Clinical target volume localization using conventional methods (anatomy and palpation) and ultrasonography in early breast cancer post-operative external irradiation

1997 ◽  
Vol 42 (3) ◽  
pp. 231-237 ◽  
Author(s):  
Riccardo Valdagni ◽  
Corrado Italia ◽  
Paolo Montanaro ◽  
Mario Ciocca ◽  
Giovanni Morandi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Breast Cancer ◽  
Clinical Target Volume ◽  
Target Volume ◽  
External Irradiation ◽  
Conventional Methods

scholarly journals Radiation-Induced Toxicity Risks in Photon Versus Proton Therapy for Synchronous Bilateral Breast Cancer

2021 ◽  
Author(s):  
Line Bjerregaard Stick ◽  
Maria Fuglsang Jensen ◽  
Søren M. Bentzen ◽  
Claus Kamby ◽  
Anni Young Lundgaard ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Radiation Therapy ◽  
Coronary Artery ◽  
Early Breast Cancer ◽  
Proton Therapy ◽  
Clinical Target Volume ◽  
Target Volume ◽  
Radiation Dermatitis ◽  
Radiation Induced

Abstract Purpose This study compares photon and proton therapy plans for patients with synchronous bilateral early breast cancer and estimates risks of early and late radiation-induced toxicities. Materials and Methods Twenty-four patients with synchronous bilateral early breast cancer receiving adjuvant radiation therapy using photons, 3-dimensional conformal radiation therapy or volumetric modulated arc therapy, were included and competing pencil beam scanning proton therapy plans were created. Risks of dermatitis, pneumonitis, acute esophageal toxicity, lung and breast fibrosis, hypothyroidism, secondary lung and esophageal cancer and coronary artery events were estimated using published dose-response relationships and normal tissue complication probability (NTCP) models. Results The primary clinical target volume V95% and/or nodal clinical target volume V90% were less than 95% in 17 photon therapy plans and none of the proton plans. Median NTCP of radiation dermatitis ≥ grade 2 was 18.3% (range, 5.4-41.7) with photon therapy and 58.4% (range, 31.4-69.7) with proton therapy. Median excess absolute risk (EAR) of secondary lung cancer at age 80 for current and former smokers was 4.8% (range, 0.0-17.0) using photons and 2.7% (range, 0.0-13.6) using protons. Median EAR of coronary event at age 80, assuming all patients have preexisting cardiac risk factors, was 1.0% (range, 0.0-5.6) with photons and 0.2% (range, 0.0-1.3) with protons. Conclusion Proton therapy plans improved target coverage and reduced risk of coronary artery event and secondary lung cancer while increasing the risk of radiation dermatitis.

Geometric contour variation in clinical target volume of axillary lymph nodes in breast cancer radiotherapy: an AIRO multi-institutional study

2021 ◽  
pp. 20201177
Author(s):  
Maria Cristina Leonardi ◽  
Matteo Pepa ◽  
Simone Giovanni Gugliandolo ◽  
Rosa Luraschi ◽  
Sabrina Vigorito ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Clinical Target Volume ◽  
Target Volume ◽  
Radiotherapy Planning ◽  
Axillary Lymph Nodes ◽  
Dice Similarity Coefficient ◽  
Axillary Lymph ◽  
Computed Tomography Images ◽  
Breast Cancer Radiotherapy

Objectives: To determine interobserver variability in axillary nodal contouring in breast cancer (BC) radiotherapy (RT) by comparing the clinical target volume of participating single centres (SC-CTV) with a gold-standard CTV (GS-CTV). Methods: The GS-CTV of 3 patients (P1, P2, P3) with increasing complexity was created in DICOM format from the median contour of axillary CTVs drawn by BC experts, validated using the simultaneous truth and performance level estimation and peer-reviewed. GS-CTVs were compared with the correspondent SC-CTVs drawn by radiation oncologists, using validated metrics and a total score (TS) integrating all of them. Results: Eighteen RT centres participated in the study. Comparative analyses revealed that, on average, the SC-CTVs were smaller than GS-CTV for P1 and P2 (by −29.25% and −27.83%, respectively) and larger for P3 (by +12.53%). The mean Jaccard index was greater for P1 and P2 compared to P3, but the overlap extent value was around 0.50 or less. Regarding nodal levels, L4 showed the highest concordance with the GS. In the intra patient comparison, L2 and L3 achieved lower TS than L4. Nodal levels showed discrepancy with GS which was not statistically significant for P1, and negligible for P2, while P3 had the worst agreement. DICE Similarity Coefficient did not exceed the minimum threshold for agreement of 0.70 in all the measurements. Conclusions: Substantial differences were observed between SC- and GS-CTV, especially for P3 with altered arm set-up. L2 and L3 were the most critical levels. The study highlighted these key points to address. Advances in knowledge The present study compares, by means of validated geometric indexes, manual segmentationsof axillary lymph nodes in breast cancer from different observers and different institutionsmade on radiotherapy planning computed tomography images. Assessing such variability is ofparamount importance, as geometric uncertainties might lead to incorrect dosimetry andcompromise oncological outcome.

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