14
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Is there a preferred IMRT technique for left‐breast irradiation?

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Not all clinics have breath‐hold radiotherapy available for left‐breast irradiation. However intensity‐modulated radiotherapy (IMRT) has also been advocated as a means of lowering heart doses. There is currently no large‐scale, long‐term follow‐up data after breast IMRT and, since dose distributions may differ from classic tangent‐based radiotherapy, caution is needed to avoid unexpected worsening of the late toxicity profile. We compared four IMRT techniques for free‐breathing left‐breast irradiation. Consistent with the aforementioned concerns, our goal in planning was to prioritize organ at risk (OAR) sparing in a way that mimicked tangent‐based radiotherapy. Ten simultaneous integrated boost treatment plans ( PTV elective = 15 × 2.67 Gy ; PTV boost = 15 × 3.35 Gy ) were created using 1) hybrid‐IMRT (H‐IMRT), 2) full IMRT (F‐IMRT), and 3) volumetric‐modulated arc therapy with two partial arcs (2ARC) and 4) six partial arcs (6ARC). Reduction in OAR mean and low dose was prioritized. End‐points included OAR sparing (e.g., heart, left anterior descending artery [ LAD + 3 mm ], lungs, and contralateral breast) and PTV coverage/dose homogeneity. Under these conditions we found the following: 1) H‐IMRT provided the best mean and low dose OAR sparing, PTV elective coverage ( mean V 95 % = 98 % ) , PTV boost coverage ( V 95 % = 98 % ) , and PTV homogeneity. However, it delivered most intermediate–high dose to the heart, LAD + 3 mm and ipsilateral lung; 2) 6ARC had the best intermediate–high dose sparing, followed by F‐IMRT, but this was at the expense of more dose in the contralateral lung and breast and worse PTV coverage ( PTV elective mean V 95 % = 96 % / 97 % and PTV boost mean V 95 % = 91 % / 96 % for 6ARC/F‐IMRT). When trying to spare mean and low dose to OARs, the preferred IMRT technique for left‐breast irradiation without breath‐hold was H‐IMRT. This is currently the standard solution in our institution for left‐breast radiotherapy under free‐breathing and breath‐hold conditions.

          PACS numbers: 87.53kn, 87.53Jw, 87.55.D‐, 87.55.de, 87.55.dk

          Related collections

          Most cited references17

          • Record: found
          • Abstract: found
          • Article: not found

          Radiation-induced second cancers: the impact of 3D-CRT and IMRT.

          Information concerning radiation-induced malignancies comes from the A-bomb survivors and from medically exposed individuals, including second cancers in radiation therapy patients. The A-bomb survivors show an excess incidence of carcinomas in tissues such as the gastrointestinal tract, breast, thyroid, and bladder, which is linear with dose up to about 2.5 Sv. There is great uncertainty concerning the dose-response relationship for radiation-induced carcinogenesis at higher doses. Some animal and human data suggest a decrease at higher doses, usually attributed to cell killing; other data suggest a plateau in dose. Radiotherapy patients also show an excess incidence of carcinomas, often in sites remote from the treatment fields; in addition there is an excess incidence of sarcomas in the heavily irradiated in-field tissues. The transition from conventional radiotherapy to three-dimensional conformal radiation therapy (3D-CRT) involves a reduction in the volume of normal tissues receiving a high dose, with an increase in dose to the target volume that includes the tumor and a limited amount of normal tissue. One might expect a decrease in the number of sarcomas induced and also (less certain) a small decrease in the number of carcinomas. All around, a good thing. By contrast, the move from 3D-CRT to intensity-modulated radiation therapy (IMRT) involves more fields, and the dose-volume histograms show that, as a consequence, a larger volume of normal tissue is exposed to lower doses. In addition, the number of monitor units is increased by a factor of 2 to 3, increasing the total body exposure, due to leakage radiation. Both factors will tend to increase the risk of second cancers. Altogether, IMRT is likely to almost double the incidence of second malignancies compared with conventional radiotherapy from about 1% to 1.75% for patients surviving 10 years. The numbers may be larger for longer survival (or for younger patients), but the ratio should remain the same.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes.

