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Title: Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes

Abstract

Purpose: To compare the Para Mixed technique for irradiation of the internal mammary nodes (IMN) with three commonly used strategies, by analyzing the dose to the heart and other organs at risk. Methods and Materials: Four different three-dimensional conformal dose plans were created for 30 breast cancer patients. The IMN were enclosed with the Para Mixed technique by a widened mediolateral tangent photon beam and an anterior electron beam, with the Patched technique by an anterior electron beam, with the Standard technique by an anterior photon and electron beam, and with the PWT technique by partially wide tangents. All techniques were optimized for conformality and produced equally adequate target coverage. Results: Heart dose was lowest with the Para Mixed and Patched technique for all patients and with the PWT technique for right-sided treatment only. Lung dose was highest with the PWT, lowest with the Patched, and intermediate with the Para Mixed and Standard techniques. Skin dose was highest with the Patched, lowest with the PWT, and intermediate with the Para Mixed and the Standard techniques. The Para Mixed technique resulted in a 13-Gy lower dose in an overlap area, and the PWT technique was the only technique that incorporated considerablemore » volumes of the contralateral breast. Conclusion: The Para Mixed technique yielded the overall best results. No other technique resulted in a lower heart dose. Lung and skin were equally spared instead of one of them being compromised, and the contralateral breast was avoided.« less

Authors:
 [1];  [2];  [2];  [2];  [2]
  1. Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands). E-mail: h.p.van.der.laan@rt.umcg.nl
  2. Department of Radiation Oncology, University Medical Center Groningen, Groningen (Netherlands)
Publication Date:
OSTI Identifier:
20788249
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2005.04.027; PII: S0360-3016(05)00719-4; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; ELECTRON BEAMS; HEART; IRRADIATION; LUNGS; MAMMARY GLANDS; PATIENTS; PHOTON BEAMS; RADIATION DOSES; SKIN; TOXICITY

