scholarly journals Three-Dimensionally-Precise Breast Conformal Device for IMRT in Breast Cancer Patients Treated With Breast-Conserving Surgery—A Pilot Randomized Controlled Trial

2020 ◽  
Vol 19 ◽  
pp. 153303382097156
Author(s):  
Chunbo He ◽  
Shilin Zhang ◽  
Lei Shi
Keyword(s):  
Breast Cancer ◽  
Controlled Trial ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Conformity Index ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
3 Dimensional ◽  
Novel Device ◽  
Prescription Dose

Objective: To examine the accuracy and efficiency of breast radiotherapy after breast-conserving surgery of a novel 3-dimensional (3D) printing tissue compensator technology, the 3D-precise breast conformer, compared with a usual compensator and an unstructured compensator. Methods: This novel device is patented in China (patent No.: ZL2015 2 0259472.9). Thirty patients with breast cancer after breast-conserving surgery were randomly divided into 2 control groups (no compensator, NST group, and usual compensator, ST group) and 1 study group (3D-precise breast conformer, 3D-BCT group) (n = 10/group). Before radiotherapy, all patients were scanned in the same CT positioning conditions to prepare the treatment plans. Results: The 3D-BCT showed the best homogeneity index (HI) (0.08 ± 0.03) and conformity index (CI) (0.95 ± 0.03), while the NST group showed the worst HI (0.34 ± 0.07) and CI (0.78 ± 0.06), with the ST group between the 2 (HI: 0.15 ± 0.05; CI: 0.87 ± 0.04) (all P < 0.01). The common tissue compensation membrane could lead to 95-100% of the prescription dose covering 85-95% of the target volume, and the uniformity and conformability of the target dose were improved overall compared with the NST group. In the 3D-BCT group, 100% of the prescription dose covered the target volume of 95-100%. Conclusion: The 3D-precision breast conformal device had the highest individualization, uniformity, and conformity. The V95, V98, CI, and HI of PTV were optimal in the 3D-BCT group, and an ideal isodose curve distribution of the breast and clavicle upper and lower target areas was achieved. This device could improve the surface dose and the efficacy of radiotherapy after breast-conserving surgery.

scholarly journals MRI reduces variation of contouring for boost clinical target volume in breast cancer patients without surgical clips in the tumour bed

2017 ◽  
Vol 51 (2) ◽  
pp. 160-168 ◽  
Author(s):  
Noora Al-Hammadi ◽  
Palmira Caparrotti ◽  
Saju Divakar ◽  
Mohamed Riyas ◽  
Suparna Halsnad Chandramouli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Clinical Target Volume ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Observer Variation ◽  
Breast Cancer Surgery ◽  
Conformity Index ◽  
Breast Cancer Patients ◽  
Ct And Mri

Abstract Background Omitting the placement of clips inside tumour bed during breast cancer surgery poses a challenge for delineation of lumpectomy cavity clinical target volume (CTVLC). We aimed to quantify inter-observer variation and accuracy for CT- and MRI-based segmentation of CTVLC in patients without clips. Patients and methods CT- and MRI-simulator images of 12 breast cancer patients, treated by breast conserving surgery and radiotherapy, were included in this study. Five radiation oncologists recorded the cavity visualization score (CVS) and delineated CTVLC on both modalities. Expert-consensus (EC) contours were delineated by a senior radiation oncologist, respecting opinions of all observers. Inter-observer volumetric variation and generalized conformity index (CIgen) were calculated. Deviations from EC contour were quantified by the accuracy index (AI) and inter-delineation distances (IDD). Results Mean CVS was 3.88 +/− 0.99 and 3.05 +/− 1.07 for MRI and CT, respectively (p = 0.001). Mean volumes of CTVLC were similar: 154 +/− 26 cm3 on CT and 152 +/− 19 cm3 on MRI. Mean CIgen and AI were superior for MRI when compared with CT (CIgen: 0.74 +/− 0.07 vs. 0.67 +/− 0.12, p = 0.007; AI: 0.81 +/− 0.04 vs. 0.76 +/− 0.07; p = 0.004). CIgen and AI increased with increasing CVS. Mean IDD was 3 mm +/− 1.5 mm and 3.6 mm +/− 2.3 mm for MRI and CT, respectively (p = 0.017). Conclusions When compared with CT, MRI improved visualization of post-lumpectomy changes, reduced interobserver variation and improved the accuracy of CTVLC contouring in patients without clips in the tumour bed. Further studies with bigger sample sizes are needed to confirm our findings.

