Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T16:16:18.041Z Has data issue: false hasContentIssue false

Comparison of skin doses of treated and contralateral breasts during whole breast radiotherapy for different treatment techniques using optically stimulated luminescent dosimeters

Published online by Cambridge University Press:  17 April 2020

Zhenia Gopalakrishnan*
Affiliation:
Division of Radiation Physics, Regional Cancer Centre, Trivandrum, Kerala, India
RaghuRam K. Nair
Affiliation:
Division of Radiation Physics, Regional Cancer Centre, Trivandrum, Kerala, India
P. Raghukumar
Affiliation:
Division of Radiation Physics, Regional Cancer Centre, Trivandrum, Kerala, India
Saju Bhasi
Affiliation:
Division of Radiation Physics, Regional Cancer Centre, Trivandrum, Kerala, India
Sharika V. Menon
Affiliation:
Division of Radiation Physics, Regional Cancer Centre, Trivandrum, Kerala, India
*
Author for correspondence: Ms. Zhenia Gopalakrishnan, Division of Radiation Physics, Regional Cancer Centre, Medical College Campus, Trivandrum, Kerala695011, India. E-mail: [email protected]

Abstract

Purpose:

To measure and compare the skin doses received by treated left breast and contralateral breast (CB) during whole breast radiotherapy using five treatment techniques in an indigenously prepared wax breast phantom.

Materials and methods:

Computed tomography (CT) images of the breast phantom were used for treatment planning and comparison of skin dose calculated from treatment planning system (TPS) with measured dose. Planning target volume (PTV) and the CB were drawn arbitrarily on the CT images acquired for the breast phantom with 10 numbers of calibrated optically stimulated luminescent dosimeters (OSLDs) fixed on the surface of both breasts. The TPS calculated surface doses of PTV breast and CB for five treatment planning techniques, viz., conventional wedge (CW), irregular surface compensator-based (ISC), field-in-field (FiF), intensity-modulated radiotherapy (IMRT) and rapid arc (RA) techniques were obtained for comparison. The plans were executed in Clinac iX Linear Accelerator with the OSLDs fixed at the same locations on the phantom as in simulation. The TPS calculated mean dose at the surface of the treated left breast and CB was noted for the 10 OSLDs from dose-volume histogram (DVH) and compared with the measured dose. Also, the mean chamber dose at the centre of the left breast was noted from the DVH for comparing with ion chamber measured dose.

Results:

With reference to the results, it is seen that the dose to the CB is lowest in ISC technique and FiF technique and greatest in IMRT technique. The CW technique also delivered a dose comparable to IMRT to the CB of the phantom. The dose to the surface of PTV breast was highest and comparable in CW plans and FiF plans (68% and 67%) and lowest in IMRT and RA plans (50% each).

Findings:

