Comparison of dose volumetric parameters of oesophagus in the radiation treatment of carcinoma breast with and without oesophagus delineation

2021 ◽  
pp. 1-6
Author(s):  
Reshma Bhaskaran ◽  
Sajeev George Pulickal ◽  
Harikrishnan Reghu ◽  
Aparna Perumangat ◽  
Girish Babu Moolath
Keyword(s):  
Lung Volume ◽  
Radiation Treatment ◽  
Three Dimensional ◽  
Conformal Radiotherapy ◽  
Target Volume ◽  
Conformity Index ◽  
Carcinoma Breast ◽  
Ipsilateral Lung ◽  
Breast Cancer Radiotherapy ◽  
Supraclavicular Fossa

Abstract Aim: There are only limited studies available in literature that discuss methods to reduce the oesophageal dose and acute oesophagitis during breast cancer radiotherapy. The aim of this study is to compare dose volumetric parameters of oesophagus in radiation treatment of breast with and without oesophagus delineation. Methods: Treatment plans of 44 patients, who underwent chest wall and supraclavicular fossa irradiation, were selected for the study. Oesophagus was later delineated and treatment replanned using three-dimensional conformal radiotherapy (3DCRT) considering oesophagus as an organ at risk (OAR). The dose prescribed was 40 Gy/15 fractions to the planning target volume (PTV). Dose volumetric parameters of oesophagus such as maximum dose (Dmax), mean dose (Dmean), the percentage of oesophagus volume receiving ≥15Gy (V15), ≥25Gy(V25), ≥33Gy(V33) and ipsilateral lung volume parameters V4, V8 and V16 were compared with already executed plans in which oesophagus was not delineated. Results: Contouring the oesophagus as an OAR as a part of the radiotherapy treatment for Carcinoma Breast resulted in statistically significant reduction in dose to the oesophagus. No statistically significant change was found in the ipsilateral lung volume parameters. No compromise in plan quality was required as evident from the statistically non-significant differences in Homogeneity index and Conformity index. Findings: 3DCRT planning with oesophagus delineation can be considered as a method to reduce oesophageal dose and the acute oesophageal toxicity during radiotherapy for carcinoma breast.

A Novel Radiotherapy Technique

2008 ◽  
pp. 1016-1023
Author(s):  
Maria F. Chan ◽  
Yan Song
Keyword(s):  
Radiation Treatment ◽  
Three Dimensional ◽  
Intensity Modulated Radiation Therapy ◽  
Special Kind ◽  
Conformal Radiotherapy ◽  
The United States ◽  
Target Volume ◽  
Normal Tissues ◽  
Intensity Modulated ◽  
Three Dimensional Conformal Radiotherapy

Cancer is the second leading cause of death behind heart disease in the United States (National Center for Health Statistics, 2006). Various caner treatments are available now, but the three most common types are surgery, chemotherapy, and radiotherapy. Radiotherapy uses radiation—in the form of a special kind of x-rays, ?-rays, electrons, or protons to kill cancer cells. The advance of modern radiotherapy is closely linked to the evolution of computer and information technology. Intensity-modulated radiation therapy (IMRT) is an advanced form of three-dimensional conformal radiotherapy (3DCRT). It has become today’s standard for state-of-the-art radiation treatment. IMRT is based on the concept of inverse treatment planning. By optimizing a constrained objective function, IMRT can modulate the shape and intensity of radiation beams to create a dose distribution highly conformal to the target volume. In this article, we report the results of our investigation on the feasibility and potential benefits of combining electrons with intensity-modulated photons, called IMRT+e, for selected types of caner, particularly for superficial tumors with critical organs underneath. The aim is to deliver high radiation dose to the tumor while sparing all the surrounding normal tissues, thereby minimizing radiation induced side-effects.

scholarly journals Dosimetric Comparison of Different 3DCRT Techniques in Left Breast Cancer Radiotherapy Planning

