Dosimetric comparison of radiotherapy plans for left-sided breast cancer patients in rolled versus supine body position.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 124-124
Author(s):  
M. L. Tao ◽  
N. Mikolajczyk ◽  
B. Martyn ◽  
L. E. Botnick
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Body Position ◽  
Organs At Risk ◽  
Left Lung ◽  
Breast Cancer Patients ◽  
Dose Volume Histograms ◽  
Increased Risk ◽  
The Mean ◽  
The Right

124 Background: Left-sided breast cancer patients receiving whole breast radiation therapy (WBRT) are potentially at increased risk for cardiac morbidity. We evaluated heart sparing of left-sided breast cancer patients when placed in the rolled vs. the standard supine body position for WBRT. Methods: Ten patients with left-sided breast cancer underwent planning CT scans in 2 different positions: supine and rolled to the right to allow for the heart to drop away from the chest wall. Patients were immobilized using vacuum cradles. The left lung, opposite breast, stomach, heart, left ventricle (LV), and left anterior descending coronary artery (LAD) were defined as organs at risk (OARs). Comparison 3D conformal tangential field plans were generated for each patient. Dose-volume histograms (DVHs) of the planning target volume (PTV) and OARs were examined. Results: All plans met PTV dose coverage and homogeneity criteria of V95 > 95% and maximal dose < 108. Median V105 for PTV was 12.75% (range, 2.5-16%). None of these parameters differed either statistically or clinically between plans done with the patient supine or rolled. The maximal doses to the opposite breast and stomach were also not significantly different between the 2 positions. The right lung V20 was similar for the 2 positions, 11.1% and 12%. Although there were no significant differences in the mean and max doses to the heart or LV, the mean heart dose decreased by 18-70% in 6 patients in the rolled vs. supine position and increased by 2.7-31.5% in 4 patients. The mean dose to the LAD and the LAD V10 and V15 were significantly decreased when the patient was rolled: 17.1 vs. 29.5 Gy, 41.1% vs. 62.6% and 40% vs. 66.7% (p < .05), respectively. Six patients had superior plans when in the rolled position with substantial differences in the mean and/or max doses and/or DVHs for the heart, LV and LAD. The remaining 4 patients had no overall improvement or worsening of the plan when the patient was rolled vs. supine. Conclusions: For patients with left-sided breast cancer receiving WBRT, the rolled position potentially reduces dose to the heart and its substructures without compromising the coverage and homogeneity of the PTV, hence limiting the need for IMRT.

scholarly journals Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-sided Breast Cancers After Breast-conserving Surgery: a Planning Study

2021 ◽  
Author(s):  
Liuwei Tang ◽  
Yojiro Ishikawa ◽  
Kengo Ito ◽  
Takaya Yamamoto ◽  
Rei Umezawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Organs At Risk ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Breath Hold ◽  
Breast Cancer Patients ◽  
Lung Dose ◽  
Dose Reductions

Abstract Background This paper aims to compare dosimetric parameters of the organs at risk (OARs) among three different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath hold (DIBH) position. Three-dimensional radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH position. A 3DCRT plan was also created in the FB position. Dose-volume histogram (DVH) was used to analyze each evaluation index of OARs. The principal outcome was heart dose, left anterior descending coronary artery (LADCA) dose and left lung dose.Results For the 3D-CRT plans, significant dose reductions were demonstrated in all evaluation parameters to heart, LADCA and left lung dose in the DIBH position compared with the FB position (p < 0.05). In DIBH position, significant dose reductions were founded in heart and LADCA in VMAT plan compared to 3DCRT plan (p < 0.05). There were no significant differences between 3DCRT and VMAT plan for the left lung dose in DIBH position.Conclusion DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity

A Dosimetrical Analysis of the Magnitude of Isocenter Shifts Using CT-on-Rails Guided Online Adaptive Planning for Left Breast Cancer Patients Treated by Intensity Modulated Radiation Therapy

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 32-32
Author(s):  
K Mashhour ◽  
S Eliteo ◽  
W Hashem
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Organs At Risk ◽  
Intensity Modulated Radiation Therapy ◽  
Target Coverage ◽  
Breast Cancer Patients ◽  
Adaptive Planning ◽  
Intensity Modulated ◽  
The Mean ◽  
3D Crt