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 Omitting radiotherapy is safe in breast cancer patients ≥ 70 years old after breast-conserving surgery without axillary lymph node operation

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ying Zhong ◽  
Yali Xu ◽  
Yidong Zhou ◽  
Feng Mao ◽  
Yan Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Breast Conserving Surgery ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Metastasis Rate

Abstract To verify whether omitting radiotherapy from breast cancer treatment for patients ≥ 70 years old following breast-conserving surgery (BCS) without axillary lymph node dissection is safe. Previous studies have shown that omitting breast radiotherapy after BCS and axillary lymph node dissection is safe for elderly breast cancer patients. We aimed to evaluate the safety of BCS without axillary surgery or breast radiotherapy (BCSNR) in elderly patients with breast cancer and clinically negative axillary lymph nodes. We performed a retrospective analysis of 481 patients with breast cancer, aged ≥ 70 years, between 2010 and 2016. Of these, 302 patients underwent BCSNR and 179 underwent other, larger scope operations. Local recurrence rate, ipsilateral breast tumor recurrence (IBTR) rate, distant metastasis rate, breast-related death, disease-free survival (DFS), and overall survival (OS) were compared between the two groups. After a median follow-up of 60 months, no significant differences in local recurrence, distant metastasis rate, breast-related death, and DFS were noted. The OS was similar (P = 0.56) between the BCSNR group (91.7%) and other operations group (93.0%). The IBTR rate was considered low in both groups, however resulted greater (P = 0.005) in the BCSNR group (5.3%) than in other operations group (1.6%). BCSNR did not affect the survival of elderly patients with breast cancer with clinically negative axillary lymph nodes. IBTR was infrequent in both groups; however, there was a significant difference between the two groups. BCSNR is a feasible treatment modality for patients with breast cancer ≥ 70 years old with clinically negative axillary lymph nodes.

Left Breast Radiotherapy With Multi Fields Hybrid Intensity Modulated Radiotherapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT): Balance Between Left Anterior Descending Artery Sparing and Secondary Cancer Induction Risk

2021 ◽  
Author(s):  
Xiaoyong Xiang ◽  
Zhen Ding ◽  
Kailian Kang ◽  
Zhitao Dai ◽  
Wenjue Zhang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Volumetric Modulated Arc Therapy ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
High Dose ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Breast Cancer Radiotherapy ◽  
Arc Therapy

Abstract To explore the feasibility of using Volumetric-Modulated Arc Therapy (VMAT) to protect left anterior descending branch (LAD) after breast-conserving surgery for left breast cancer. 15 left breast cancer patients after breast-conserving surgery were selected. 7F-IMRT and 2A-VMAT treatment plans were designed with Varian Eclipse TPS (13.6version). The prescriptions of PTV and PTV Boost were 43.5Gy and 49.5Gy in 15 fractions. The dosimetric parameters, OARs dose sparing and second cancer risk (SCR) were compared between the two plans using a paired t-test. The VMAT plans obtain better PTV conformity and higher mean dose. VMAT plans show a better dose distribution in high dose areas and better sparing of OARs, including left lung, heart, and LAD. The Dmax and Dmean of LAD decreased significantly in VMAT plans. The SCRs of the contralateral lung and breast significantly increased with a higher mean dose. We recommend that contouring and evaluating the dose of LAD and LAD helping structures in left breast cancer radiotherapy. SCR should be evaluated for younger patients.

scholarly journals Acute and Late Toxicity In Breast Cancer Patient That Received Hypofractionated Adjuvant Radiotherapy after Breast Conserving Surgery: A Case Report

2020 ◽  
Vol 14 (4) ◽  
pp. 144
Author(s):  
Sinta Prastiana Dewi
Keyword(s):  
Breast Cancer ◽  
Adjuvant Radiotherapy ◽  
Late Toxicity ◽  
Skin Toxicity ◽  
Breast Conserving Surgery ◽  
Hypofractionated Radiotherapy ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Whole Breast Radiotherapy

