Novel method of radiotherapy planning to improve the dose homogeneity at the junction region for breast cancer

Introduction: Radiotherapy after Breast-Conserving Surgery (BCS) is a standard treatment for breast cancer. Currently, surgical clips are used to determine the tumour bed before radiotherapy planning. This study aimed to evaluate the migration of these clips on mammograms. Methods: The study was conducted on 121 females who were treated with radiotherapy after BCS at their first radiologic control examination 6 months after the end of treatment. MLO and CC views of all cases were evaluated regarding the clips. The distance between the surgical scar centre and the centre of the area covered by the clips was measured on both MLO and CC projections and recorded separately. This distance was determined as the clip displacement. A displacement ≤10 mm was recorded as no displacement. Results: The clips were out of the images and were not evaluated in 45 cases (37.2%) on CC and in 9 cases (7.4%) on MLO projections. There were no clip displacements in 37 (30.6%) cases on CC and in 43 (35.5%) cases on MLO views. The amount of displacement ranged from 11 to 56 mm with a mean of 24.38 mm on CC views, while on MLO projections, displacement ranged from 11 to 66 mm with a mean of 24.42 mm. Conclusion: A clip displacement of greater than 10 mm was found in 64.5% of cases on MLO views. Therefore, we believe that the reliability of these clips for accurate delineation of the tumour bed in radiotherapy planning is controversial and other methods must be added.

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Contribution of Magnetic Resonance Imaging in Determining Lumpectomy Cavity in Breast Radiotherapy

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405615666191008162447 ◽

2020 ◽

Vol 16 (8) ◽

pp. 997-1003

Author(s):

Ozlem Demircioglu ◽

Huseyin Tepetam ◽

Ayfer Ay Eren ◽

Zerrin Ozgen ◽

Fatih Demircioglu ◽

...

Keyword(s):

Breast Cancer ◽

Supine Position ◽

Radiotherapy Planning ◽

Breast Cancer Patients ◽

Breast Radiotherapy ◽

Lumpectomy Cavity ◽

Breast Cancer Radiotherapy ◽

Significant Difference ◽

Mean Diameter ◽

Ct And Mri

Background: Accurate localization of the lumpectomy cavity is important for breast cancer radiotherapy after breast-conserving surgery (BCS), but the LC localization based on CT is often difficult to delineate accurately. The study aimed to compare CT-defined LC planning to MRI-defined findings in the supine position for higher soft-tissue resolution of MRI. Methods: Fifty-nine breast cancer patients underwent radiotherapy CT planning in supine position followed by MR imaging on the same day. LC was contoured by the radiologist and radiation oncologist together by CT and MRI separately. T2 weighted MR images and tomography findings were combined and the LC volume, mean diameter and the longest axis length were measured after contouring. Subsequently, patients were divided into two groups according to seroma in LC and the above-mentioned parameters were compared. Results: We did not find any statistically significant difference in the LC volume, mean diameter and length at the longest axis between CT and MRI but based on the presence or absence of seroma, statistically significant differences were found in the LC volumes and the length at the longest axis of LC volumes. Conclusion: We believe that the supine MRI in the same position with CT will be more effective for radiotherapy planning, particularly in patients without a seroma in the surgical cavity.

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Anatomical, clinical and radiological delineation of target volumes in the radiotherapy planning of breast cancer: individual variability, questions and answers

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(08)70647-5 ◽

2008 ◽

Vol 6 (7) ◽

pp. 146

Author(s):

P. Castro Pena ◽

Y. Kirova ◽

F. Campana ◽

R. Dendale ◽

M. Bollet ◽

...

Keyword(s):

Breast Cancer ◽

Individual Variability ◽

Radiotherapy Planning ◽

Questions And Answers ◽

Target Volumes

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Designing Personalized Treatment Plans for Breast Cancer

Information Systems Research ◽

10.1287/isre.2021.1002 ◽

2021 ◽

Author(s):

Wei Chen ◽

Yixin Lu ◽

Liangfei Qiu ◽

Subodha Kumar

Keyword(s):

Breast Cancer ◽

Domain Knowledge ◽

Early Stage ◽

Radiotherapy Planning ◽

Breast Cancer Patients ◽

Support Tools ◽

Treatment Plans ◽

Radiation Induced ◽

Effective Decision ◽

Effective Decision Support

Breast cancer remains the leading cause of cancer deaths among women around the world. Contemporary treatment for breast cancer is complex and involves highly specialized medical professionals collaborating in a series of information-intensive processes. This poses significant challenges to optimization of treatment plans for individual patients. We propose a novel framework that enables personalization and customization of treatment plans for early stage breast cancer patients undergoing radiotherapy. Using a series of simulation experiments benchmarked with real-world clinical data, we demonstrate that the treatment plans generated from our proposed framework consistently outperform those from the existing practices in balancing the risk of local tumor recurrence and radiation-induced adverse effects. Our research sheds new light on how to combine domain knowledge and patient data in developing effective decision-support tools for clinical use. Although our research is specifically geared toward radiotherapy planning for breast cancer, the design principles of our framework can be applied to the personalization of treatment plans for patients with other chronic diseases that typically involve complications and comorbidities.