Introduction: This study was conducted to check the accuracy and validity of an automated adaptive planning (AAP) method which combines automated re-contouring and re-planning to check for inter-fractional anatomical changes in breast cancer patients receiving intensity modulated radiation therapy (IMRT) based on a weekly computed tomography (CT)-on rails images dosimetrically viewing the magnitude of difference in isocenter shifts and the degree of dose deviations regarding target coverage and dose received by organs at risk. Methods and Materials: Twenty left sided conservative breast cancer patients were selected for IMRT treatment. Automatic generation of the contours on each repeat CT image was performed by mapping the contours from the planning CT image using deformable image registration. 3D- CRT and IMRT plans were automatically recalculated for each patient. The magnitude of isocenter shifts in postero-anterior (PA), cranio-caudal (CC) and right-left (RL) directions was calculated and the degree of dose deviations regarding target coverage and dose received by organs at risk. Results: In the PA,CC and RL directions, 9.2%, 11.4% and 6.4% of the 100 CT scans didn’t require any position adjustments. The mean isocenter shifts and standard deviation (SD) were 0.5 & 0.6 +/- 1.1mm, 0.3 &0.4 +/- 0.5mm and 0.2 & 0.4+/- 0.6mm for the IMRT and 3D-CRT plans in the PA,CC and RL directions, respectively. 74.1%, 65.1%, and 55.8% required a shift of 1 - 3 mm; 10.5%, 23.9%, and 33.2% required a shift of 3 - 5mm; and 1.5%, 3.3%, and 5.4% required a shift of more than 5 mm, respectively. With respect to target coverage, the D90[Gy] for the breast CTV was 46.2 Gy and 45.6 for the IMRT and 3D-CRT plans. The mean doses to the heart and left lung were reduced by 5.5 %, 3.7 Gy and 4.1%, 2.6 Gy using the AAP method. Conclusions: The fully automated AAP method using CT on rails for online re-planning was effective in reducing the magnitude of isocenter shifts and compensating for target volume coverage underdosing and higher doses perceived by risk organs caused by anatomical inter-fractional changes in breast cancer patients.

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.

scholarly journals Clinical feasibility of deep learning-based auto-segmentation of target volumes and organs-at-risk in breast cancer patients after breast-conserving surgery

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Seung Yeun Chung ◽  
Jee Suk Chang ◽  
Min Seo Choi ◽  
Yongjin Chang ◽  
Byong Su Choi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
At Risk ◽  
Deep Learning ◽  
Cancer Patients ◽  
Organs At Risk ◽  
Breast Conserving Surgery ◽  
Dice Similarity Coefficient ◽  
Breast Cancer Patients ◽  
Dose Volume Histograms ◽  
Radiation Oncologists

Abstract Background In breast cancer patients receiving radiotherapy (RT), accurate target delineation and reduction of radiation doses to the nearby normal organs is important. However, manual clinical target volume (CTV) and organs-at-risk (OARs) segmentation for treatment planning increases physicians’ workload and inter-physician variability considerably. In this study, we evaluated the potential benefits of deep learning-based auto-segmented contours by comparing them to manually delineated contours for breast cancer patients. Methods CTVs for bilateral breasts, regional lymph nodes, and OARs (including the heart, lungs, esophagus, spinal cord, and thyroid) were manually delineated on planning computed tomography scans of 111 breast cancer patients who received breast-conserving surgery. Subsequently, a two-stage convolutional neural network algorithm was used. Quantitative metrics, including the Dice similarity coefficient (DSC) and 95% Hausdorff distance, and qualitative scoring by two panels from 10 institutions were used for analysis. Inter-observer variability and delineation time were assessed; furthermore, dose-volume histograms and dosimetric parameters were also analyzed using another set of patient data. Results The correlation between the auto-segmented and manual contours was acceptable for OARs, with a mean DSC higher than 0.80 for all OARs. In addition, the CTVs showed favorable results, with mean DSCs higher than 0.70 for all breast and regional lymph node CTVs. Furthermore, qualitative subjective scoring showed that the results were acceptable for all CTVs and OARs, with a median score of at least 8 (possible range: 0–10) for (1) the differences between manual and auto-segmented contours and (2) the extent to which auto-segmentation would assist physicians in clinical practice. The differences in dosimetric parameters between the auto-segmented and manual contours were minimal. Conclusions The feasibility of deep learning-based auto-segmentation in breast RT planning was demonstrated. Although deep learning-based auto-segmentation cannot be a substitute for radiation oncologists, it is a useful tool with excellent potential in assisting radiation oncologists in the future. Trial registration Retrospectively registered.

