The impact of breast separation on radiation dose delivery to the ipsilateral lung as a result of respiratory motion quantified using free breathing and 4D-CT-based planning for radiotherapy to whole breast and regional lymphatics in patients with locally advanced breast cancers: results of Weill Cornell Medical College, New York

e20091 Background: 4D CT simulation has been evolved to estimate the internal body motion and considered as a useful tool for intra-thoracic tumor definition. This study aimed to evaluate the impact of using 4D simulation on the planning target volume (PTV) for primary lung tumor. Methods: Patients who underwent CT simulation for primary lung cancer radiotherapy between 2012-2016 using 3D- (free breathing) and 4D- (respiratory gated) institutional protocol were included in this retrospective review. For each patient, gross tumor volume (GTV) was contoured in free breathing scan (3D-GTV), exhale scan (e-GTV) and inhale scan (i-GTV). The corresponding CTVs (3D-CTV, e-CTV and i-CTV) were created by adding 1 cm in all directions. 3D-internal target volume (3D-ITV) was generated by 0.5 cm cranio-caudal expansion of 3D-CTV, while 4D-ITV was created by combination of e-CTV and i-CTV. Subsequently, a 0.5 cm margin was added to generate the 3D-PTV and 4D-PTV respectively. The volumes of 3D-PTV and 4D-PTV were compared to examine the impact of 4D CT simulation on changes in the volume of PTV. Univariable and multivariable analysis were performed to test the impact of volume and location of GTV on the changes of PTV volume by more than 10 % between free breathing and respiratory gated scans. Results: A total of 10 patients were identified. The median [range] GTV, i-GTV, e-GTV volumes were 13.55 [1.44-628.66], 13.17 [1.77-627.36], 12.85 [1.34-630.25] cc respectively. The 3D-CTV, i-CTV, e-CTV volumes were 86.37 [23.76-1209], 84.97 [25.5- 1220.4], 83.40 [23.36-1224.12] cc respectively. 3D-ITV and 4D-ITV median volume was 106.06 [3.99-1422.8], 88.02 [20.51-1338.18] cc respectively. 3D-PTV was significantly larger than the 4D-PTV; median [range] volumes were 182.79 [58.65- 1861.05] vs. 158.21 [52.76-1771.02] cc, p = 0.0068). On multivariable analysis, neither the volume of GTV (p = 0.4917), nor the location of the tumor (peripheral, p = 0.4914 or lower location, p = 0.9594) had an in impact on PTV differences between free breathing and respiratory gated scans. Conclusions: The use of 4D simulation reduces the PTV for primary lung cancer, and it should be routinely implemented in clinical practice regardless the tumor volume or location.

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Impact of respiratory motion on breast tangential radiotherapy using the field-in-field technique compared to irradiation using physical wedges

Radiology and Oncology ◽

10.2478/raon-2013-0032 ◽

2014 ◽

Vol 48 (1) ◽

pp. 94-98 ◽

Cited By ~ 6

Author(s):

Hidekazu Tanaka ◽

Shinya Hayashi ◽

Kazuhiro Ohtakara ◽

Hiroaki Hoshi

Keyword(s):

Respiratory Motion ◽

Early Stage ◽

Free Breathing ◽

Ct Images ◽

Data Set ◽

Acceptable Range ◽

Treatment Plans ◽

Prescription Dose ◽

Ct Data ◽

The Impact

Abstract Background. This study aimed to evaluate whether the field-in-field (FIF) technique was more vulnerable to the impact of respiratory motion than irradiation using physical wedges (PWs). Patients and methods. Ten patients with early stage breast cancer were enrolled. Computed tomography (CT) was performed during free breathing (FB). After the FB-CT data set acquisition, 2 additional CT scans were obtained during a held breath after light inhalation (IN) and light exhalation (EX). Based on the FB-CT images, 2 different treatment plans were created for the entire breast for each patient and copied to the IN-CT and EX-CT images. The amount of change in the volume of the target receiving 107%, 95%, and 90% of the prescription dose (V107%, V95%, and V90%, respectively), on the IN-plan and EX-plan compared with the FB-plan were evaluated. Results. The V107%, V95%, and V90% were significantly larger for the IN-plan than for the FB-plan in both the FIF technique and PW technique. While the amount of change in the V107% was significantly smaller in the FIF than in the PW plan, the amount of change in the V95% and V90% was significantly larger in the FIF plan. Thus, the increase in the V107% was smaller while the increases in the V95% and V90% were larger in the FIF than in the PW plan. Conclusions. During respiratory motion, the dose parameters stay within acceptable range irrespective of irradiation technique used although the amount of change in dose parameters was smaller with FIF technique.

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Survival advantage by neoadjuvant radiochemotherapy in locally advanced noninflammatory breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.638 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 638-638

Author(s):

S. L. Roth

Keyword(s):

Breast Cancer ◽

Survival Rate ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Breast Conservation ◽

Breast Conserving Surgery ◽

Neoadjuvant Radiochemotherapy ◽

Time Interval ◽

Breast Cancers ◽

The Impact

638 Background: The impact of timing of radiochemotherapy (RCT) relative to surgery has been assessed in terms of ten year survival rate for locally advanced or surgically in terms of breast conserving surgery or simple mastectomy unfavourable, noninflammatory breast cancers (LABC). Methods: A total of 644 women were included in the retrospective study from 1991–1998. Chemotherapy was applied in 166 as neoadjuvant, in 236 simultaneously and in 113 as adjuvant. 119 patients received no chemotherapy. 40% of the patients received four courses of epirubicin/ cyclophosphamide, 26% concurrent mitoxantrone, 5% three cycles of CMF, 3% six cycles of CMF and 15% had no chemotherapy. 315 patients with locally advanced breast cancer (LABC) received neoadjuvant and 329 adjuvant RCT. Preoperative radiotherapy consisted of 50 Gy to the breast and the supra/infraclavicular lymph nodes with a 10 Gy electron or interstitial boost. The mean time interval between the end of radiotherapy and the surgery was 27 weeks (6–89 weeks). Results: Breast conservation was possible in 48% in the preoperative arm and in 52% in the postoperative arm. The rate of pT0 after neoadjuvant RCT was 38% (120/315) and the pCR in breast and axilla 30% (95/315). The ten year survival in the neoadjuvant group (n = 315) compared favourably 68.6% vs. 65% in case of the adjuvant group (n = 329; p = 0.21) in spite of more advanced disease. Patients with cT1- (n = 3) and cT2- (n = 97) categories had a significantly 13.6% better ten year survival rate after neoadjuvant RCT (85.76% vs. 72.19%) compared to cT1- (n = 1) and cT2- (n = 180) after adjuvant RCT (p = 0.0026). Conclusions: This study compares, retrospectively, neoadjuvant RCT vs. adjuvant RCT in LABC. Preoperative RCT achieved a pT0-rate of 38% and a prolonged ten year survival to a degree of 13.6% statistically significant in patients with cT2- category breast cancer compared to adjuvant RCT. No significant financial relationships to disclose.

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