Introduction: Breast cancer is the most common female malignancy worldwide. Breastconserving surgery followed by adjuvant radiotherapy is a preferable treatment option. Hypofractionated radiotherapy is an attractive fractionation scheme because of its shorter treatment duration. This paper aims to report the short-term and long-term toxicity of hypofractionated radiotherapy in breast cancer patients at our institution. Case Presentation: A 58-year-old woman with right breast cancer T2N1M0 had undergone breast-conserving surgery with axilla lymph node dissection. This patient underwent adjuvant whole breast radiotherapy with a dose of 42.56 Gy in 16 fractions followed by tumor bed boost with a dose of 16 Gy in 8 fractions. After undergoing the fourth fraction of boost, she had hyperpigmentation on her radiation area (RTOG skin toxicity grade 1). At the 6-month follow-up, the hyperpigmentation still appeared. Until the 24-month follow-up, after she completed radiotherapy, there was no sign of tumor recurrence and toxicity.Conclusion: Hypofractionated radiotherapy could be an option for breast cancer treatment that provides equivalent local control, survival, and side effects to conventional fractionation radiotherapy.

Non-coplanar VMAT improves plan quality for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes

2020 ◽  
Author(s):  
Yuan Xu ◽  
Pan Ma ◽  
Zhihu Hu ◽  
Yuan Tian ◽  
Kuo Men ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Organs At Risk ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Conformity Index ◽  
Internal Mammary Nodes ◽  
Significant Difference ◽  
Internal Mammary ◽  
The Mean

Abstract Purpose A planning study was performed to evaluate the feasibility of non-coplanar volume modulated arc therapy (ncVMAT) for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes. Methods and materials Ten patients with left-sided breast cancer after breast conserving surgery were retrospectively studied. The planning target volumes (PTV) were contoured encompassing the whole breast/chestwall, internal mammary nodes (IMN) and supraclavicular nodal (SCN) region. For each patient, ncVMAT plan with 4 partial arcs composing of two coplanar arcs and two non-coplanar arcs with couch rotating to 90˚ was generated. The prescription dose was normalized to cover 95% of PTV with 50 Gy delivering in 25 fractions. For each ncVMAT plan, dosimetric parameters were compared with coplanar VMAT (coVMAT) plan optimizing with identical coplanar beam angle arrangement. Results With ncVMAT, the mean conformity index of the whole PTV increased from 0.82±0.02 to 0.86±0.01 (p=0.005), and there was no significant difference for the homogeneity index. The mean coverage of internal mammary target volume (PTVimn) with ncVMAT increased from 88.77±3.07% to 91.67±3.84% comparing with coVMAT (p=0.005). Meanwhile, the V55 in PTVscn and PTVimn decreased significantly from 5.76±6.03%, 13.73±7.77% to 2.94±3.93%, 3.75±3.36%, separately (p<0.01). For organs at risk, the average V30, V20, V10, V5 and Dmean of heart decreased from 5.13±3.22%, 12.18±7.29%, 33.98±15.73%, 72.03±16.79% and 10.47±2.97 Gy to 4.86±2.54%, 9.35±5.43%, 25.16±12.42%, 62.27±13.18% and 9.08±2.34 Gy, separately (p<0.01). Furthermore, ncVMAT significantly reduced the mean V20, V10, V5, Dmean of left lung, and V10, V5, Dmean of contralateral lung (p<0.01). A better sparing of LAD descending coronary artery and right breast were also shown with ncVMAT (p<0.01). Conclusions Compared to coVMAT, ncVMAT provides better conformity, lower V55 in PTVscn and PTVimn, better coverage of PTVimn, better dose sparing in heart, bilateral lung, LAD and right breast for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes, which potentially increase the local control in IMN and reduce the risk of deleterious effects.

scholarly journals Helical tomotherapy with a complete-directional-complete block technique effectively reduces cardiac and lung dose for left-sided breast cancer

