The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice

2021 ◽  
Author(s):  
Pierre Loap ◽  
Youlia Kirova
Keyword(s):  
Clinical Practice ◽  
Breast Radiotherapy ◽  
Cardiac Dose ◽  
Dose Constraint

scholarly journals Hypofractionation in postmastectomy breast irradiation. How safe are we in using standard tangentials?

2017 ◽  
Vol 03 (02) ◽  
pp. 101-105
Author(s):  
Bindhu Joseph ◽  
Nisma Farooq ◽  
Muhammed N. Shafeeque ◽  
S. Sathiyan ◽  
V. Lokesh ◽  
...  
Keyword(s):  
Conformal Radiotherapy ◽  
Target Volume ◽  
Conformity Index ◽  
High Dose ◽  
Average Dose ◽  
Breast Radiotherapy ◽  
Cardiac Dose ◽  
Radiotherapy Field ◽  
Dose Homogeneity ◽  
Gray Areas

Abstract Aim: Hypofractionation in breast radiotherapy is gaining increasing relevance in routine clinical practice; however, gray areas remain on its safety. Majority of data regarding the same pertains to the treatment of the conserved breast. This study aimed to compare the use of standard wedge-based tangentials (two-dimensional [2D] TW) versus 3D conformal radiotherapy field in the field (3DCRT FIF) with the intent of evaluating if the latter would provide a dosimetric advantage. Materials and Methods: Twenty-six postmastectomy patients were enrolled in this study. Comparative plans using 2D TW and 3DCRT FIF were generated to deliver 50 Gy in 25 fractions. Dosimetric parameters pertaining target dose, Homogeneity Index (HI), Conformity Index, and dose to normal structures were compared and analyzed. The parameters that achieved significance were evaluated using the hypofractionated plan. Results: The 3DCRT FIF plan showed better planning target volume coverage, V95% (P < 0.001) and less cardiac dose (V30 and MD) as well as lung V20, V30, MD, and V5 for both lungs (P < 0.001). The dose to the left descending coronary artery (LAD) was also less with a trend toward significance (P = 0.07). The 3DCRT FIF plan also improved HI (P = 0.02). However, the high-dose volume V107% and radiation exposure were not higher. The significant parameters were evaluated in the hypofractionated schedule of 40 Gy/15 Fr. The MD to the heart was 8.96 Gy in FIF plan versus 20.16 Gy in TW plan. The average V20 to the ipsilateral lung was 37.8% versus 65.2%. The average dose to the contralateral breast was 50% less, i.e., 3.92 Gy versus 8.96 Gy. Conclusion: The results of this study suggest that there would be a significant benefit of using 3DCRT FIF plans for patients being considered for hypofractionated radiotherapy in the postmastectomy setup.

scholarly journals Beam angle manipulation to reduce cardiac dose during breast radiotherapy

2012 ◽  
Vol 85 (1011) ◽  
pp. 265-271 ◽  
Author(s):  
S Vivekanandan ◽  
J Mhlanga ◽  
D Launders ◽  
A Przeslak ◽  
D A L Morgan
Keyword(s):  
Beam Angle ◽  
Breast Radiotherapy ◽  
Cardiac Dose

scholarly journals EP-1973 Cardiac dose sparing with active breath coordinator in breast radiotherapy: a dosimetric analysis

2019 ◽  
Vol 133 ◽  
pp. S1077
Author(s):  
A. Ianiro ◽  
M. Boccardi ◽  
G. Macchia ◽  
F. Deodato ◽  
P. Viola ◽  
...  
Keyword(s):  
Breast Radiotherapy ◽  
Cardiac Dose ◽  
Dose Sparing ◽  
Dosimetric Analysis

scholarly journals Cardiac Dose Control and Optimization Strategy for Left Breast Cancer Radiotherapy With Non-Uniform VMAT Technology

2021 ◽  
Vol 20 ◽  
pp. 153303382110537
Author(s):  
Jianjian Qiu ◽  
Shujun Zhang ◽  
Bo Lv ◽  
Xiangpeng Zheng
Keyword(s):  
Breast Cancer ◽  
Dose Reduction ◽  
Left Breast ◽  
Dose Verification ◽  
Delivery Time ◽  
Breast Radiotherapy ◽  
Cancer Radiotherapy ◽  
Breast Cancer Radiotherapy ◽  
Cardiac Dose ◽  
Delivery Efficiency

Purpose: A novel in-house technology “Non-Uniform VMAT (NU-VMAT)” was developed for automated cardiac dose reduction and treatment planning optimization in the left breast radiotherapy. Methods: The NU-VMAT model based on IGM (gantry MLC Movement coefficient index) was established to optimize the volumetric modulated arc therapy (VMAT) MLC movement and modulation intensity in certain gantry angles. The ESAPI embedded in Eclipse® was employed to connect TPS and the optimization program via I/O relevant DICOM RT files. The adjuvant whole-breast radiotherapy of 14 patients with left breast cancer was replanned using our NU-VMAT technology in comparison with VMAT and IMRT technology. Dosimetric parameters including D1%, D99%, and Dmean of PTV, V5, V10, and V20 of ipisilateral lung, V5, D20, D30, and Dmean of heart, monitor units (MUs), and delivery time derived from IMRT, VMAT, and NU-VMAT plans were evaluated for plan quality and delivery efficiency. The quality assurance (QA) was conducted using both point-dose and planar-dose measurements for all treatment plans. Results: The IGM−NU−VMAT curves with plan optimization (range from 50% to 147%) were converged more significantly than IGM-VMAT curves (range from 0% to 297%). The dose distribution requirements of the target and normal tissues could be met using IMRT, VMAT, or NU-VMAT; the lowest Dmean was achieved in NU-VMAT plans (5.38 ± 0.46 Gy vs 5.63 ± 0.61 Gy in IMRT and 7.95 ± 0.52 Gy in VMAT plans). Statistically significant differences were found in terms of delivery time and MU when comparing IMRT with VMAT and NU-VMAT plans ( P < .05). In comparison with IMRT plans, the MU and delivery time in NU-VMAT plans dramatically decreased by 69.8% and 28.4%, respectively. Moreover, NU-VMAT plans showed a high gamma passing rate (96.5% ± 1.11) in plane dose verification and minimal dose difference (2.4% ± 0.19) in point absolute dose verification. Conclusion: Our non-uniform VMAT facilitated the treatment strategy optimization for left breast cancer radiotherapy with dosimetric advantage in cardiac dose reduction and delivery efficiency in comparison with the conventional VMAT and IMRT.

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