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Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

Polish Journal of Medical Physics and Engineering ◽

10.2478/pjmpe-2021-0024 ◽

2021 ◽

Vol 27 (3) ◽

pp. 201-206

Author(s):

Özlem Mermut ◽

Aysun Ozsoy Ata ◽

Didem Can Trabulus

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Organs At Risk ◽

Bilateral Breast Cancer ◽

Radiotherapy Planning ◽

Conformity Index ◽

Treatment Unit ◽

Significant Difference ◽

Synchronous Bilateral Breast Cancer ◽

The Right

Abstract Objective: We compared mono-isocenter and dual-isocenter plans in synchronous bilateral breast cancer (SBBC), which is defined as tumours occurring simultaneously in both breasts, and evaluated the effects of these differences in plans on organs-at-risk (OARs). Materials and methods: We evaluated 10 women with early stage, nod negative (Tis-2N0M0) SBBC. The treatment dose was determined to be 50 Gy. We used mean dose and VXGy to evaluate the OARs. To evaluate the effectiveness of treatment plans, Homogeneity index (HI), conformity index (CI) and sigma index (SI) and monitor units (MU) of monoisocenter (MIT) and dual-isocenter (DIT) plans were compared. During bilateral breast planning, for the single-centre plan, the isocenter was placed at the center of both breasts at a depth of 3-4 cm. For the two-center plan, dual-isocenters were placed on the right and left breasts. Results: No significant difference between the techniques in terms of the scope of the target volume was observed. Statistically significant results were not achieved in MIT and DIT plans for OARs. Upon comparing MIT and DIT, the right-side monitor unit (MU) value in DIT (p = 0.011) was statistically significantly lower than that in MIT. Upon comparing right-left side MIT and DIT, the MU value (p = 0.028) was significantly lower in DIT than MIT. Conclusion: SBBC irradiation is more complex than unilateral breast radiotherapy. No significant difference between both techniques and OARs was observed. However, we recommend MIT as a priority technique due to the ability to protect OARs, ease of administration during treatment, and the fact that the patient stays in the treatment unit for a shorter period of time.

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Natural progression and clinical significance of incidentally detected pulmonary nodules in radiotherapy planning CT scans of breast cancer patients: a retrospective cohort

Journal of Radiotherapy in Practice ◽

10.1017/s1460396916000376 ◽

2016 ◽

Vol 15 (4) ◽

pp. 359-363

Author(s):

Sasidharan Balu Krishna ◽

Sunitha Susan Varghese ◽

Paul Gopu Gopurathingal ◽

Venkata Krishna Reddy Pilaka ◽

Selvamani Backianathan

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Clinical Significance ◽

Pulmonary Nodules ◽

Locoregional Therapy ◽

Radiotherapy Planning ◽

Lung Nodules ◽

Breast Cancer Patients ◽

Natural Progression

AbstractAimIndeterminate pulmonary nodules incidentally detected during radiological imaging completed for radiotherapy planning always creates dilemma for the oncologist. The purpose of this study is to evaluate the clinical significance of pulmonary nodules incidentally detected in patients undergoing locoregional radiotherapy for breast cancer and present a retrospective analysis of the natural progression of such nodules.MethodsA retrospective review of computed tomography scans of breast cancer patients who underwent radiotherapy over a period of 3 years to screen out patients with indeterminate lung nodules was undertaken. This was correlated with the patient and tumour characteristics and the status of the disease at last follow-up.ResultsOf the 132 patients reviewed 28 had indeterminate lung nodules. Of the 28 patients, four had progressive lung nodules on follow-up. Subgroup analyses did not show any significant correlation.Discussion and conclusionOne fifth of patients may present with incidentally detected lung nodules. Multiple nodules, ER negative status and locally advanced breast cancer may point to a higher risk of these nodules progressing to metastatic cancer. There is no indication to stop locoregional therapy in the presence of indeterminate nodules, but close follow-up of high-risk group is recommended.

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