2020 ◽  
Vol 93 (1108) ◽  
pp. 20190792 ◽  
Author(s):  
Hsin-Pei Yeh ◽  
Yu-Chuen Huang ◽  
Li-Ying Wang ◽  
Pei-Wei Shueng ◽  
Hui-Ju Tien ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Helical Tomotherapy ◽  
Organs At Risk ◽  
Intensity Modulated Radiation Therapy ◽  
Target Volume ◽  
Conformity Index ◽  
Breast Cancer Patients ◽  
Lung Dose ◽  
The Mean

Objectives: To evaluate the feasibility and optimal restricted angle of the complete-directional-complete block (CDCB) technique in helical tomotherapy (HT) by including regional nodal irradiation (RNI) with the internal mammary node (IMN) in left-sided breast cancer. Methods: Ten left-sided breast cancer patients treated with 50 Gy in 25 fractions were compared with five-field intensity-modulated radiation therapy (5F-IMRT) and six types of HT plans. In the HT plans, complete block (CB), organ-based directional block (OBDB) and CDCB with different restricted angles were used. Results: The conformity index (CI) between the CDCB0,10,15,20 and 5F-IMRT groups was similar. Compared to CB, OBDB and 5F-IMRT, CDCB20 resulted in a decreased ipsilateral mean lung dose. The low-dose region (V5) of the ipsilateral lung in OBDB (84.0%) was the highest among all techniques (p < 0.001). The mean dose of the heart in CB was significantly reduced (by 11.5–22.4%) compared with other techniques. The V30 of the heart in CDCB20 (1.9%) was significantly lower than that of CB, OBDB and 5F-IMRT. Compared to the mean dose of the left anterior descending (LAD) artery of 5F-IMRT (27.0 Gy), CDCB0, CDCB10, CDCB15, CDCB20 and OBDB reduced the mean dose effectively by 31.7%, 38.3%, 39.6%, 42.0 and 56.2%, respectively. Considering the parameters of the organs-at-risk (OARs), CDCB10,15,20 had higher expectative values than the other techniques (p = 0.01). Conclusions: HT with the CDCB technique is feasible for treating left-sided breast cancer patients. The CDCB10-20 techniques not only achieved similar planning target volume coverage, homogeneity and dose conformity but also allowed better sparing of the heart and bilateral lungs. Advances in knowledge: For left-sided breast cancer patients whose RNI field includes the IMN, heart avoidance is an important issue. The CDCB technique achieved good PTV coverage, homogeneity and dose conformity and allowed better sparing of the mean dose of the lung, the LAD artery, and the heart and reduced the V30 of the heart.

Contribution of Magnetic Resonance Imaging in Determining Lumpectomy Cavity in Breast Radiotherapy

2020 ◽  
Vol 16 (8) ◽  
pp. 997-1003
Author(s):  
Ozlem Demircioglu ◽  
Huseyin Tepetam ◽  
Ayfer Ay Eren ◽  
Zerrin Ozgen ◽  
Fatih Demircioglu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Supine Position ◽  
Radiotherapy Planning ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Lumpectomy Cavity ◽  
Breast Cancer Radiotherapy ◽  
Significant Difference ◽  
Mean Diameter ◽  
Ct And Mri

Background: Accurate localization of the lumpectomy cavity is important for breast cancer radiotherapy after breast-conserving surgery (BCS), but the LC localization based on CT is often difficult to delineate accurately. The study aimed to compare CT-defined LC planning to MRI-defined findings in the supine position for higher soft-tissue resolution of MRI. Methods: Fifty-nine breast cancer patients underwent radiotherapy CT planning in supine position followed by MR imaging on the same day. LC was contoured by the radiologist and radiation oncologist together by CT and MRI separately. T2 weighted MR images and tomography findings were combined and the LC volume, mean diameter and the longest axis length were measured after contouring. Subsequently, patients were divided into two groups according to seroma in LC and the above-mentioned parameters were compared. Results: We did not find any statistically significant difference in the LC volume, mean diameter and length at the longest axis between CT and MRI but based on the presence or absence of seroma, statistically significant differences were found in the LC volumes and the length at the longest axis of LC volumes. Conclusion: We believe that the supine MRI in the same position with CT will be more effective for radiotherapy planning, particularly in patients without a seroma in the surgical cavity.

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