2016 ◽  
Vol 17 (2) ◽  
pp. 108-113
Author(s):  
Abdus Sattar Mollah ◽  
Meher Niger Sharmin
Keyword(s):  
Breast Cancer ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Dose Calculation ◽  
Conformal Radiotherapy ◽  
Radiotherapy Planning ◽  
Conformity Index ◽  
Calculation Algorithm ◽  
Breast Cancer Radiotherapy ◽  
The Mean

Treatment plan of 10 patients with left-sided breast cancer treated to a prescribed dose of 50 Gy in 25 fractions were selected. The treatment plans were generated by using an Elekta Precise PLAN treatment plan system (TPS) in three different ways namely M1 method, M2 method and M3 method for evaluation of dosimetric parameters based on three dimensional conformal radiotherapy (3DCRT) technique. Pencil beam calculation algorithm was used for dose calculation of Planning Treatment Volume (PTV) as well as Organ At Risk (OAR), with heterogeneity corrections. Plans were compared according to dose-volume histogram (DVH) analysis in terms of PTV homogeneity and conformity indices (HI and CI) as well as OARs dose and volume parameters. All the three treatment methods achieved comparable radiation dose delivery to PTV-95% of the prescribed dose covering > 95% of the breast PTV. The mean volume of PTV receiving 105% (V105) of the prescribed dose was 2.12% (range 0 - 5.7%) for M1 plan, 1.9% for M2 plan, and 3.08% for M3 plan. The homogeneity and conformity indices (HI and CI) were similar for M1 plan and M2 plan, whereas the M3 plan had better conformity index at the cost of less homogeneity. The low-dose volumes (V5Gy) in the heart and lungs were larger in M1 plan than in the other methods. The value of the mean dose to the ipsilateral lung was higher for M2 plan than the values for with M1 plan and M3 plan. Compared with M1 and M3 plan, M2 plan proved to be a simple planning method for 3DCRT breast irradiation.Bangladesh J. Nuclear Med. 17(2): 108-113, July 2014

scholarly journals Deep-inspirational breath-hold (DIBH) technique in left-sided breast cancer: various aspects of clinical utility

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Szilvia Gaál ◽  
Zsuzsanna Kahán ◽  
Viktor Paczona ◽  
Renáta Kószó ◽  
Rita Drencsényi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Clinical Utility ◽  
Prospective Trial ◽  
Conformal Radiotherapy ◽  
Free Breathing ◽  
Left Breast ◽  
Breath Hold ◽  
Ipsilateral Lung ◽  
Breast Cancer Radiotherapy

Abstract Background Studying the clinical utility of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and feasibility aspects. Methods In this prospective trial all enrolled patients went through planning CT in supine position under both DIBH and free breathing (FB); in whole breast irradiation (WBI) cases prone CT was also taken. In 3-dimensional conformal radiotherapy (3DCRT) plans heart, left anterior descending coronary artery (LAD), ipsilateral lung and contralateral breast doses were analyzed. The acceptance of DIBH technique as reported by the patients and the staff was analyzed; post-RT side-effects including radiation lung changes (visual scores and lung density measurements) were collected. Results Among 130 enrolled patients 26 were not suitable for the technique while in 16, heart or LAD dose constraints were not met in the DIBH plans. Among 54 and 34 patients receiving WBI and postmastectomy/nodal RT, respectively with DIBH, mean heart dose (MHD) was reduced to < 50%, the heart V25 Gy to < 20%, the LAD mean dose to < 40% and the LAD maximum dose to about 50% as compared to that under FB; the magnitude of benefit was related to the relative increase of the ipsilateral lung volume at DIBH. Nevertheless, heart and LAD dose differences (DIBH vs. FB) individually varied. Among the WBI cases at least one heart/LAD dose parameter was more favorable in the prone or in the supine FB plan in 15 and 4 cases, respectively; differences were numerically small. All DIBH patients completed the RT, inter-fraction repositioning accuracy and radiation side-effects were similar to that of other breast RT techniques. Both the patients and radiographers were satisfied with the technique. Conclusions DIBH is an excellent heart sparing technique in breast RT, but about one-third of the patients do not benefit from that otherwise laborious procedure or benefit less than from an alternative method. Trial registration: retrospectively registered under ISRCTN14360721 (February 12, 2021)