Analysis of the results shows that the FiF and ISC techniques are preferred while planning breast radiotherapy due to the reduced dose to the CB.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chang, S X, Deschesne, K M, Cullip, T J, Parker, S A, Earnhart, J. A comparison of different intensity modulation treatment techniques for tangential breast irradiation. Int J Radiat Oncol Biol Phys 1999; 45: 13051314.CrossRefGoogle ScholarPubMed
Smith, W, Menon, G, Wolfe, N, Ploquin, N, Trotter, T, Pudney, D. IMRT for the breast: a comparison of tangential planning techniques. Phys Med Biol 2010; 55: 12311241.CrossRefGoogle ScholarPubMed
Al-Rahbi, Z S, Ravichandran, R, Binukumar, J P, Davis, C A, Satyapal, N, Al-Mandhari, Z. A dosimetric comparison of radiotherapy techniques in the treatment of carcinoma of breast. J Cancer Ther 2013; 4: 1017.CrossRefGoogle Scholar
Al-Rahbi, Z S, Al Mandhari, Z, Ravichandran, R, et al. Dosimetric comparison of intensity modulated radiotherapy isocentric field plans and field in field (FIF) forward plans in the treatment of breast cancer. J Med Phys 2013; 38: 2229.Google ScholarPubMed
Sun, L M, Meng, F Y, Yang, T H, Tsao, M J. Field-in-field plan does not improve the dosimetric outcome compared with the wedged beams plan for breast cancer radiotherapy. Med Dosim 2014; 39: 7982.CrossRefGoogle Scholar
Garg, C, Patro, K. Dosimetric Comparison In Carcinoma Breast Between Volume] Modulated Arc Therapy, Intensity Modulated Radiation Therapy And Conventional Radiotherapy For Target Coverage. J Cancer Res Therap 2017; 311312.Google Scholar
Soleymanifard, S, Aledavood, S A, Noghreiyan, A V, Ghorbani, M, Jamali, F, Davenport, D. In vivo skin dose measurement in breast conformal radiotherapy. Contemp Oncol 2016; 20: 137140.Google ScholarPubMed
Archambeau, J O, Pezner, R, Wasserman, T. Pathophysiology of irradiated skin and breast. Int J Radiat Oncol Biol Phys 1995; 31: 11711185.CrossRefGoogle ScholarPubMed
Stern, R L. Peripheral dose from a linear accelerator equipped with multi-leaf collimation. Med Phys 1999; 26: 559563.CrossRefGoogle Scholar
Howell, R M, Scarboro, S B, Kry, S F, Yaldo, D Z. Accuracy of out-of-field dose calculations by a commercial treatment planning system. Phys Med Biol 2010; 55: 69997008.CrossRefGoogle ScholarPubMed
Huang, J Y, Followill, D S, Wang, X A, Kry, S F. Accuracy and sources of error of out‐of field dose calculations by a commercial treatment planning system for intensity-modulated radiation therapy treatments. J Appl Clin Med Phys 2013; 14: 186197.CrossRefGoogle ScholarPubMed
Yadav, B S, Sharma, S C, Patel, F D, Ghoshal, S, Kapoor, R K. Second primary in the contralateral breast after treatment of breast cancer. Radiother Oncol 2008; 86: 171176.CrossRefGoogle ScholarPubMed
Stovall, M, Smith, S A, Langholz, B M et al. Dose to the contralateral breast from radiotherapy and risk of second primary breast cancer in the WECARE study. Int J Radiat Oncol Biol Phys 2008; 72: 10211030.CrossRefGoogle ScholarPubMed
Jursinic, PA. Characterization of optically stimulated luminescent dosimeters, OSLDs, for clinical dosimetric measurements. Med Phys 2007; 34: 45944604.CrossRefGoogle ScholarPubMed
Gopalakrishnan, Z, Nair, R K, Raghukumar, P, Menon, S V, Bhasi, S. “Verification of treatment planning algorithms using optically stimulated luminescent dosimeters in a breast phantom.” Med Phys 2018; 4: 264269.CrossRefGoogle Scholar
Remouchamps, V M, Huyskens, D P, Mertens, I, et al.The use of magnetic sensors to monitor moderate deep inspiration breath hold during breast irradiation with dynamic MLC compensators.” Radiother Oncol 2007; 82 (3): 341348.CrossRefGoogle ScholarPubMed
Radiation Therapy Oncology Group. “NSABP Protocol B-39/RTOG Protocol 0413: a randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer.” Philadelphia (PA): RTOG 2005.Google Scholar
Quach, K Y, Morales, J, Butson, M J, Rosenfeld, A B, Metcalfe, P E. “Measurement of radiotherapy x-ray skin dose on a chest wall phantom.” Med Phys 2000; 27 (7): 16761680.CrossRefGoogle ScholarPubMed
Nakano, M, Hill, R F, Whitaker, M, Kim, J‐H, Kuncic, Z. “A study of surface dosimetry for breast cancer radiotherapy treatments using Gafchromic EBT2 film.” J Appl Clin Med Phys 2012; 13 (3): 8397.CrossRefGoogle ScholarPubMed
Akino, Y, Das, I J, Bartlett, G K, Zhang, H, Thompson, E, Zook, J E. “Evaluation of superficial dosimetry between treatment planning system and measurement for several breast cancer treatment techniques.” Med Phys 2013; 40 (1): 011714.Google ScholarPubMed
Almberg, S S, Tore, L, Jomar, F. “Superficial doses in breast cancer radiotherapy using conventional and IMRT techniques: a film-based phantom study.” Radiother Oncol 2011; 100 (2): 259264.CrossRefGoogle ScholarPubMed
Williams, T M., Moran, J M, Hsu, S-H et al.Contralateral breast dose after whole-breast irradiation: an analysis by treatment technique.” Int J Radiat Oncol Biol Phys 2012; 82 (5): 20792085.CrossRefGoogle ScholarPubMed
Bhatnagar, A K, Brandner, E, Sonnik, D, et al.Intensity-modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation.” Breast Cancer Res Treatment 2006; 96 (1): 4146.CrossRefGoogle ScholarPubMed
Kundrát, P, Remmele, J, Rennau, H et al.Inter-patient variability in doses to nearby organs in breast-cancer radiotherapy: inference from anatomic features.” Rad Prot Dosim 2019; 183 (1–2): 255258.CrossRefGoogle ScholarPubMed
Harsolia, A, Kestin, L, Grills, I, et al.Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy.” Int J Radiat Oncol Biol Phys 2007; 68 (5): 13751380.CrossRefGoogle ScholarPubMed
Fong, A, Bromley, R, Beat, M, Vien, D, Dineley, J, Morgan, G. “Dosimetric comparison of intensity modulated radiotherapy techniques and standard wedged tangents for whole breast radiotherapy.” J Med Imaging Radiat Oncol 2009; 53 (1): 9299.CrossRefGoogle ScholarPubMed