            Volumetric modulated arc therapy (VMAT) is a novel extension of conventional intensity-modulated radiotherapy (cIMRT), in which an optimized three-dimensional dose distribution may be delivered in a single gantry rotation. VMAT is the predecessor to RapidArc (Varian Medical System). This study compared VMAT with cIMRT and with conventional modified wide-tangent (MWT) techniques for locoregional radiotherapy for left-sided breast cancer, including internal mammary nodes. Therapy for 5 patients previously treated with 50 Gy/25 fractions using nine-field cIMRT was replanned with VMAT and MWT. Comparative endpoints were planning target volume (PTV) dose homogeneity, doses to surrounding structures, number of monitor units, and treatment delivery time. For VMAT, two 190 degrees arcs with 2-cm overlapping jaws were required to optimize over the large treatment volumes. Treatment plans generated using VMAT optimization resulted in PTV homogeneity similar to that of cIMRT and MWT. The average heart volumes receiving >30 Gy for VMAT, cIMRT, and MWT were 2.6% +/- 0.7%, 3.5% +/- 0.8%, and 16.4% +/- 4.3%, respectively, and the average ipsilateral lung volumes receiving >20 Gy were 16.9% +/- 1.1%, 17.3% +/- 0.9%, and 37.3% +/- 7.2%, respectively. The average mean dose to the contralateral medial breast was 3.2 +/- 0.6 Gy for VMAT, 4.3 +/- 0.4 Gy for cIMRT, and 4.4 +/- 4.7 Gy for MWT. The healthy tissue volume percentages receiving 5 Gy were significantly larger with VMAT (33.1% +/- 2.1%) and IMRT (45.3% +/- 3.1%) than with MWT (19.4% +/- 3.7%). VMAT reduced the number of monitor units by 30% and the treatment time by 55% compared with cIMRT. VMAT achieved similar PTV coverage and sparing of organs at risk, with fewer monitor units and shorter delivery time than cIMRT.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The UK HeartSpare Study: randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy.

              To determine whether voluntary deep-inspiratory breath-hold (v_DIBH) and deep-inspiratory breath-hold with the active breathing coordinator™ (ABC_DIBH) in patients undergoing left breast radiotherapy are comparable in terms of normal-tissue sparing, positional reproducibility and feasibility of delivery. Following surgery for early breast cancer, patients underwent planning-CT scans in v_DIBH and ABC_DIBH. Patients were randomised to receive one technique for fractions 1-7 and the second technique for fractions 8-15 (40 Gy/15 fractions total). Daily electronic portal imaging (EPI) was performed and matched to digitally-reconstructed radiographs. Cone-beam CT (CBCT) images were acquired for 6/15 fractions and matched to planning-CT data. Population systematic (Σ) and random errors (σ) were estimated. Heart, left-anterior-descending coronary artery, and lung doses were calculated. Patient comfort, radiographer satisfaction and scanning/treatment times were recorded. Within-patient comparisons between the two techniques used the paired t-test or Wilcoxon signed-rank test. Twenty-three patients were recruited. All completed treatment with both techniques. EPI-derived Σ were ≤ 1.8mm (v_DIBH) and ≤ 2.0mm (ABC_DIBH) and σ ≤ 2.5mm (v_DIBH) and ≤ 2.2mm (ABC_DIBH) (all p non-significant). CBCT-derived Σ were ≤ 3.9 mm (v_DIBH) and ≤ 4.9 mm (ABC_DIBH) and σ ≤ 4.1mm (v_DIBH) and ≤ 3.8mm (ABC_DIBH). There was no significant difference between techniques in terms of normal-tissue doses (all p non-significant). Patients and radiographers preferred v_DIBH (p=0.007, p=0.03, respectively). Scanning/treatment setup times were shorter for v_DIBH (p=0.02, p=0.04, respectively). v_DIBH and ABC_DIBH are comparable in terms of positional reproducibility and normal tissue sparing. v_DIBH is preferred by patients and radiographers, takes less time to deliver, and is cheaper than ABC_DIBH. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
                Bookmark

                Author and article information

                Contributors
                m.jeulink@vumc.nl
                Journal
                J Appl Clin Med Phys
                J Appl Clin Med Phys
                10.1002/(ISSN)1526-9914
                ACM2
                Journal of Applied Clinical Medical Physics
                John Wiley and Sons Inc. (Hoboken )
                1526-9914
                08 May 2015
                May 2015
                : 16
                : 3 ( doiID: 10.1002/acm2.2015.16.issue-3 )
                : 197-205
                Affiliations
                [ 1 ] Department of Radiotherapy VU University Medical Center Amsterdam The Netherlands
                Author notes
                [*] [* ] a Corresponding author: Marloes Jeulink, Department of Radiotherapy, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; phone: 0031 204440414; fax: 0031 204440410; email: m.jeulink@ 123456vumc.nl

                Article
                ACM20197
                10.1120/jacmp.v16i3.5266
                5690145
                26103488
                edfee053-f6c8-43d4-a092-9a12c2216e3b
                © 2015 The Authors.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 August 2014
                : 23 January 2015
                Page count
                Figures: 3, Tables: 1, References: 23, Pages: 9, Words: 4394
                Categories
                Radiation Oncology Physics
                Radiation Oncology Physics
                Custom metadata
                2.0
                acm20197
                May 2015
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.5 mode:remove_FC converted:16.11.2017

                breast radiotherapy,imrt,vmat,rapidarc,arc therapy
                breast radiotherapy, imrt, vmat, rapidarc, arc therapy

                Comments

                Comment on this article