Planning With Intensity-Modulated Radiotherapy and Tomotherapy to Modulate Dose Across Breast to Reflect Recurrence Risk (IMPORT High Trial)

Journal Article · Tue Mar 15 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.12.052· OSTI ID:21491658

Ciurlionis, Laura ^[1]; Fairfoul, Jamie ^[2]; James, Hayley ^[3]; Mayles, Helen ^[4]; Manktelow, Sophie; Raj, Sanjay ^[2]; Tsang, Yat ^[1]; Tywman, Nicola ^[2]; Yarnold, John ^[5]; Coles, Charlotte ^[2]

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1. Mount Vernon National Health Service Trust, Hertfordshire (United Kingdom)
2. Cambridge University Hospitals National Health Service Foundation Trust, Cambridge (United Kingdom)
3. Ipswich Hospital National Health Service Trust, Ipswich (United Kingdom)
4. Clatterbridge National Health Service Trust, Wirrel (United Kingdom)
5. Academic Radiotherapy Department, Institute of Cancer Research, Sutton (United Kingdom)

Purpose: To establish planning solutions for a concomitant three-level radiation dose distribution to the breast using linear accelerator- or tomotherapy-based intensity-modulated radiotherapy (IMRT), for the U.K. Intensity Modulated and Partial Organ (IMPORT) High trial. Methods and Materials: Computed tomography data sets for 9 patients undergoing breast conservation surgery with implanted tumor bed gold markers were used to prepare three-level dose distributions encompassing the whole breast (36 Gy), partial breast (40 Gy), and tumor bed boost (48 or 53 Gy) treated concomitantly in 15 fractions within 3 weeks. Forward and inverse planned IMRT and tomotherapy were investigated as solutions. A standard electron field was compared with a photon field arrangement encompassing the tumor bed boost volume. The out-of-field doses were measured for all methods. Results: Dose-volume constraints of volume >90% receiving 32.4 Gy and volume >95% receiving 50.4 Gy for the whole breast and tumor bed were achieved. The constraint of volume >90% receiving 36 Gy for the partial breast was fulfilled in the inverse IMRT and tomotherapy plans and in 7 of 9 cases of a forward planned IMRT distribution. An electron boost to the tumor bed was inadequate in 8 of 9 cases. The IMRT methods delivered a greater whole body dose than the standard breast tangents. A contralateral lung volume >2.5 Gy was increased in the inverse IMRT and tomotherapy plans, although it did not exceed the constraint. Conclusion: We have demonstrated a set of widely applicable solutions that fulfilled the stringent clinical trial requirements for the delivery of a concomitant three-level dose distribution to the breast.

• OSTI ID: 21491658
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 79; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ACCELERATORS
BODY
CT-GUIDED RADIOTHERAPY
DISEASES
GLANDS
LINEAR ACCELERATORS
MAMMARY GLANDS
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
ORGANS
PLANNING
RADIATION DOSE DISTRIBUTIONS
RADIOLOGY
RADIOTHERAPY
THERAPY