Can the Choice of Radiotherapy Delivery Technique Influence Which Target Delineation Protocol to Use? A Plan-Quality-Based Analysis in Left Breast Cancer

Abstract Introduction This study investigates the optimal target delineation protocol stratified by treatment planning technique in patients undergoing whole breast radiotherapy after breast conservation surgery. Materials and Methods Target delineation using Tangent (RTOG 0413 Whole Breast Irradiation Protocol), European SocieTy for Radiotherapy and Oncology (ESTRO), and Radiation Therapy & Oncology Group (RTOG) guidelines was performed on 10 randomly selected treatment planning computed tomography datasets of patients with left-sided breast cancer. An objective plan quality metric (PQM) scoring schema was defined and communicated to the medical physicist prior to commencement of treatment planning. Treatment planning was performed using field-in-field (FiF) intensity modulated radiotherapy technique (IMRT), inverse IMRT, and volumetric modulated arc therapy (VMAT), for each type of target. Two-way repeated measures, analysis of variance was utilized to compare the total PQM scores and dosimetric variables, stratified by treatment planning method. Results Total PQM score of plans for FiF, IMRT, and VMAT revealed that Tangent and ESTRO delineations were equivalent regardless of planning technique (Tangent vs. ESTRO for FiF, p = 0.099; Tangent vs. ESTRO for IMRT, p = 0.029; Tangent vs. ESTRO for VMAT, p = 0.438). Both delineation protocols were significantly superior to RTOG for all treatment planning techniques. Conclusion For all treatment planning techniques, ESTRO and Tangent delineation were equivalent and both achieved significantly higher scores than RTOG delineation.

Download Full-text

Plan quality assessment of modern radiotherapy delivery techniques in left-sided breast cancer: an analysis stratified by target delineation guidelines

BJR|Open ◽

10.1259/bjro.20200007 ◽

2020 ◽

Vol 2 (1) ◽

pp. 20200007

Author(s):

Irfan Ahmad ◽

Kundan Singh Chufal ◽

Chandi Prasad Bhatt ◽

Alexis Andrew Miller ◽

Ram Bajpai ◽

...

Keyword(s):

Breast Cancer ◽

Quality Assessment ◽

Repeated Measures ◽

Volumetric Modulated Arc Therapy ◽

Plan Quality ◽

Breast Radiotherapy ◽

Planning Techniques ◽

Target Delineation ◽

Whole Breast Radiotherapy ◽

Imrt Planning

Objective: This study compares planning techniques stratified by consensus delineation guidelines in patients undergoing whole-breast radiotherapy based on an objective plan quality assessment scale. Methods: 10 patients with left-sided breast cancer were randomly selected, and target delineation for intact breast was performed using Tangent (RTOG 0413), ESTRO, and RTOG guidelines. Consensus Plan Quality Metric (PQM) scoring was defined and communicated to the physicist before commencing treatment planning. Field-in-field IMRT (FiF), inverse IMRT (IMRT) and volumetric modulated arc therapy (VMAT) plans were created for each delineation. Statistical analyses utilised a two-way repeated measures analysis of variance, after applying a Bonferroni correction. Results: Total PQM score of plans for Tangent and ESTRO were comparable for FiF and IMRT techniques (FiF vs IMRT for Tangent, p = 0.637; FiF vs IMRT for ESTRO, p = 0.304), and were also significantly higher compared to VMAT. Total PQM score of plans for RTOG revealed that IMRT planning achieved a significantly higher score compared to both FiF and VMAT (IMRT vs FiF, p < 0.001; IMRT vs VMAT, p < 0.001). Conclusions: Total PQM scores were equivalent for FiF and IMRT for both Tangent and ESTRO delineations, whereas IMRT was best suited for RTOG delineation. Advances in knowledge: FiF and IMRT planning techniques are best suited for ESTRO or Tangent delineations. IMRT also yields better results with RTOG delineation.

Download Full-text

94P Influence of different treatment planning techniques on radiation doses to the heart, left anterior descending coronary artery and lungs in the radiotherapy of left-sided breast cancer patients

Annals of Oncology ◽

10.1093/annonc/mdw575.033 ◽

2016 ◽

Vol 27 (suppl_9) ◽

Author(s):

F. Hadjilooei ◽

P. Haddad ◽

B. Kalaghchi ◽

F. Amouzgar Hashemi ◽

M. Esfahani ◽

...

Keyword(s):

Breast Cancer ◽

Coronary Artery ◽

Cancer Patients ◽

Treatment Planning ◽

Radiation Doses ◽

Breast Cancer Patients ◽

Planning Techniques

Download Full-text

An Innovative VMAT Technique for Left-sided Breast Cancer Patients With Postmastectomy Radiotherapy (PMRT) Evaluated by Ratio of Heart Volume in Tangent Line (RHVTL)

10.21203/rs.3.rs-578136/v1 ◽

2021 ◽

Author(s):

Zhe Zhang ◽

Daming Li ◽

Feng Peng ◽

ZhiBo Tan ◽

PengFei Yang ◽

...

