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Title: Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy

Abstract

Our goal was to evaluate brachial plexus (BP) dose with and without the use of supraclavicular (SCL) irradiation in patients undergoing breast-conserving therapy with whole-breast radiation therapy (RT) after lumpectomy. Using the standardized Radiation Therapy Oncology Group (RTOG)-endorsed guidelines delineation, we contoured the BP for 10 postlumpectomy breast cancer patients. The radiation dose to the whole breast was 50.4 Gy using tangential fields in 1.8-Gy fractions, followed by a conedown to the operative bed using electrons (10 Gy). The prescription dose to the SCL field was 50.4 Gy, delivered to 3-cm depth. The mean BP volume was 14.5 {+-} 1.5 cm{sup 3}. With tangential fields alone, the median mean dose to the BP was 0.57 Gy, the median maximum dose was 1.93 Gy, and the irradiated volume of the BP receiving 40, 45, and 50 Gy was 0%. When the third (SCL field) was added, the dose to the BP was significantly increased (P = .01): the median mean dose to the BP was 40.60 Gy, and the median maximum dose was 52.22 Gy. With 3-field RT, the median irradiated volume of the BP receiving 40, 45, and 50 Gy was 83.5%, 68.5%, and 24.6%, respectively. The addition of themore » SCL field significantly increases dose to the BP. The possibility of increasing the risk of BP morbidity should be considered in the context of clinical decision making.« less

Authors:
; ; ; ;  [1];  [1]
  1. Department of Radiation Oncology, University of California, Davis, Sacramento, CA (United States)
Publication Date:
OSTI Identifier:
22130391
Resource Type:
Journal Article
Journal Name:
Medical Dosimetry
Additional Journal Information:
Journal Volume: 37; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0958-3947
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; DECISION MAKING; DISEASE INCIDENCE; DOSIMETRY; ELECTRONS; HEALTH HAZARDS; IRRADIATION; MAMMARY GLANDS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; RECOMMENDATIONS

Citation Formats

Stanic, Sinisa, Mathai, Mathew, Mayadev, Jyoti S., Do, Ly V., Purdy, James A., and Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu. Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy. United States: N. p., 2012. Web. doi:10.1016/J.MEDDOS.2011.03.001.
Stanic, Sinisa, Mathai, Mathew, Mayadev, Jyoti S., Do, Ly V., Purdy, James A., & Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu. Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy. United States. doi:10.1016/J.MEDDOS.2011.03.001.
Stanic, Sinisa, Mathai, Mathew, Mayadev, Jyoti S., Do, Ly V., Purdy, James A., and Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu. Sun . "Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy". United States. doi:10.1016/J.MEDDOS.2011.03.001.
@article{osti_22130391,
title = {Addition of a third field significantly increases dose to the brachial plexus for patients undergoing tangential whole-breast therapy after lumpectomy},
author = {Stanic, Sinisa and Mathai, Mathew and Mayadev, Jyoti S. and Do, Ly V. and Purdy, James A. and Chen, Allen M., E-mail: allen.chen@ucdmc.ucdavis.edu},
abstractNote = {Our goal was to evaluate brachial plexus (BP) dose with and without the use of supraclavicular (SCL) irradiation in patients undergoing breast-conserving therapy with whole-breast radiation therapy (RT) after lumpectomy. Using the standardized Radiation Therapy Oncology Group (RTOG)-endorsed guidelines delineation, we contoured the BP for 10 postlumpectomy breast cancer patients. The radiation dose to the whole breast was 50.4 Gy using tangential fields in 1.8-Gy fractions, followed by a conedown to the operative bed using electrons (10 Gy). The prescription dose to the SCL field was 50.4 Gy, delivered to 3-cm depth. The mean BP volume was 14.5 {+-} 1.5 cm{sup 3}. With tangential fields alone, the median mean dose to the BP was 0.57 Gy, the median maximum dose was 1.93 Gy, and the irradiated volume of the BP receiving 40, 45, and 50 Gy was 0%. When the third (SCL field) was added, the dose to the BP was significantly increased (P = .01): the median mean dose to the BP was 40.60 Gy, and the median maximum dose was 52.22 Gy. With 3-field RT, the median irradiated volume of the BP receiving 40, 45, and 50 Gy was 83.5%, 68.5%, and 24.6%, respectively. The addition of the SCL field significantly increases dose to the BP. The possibility of increasing the risk of BP morbidity should be considered in the context of clinical decision making.},
doi = {10.1016/J.MEDDOS.2011.03.001},
journal = {Medical Dosimetry},
issn = {0958-3947},
number = 2,
volume = 37,
place = {United States},
year = {2012},
month = {7}
}