scholarly journals Dosimetric Comparison of Three Radiotherapy Techniques in Irradiation of Left-Sided Breast Cancer Patients after Radical Mastectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jian Hu ◽  
Guang Han ◽  
Yu Lei ◽  
Ximing Xu ◽  
Wei Ge ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Volumetric Modulated Arc Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Radical Mastectomy ◽  
Target Volume ◽  
Conformity Index ◽  
Breast Cancer Patients ◽  
Ipsilateral Lung ◽  
Significant Difference

Introduction. This study is aimed at evaluating the dosimetric differences among target segmented planning (TSP), conventional 9-field intensity modulated radiation therapy (9FIMRT) planning, and volumetric modulated arc therapy (VMAT) planning for postmastectomy radiotherapy of left-sided breast cancer patients. Material and Methods. Fifteen left-sided breast cancer patients who underwent radical mastectomy were enrolled. In TSP, the planning target volume (PTV) was divided into four regions (supra/infraclavicular, chest wall, external mammary region, and internal mammary region), and each individual PTV region was treated with respective fixed fields. Results. The VMAT plans showed superior to PTV dose conformity index (CI), homogeneity index (HI), protection of the ipsilateral lung, monitor units (MUs), and maximum dose (Dmax) to the contralateral breast compared with TSP and 9FIMRT plans. The TSP provided better protection for Dmean of the heart and left ventricle (p<0.05). A dose for left anterior descending artery from the three techniques had no significant difference. Compared with the 9FIMRT plans, the V5Gy (%) and V10Gy (%) for the ipsilateral lung were significantly reduced with TSP and VMAT (p<0.05). The V5Gy (%) and V10Gy (%) for the ipsilateral lung turned out to be similar between VMAT and TSP techniques. Conclusions. Our study indicates that VMAT should be a better choice of radiotherapy for left-sided breast cancer patients after radical mastectomy. If VMAT is unavailable, 9FIMRT can achieve better CI and HI values and be more MU-efficient compared with TSP; however, TSP can effectively reduce the low dose volume of the ipsilateral lungs and heart.

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 Utilization of PET-CT in target volume delineation for three-dimensional conformal radiotherapy in patients with non-small cell lung cancer and atelectasis

2013 ◽  
Vol 8 ◽  
Author(s):  
Li-Jie Yin ◽  
Xiao-Bin Yu ◽  
Yan-Gang Ren ◽  
Guang-Hai Gu ◽  
Tian-Gui Ding ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Conformal Radiotherapy ◽  
Target Volume ◽  
Target Volume Delineation ◽  
Target Delineation ◽  
Volume Delineation ◽  
Pet Ct ◽  
Treatment Plans ◽  
Three Dimensional Conformal Radiotherapy ◽  
Nsclc Patients

