scholarly journals Prone versus supine free-breathing for right-sided whole breast radiotherapy

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Odile Fargier-Bochaton ◽  
Xinzhuo Wang ◽  
Giovanna Dipasquale ◽  
Mohamed Laouiti ◽  
Melpomeni Kountouri ◽  
...  
Keyword(s):  
Free Breathing ◽  
September 11 ◽  
Breast Cancer Patients ◽  
Lung Dose ◽  
Breast Radiotherapy ◽  
Tumor Bed ◽  
Whole Breast Radiotherapy ◽  
The Mean ◽  
The Right ◽  
Robust Linear Regression

AbstractProne setup has been advocated to improve organ sparing in whole breast radiotherapy without impairing breast coverage. We evaluate the dosimetric advantage of prone setup for the right breast and look for predictors of the gain. Right breast cancer patients treated in 2010–2013 who had a dual supine and prone planning were retrospectively identified. A penalty score was computed from the mean absolute dose deviation to heart, lungs, breasts, and tumor bed for each patient's supine and prone plan. Dosimetric advantage of prone was assessed by the reduction of penalty score from supine to prone. The effect of patients' characteristics on the reduction of penalty was analyzed using robust linear regression. A total of 146 patients with right breast dual plans were identified. Prone compared to supine reduced the penalty score in 119 patients (81.5%). Lung doses were reduced by 70.8%, from 4.8 Gy supine to 1.4 Gy prone. Among patient's characteristics, the only significant predictors were the breast volumes, but no cutoff could identify when prone would be less advantageous than supine. Prone was associated with a dosimetric advantage in most patients. It sets a benchmark of achievable lung dose reduction.Trial registration: ClinicalTrials.gov NCT02237469, HUGProne, September 11, 2014, retrospectively registered.

scholarly journals Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence

Breast Care ◽  
2014 ◽  
Vol 10 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Pierfrancesco Franco ◽  
Domenico Cante ◽  
Piera Sciacero ◽  
Giuseppe Girelli ◽  
Maria Rosa La Porta ◽  
...  
Keyword(s):  
Treatment Time ◽  
Therapeutic Option ◽  
Breast Conserving Surgery ◽  
Current Evidence ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Overall Treatment Time ◽  
Tumor Bed ◽  
Whole Breast Radiotherapy ◽  
Tumor Bed Boost

Radiation therapy delivered with hypofractionation, which involves the delivery of a higher dose per fraction in fewer fractions (generally with a lower total nominal dose) over a shorter overall treatment time, is an established therapeutic option at least for a selected group of early breast cancer patients after breast-conserving surgery. Optimal delivery of the tumor bed boost dose in terms of timing, fractionation, and total dose whenever a hypofractionated schedule is employed has yet to be established. We herein present a review of the current evidence on the role of boost integration in whole breast radiotherapy.

scholarly journals Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

2021 ◽  
Author(s):  
Xinzhuo Wang ◽  
Odile Fargier-Bochaton ◽  
Giovanna Dipasquale ◽  
Mohamed Laouiti ◽  
Melpomeni Kountouri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Free Breathing ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Deep Inspiration Breath Hold ◽  
Number Of Patients ◽  
Whole Breast Radiotherapy

Abstract Purpose The advantage of prone setup compared with supine for left-breast radiotherapy is controversial. We evaluate the dosimetric gain of prone setup and aim to identify predictors of the gain. Methods Left-sided breast cancer patients who had dual computed tomography (CT) planning in prone free breathing (FB) and supine deep inspiration breath-hold (DiBH) were retrospectively identified. Radiation doses to heart, lungs, breasts, and tumor bed were evaluated using the recently developed mean absolute dose deviation (MADD). MADD measures how widely the dose delivered to a structure deviates from a reference dose specified for the structure. A penalty score was computed for every treatment plan as a weighted sum of the MADDs normalized to the breast prescribed dose. Changes in penalty scores when switching from supine to prone were assessed by paired t-tests and by the number of patients with a reduction of the penalty score (i.e., gain). Robust linear regression and fractional polynomials were used to correlate patients’ characteristics and their respective penalty scores. Results Among 116 patients identified with dual CT planning, the prone setup, compared with supine, was associated with a dosimetric gain in 72 (62.1%, 95% CI: 52.6–70.9%). The most significant predictors of a gain with the prone setup were the breast depth prone/supine ratio (>1.6), breast depth difference (>31 mm), prone breast depth (>77 mm), and breast volume (>282 mL). Conclusion Prone compared with supine DiBH was associated with a dosimetric gain in 62.1% of our left-sided breast cancer patients. High pendulousness and moderately large breast predicted for the gain.

Comparison between different boost dose delivery techniques to the tumor bed of right sided breast cancer patients.

