Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-19T23:58:38.342Z Has data issue: false hasContentIssue false
  • English
  • Français

Dosimetric study of three-dimensional conformal radiotherapy, electronic compensator technique, intensity-modulated radiation therapy and volumetric-modulated arc therapy in whole breast irradiation†

Published online by Cambridge University Press:  09 May 2017

Chonnipa Nantavithya ,
Kitwadee Saksornchai ,
Puntiwa Oonsiri  and
Kanjana Shotelersuk
Chonnipa Nantavithya
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Kitwadee Saksornchai
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Puntiwa Oonsiri
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Kanjana Shotelersuk*
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
*
Correspondence to: Kanjana Shotelersuk, Associate Professor, Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital (KCMH), 1873 Rama 4 Road, Patumwan, Bangkok 10330, Thailand. Tel: +66 256 4334; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Whole breast irradiation is an essential treatment after breast-conserving surgery (BCS). However, there are some adverse effects from inhomogeneity and dose to adjacent normal tissues.

Objective

Aim of this study was to compare dosimetry among standard technique, three-dimensional conformal radiotherapy (3D-CRT), and advanced techniques, electronic compensator (ECOMP), inverse intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).

Methods

Whole breast irradiation treatment plans of patients who had underwent BCS and whole breast irradiation were re-planned with all four techniques. Clinical target volume was contoured according to the Radiation Therapy Oncology Group atlas for breast only in patients who had negative node or ductal carcinoma in situ and breast with chest wall for patients with positive node. Planning target volume was non-uniformly expanded. Dose prescription was 50 Gy in 25 fractions with 6 MV photon energy.

Results

In total, 25 patients underwent whole breast irradiation with computed tomography simulation from November 2013 to November 2014 were included. Six patients with positive nodes were re-planned for breast with chest wall irradiation and 19 patients with negative nodes were re-planned for breast only irradiation. Primary outcome, radical dose homogeneity index (HI) of 3D-CRT, ECOMP, IMRT and VMAT were 0·865, 0·889, 0·890 and 0·866, respectively. ECOMP and IMRT showed significant higher HI than 3D-CRT (p-value<0·001). Secondary outcome, conformity index (CI) of advanced technique were significantly better than 3D-CRT. Lung V20, mean ipsilateral lung dose (MILD), mean heart dose (MHD), heart V25, heart V30 of advanced techniques were also lower than 3D-CRT. ECOMP had better mean lung dose (MLD), mean contralateral lung dose (MCLD) and mean contralateral breast dose (MCBD) when compared with 3D-CRT. Monitor units of advanced techniques were significantly higher than 3D-CRT.

Conclusions

HI of ECOMP and IMRT were significantly higher than 3D-CRT technique. All advanced techniques showed statistically better in CI. Lung V20, MILD, heart V25 and heart V30 of advanced techniques were lower than 3D-CRT. However, only ECOMP showed decreased MLD, MHD, MCLD and MCBD when compared with 3D-CRT.

Keywords

electronic compensatorintensity-modulated radiation therapythree-dimensional conformal radiotherapyvolumetric-modulated arc therapywhole breast irradiation
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 4 , December 2017 , pp. 431 - 443
Check for updates
Copyright
© Cambridge University Press 2017 

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.)

Footnotes

†

Presentation at a conference; 2015 Breast Cancer Symposium, San Francisco, CA, USA.