Background: To investigate the utilization of PET-CT in target volume delineation for three-dimensional conformal radiotherapy in patients with non-small cell lung cancer (NSCLC) and atelectasis. Methods: Thirty NSCLC patients who underwent radical radiotherapy from August 2010 to March 2012 were included in this study. All patients were pathologically confirmed to have atelectasis by imaging examination. PET-CT scanning was performed in these patients. According to the PET-CT scan results, the gross tumor volume (GTV) and organs at risk (OARs, including the lungs, heart, esophagus and spinal cord) were delineated separately both on CT and PET-CT images. The clinical target volume (CTV) was defined as the GTV plus a margin of 6-8 mm, and the planning target volume (PTV) as the GTV plus a margin of 10-15 mm. An experienced physician was responsible for designing treatment plans PlanCT and PlanPET-CT on CT image sets. 95% of the PTV was encompassed by the 90% isodose curve, and the two treatment plans kept the same beam direction, beam number, gantry angle, and position of the multi-leaf collimator as much as possible. The GTV was compared using a target delineation system, and doses distributions to OARs were compared on the basis of dose-volume histogram (DVH) parameters. Results: The GTVCT and GTVPET-CT had varying degrees of change in all 30 patients, and the changes in the GTVCT and GTVPET-CT exceeded 25% in 12 (40%) patients. The GTVPET-CT decreased in varying degrees compared to the GTVCT in 22 patients. Their median GTVPET-CT and median GTVPET-CT were 111.4 cm3 (range, 37.8 cm3-188.7 cm3) and 155.1 cm3 (range, 76.2 cm3-301.0 cm3), respectively, and the former was 43.7 cm3 (28.2%) less than the latter. The GTVPET-CT increased in varying degrees compared to the GTVCT in 8 patients. Their median GTVPET-CT and median GTVPET-CT were 144.7 cm3 (range, 125.4 cm3-178.7 cm3) and 125.8 cm3 (range, 105.6 cm3-153.5 cm3), respectively, and the former was 18.9 cm3 (15.0%) greater than the latter. Compared to PlanCT parameters, PlanPET-CT parameters showed varying degrees of changes. The changes in lung V20, V30, esophageal V50 and V55 were statistically significant (Ps< 0.05 for all), while the differences in mean lung dose, lung V5, V10, V15, heart V30, mean esophageal dose, esophagus Dmax, and spinal cord Dmax were not significant (Ps> 0.05 for all). Conclusions: PET-CT allows a better distinction between the collapsed lung tissue and tumor tissue, improving the accuracy of radiotherapy target delineation, and reducing radiation damage to the surrounding OARs in NSCLC patients with atelectasis.

Dosimetric study of three-dimensional conformal radiotherapy, electronic compensator technique, intensity-modulated radiation therapy and volumetric-modulated arc therapy in whole breast irradiation

2017 ◽  
Vol 16 (4) ◽  
pp. 431-443 ◽  
Author(s):  
Chonnipa Nantavithya ◽  
Kitwadee Saksornchai ◽  
Puntiwa Oonsiri ◽  
Kanjana Shotelersuk
Keyword(s):  
Radiation Therapy ◽  
Volumetric Modulated Arc Therapy ◽  
Three Dimensional ◽  
Intensity Modulated Radiation Therapy ◽  
Conformal Radiotherapy ◽  
Target Volume ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Lung Dose ◽  
3D Crt

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.

An investigation of rotational issues for rectal carcinoma treated with radiotherapy

2013 ◽  
Vol 13 (2) ◽  
pp. 195-202
Author(s):  
Dominique A. Taylor ◽  
Thomas ffrench ◽  
Charlotte A. Sale ◽  
Paul Foulstone
Keyword(s):  
Rectal Carcinoma ◽  
Three Dimensional ◽  
Conformal Radiotherapy ◽  
Target Volume ◽  
Dose Volume Histograms ◽  
Action Threshold ◽  
Prescription Dose ◽  
Pre Treatment ◽  
Clinically Significant ◽  
Three Dimensional Conformal Radiotherapy

AbstractPurposeTo quantify the amount of inter-fractional pitch for rectal carcinoma patients, to investigate the dosimetric impact of pitch on the target volume and critical structures and to determine a tolerance where no pitch correction is required.Materials and methodsDaily pre-treatment images of rectal carcinoma patients were analysed to determine the residual pitch compared with the computed tomography (CT) planning scan. The dosimetric impact of pelvic rotation was modelled. The dose coverage of the clinical target volume (CTV) and small bowel were evaluated using dose–volume histograms.ResultsPre-treatment images had a mean of 0·27° and standard deviation was 2·23°. The volume of CTV receiving 95% of the prescription dose altered by 0·1% when up to ±10° of pitch was simulated.ConclusionsNo clinically significant change in CTV coverage was found (when ±10° of pitch was simulated). A tolerance of ±10° of pitch has been implemented for rectal carcinoma patients treated with three-dimensional conformal radiotherapy in our institution, when daily pre-treatment imaging with a zero action threshold for translational shifts is used.

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