Field match verification during combination proton, photon, and electron therapy for oligometastatic inflammatory breast cancer

Woodward, Wendy A.

doi:10.1016/J.MEDDOS.2012.04.002

Title: Field match verification during combination proton, photon, and electron therapy for oligometastatic inflammatory breast cancer

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Abstract

Postmastectomy radiation therapy (PMRT) has been shown in randomized trials to improve overall survival for patients with locally advanced breast cancer. The standard PMRT clinical target volume (CTV) encompasses the chest wall and undissected regional lymphatics. Conformal isodose distributions covering the standard CTV with acceptable dose limits to normal tissue can typically be achieved with a combination of photon and electron fields. Field borders are marked on the patient's skin using a light field projection of each beam and are subsequently used to verify daily field matching clinically. Initial imaging of a patient with oligometastatic inflammatory breast cancer demonstrated direct extension of disease from the involved internal mammary lymph node chain into the anterior mediastinum as the only site of metastatic disease. The patient achieved a pathologic complete response to neoadjuvant chemotherapy and underwent mastectomy. The initial sites of gross disease, including the anterior mediastinal node was included in the CTV for PMRT, and treatment planning demonstrated a clear advantage to the inclusion of proton fields in this case. The absence of a light source on the proton delivery system that accurately projects proton field edges onto the patient's skin posed a significant challenge for daily verification of proton-to-photon andmore »« less

Authors:

Woodward, Wendy A. ^[1]

Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

Publication Date:: Sun Jan 01 00:00:00 EST 2012

OSTI Identifier:: 22131262

Resource Type:: Journal Article

Journal Name:: Medical Dosimetry

Additional Journal Information:: Journal Volume: 37; Journal Issue: 4; 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; CHEMOTHERAPY; DOSE LIMITS; DOSIMETRY; ELECTRONS; INFLAMMATION; LYMPH NODES; MAMMARY GLANDS; MEDIASTINUM; METASTASES; NEOPLASMS; PATIENTS; PHOTONS; PLANNING; PROTONS; RADIOTHERAPY; SKIN; VERIFICATION

Citation Formats


                    Amos, Richard A., E-mail: richamos@mdanderson.org, and Woodward, Wendy A. Field match verification during combination proton, photon, and electron therapy for oligometastatic inflammatory breast cancer.  United States: N. p., 2012. 
        Web.  doi:10.1016/J.MEDDOS.2012.04.002.

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                    Amos, Richard A., E-mail: richamos@mdanderson.org, & Woodward, Wendy A. Field match verification during combination proton, photon, and electron therapy for oligometastatic inflammatory breast cancer.  United States.  https://doi.org/10.1016/J.MEDDOS.2012.04.002

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                    Amos, Richard A., E-mail: richamos@mdanderson.org, and Woodward, Wendy A. 2012.  
        "Field match verification during combination proton, photon, and electron therapy for oligometastatic inflammatory breast cancer".  United States.  https://doi.org/10.1016/J.MEDDOS.2012.04.002.

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@article{osti_22131262,

  title        = {Field match verification during combination proton, photon, and electron therapy for oligometastatic inflammatory breast cancer},

  author       = {Amos, Richard A., E-mail: richamos@mdanderson.org and Woodward, Wendy A.},

  abstractNote = {Postmastectomy radiation therapy (PMRT) has been shown in randomized trials to improve overall survival for patients with locally advanced breast cancer. The standard PMRT clinical target volume (CTV) encompasses the chest wall and undissected regional lymphatics. Conformal isodose distributions covering the standard CTV with acceptable dose limits to normal tissue can typically be achieved with a combination of photon and electron fields. Field borders are marked on the patient's skin using a light field projection of each beam and are subsequently used to verify daily field matching clinically. Initial imaging of a patient with oligometastatic inflammatory breast cancer demonstrated direct extension of disease from the involved internal mammary lymph node chain into the anterior mediastinum as the only site of metastatic disease. The patient achieved a pathologic complete response to neoadjuvant chemotherapy and underwent mastectomy. The initial sites of gross disease, including the anterior mediastinal node was included in the CTV for PMRT, and treatment planning demonstrated a clear advantage to the inclusion of proton fields in this case. The absence of a light source on the proton delivery system that accurately projects proton field edges onto the patient's skin posed a significant challenge for daily verification of proton-to-photon and -electron field matching. Proton field-specific radiographic imaging devices were designed and used such that proton field edges could be delineated on the patient's skin and used for daily matching with photon and electron fields. Manufacture of the imaging devices was quick and inexpensive. Weekly verification of proton field alignment with the proton field delineation on the skin demonstrated agreement within 3-mm tolerance. The patient remains with no evidence of disease 18 months after completing radiation. Other patients with similar indications may benefit from multimodality radiation therapy.},

  doi          = {10.1016/J.MEDDOS.2012.04.002},

  url          = {https://www.osti.gov/biblio/22131262},
  journal      = {Medical Dosimetry},

  issn         = {0958-3947},

  number       = 4,

  volume       = 37,

  place        = {United States},

  year         = {Sun Jan 01 00:00:00 EST 2012},

  month        = {Sun Jan 01 00:00:00 EST 2012}

}

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