References

1. Veronesi, U, Cascinelli, N, Mariani, L et al. Twenty year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227–1232.CrossRefGoogle ScholarPubMed
2. Fisher, B, Anderson, S, Bryant, J et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233–1241.CrossRefGoogle ScholarPubMed
3. Vinh-Hung, V, Verschraegen, C. Breast-conserving surgery with or without radiotherapy: pooled-analysis for risks of ipsilateral breast tumor recurrence and mortality. J Natl Cancer Inst 2004; 96: 115–121.CrossRefGoogle ScholarPubMed
4. Clarke, M, Collins, R, Darby, S et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366: 2087–2106.Google ScholarPubMed
5. Curran, D, Van Dongen, JP, Aaronson, NK et al. Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer 1998; 34: 307–314.CrossRefGoogle ScholarPubMed
6. Fernando, IN, Ford, HT, Powles, TJ et al. Factors affecting acute skin toxicity in patients having breast irradiation after conservative surgery: a prospective study of treatment practice at the Royal Marsden Hospital. Clin Oncol 1996; 8: 226–233.CrossRefGoogle ScholarPubMed
7. Vicini, FA, Sharpe, M, Kestin, L et al. Optimizing breast cancer treatment efficacy with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2002; 54 (5): 1336–1344.CrossRefGoogle ScholarPubMed
8. Pignol, JP, Olivotto, I, Rakovitch, E et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008; 26: 2085–2092.CrossRefGoogle ScholarPubMed
9. Donovan, E, Bleakley, N, Denholm, E et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 2007; 82: 254–264.CrossRefGoogle ScholarPubMed
10. Cox, JD, Stetz, JA, Pajak, TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341–1346.CrossRefGoogle ScholarPubMed
11. Gyenes, G, Rutqvist, LE, Liedberg, A, Fornander, T. Long-term cardiac morbidity and mortality in a randomized trial of pre- and postoperative radiation therapy versus surgery alone in primary breast cancer. Radiother Oncol 1998; 48: 185–190.CrossRefGoogle Scholar
12. Paszat, LF, Mackillop, WJ, Groome, PA, Schulze, K, Holowaty, E. Mortality from myocardial infarction following post lumpectomy radiotherapy for breast cancer: a population-based study in Ontario, Canada. Int J Radiat Oncol Biol Phys 1999; 43: 755–762.CrossRefGoogle Scholar
13. Gagliardi, G, Constine, LS, Moiseenko, V et al. Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 2010; 76: 77–85.CrossRefGoogle ScholarPubMed
14. Darby, SC, Ewertz, M, McGale, P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368: 987–998.CrossRefGoogle ScholarPubMed
15. Giordano, SH, Kuo, YF, Freeman, JL et al. Risk of cardiac death after adjuvant radio therapy for breast cancer. J Natl Cancer Inst 2005; 97: 419–424.CrossRefGoogle Scholar
16. Kahán, Z, Csenki, M, Varga, z et al. The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys 2007; 68: 673–681.CrossRefGoogle ScholarPubMed
17. Kubo, A, Osaki, K, Kawanaka, T, Furutani, S, Ikushima, H, Nishitani, H. Risk factors for radiation pneumonitis caused by whole breast irradiation following breast-conserving surgery. J Med Invest 2009; 56: 99–110.CrossRefGoogle ScholarPubMed
18. Marks, LB, Bentzen, SM, Deasy, JO et al. Radiation dose-volume effects in the lung. Int J Radiat Oncol Biol Phys 2010; 76: 70–76.CrossRefGoogle ScholarPubMed
19. Boice, JD, Harvry, EB, Blettner, M, Stovall, M, Flannery, JT. Cancer in the contralateral breast after radiotherapy for breast cancer. N Engl J Med 1992; 326: 781–785.CrossRefGoogle ScholarPubMed
20. Pignol, JP, Olivotto, I, Rakovitch, E et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008; 26: 2085–2092.CrossRefGoogle ScholarPubMed
21. Caudell, JJ, De Los Santos, JF, Keene, KS et al. A dosimetric comparison of electronic compensation, conventional intensity modulated radiotherapy, and tomotherapy in patients with early-stage carcinoma of the left breast. Int J Radiat Oncol Biol Phys 2007; 68: 1505–1511.CrossRefGoogle ScholarPubMed
22. Hong, L, Hunt, M, Chui, C et al. Intensity-modulated tangential beam irradiation of the intact breast. Int J Radiat Oncol Biol Phys 1999; 44: 1155–1164.CrossRefGoogle ScholarPubMed
23. Otto, K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008; 35 (1): 310–317.CrossRefGoogle Scholar
24. Popescu, CC, Olivotto, IA, Beckham, WA et al. Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys 2010; 76: 287–295.CrossRefGoogle ScholarPubMed
25. Rongsriyam, K, Rojpornpradit, P, Lertbutsayanukul, C, Sanghangthum, T, Oonsiri, S. Dosimetric study of inverse-planned intensity modulated, forward-planned intensity modulated and conventional tangential techniques in breast conserving radiotherapy. J Med Assoc Thai 2008; 91: 1571–1582.Google Scholar
26. Tsai, PF, Lin, SM, Lee, SH et al. The feasibility study of using multiple partial volumetric-modulated arcs therapy in early stage left-sided breast cancer patients. J Appl Clin Med Phys 2012; 13: 3806.CrossRefGoogle ScholarPubMed
27.Radiation Therapy Oncology Group (RTOG). Breast cancer atlas for radiation therapy planning: consensus definitions. https://www.rtog.org/LinkClick.aspx?fileticket=vzJFhPaBipE%3d&tabid=236. Accessed on 8th August 2013.Google Scholar
28.Radiation Therapy Oncology Group (RTOG). RTOG 1005: a phase III trial of accelerated whole breast irradiation with hypofractionation plus concurrent boost versus standard whole breast irradiation plus sequential boost for early stage breast cancer. https://www.rtog.org/clinicaltrials/protocoltable/studydetails.aspx?study=1005. Accessed on 8th August 2013.Google Scholar
29. Nielsen, MH, Berg, M, Pedersen, AN et al. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group. Acta Oncol 2013; 52: 703–710.CrossRefGoogle ScholarPubMed
30. Zhang, F, Zheng, M. Dosimetric evaluation of conventional radiotherapy, 3-D conformal radiotherapy and direct machine parameter optimisation intensity-modulated radiotherapy for breast cancer after conservative surgery. J Med Imaging Radiat Oncol 2011; 55: 595–602.CrossRefGoogle ScholarPubMed
31. Zaghloul, HA, Rashed, YA, Shaukat, AA, Rostom, YA, Badawy, SE. Intensity modulated radiotherapy using multiple in fields compared to wedged fields in breast irradiation: clinical impact on early skin reaction and organs at risk doses. J Nucl Med Radiat Ther 2014; 5: 2.CrossRefGoogle Scholar
32. Swanson, T, Grills, I, Ye, H, Entwistle, A, Teahan, M, Letts, N. Six-year experience routinely utilizing moderate deep inspiration breath-hold (mDIBH) for the reduction of cardiac dose in left-sided breast irradiation for patients with early stage or locally advanced breast cancer. Am J Clin Oncol 2013; 36: 24–30.CrossRefGoogle ScholarPubMed
33. Beckham, WA, Popescu, CC, Patenaude, VV, et al. Is mutibeam IMRT better than standard treatment for patients with left-sided breast cancer? Int J Radiat Oncol Biol Phys 2007; 2007; 69:918–924.CrossRefGoogle Scholar
34. Jin, GH, Chen, LX, Deng, XW, et al. A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, field-in-field, tangential-IMRT, multiple beam IMRT and VMAT. Radiat Oncol 2013; 8:89.CrossRefGoogle Scholar
35. Edge, SB, Byrd, DR, Compton, CC, et al. AJCC cancer staging manual. 7th ed. New York, NY: Springer; 2010.Google Scholar
Supplementary material: File

Nantavithya supplementary material

Supplementary Table

Download Nantavithya supplementary material(File)
File 39.4 KB