RP method had a strong association (η) with PTV V105% (η= 0.79; P<0.001) and BPe V105% (η=0.76; P<0.001). The FIF w/ 2RP method had a significant impact on lowering the skin toxicity grade in weeks 3 and 4, and increasing the occurrence of skin toxicity grade 0. The FIF w/ 2RP method vs. the W method had a moderate association with skin toxicity grade at week 3 (η= 0.49; P<0.001). Using the FIF w/ 2RP method, the high-dose range V105% of the target decreased to 0%, and skin adverse events were decreased in conjunction. For patients with early-stage breast cancer, particularly patients with relatively small-sized breasts, the FIF w/ 2RP method may be an optimal irradiation method.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

et al. 2021

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“…As previously mentioned, breast size grouping could be useful in this context, helping to tailor whole breast irradiation. 19 FIGURE 2. Bull's eye diagrams of the left ventricle and segment models of the coronary arteries with reported median D mean distributions in three-dimensional conformal radiotherapy plans, divided in groups according to clinical target volume size.…”

Section: Discussionmentioning

confidence: 99%

“…9,17,18 If a cohort of breast cancer patients with similar breast volume is defined, specific problems and resolutions can be proposed, because breast contours according to breast size and shape may be associated with the variations in the target volume coverage and calculated dose to organs at risk. 19 Three-dimensional treatment planning allows target volume to be measured and CTVs of ≤ 500-975 cm 3 , 975-1.600 cm 3 and ≥ 1.600 cm 3 have been typically, but not consistently, defined as small, medium and large breasts, respectively. 20,21 Additionally, quite a few clinical studies have reported a comparison of the clinical adverse events in regard to the three groups of breast sizes.…”

Section: Introductionmentioning

confidence: 99%

Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

Ratoša

Jenko

Šljivić

et al. 2020

Radiology and Oncology

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BackgroundThe aim of the study was to quantify planned doses to the heart and specific cardiac substructures in free-breathing adjuvant three-dimensional radiation therapy (3D-CRT) and tangential intensity modulated radiotherapy (t-IMRT) for left-sided node-negative breast cancer, and to assess the differences in planned doses to organs at risk according to patients’ individual anatomy, including breast volume.Patients and methodsIn the study, the whole heart and cardiac substructures were delineated for 60 patients using cardiac atlas. For each patient, 3D-CRT and t-IMRT plans were generated. The prescribed dose was 42.72 Gy in 16 fractions. Patients were divided into groups with small, medium, and large clinical target volume (CTV). Calculated dose distributions were compared amongst the two techniques and the three different groups of CTV.ResultsMean absorbed dose to the whole heart (MWHD) (1.9 vs. 2.1 Gy, P < 0.005), left anterior descending coronary artery mean dose (8.2 vs. 8.4 Gy, P < 0.005) and left ventricle (LV) mean dose (3.0 vs. 3.2, P < 0.005) were all significantly lower with 3D-CRT technique compared to t-IMRT. Apical (8.5 vs. 9.0, P < 0.005) and anterior LV walls (5.0 vs. 5.4 Gy, P < 0.005) received the highest mean dose (Dmean). MWHD and LV-Dmean increased with increasing CTV size regardless of the technique. Low MWHD values (< 2.5 Gy) were achieved in 44 (73.3%) and 41 (68.3%) patients for 3D-CRT and t-IMRT techniques, correspondingly.ConclusionsOur study confirms a considerable range of the planned doses within the heart for adjuvant 3D-CRT or t-IMRT in node-negative breast cancer. We observed differences in heart dosimetric metrics between the three groups of CTV size, regardless of the radiotherapy planning technique.

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Set-up uncertainty during breast radiotherapy

et al. 2013

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Whole breast irradiation for small-sized breasts after conserving surgery: is the field-in-field technique optimal?

Abstract: cFIF has favorable dose conformity and is suggested to be an optimal method for small-sized breasts. However, OT for dose coverage close to the skin and mFIF for normal tissue may also be potential alternatives. Respiratory effects are minimal.

Cited by 5 publications

References 25 publications

New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

Breast size and dose to cardiac substructures in adjuvant three-dimensional conformal radiotherapy compared to tangential intensity modulated radiotherapy

Set-up uncertainty during breast radiotherapy

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