Keyword(s):

Breast Cancer ◽

Treatment Planning ◽

Tangent Line ◽

Planning Techniques ◽

Heart Volume ◽

Postmastectomy Radiotherapy ◽

Heart Dose ◽

Advanced Planning ◽

The Mean ◽

Mean Heart Dose

Abstract For patients with left-sided breast cancer (LBC), postmastectomy radiotherapy (PMRT) has been shown to improve the overall survival and many advanced planning techniques was adopted in PMRT. We aim to use an innovative VMAT technique to enhance the conformity of PTV and reduce the scattering dose of surrounding OARs, thereby reducing the long-term toxicity of the heart as well as ipsilateral lung (IL). The study further analyzes the more appropriate treatment planning techniques for personalized LBC patients with PMRT. 35 LBC patients were retrospectively selected undergoing PMRT. The PTV included lymph nodes, chest walls, excluding internal mammary nodes, where 95% of PTV receiving the prescription dose of 50Gy (2Gy/fraction) with three different techniques, VMAT, IMRT, Hybrid VMAT. Furthermore, the ratio of Heart Volume in Tangent line and heart volume (RHVTL) was proposed to evaluate the relative antonymy position between patient's heart and PTV, which hypothetically represents the complexity of treatment planning. The data from this study showed that for LBC patients undergoing PMRT, the CI from VMAT was 0.85 (IMRT and H-VMAT were 0.77 and 0.83), the heart D mean was 502.9cGy (IMRT and H-VMAT were 675.6cGy and 687cGy) and the V20 of IL was 21.3 as the lowest of the three techniques, but the dose of the contralateral breast (CB) and contralateral lung increased noticeably. In H-VMAT and IMRT, the mean heart dose was significantly related to RHVTL, with R-values of 0.911 and 0.892 respectively, while the values in VMAT was 0.613, thus the VMAT technique was relatively unaffected by the difficulty of treatment plan. For RHVTL values exceed than 0.06, the mean heart dose under VMAT technique raised by 98.7cGy compared to the RHVTL value of less than 0.06, but H-VMAT and IMRT increased by 233cGy and 261.58cGy individually. This study illustrates that separated fields and adjacent fields in VMAT technique obtained the optimal conformality and lowest doses of heart in three techniques for LBC with PMRT. Thus, based on the results of our preliminary study, the VMAT technique is highly recommended when RHVTL is exceeded 0.06.

Download Full-text

Adherence to 'Choosing Wisely' recommendations for radiation therapy in a commercially insured breast cancer population.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18267 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18267-e18267

Author(s):

Joshua A. Roth ◽

Jean A. McDougall ◽

Lia Moriguchi Halasz ◽

Catherine R. Fedorenko ◽

Qin Sun ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Breast Conservation ◽

Cancer Surveillance ◽

Stage I ◽

Choosing Wisely ◽

Breast Radiotherapy ◽

Primary Stage ◽

Commercial Insurance ◽

Whole Breast Radiotherapy

e18267 Background: ASTRO ‘Choosing Wisely recommendations’ (CWr) note radiation therapy (RT) interventions lacking evidence of benefit in cancer care. This study evaluates adherence to the 2013 CWr to ‘not routinely use intensity modulated radiotherapy (IMRT) to deliver whole breast radiotherapy as part of breast conservation therapy’ using a novel linkage between the Western WA Cancer Surveillance System (CSS) and claims from two large commercial insurance plans. No studies have evaluated adherence to this CWr in a commercial insurance setting. Methods: CSS records for first primary Stage I/II breast cancer cases (2008-2015) were linked with Premera Blue Cross and Regence Blue Shield claims. Included cases had coverage for ≥12-months before/after diagnosis (or until death), lumpectomy within 6 months of diagnosis, and RT within 6 months of lumpectomy. We used generalized estimating equations (GEE) to evaluate associations between demographic (age, race) and tumor (grade, laterality, diagnosis year) variables and use of IMRT vs conventional conformal RT within 1 year of diagnosis. Results: We identified 1,048 first primary Stage I/II breast cancer cases that met inclusion criteria. Mean age was 61, 91% were white, 52% were left-side cases. The non-adherent proportions are in the table below. In GEE analysis, only left-side cases (OR=6.4, p<0.001) and years of age (OR=1.03, p<0.01) were independently associated with IMRT use. Conclusions: Patients with IMRT vs. conventional conformal RT after lumpectomy may incur additional cost without commensurate clinical benefit. In the first study of adherence to a CWr against IMRT in this setting, we found that left-side cases were 6-fold more likely to be non-adherent vs right-side cases. This association suggests that IMRT is being used to reduce radiation dose to the heart, though not supported by evidence. Overall, the small non-adherent proportion before/after the CWr suggests alignment between guidelines and use of IMRT in Western WA. Future studies should evaluate IMRT use in other regions and develop strategies to improve CWr adherence in left-side cases. [Table: see text]

Download Full-text