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Title: Inverse-planned, dynamic, multi-beam, intensity-modulated radiation therapy (IMRT): A promising technique when target volume is the left breast and internal mammary lymph nodes

Abstract

The purpose of this study was to determine the optimum beam number and orientation for inverse-planned, dynamic intensity-modulated radiation therapy (IMRT) for treatment of left-sided breast cancer and internal mammary nodes (IMNs) to improve target coverage while reducing cardiac and ipsilateral lung irradiation. Computed tomography (CT) data was used from 5 patients with left-sided breast cancer in whom the heart was close to the chest wall. The planning target volume (PTV) was the full breast plus ipsilateral IMNs. Two geometric beam arrangements were investigated, 240{sup o} and 190{sup o} sector angles, and the number of beams was increased from 7 to 9 to 11. Dose comparison metrics included: PTV homogeneity and conformity indices (HI, CI), heart V30, left lung V20, and mean doses to surrounding structures. To assess clinical application, the IMRT plans with 11 beams equally spaced in a 190{sup o} sector angle were compared to conventional plans. Treatment times were modeled. The 190{sup o} IMRT plans improved PTV HI and CI and reduced mean dose to the heart, lungs, contralateral breast, and total healthy tissue (all p < 0.05) compared to a 240{sup o} sector angle. The 11-beam plan significantly improved PTV HI and CI, heart V30, leftmore » lung V20, and healthy tissue V5 compared to a 7-beam plan (all p < 0.05). The 11-beam plan reduced heart V30 and left lung V20 (p < 0.05) without compromising PTV coverage, compared to a 9-beam plan. Compared to a conventional plan, the IMRT class solution significantly improved PTV HI and CI (both p < 0.01), heart V30 (p = 0.01), and marginally reduced left lung V20 (p = 0.07) but increased contralateral breast and lung mean dose (p < 0.001) and healthy tissue V5 (p < 0.001). An 11-beam 190{sup o} sector angle IMRT technique as a class solution is clinically feasible.« less

Authors:
 [1];  [2];  [3];  [2];  [2];  [3];  [2];  [3]
  1. Radiation Therapy Program, British Columbia Cancer Agency-Vancouver Island Centre, Victoria, British Columbia (Canada). E-mail: cpopescu@bccancer.bc.ca
  2. Radiation Therapy Program, British Columbia Cancer Agency-Vancouver Island Centre, Victoria, British Columbia (Canada)
  3. (Canada)
Publication Date:
OSTI Identifier:
20858084
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Dosimetry; Journal Volume: 31; Journal Issue: 4; Other Information: DOI: 10.1016/j.meddos.2006.05.003; PII: S0958-3947(06)00127-0; Copyright (c) 2006 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; BEAMS; CHEST; COMPARATIVE EVALUATIONS; COMPUTERIZED TOMOGRAPHY; HEART; IRRADIATION; LUNGS; LYMPH NODES; MAMMARY GLANDS; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Popescu, Carmen C., Olivotto, Ivo, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia, Patenaude, Veronica, Wai, Elaine, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia, Beckham, Wayne A., and Physics and Astronomy Department, University of Victoria, Victoria, British Columbia. Inverse-planned, dynamic, multi-beam, intensity-modulated radiation therapy (IMRT): A promising technique when target volume is the left breast and internal mammary lymph nodes. United States: N. p., 2006. Web. doi:10.1016/j.meddos.2006.05.003.
Popescu, Carmen C., Olivotto, Ivo, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia, Patenaude, Veronica, Wai, Elaine, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia, Beckham, Wayne A., & Physics and Astronomy Department, University of Victoria, Victoria, British Columbia. Inverse-planned, dynamic, multi-beam, intensity-modulated radiation therapy (IMRT): A promising technique when target volume is the left breast and internal mammary lymph nodes. United States. doi:10.1016/j.meddos.2006.05.003.
Popescu, Carmen C., Olivotto, Ivo, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia, Patenaude, Veronica, Wai, Elaine, Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia, Beckham, Wayne A., and Physics and Astronomy Department, University of Victoria, Victoria, British Columbia. Sun . "Inverse-planned, dynamic, multi-beam, intensity-modulated radiation therapy (IMRT): A promising technique when target volume is the left breast and internal mammary lymph nodes". United States. doi:10.1016/j.meddos.2006.05.003.
@article{osti_20858084,
title = {Inverse-planned, dynamic, multi-beam, intensity-modulated radiation therapy (IMRT): A promising technique when target volume is the left breast and internal mammary lymph nodes},
author = {Popescu, Carmen C. and Olivotto, Ivo and Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia and Patenaude, Veronica and Wai, Elaine and Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver, British Columbia and Beckham, Wayne A. and Physics and Astronomy Department, University of Victoria, Victoria, British Columbia},
abstractNote = {The purpose of this study was to determine the optimum beam number and orientation for inverse-planned, dynamic intensity-modulated radiation therapy (IMRT) for treatment of left-sided breast cancer and internal mammary nodes (IMNs) to improve target coverage while reducing cardiac and ipsilateral lung irradiation. Computed tomography (CT) data was used from 5 patients with left-sided breast cancer in whom the heart was close to the chest wall. The planning target volume (PTV) was the full breast plus ipsilateral IMNs. Two geometric beam arrangements were investigated, 240{sup o} and 190{sup o} sector angles, and the number of beams was increased from 7 to 9 to 11. Dose comparison metrics included: PTV homogeneity and conformity indices (HI, CI), heart V30, left lung V20, and mean doses to surrounding structures. To assess clinical application, the IMRT plans with 11 beams equally spaced in a 190{sup o} sector angle were compared to conventional plans. Treatment times were modeled. The 190{sup o} IMRT plans improved PTV HI and CI and reduced mean dose to the heart, lungs, contralateral breast, and total healthy tissue (all p < 0.05) compared to a 240{sup o} sector angle. The 11-beam plan significantly improved PTV HI and CI, heart V30, left lung V20, and healthy tissue V5 compared to a 7-beam plan (all p < 0.05). The 11-beam plan reduced heart V30 and left lung V20 (p < 0.05) without compromising PTV coverage, compared to a 9-beam plan. Compared to a conventional plan, the IMRT class solution significantly improved PTV HI and CI (both p < 0.01), heart V30 (p = 0.01), and marginally reduced left lung V20 (p = 0.07) but increased contralateral breast and lung mean dose (p < 0.001) and healthy tissue V5 (p < 0.001). An 11-beam 190{sup o} sector angle IMRT technique as a class solution is clinically feasible.},
doi = {10.1016/j.meddos.2006.05.003},
journal = {Medical Dosimetry},
number = 4,
volume = 31,
place = {United States},
year = {Sun Jan 01 00:00:00 EST 2006},
month = {Sun Jan 01 00:00:00 EST 2006}
}