Citation Formats

Laan, Hans P. van der, Dolsma, Wil V., Veld, Aart A. van 't, Bijl, Hendrik P., and Langendijk, Johannes A.. Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes. United States: N. p., 2005. Web. doi:10.1016/J.IJROBP.2005.0.
Laan, Hans P. van der, Dolsma, Wil V., Veld, Aart A. van 't, Bijl, Hendrik P., & Langendijk, Johannes A.. Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes. United States. doi:10.1016/J.IJROBP.2005.0.
Laan, Hans P. van der, Dolsma, Wil V., Veld, Aart A. van 't, Bijl, Hendrik P., and Langendijk, Johannes A.. Thu . "Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20788249,
title = {Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes},
author = {Laan, Hans P. van der and Dolsma, Wil V. and Veld, Aart A. van 't and Bijl, Hendrik P. and Langendijk, Johannes A.},
abstractNote = {Purpose: To compare the Para Mixed technique for irradiation of the internal mammary nodes (IMN) with three commonly used strategies, by analyzing the dose to the heart and other organs at risk. Methods and Materials: Four different three-dimensional conformal dose plans were created for 30 breast cancer patients. The IMN were enclosed with the Para Mixed technique by a widened mediolateral tangent photon beam and an anterior electron beam, with the Patched technique by an anterior electron beam, with the Standard technique by an anterior photon and electron beam, and with the PWT technique by partially wide tangents. All techniques were optimized for conformality and produced equally adequate target coverage. Results: Heart dose was lowest with the Para Mixed and Patched technique for all patients and with the PWT technique for right-sided treatment only. Lung dose was highest with the PWT, lowest with the Patched, and intermediate with the Para Mixed and Standard techniques. Skin dose was highest with the Patched, lowest with the PWT, and intermediate with the Para Mixed and the Standard techniques. The Para Mixed technique resulted in a 13-Gy lower dose in an overlap area, and the PWT technique was the only technique that incorporated considerable volumes of the contralateral breast. Conclusion: The Para Mixed technique yielded the overall best results. No other technique resulted in a lower heart dose. Lung and skin were equally spared instead of one of them being compromised, and the contralateral breast was avoided.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 63,
place = {United States},
year = {Thu Dec 01 00:00:00 EST 2005},
month = {Thu Dec 01 00:00:00 EST 2005}
}
  • Purpose: We previously reported that most of axillary regions could be irradiated by the modified tangential irradiation technique (MTIT). The purpose of this study was to determine whether the three-dimensional conformal radiotherapy (3D-CRT) with a field-in-field technique improves dosimetry for the breast and axillary nodes. Methods and Materials: Fifty patients with left-sided breast cancer were enrolled. With MTIT, we planned the radiation field to be wider in the cranial direction than the standard tangential fields to include the axillary regions. With 3D-CRT, a field-in-field technique was used to spare the heart and contralateral breast to the extent possible by applyingmore » the multileaf collimator manually. Dose-volume histograms were compared for the breast, axillary region, heart, lung, and other normal tissues. Results: There were no significant differences in the percent volume of the breast receiving >90% of the prescribed dose (V90) between MTIT and 3D-CRT. The mean V90 of the level I to III axillary regions were increased from 93.7%, 48.2%, and 41.3% with MTIT to 97.6%, 85.8%, and 82.8% with 3D-CRT. 3D-CRT significantly reduced the volume of the heart receiving >30 Gy (mean, 7.6 vs. 15.9 mL), the percent volume of the bilateral lung receiving >20 Gy (7.4% vs. 8.9%), and the volume of other normal tissues receiving >107% of the prescribed dose (0.1 vs. 2.9 mL). Conclusion: The use of 3D-CRT with a field-in-field technique improves axillary node coverage, while decreasing doses to the heart, lungs, and the other normal tissues, compared with MTIT.« less
  • Purpose: To perform dose modeling of a noninvasive image-guided breast brachytherapy (NIIGBB) for comparison to electrons and 3DCRT. Methods and Materials: The novel technology used in this study is a mammography-based, noninvasive breast brachytherapy system whereby the treatment applicators are centered on the planning target volume (PTV) to direct {sup 192}Ir emissions along orthogonal axes. To date, three-dimensional dose modeling of NIIGBB has not been possible because of the limitations of conventional treatment planning systems (TPS) to model variable tissue deformation associated with breast compression. In this study, the TPS was adapted such that the NIIGBB dose distributions were modeledmore » as a virtual point source. This dose calculation technique was applied to CT data from 8 patients imaged with the breast compressed between parallel plates in the cranial-caudal and medial-lateral axes. A dose-volume comparison was performed to simulated electron boost and 3DCRT APBI. Results: The NIIGBB PTV was significantly reduced as compared with both electrons and 3DCRT. Electron boost plans had a lower D{sub min} than the NIIGBB technique but higher V{sub 100}, D{sub 90}, and D{sub 50}. With regard to PTV coverage for APBI, the only significant differences were minimally higher D{sub 90}, D{sub 100}, V{sub 80}, and V{sub 90}, with 3DCRT and D{sub max} with NIIGBB. The NIIGBB technique, as compared with electrons and 3D-CRT, achieved a lower maximum dose to skin (60% and 10%, respectively) and chest wall/lung (70-90%). Conclusions: NIIGBB achieves a PTV that is smaller than electron beam and 3DCRT techniques. This results in significant normal tissue sparing while maintaining dosimetric benchmarks to the target tissue.« less
  • Purpose: To compare dose-volume histograms (DVH) in patients with non-small-cell lung cancer (NSCLC) treated by photon or proton radiotherapy. Methods and Materials: Dose-volume histograms were compared between photon, including three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and proton plans at doses of 66 Gy, 87.5 Gy in Stage I (n = 10) and 60-63 Gy, and 74 Gy in Stage III (n 15). Results: For Stage I, the mean total lung V5, V10, and V20 were 31.8%, 24.6%, and 15.8%, respectively, for photon 3D-CRT with 66 Gy, whereas they were 13.4%, 12.3%, and 10.9%, respectively, with proton withmore » dose escalation to 87.5 cobalt Gray equivalents (CGE) (p = 0.002). For Stage III, the mean total lung V5, V10, and V20 were 54.1%, 46.9%, and 34.8%, respectively, for photon 3D-CRT with 63 Gy, whereas they were 39.7%, 36.6%, and 31.6%, respectively, for proton with dose escalation to 74 CGE (p = 0.002). In all cases, the doses to lung, spinal cord, heart, esophagus, and integral dose were lower with proton therapy even compared with IMRT. Conclusions: Proton treatment appears to reduce dose to normal tissues significantly, even with dose escalation, compared with standard-dose photon therapy, either 3D-CRT or IMRT.« less
  • In a controlled clinical trial preoperative radiotherapy was compared to modified radical mastectomy followed either by no further treatment or by postoperative radiotherapy. The total number of patients was 960; 654 of these had a follow-up time of more than five years. The patients who were irradiated preoperatively, had a significantly better survival rate than the patients who were treated with surgery only (p = 0.05); however, this was not true for those irradiated postoperatively. The radiation dose in the ipsilateral internal mammary nodes was, on the average, lower with the postoperative treatment technique than with the preoperative technique. Thismore » difference in dose-distribution in the internal mammary nodes is analyzed. The result of the study indicates that adequate local treatment may increase survival in a subgroup of patients.« less
  • Breast, chest wall, and regional nodal irradiation have been associated with an improved outcome in high-risk breast cancer patients. Complex treatment planning is often utilized to ensure complete coverage of the target volume while minimizing the dose to surrounding normal tissues. The 2 techniques evaluated in this report are the partially wide tangent fields (PWTFs) and the 4-field photon/electron combination (the modified 'Kuske Technique'). These 2 techniques were evaluated in 10 consecutive breast cancer patients. All patients had computerized tomographic (CT) scans for 3D planning supine on a breast board. The breast was defined clinically by the physician and confirmedmore » radiographically with radiopaque bebes. The resulting dose-volume histograms (DVHs) of normal and target tissues were then compared. The deep tangent field with blocks resulted in optimal coverage of the target and the upper internal mammary chain (IMC) while sparing of critical and nontarget tissues. The wide tangent technique required less treatment planning and delivery time. We compared the 2 techniques and their resultant DVHs and feasibility in a busy clinic.« less