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Title: Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment

Abstract

To select among breast cancer patients and according to breast volume size those who may benefit from 3D conformal radiotherapy after conservative surgery applied with prone-position technique. Thirty-eight patients with early-stage breast cancer were grouped according to the target volume (TV) measured in the supine position: small ({<=}400 mL), medium (400-700 mL), and large ({>=}700 ml). An ad-hoc designed and built device was used for prone set-up to displace the contralateral breast away from the tangential field borders. All patients underwent treatment planning computed tomography in both the supine and prone positions. Dosimetric data to explore dose distribution and volume of normal tissue irradiated were calculated for each patient in both positions. Homogeneity index, hot spot areas, the maximum dose, and the lung constraints were significantly reduced in the prone position (p < 0.05). The maximum heart distance and the V{sub 5Gy} did not vary consistently in the 2 positions (p = 0.06 and p = 0.7, respectively). The number of necessary monitor units was significantly higher in the supine position (312 vs. 232, p < 0.0001). The subgroups analysis pointed out the advantage in lung sparing in all TV groups (small, medium and large) for all the evaluated dosimetricmore » constraints (central lung distance, maximum lung distance, and V{sub 5Gy}, p < 0.0001). In the small TV group, a dose reduction in nontarget areas of 22% in the prone position was detected (p = 0.056); in the medium and high TV groups, the difference was of about -10% (p = NS). The decrease in hot spot areas in nontarget tissues was 73%, 47%, and 80% for small, medium, and large TVs in the prone position, respectively. Although prone breast radiotherapy is normally proposed in patients with breasts of large dimensions, this study gives evidence of dosimetric benefit in all patient subgroups irrespective of breast volume size.« less

Authors:
 [1]; ; ; ; ; ; ;  [1]; ; ;  [2];  [3];  [4];  [5];  [1]
  1. Radiation Oncology, Campus Bio-Medico University, Rome (Italy)
  2. Breast Unit, S. Pertini Hospital, Rome (Italy)
  3. Department of Physics, Catholic University, Rome (Italy)
  4. CdC San Raffaele Velletri (Italy)
  5. (Italy)
Publication Date:
OSTI Identifier:
22130402
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; COMPUTERIZED TOMOGRAPHY; DOSIMETRY; HEART; HOT SPOTS; IRRADIATION; LUNGS; MAMMARY GLANDS; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIATION MONITORS; RADIOTHERAPY; SURGERY

Citation Formats

Ramella, Sara, E-mail: s.ramella@unicampus.it, Trodella, Lucio, Ippolito, Edy, Fiore, Michele, Cellini, Francesco, Stimato, Gerardina, Gaudino, Diego, Greco, Carlo, Ramponi, Sara, Cammilluzzi, Eugenio, Cesarini, Claudio, Piermattei, Angelo, Cesario, Alfredo, Department of Thoracic Surgery, Catholic University, Rome, and D'Angelillo, Rolando Maria. Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment. United States: N. p., 2012. Web. doi:10.1016/J.MEDDOS.2011.06.010.
Ramella, Sara, E-mail: s.ramella@unicampus.it, Trodella, Lucio, Ippolito, Edy, Fiore, Michele, Cellini, Francesco, Stimato, Gerardina, Gaudino, Diego, Greco, Carlo, Ramponi, Sara, Cammilluzzi, Eugenio, Cesarini, Claudio, Piermattei, Angelo, Cesario, Alfredo, Department of Thoracic Surgery, Catholic University, Rome, & D'Angelillo, Rolando Maria. Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment. United States. doi:10.1016/J.MEDDOS.2011.06.010.
Ramella, Sara, E-mail: s.ramella@unicampus.it, Trodella, Lucio, Ippolito, Edy, Fiore, Michele, Cellini, Francesco, Stimato, Gerardina, Gaudino, Diego, Greco, Carlo, Ramponi, Sara, Cammilluzzi, Eugenio, Cesarini, Claudio, Piermattei, Angelo, Cesario, Alfredo, Department of Thoracic Surgery, Catholic University, Rome, and D'Angelillo, Rolando Maria. Sun . "Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment". United States. doi:10.1016/J.MEDDOS.2011.06.010.
@article{osti_22130402,
title = {Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment},
author = {Ramella, Sara, E-mail: s.ramella@unicampus.it and Trodella, Lucio and Ippolito, Edy and Fiore, Michele and Cellini, Francesco and Stimato, Gerardina and Gaudino, Diego and Greco, Carlo and Ramponi, Sara and Cammilluzzi, Eugenio and Cesarini, Claudio and Piermattei, Angelo and Cesario, Alfredo and Department of Thoracic Surgery, Catholic University, Rome and D'Angelillo, Rolando Maria},
abstractNote = {To select among breast cancer patients and according to breast volume size those who may benefit from 3D conformal radiotherapy after conservative surgery applied with prone-position technique. Thirty-eight patients with early-stage breast cancer were grouped according to the target volume (TV) measured in the supine position: small ({<=}400 mL), medium (400-700 mL), and large ({>=}700 ml). An ad-hoc designed and built device was used for prone set-up to displace the contralateral breast away from the tangential field borders. All patients underwent treatment planning computed tomography in both the supine and prone positions. Dosimetric data to explore dose distribution and volume of normal tissue irradiated were calculated for each patient in both positions. Homogeneity index, hot spot areas, the maximum dose, and the lung constraints were significantly reduced in the prone position (p < 0.05). The maximum heart distance and the V{sub 5Gy} did not vary consistently in the 2 positions (p = 0.06 and p = 0.7, respectively). The number of necessary monitor units was significantly higher in the supine position (312 vs. 232, p < 0.0001). The subgroups analysis pointed out the advantage in lung sparing in all TV groups (small, medium and large) for all the evaluated dosimetric constraints (central lung distance, maximum lung distance, and V{sub 5Gy}, p < 0.0001). In the small TV group, a dose reduction in nontarget areas of 22% in the prone position was detected (p = 0.056); in the medium and high TV groups, the difference was of about -10% (p = NS). The decrease in hot spot areas in nontarget tissues was 73%, 47%, and 80% for small, medium, and large TVs in the prone position, respectively. Although prone breast radiotherapy is normally proposed in patients with breasts of large dimensions, this study gives evidence of dosimetric benefit in all patient subgroups irrespective of breast volume size.},
doi = {10.1016/J.MEDDOS.2011.06.010},
journal = {Medical Dosimetry},
issn = {0958-3947},
number = 2,
volume = 37,
place = {United States},
year = {2012},
month = {7}
}