scholarly journals Comparison of sliding window and field-in-field techniques for tangential whole breast irradiation using the Halcyon and Synergy Agility systems

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Anne Richter ◽  
Sonja Wegener ◽  
Kathrin Breuer ◽  
Gary Razinskas ◽  
Stefan Weick ◽  
...  
Keyword(s):  
Sliding Window ◽  
Contralateral Breast ◽  
Treatment Technique ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Portal Dosimetry ◽  
Treatment Plans ◽  
Imaging Dose ◽  
Tissue Sparing ◽  
Fraction Dose

Abstract Background To implement a tangential treatment technique for whole breast irradiation using the Varian Halcyon and to compare it with Elekta Synergy Agility plans. Methods For 20 patients two comparable treatment plans with respect to dose coverage and normal tissue sparing were generated. Tangential field-in-field treatment plans (Pinnacle/Synergy) were replanned using the sliding window technique (Eclipse/Halcyon). Plan specific QA was performed using the portal Dosimetry and the ArcCHECK phantom. Imaging and treatment dose were evaluated for treatment delivery on both systems using a modified CIRS Phantom. Results The mean number of monitor units for a fraction dose of 2.67 Gy was 515 MUs and 260 MUs for Halcyon and Synergy Agility plans, respectively. The homogeneity index and dose coverage were similar for both treatment units. The plan specific QA showed good agreement between measured and calculated plans. All Halcyon plans passed portal dosimetry QA (3%/2 mm) with 100% points passing and ArcCheck QA (3%/2 mm) with 99.5%. Measurement of the cumulated treatment and imaging dose with the CIRS phantom resulted in lower dose to the contralateral breast for the Halcyon plans. Conclusions For the Varian Halcyon a plan quality similar to the Elekta Synergy device was achieved. For the Halcyon plans the dose contribution from the treatment fields to the contralateral breast was even lower due to less interleaf transmission of the Halcyon MLC and a lower contribution of scattered dose from the collimator system.

scholarly journals Comparison of Sliding Window and Field-In-Field Techniques For Tangential Whole Breast Irradiation Using The Halcyon and Synergy Agility Systems

2021 ◽  
Author(s):  
Anne Richter ◽  
Sonja Wegener ◽  
Kathrin Breuer ◽  
Gary Razinskas ◽  
Stefan Weick ◽  
...  
Keyword(s):  
Sliding Window ◽  
Contralateral Breast ◽  
Treatment Technique ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Portal Dosimetry ◽  
Treatment Plans ◽  
Imaging Dose ◽  
Tissue Sparing ◽  
Fraction Dose

Abstract Background: To develop a tangential treatment technique for whole breast irradiation using the Varian Halcyon and to compare it with Elekta Synergy Agility plans.Methods: For 20 patients two comparable treatment plans with respect to dose coverage and normal tissue sparing were generated. Tangential field-in-field treatment plans (Pinnacle/Synergy) were replanned using the sliding window technique (Eclipse/Halcyon). Plan specific QA was performed using the portal Dosimetry and the ArcCHECK phantom. Imaging and treatment dose were evaluated for treatment delivery on both systems using a modified CIRS Phantom.Results: The mean number of monitor units for a fraction dose of 2.67 Gy was 515 MUs and 260 MUs for Halcyon and Synergy Agility plans, respectively. The homogeneity index and dose coverage were similar for both treatment units. The plan specific QA showed good agreement between measured and calculated plans. All Halcyon plans passed portal dosimetry QA (3%/2 mm) with 100% points passing and ArcCheck QA (3%/2 mm) with 99.5%. Measurement of the treatment and imaging dose with the CIRS phantom resulted in lower dose to the contralateral breast for the Halcyon plans.Conclusions: For the Varian Halcyon a plan quality similar to the Elekta Synergy device was achieved. For the Halcyon plans the dose contribution from the treatment fields to the contralateral breast was even lower due to less interleaf transmission of the Halcyon MLC and a contribution of scattered dose from the collimator system.

