Toxicity and Cosmetic Outcome After Breast Conservation and Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiation Therapy

AbstractBackgroundWhole 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.ObjectiveAim 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).MethodsWhole 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.ResultsIn 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.ConclusionsHI 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.

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Comparison study of the partial-breast irradiation techniques: Dosimetric analysis of three-dimensional conformal radiation therapy, electron beam therapy, and helical tomotherapy depending on various tumor locations

Medical Dosimetry ◽

10.1016/j.meddos.2013.03.004 ◽

2013 ◽

Vol 38 (3) ◽

pp. 327-331 ◽

Cited By ~ 2

Author(s):

Min-Joo Kim ◽

So-Hyun Park ◽

Seok-Hyun Son ◽

Keum-Seong Cheon ◽

Byung-Ock Choi ◽

...

Keyword(s):

Radiation Therapy ◽

Electron Beam ◽

Helical Tomotherapy ◽

Three Dimensional ◽

Partial Breast Irradiation ◽

Comparison Study ◽

Breast Irradiation ◽

Conformal Radiation Therapy ◽

Electron Beam Therapy ◽

Dosimetric Analysis

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Survival and Recurrence Patterns After 3-D Conformal Radiation Therapy For Whole-Breast Irradiation in the Prone Position

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2015.07.668 ◽

2015 ◽

Vol 93 (3) ◽

pp. E49-E50

Author(s):

H. Saeed ◽

H. Cheng ◽

T.R. Kelly ◽

J.A. Bovi ◽

J.R. White ◽

...

Keyword(s):

Radiation Therapy ◽

Prone Position ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Conformal Radiation Therapy ◽

Recurrence Patterns

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Feasibility of accelerated partial breast irradiation using three-dimensional conformal radiation therapy for Japanese women: a theoretical plan using six patients’ CT data

Breast Cancer ◽

10.1007/s12282-007-0013-0 ◽

2007 ◽

Vol 15 (1) ◽

pp. 108-114 ◽

Cited By ~ 6

Author(s):

Yasuhiro Kosaka ◽

Michihide Mitsumori ◽

Chikako Yamauchi ◽

Yuichiro Narita ◽

Masahiro Hiraoka

Keyword(s):

Radiation Therapy ◽

Three Dimensional ◽

Japanese Women ◽

Accelerated Partial Breast Irradiation ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

Conformal Radiation Therapy ◽

Ct Data

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A Phase I/II Trial to Evaluate the Technical Feasibility of Partial Breast Irradiation with Three-Dimensional Conformal Radiation Therapy in Korean Women with Stage I Breast Carcinoma: An Initial Report of the Korean Radiation Therapy Oncology Group (KROG) Study 0804

Cancer Research and Treatment ◽

10.4143/crt.2013.202 ◽

1970 ◽

Vol 47 (1) ◽

pp. 18-25 ◽

Cited By ~ 2

Author(s):

Jae-Uk Jeong ◽

Jung Han Yoon ◽

Min Ho Park ◽

Mee Sun Yoon ◽

Ju-Young Song ◽

...

Keyword(s):

Radiation Therapy ◽

Radiation Therapy Oncology Group ◽

Three Dimensional ◽

Partial Breast Irradiation ◽

Korean Women ◽

Breast Irradiation ◽

Oncology Group ◽

Technical Feasibility ◽

Conformal Radiation Therapy ◽

Initial Report

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Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy in Women Undergoing Breast Conservation for Early Disease Yields High Rates of Excellent to Good Cosmetic Outcomes in Patients With Large and/or Pendulous Breasts

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2011.08.020 ◽

2012 ◽

Vol 83 (3) ◽

pp. 821-828 ◽

Cited By ~ 36

Author(s):

Carmen Bergom ◽

Tracy Kelly ◽

Natalya Morrow ◽

J. Frank Wilson ◽

Alonzo Walker ◽

...

Keyword(s):

Breast Conservation ◽

Three Dimensional ◽

Conformal Radiotherapy ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Early Disease ◽

Good Cosmetic ◽

Cosmetic Outcomes ◽

Three Dimensional Conformal Radiotherapy

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Are Patients Traveling for Intraoperative Radiation Therapy?

International Journal of Breast Cancer ◽

10.1155/2017/6395712 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Kelsey E. Larson ◽

Stephanie A. Valente ◽

Chirag Shah ◽

Rahul D. Tendulkar ◽

Sheen Cherian ◽

...

Keyword(s):

Radiation Therapy ◽

Breast Conservation ◽

Group Living ◽

Travel Distance ◽

Intraoperative Radiation Therapy ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Intraoperative Radiation ◽

Zip Code

Purpose. One benefit of intraoperative radiation therapy (IORT) is that it usually requires a single treatment, thus potentially eliminating distance as a barrier to receipt of whole breast irradiation. The aim of this study was to evaluate the distance traveled by IORT patients at our institution. Methods. Our institutional prospective registry was used to identify IORT patients from 10/2011 to 2/2017. Patient’s home zip code was compared to institution zip code to determine travel distance. Characteristics of local (<50 miles), regional (50–100 miles), and faraway (>100 miles) patients were compared. Results. 150 were patients included with a median travel distance of 27 miles and mean travel distance of 121 miles. Most were local (68.7%), with the second largest group living faraway (20.0%). Subset analysis of local patients demonstrated 20.4% traveled <10 miles, 34.0% traveled 10–20 miles, and 45.6% traveled 20–50 miles. Six patients traveled >1000 miles. The local, regional, and faraway patients did not differ with respect to age, race, tumor characteristics, or whole breast irradiation. Conclusions. Breast cancer patients are traveling for IORT, with 63% traveling >20 miles for care. IORT is an excellent strategy to promote breast conservation in selected patients, particularly those who live remote from a radiation facility.

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