Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T11:24:23.225Z Has data issue: false hasContentIssue false
  • English
  • Français

An alternative option to reduce lung dose for electron scar boost irradiation in post-mastectomy breast cancer patients with a thin chest wall

Published online by Cambridge University Press:  18 October 2016

Yongsook C. Lee  and
Parvesh Kumar
Yongsook C. Lee*
Affiliation:
Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
Parvesh Kumar
Affiliation:
Department of Radiation Oncology, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
*
Correspondence to: Dr Yongsook C. Lee, Department of Radiation Oncology, The University of Arizona, 1501 N. Campbell Avenue, P.O. Box 245081, Tucson, AZ 85724-5081, USA. Tel: 1 520 626 6773. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

We evaluated water-equivalent slabs as an alternative to a bolus to reduce radiation dose to the underlying lungs during electron scar boost irradiation in breast cancer patients with a thin chest wall undergoing post-mastectomy radiation therapy.

Materials and methods

Percent depth doses (PDDs) and attenuation factors were obtained for 6 MeV (the lowest electron energy in most clinics) with solid water slabs (1–10 mm by 1 mm increments) placed on top of electron cones. Scatter dose to contralateral breast caused by the solid water slabs was measured on a human-like phantom using two selective scar boost patient setups.

Results

The PDD plots showed that the solid water slabs had similar dosimetric effects to the bolus with lower skin dose to ipsilateral breast for the same thickness. Slab attenuation and scatter dose to the contralateral breast were increased by ~220% and by a factor of 3 with a 5 mm slab, respectively.

Findings

Our results demonstrate the feasibility of using water-equivalent slabs to reduce lung dose for electron scar boost treatment in mastectomy patients with a thin chest wall. However, the increases in treatment time and scatter dose to the contralateral breast are the disadvantages of this approach.

Keywords

breast cancerlung dosepost-mastectomy radiation therapyscar boostthin chest wall
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 1 , March 2017 , pp. 20 - 28
Check for updates
Copyright
© Cambridge University Press 2016 

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

1. Horst, K C, Haffty, B G, Harris, E E R et al. ACR Appropriateness Criteria®: Postmastectomy Radiotherapy. Reston, VA, USA: American College of Radiology, 2012: 1–18.Google Scholar
2. Jagsi, R. Postmastectomy radiation therapy: an overview for the practicing surgeon. ISRN Surg 2013; 2013: 1–16.CrossRefGoogle ScholarPubMed
3. Ma, J, Li, J, Xie, L et al. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities. Radiat Oncol 2013; 8: 81.CrossRefGoogle ScholarPubMed
4. Rong, Y, Yadav, P, Welsh, J S et al. Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy. Med Dosim 2012; 37: 233–239.Google Scholar
5. Gez, E, Ashaf, N, Bar-Deroma, R et al. Postmastectomy electron-beam chest-wall irradiation in women with breast cancer. Int J Radiat Oncol Biol Phys 2004; 60: 1190–1194.Google Scholar
6. Huang, E, Chen, H, Sun, L et al. Multivariate analysis of locoregional recurrences and skin complications after postmastectomy radiotherapy using electrons or photons. Int J Radiat Oncol Biol Phys 2006; 65: 1389–1396.Google Scholar
7. Perkins, G H, McNeese, M D, Antolak, J A et al. A custom three-dimensional electron bolus technique for optimization of postmastectomy irradiation. Int J Radiat Oncol Biol Phys 2001; 51: 1143–1151.Google Scholar
8. Blitzblau, R, Horton, J K. Treatment planning technique in patients receiving postmastectomy radiation therapy. Prac Rad Oncol 2013; 3: 241–248.Google Scholar
9. Balaji, K, Subramanian, B, Yadav, P et al. Radiation therapy for breast cancer: literature review. Med Dosim 2016; 41: 253–257.Google Scholar
10. MacDonald, S M, Jimenez, R, Paetzold, P et al. Proton radiotherapy for chest wall and regional lymphatic radiation; dose comparisons and treatment delivery. Radiat Oncol 2013; 8: 71.Google Scholar
11. Vijayaprabhu, N, Gunaseelan, K, Vivekanandan, N et al. Postmastectomy scar boost irradiation using HDR surface mold brachtherapy by 3D image-based volume optimization. Int J Med Phys Clin Eng Radiat Oncol 2013; 2: 139–146.Google Scholar
12. Goldman, U B, Anderson, M, Wennberg, B et al. Radiation pneumonitis and pulmonary function with lung dose-volume constraints in breast cancer irradiation. J Radiother Prac 2014; 13: 211–217.CrossRefGoogle Scholar
13. Chung, Y, Yoon, H I, Kim, Y B et al. Radiation pneumonitis in breast cancer patients who received radiotherapy. J Breast Cancer 2012; 15: 337–343.Google Scholar
14. Mehta, V. Radiation pneumonitis and pulmonary fibrosis in non-small-cell lung cancer: pulmonary function, prediction and prevention. Int J Radiat Oncol Biol Phys 2005; 63: 5–24.Google Scholar
15. Ordonez-Sanz, C, Bowles, S, Hirst, A et al. A single plan solution to chest wall radiotherapy with bolus? Br J Radiol 2014; 87: 20140035.CrossRefGoogle ScholarPubMed
16. Khan, F M, Doppke, K P, Hogstrom, K R et al. Clinical electron-beam dosimetry: report of AAPM Radiation Committee Task Group No. 25. Med Phys 1991; 18: 73–109.Google Scholar
17. Karzmark, C J, Anderson, J, Fessenden, P et al. Total Skin Electron Therapy: Technique and Dosimetry: Report of Task Group No. 30. New York, NY, USA: American Institute of Physics, Inc, 1988: 1–55.Google Scholar