Contralateral Breast Dose After Whole-Breast Irradiation: An Analysis by Treatment Technique

2012 ◽  
Vol 82 (5) ◽  
pp. 2079-2085 ◽  
Author(s):  
Terence M. Williams ◽  
Jean M. Moran ◽  
Shu-Hui Hsu ◽  
Robin Marsh ◽  
Beth Yanke ◽  
...  
Keyword(s):  
Contralateral Breast ◽  
Treatment Technique ◽  
Whole Breast Irradiation ◽  
Breast Irradiation

scholarly journals Objective Evaluation of Risk Factors for Radiation Dermatitis in Whole-Breast Irradiation Using the Spectrophotometric L*a*b Color-Space

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2444
Author(s):  
Alexander M. C. Böhner ◽  
David Koch ◽  
Frederic Carsten Schmeel ◽  
Fred Röhner ◽  
Felix Schoroth ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Background Radiation ◽  
Color Space ◽  
Radiation Dermatitis ◽  
Treatment Technique ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Breast Cancer Patients

Background: Radiation-induced dermatitis (RID) is frequent in breast cancer patients undergoing radiotherapy (RT). Spectrophotometry (SP) is an objective and reliable tool for assessing RID severity. Despite intensive research efforts during the past decades, no sustainable prophylactic and treatment strategies have been found. Estimation of new and reevaluation of established risk factors leading to severe RID is therefore of major importance. Methods: 142 early breast cancer patients underwent whole-breast irradiation following breast-conserving surgery. RID was evaluated by physician-assessed Common Terminology Criteria of Adverse Events (CTCAE v4.03). Spectrophotometers provided additional semi quantification of RID using the L*a*b color-space. A total of 24 patient- and treatment-related parameters as well as subjective patient-assessed symptoms were analyzed. Results: Values for a*max strongly correlated with the assessment of RID severity by physicians. Breast volume, initial darker skin, boost administration, and treatment technique were identified as risk factors for severe RID. RID severity positively correlated with the patients’ perception of pain, burning, and reduction of everyday activities. Conclusions: Physician-assessed RID gradings correlate with objective SP skin measurements. Treatment technique and high breast volumes were identified as objective and significant predictors of RID. Our data provide a solid benchmark for future studies on RID with objective SP.

A Phantom Evaluation of Contralateral Breast Dose for Whole Breast Irradiation Techniques

2009 ◽  
Vol 75 (3) ◽  
pp. S205
Author(s):  
T.M. Williams ◽  
J. Moran ◽  
S. Hsu ◽  
I. Gallagher ◽  
S. Henshaw ◽  
...  
Keyword(s):  
Contralateral Breast ◽  
Whole Breast Irradiation ◽  
Breast Irradiation

scholarly journals External Beam Partial Breast Irradiation Versus Whole Breast Irradiation for in Early Breast Cancer：A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Peiling Dai ◽  
Kai Chen ◽  
Lan Li ◽  
Li Wang ◽  
Yaoxiong Xia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Contralateral Breast Cancer ◽  
Skin Toxicity ◽  
Distant Recurrence ◽  
Contralateral Breast ◽  
Partial Breast Irradiation ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Acute Skin Toxicity ◽  
Regional Node