2017 ◽  
Vol 13 (1) ◽  
pp. 4605-4617
Author(s):  
Aly Mahmoud El-Hdidy
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Target Location ◽  
Breast Cancer Patients ◽  
Photon Beams ◽  
Lung Dose ◽  
Dose Volume Histograms ◽  
Tumor Bed ◽  
Boost Dose ◽  
Treatment Plans

Comparisons between three different techniques by which the boost dose was delivered to the tumor bed were carried out , aiming to present the best technique of treatment for right breast cancer patients.In this study, ten right sided breast cancer computed tomography (CT) scans were selected for ten early right breast cancer patients. We made three different treatment plans for each patient CT using three different irradiation techniques to deliver a prescribed boost dose of 10 Gy in 5 fractions to the boost PTV. In the first technique, two tangential photon beams were used, in the second technique we, two oblique photon beams were used and in the third technique, a single electron beam was used. The comparative analyses between the three techniques were performed by comparing the boost PTV- dose volume histograms (DVHs), the ipsilateral breast (right breast) DVHs, the ipsilateral lung (right lung) DVHs and the heart DVHs of the three techniques for each patient. Furthermore the dose that covering 100% , 95% of the volume (D100% , D95%) and the volume covered by 95% of the dose (V95%)of  the boost PTV of all techniques, were calculated for each patient to investigate the dose coverage of the target.Results showed that there were variations of the dose received by tumor bed, right breast and OARs depending on the technique used and the target location and size. A decrease of D100% than 90% of the prescribed dose was observed with the 3rd technique for patients 8, 9 and 10, and was observed with the 2nd technique for patient 5. A reduction of right breast dose was observed when the 3rd technique was use in comparison with the 1st and the 2nd techniques for patients 1, 2, 3, 4, 6 and 8.  Also reduction of right breast was observed when the 2nd technique used in comparison with 1st technique. An increase of lung dose was observed with the 3rd technique for patients 1, 2, 5 and 6, also was observed with 2nd technique in patient 3, 5 and 7. A decrease of lung dose was observed with the 1st technique for patients 2, 4, 5, 6, 7, 8 and 9An individualized treatment, several plans using different irradiation techniques should be developed for each patient individually to reach the best boost PTV dose coverage with minimal OARs’ dose. 

Acute side effects of intraoperative electron radiotherapy of breast cancer.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 112-112
Author(s):  
Edwin Boelke ◽  
Wilfried Budach ◽  
Wolfgang Janni ◽  
Karin Zwiefel ◽  
Freddy-Joel Njanang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Side Effects ◽  
Acute Toxicity ◽  
Intraoperative Radiotherapy ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
European Organization ◽  
Whole Breast Radiotherapy ◽  
Acute Side Effects

112 Background: Intraoperative boost irradiation as part of breast-conserving therapy is a perfect method to adequately capture the high risk tumor relapse area. The most homogeneous dose distribution is achieved with electrons. Intraoperative radiotherapy (IOERT) as a boost for breast cancer releases a high single dose of radiation to the breast tissue; therefore acute toxicity is of particular attention. To date there is only inadequate information available on breast cancer patients treated with IORT using electrons applied as a boost. We therefore analyzed the acute toxicity after radiotherapy with 10 Gy as a boost with a minimum follow-up of 3 months. Methods: A total of 69 patients treated with IOERT (10Gy with 5, 7 and 9 MeV electrons) with a dedicated robotic linac (NOVAC 7, New Radiant Technology, Aprilia, Italy) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT, 50.4 Gy; 1.8 Gy per fraction) were included in this study. All patients underwent a retrospective follow-up (median, 8 months; range 1-17 months) regarding acute side effects within the first three months. Toxicities were documented using the common toxicity criteria (CTC 4.0 of the European Organization for Research and Treatment of Cancer). Results: The IOERT was well tolerated. As a side effect there was one patient with seroma. Two patients developed chronic pain in the irradiated breast. Two patients developed a secondary wound healing. The remaining patients did not develop any grade 3 or 4 side effects. The observed toxicity rates were not influenced by age, tubus size, electron energy or systemic therapy. Conclusions: After IOERT of the breast using electrons we did not find any unexpected acute toxicity rates.

Longterm blood cell counts after intraoperative radiotherapy with or without whole breast radiotherapy in breast cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12014-e12014
Author(s):  
Elena Sperk ◽  
Cornelia Wersal ◽  
Christel Weiss ◽  
Anke Keller ◽  
Anette Kipke ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Blood Cell ◽  
Cancer Patients ◽  
Cell Lines ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Whole Breast Radiotherapy

e12014 Background: After radiotherapy changes in blood cell counts (BCC) can be seen. Leukocytopenia may have a negative impact on the immune system, outcome and quality of life of breast cancer survivors. No reports on changes of the three blood cell lines (leukocytes=WBC, erythrocytes=RBC, thrombocytes=PLT) after IORT w/o whole breast radiotherapy (WBRT) in breast cancer patients have been reported. Methods: 256 patients had IORT during breast conserving surgery. In 198 patients WBRT (46-50Gy/2Gy) + IORT (20Gy) and in 58 patients IORT as accelerated partial breast irradiation=APBI (20Gy) was given. Preoperative BCC were used as baseline. In 214 patients BCC were available after 1-90 days, in 139 during the 1st year, in 86 in the 2nd, in 66 in the 3rd, in 51 in the 4th and in 34 in the 5th year of follow-up. Dunnett-tests were used to calculate adjusted p-values (p<0.05=significant). Results: After IORT/WBRT a decrease of WBC was seen during the 1st year. Afterwards no changes were seen. After IORT APBI no changes were seen during 5 years follow-up. RBC was decreased at all time points after IORT/WBRT, and through the 1st year after IORT APBI. PLT decreased during the 1st year and stayed low during 5 years after IORT/WBRT. No changes in PLT were seen after IORT APBI. Hemoglobin (HGB) decreased after 3 months, during the 1st and 5th year after IORT/WBRT. After IORT APBI, HGB decreased only during the 1st year and stayed stable during follow-up. Conclusions: Decreases of all blood cell lines were seen at least transiently after IORT/WBRT. PLT and RBC stayed decreased. After IORT APBI, HGB and RBC decreased only during the 1st year and WBC and PLT remained stable during the whole follow-up. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document