Abstract PurposePostoperative radiotherapy can reduce the recurrence of breast cancer. Postoperative radiotherapy is divided into whole breast irradiation (WBI) and partial breast irradiation (PBI) for early breast cancers. Due to the characters of saving time, money, and easy to deliver, external beams PBI (EB PBI) is brought into focus. However, the researches on outcomes, safety, and efficacy between EB PBI and WBI are still insufficient. We concluded a meta-analysis for LRR, regional node recurrence, contralateral breast cancer, distant recurrence, mortality, less acute skin toxicity (˃ 1 grade), late skin toxicity and the cosmetic score of external beam partial breast irradiation (EB PBI) and whole breast irradiation(WBI) to develop a radiotherapy plan for early low recurrence risk breast cancer patients. MethodWe searched Pubmed、Embase、Cochrane Library、Clinicaltrals. Study eligibility criteria are as below: (1) RCTs for EB PBI vs WBI; (2) Histologically confirmed breast cancer; (3) AJCC staged Tis-2N0-1M0; (4) ≥ 40 years old; (5) Tumor size ≤ 3 cm;(6) microscopically clear margins ≤ 5 cm; (7) Mean follow-up time༞5 years. All data is used by Cochrane’s Review Manager 5.3 (RevMan) to process.ResultsThere were 4 RCT studies included in our study with 1999 patients in EB PBI group and 1999 patients in EB PBI. There was no statistic difference between PBI and WBI groups in local recurrence rates (RR = 1.15; 95% CI, 0.76 to 1.74; p = 0.52; I2 = 0%), regional node recurrence(RR = 1.00; 95% CI, 0.49 to 2.04, p = 0.99, I2 = 0%), contralateral breast cancer (RR = 0.79; 95% CI, 0.54 to 1.16; p = 0.23; I2 = 0%), distant recurrence(RR = 1.00; 95% CI, 0.63 to 1.59; p = 1.00; I2 = 0%), non-breast second cancer (RR = 1.03; 95% CI, 0.50 to 2.16; p = 0.93; I2 = 83%), mortality(RR = 0.96; 95% CI, 0.60 to 1.55; p = 0.88, I2 = 54%). EB PBI had worse cosmetic score (RR = 1.56; 95% CI, 1.04 to 2.34; p = 0.003, I2 = 84%), less acute skin toxicity (˃ 1 grade) (RR = 0.17; 95% CI, 0.07 to 0.42; p༜ 0.0001, I2 = 87%) and late skin toxicity(RR = 0.65; 95% CI, 0.48 to 0.88; p = 0.005; I2 = 27%) than WBI.ConclusionEB PBI has similar LRR, regional node recurrence, contralateral breast cancer, distant recurrence, non-breast second cancer and mortality with WBI. But EB PBI has worse cosmetic score, less acute skin toxicity (˃ 1 grade) and late skin toxicity than WBI.

scholarly journals Comparison of volumetric modulated arc therapy and intensity-modulated radiotherapy for left-sided whole-breast irradiation using automated planning

2021 ◽  
Author(s):  
L. Redapi ◽  
L. Rossi ◽  
L. Marrazzo ◽  
J. J. Penninkhof ◽  
S. Pallotta ◽  
...  
Keyword(s):  
Volumetric Modulated Arc Therapy ◽  
Intensity Modulated Radiotherapy ◽  
Breath Hold ◽  
Treatment Technique ◽  
Whole Breast Irradiation ◽  
Breast Irradiation ◽  
Ipsilateral Lung ◽  
Intensity Modulated ◽  
Delivery Times ◽  
Arc Therapy

Abstract Background Published treatment technique comparisons for postoperative left-sided whole breast irradiation (WBI) with deep-inspiration breath-hold (DIBH) are scarce, small, and inconclusive. In this study, fully automated multi-criterial plan optimization, generating a single high-quality, Pareto-optimal plan per patient and treatment technique, was used to compare for a large patient cohort 1) intensity modulated radiotherapy (IMRT) with two tangential fields and 2) volumetric modulated arc therapy (VMAT) with two small tangential subarcs. Materials and methods Forty-eight randomly selected patients recently treated with DIBH and 16 × 2.66 Gy were included. The optimizer was configured for the clinical planning protocol. Comparisons between IMRT and VMAT included dosimetric plan parameters, estimated excess relative risks (ERR) for toxicities, delivery times, MUs, and deliverability accuracy at a linac. Results The automatically generated IMRT and VMAT plans applied in this study were similar or higher in quality than the manually generated clinical plans. For equal PTVin V95% (98.4 ± 0.9%), VMAT had significant advantages compared to IMRT regarding breast dose homogeneity and doses in heart and ipsilateral lung, at the cost of some minor deteriorations for contralateral breast (few cases with larger deteriorations) and lung. Conformality improved from 1.38 to 1.18 (p < 0.001). With VMAT, ERR for major coronary events and ipsilateral lung tumors were reduced by 3% (range: −1–12%) and 16% (range: −3–38%), respectively. MUs and delivery times were higher for VMAT. There were no statistical differences in γ passing rates. Conclusion For WBI in conservative therapy of left-sided breast patients treated with DIBH, VMAT with two tangential subarcs was generally dosimetrically superior to IMRT with two tangential static fields. Results need confirmation by robustness analyses.

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