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. 

Correlation of AGR2 expression with the incidence of metastasis in luminal breast cancer

2021 ◽  
pp. 1-5
Author(s):  
David Samuel Kereh ◽  
John Pieter ◽  
William Hamdani ◽  
Haryasena Haryasena ◽  
Daniel Sampepajung ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Mean Value ◽  
Rank Test ◽  
Luminal Breast Cancer ◽  
P Value ◽  
Strong Positive Correlation ◽  
Breast Cancer Patients ◽  
The Mean ◽  
Spearman Test

BACKGROUND: AGR2 expression is associated with luminal breast cancer. Overexpression of AGR2 is a predictor of poor prognosis. Several studies have found correlations between AGR2 in disseminated tumor cells (DTCs) in breast cancer patients. OBJECTIVE: This study aims to determine the correlation between anterior Gradient2 (AGR2) expression with the incidence of distant metastases in luminal breast cancer. METHODS: This study was an observational study using a cross-sectional method and was conducted at Wahidin Sudirohusodo Hospital and the network. ELISA methods examine AGR2 expression from blood serum of breast cancer patients. To compare the AGR2 expression in metastatic patients and the non-metastatic patient was tested with Mann Whitney test. The correlation of AGR2 expression and metastasis was tested with the Rank Spearman test. RESULTS: The mean value of AGR2 antibody expression on ELISA in this study was 2.90 ± 1.82 ng/dl, and its cut-off point was 2.1 ng/dl. Based on this cut-off point value, 14 subjects (66.7%) had overexpression of AGR2 serum ELISA, and 7 subjects (33.3%) had not. The mean value AGR2 was significantly higher in metastatic than not metastatic, 3.77 versus 1.76 (p < 0.01). The Spearman rank test obtained a p-value for the 2 tail test of 0.003 (p < 0.05), which showed a significant correlation of both, while the correlation coefficient of 0.612 showed a strong positive correlation of AGR2 overexpression and metastasis. CONCLUSIONS: AGR2 expression is correlated with metastasis in Luminal breast cancer.

scholarly journals An Exploration of Heart Failure Risk in Breast Cancer Patients Receiving Anthracyclines with or without Trastuzumab in Thailand: A Retrospective Study

2021 ◽  
Vol 11 (3) ◽  
pp. 484-493
Author(s):  
Jukapun Yoodee ◽  
Aumkhae Sookprasert ◽  
Phitjira Sanguanboonyaphong ◽  
Suthan Chanthawong ◽  
Manit Seateaw ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Ventricular Ejection Fraction ◽  
Factors Associated ◽  
Palliative Intent ◽  
Increased Risk

Anthracycline-based regimens with or without anti-human epidermal growth factor receptor (HER) 2 agents such as trastuzumab are effective in breast cancer treatment. Nevertheless, heart failure (HF) has become a significant side effect of these regimens. This study aimed to investigate the incidence and factors associated with HF in breast cancer patients treated with anthracyclines with or without trastuzumab. A retrospective cohort study was performed in patients with breast cancer who were treated with anthracyclines with or without trastuzumab between 1 January 2014 and 31 December 2018. The primary outcome was the incidence of HF. The secondary outcome was the risk factors associated with HF by using the univariable and multivariable cox-proportional hazard model. A total of 475 breast cancer patients were enrolled with a median follow-up time of 2.88 years (interquartile range (IQR), 1.59–3.93). The incidence of HF was 3.2%, corresponding to an incidence rate of 11.1 per 1000 person-years. The increased risk of HF was seen in patients receiving a combination of anthracycline and trastuzumab therapy, patients treated with radiotherapy or palliative-intent chemotherapy, and baseline left ventricular ejection fraction <65%, respectively. There were no statistically significant differences in other risk factors for HF, such as age, cardiovascular comorbidities, and cumulative doxorubicin dose. In conclusion, the incidence of HF was consistently high in patients receiving combination anthracyclines trastuzumab regimens. A reduced baseline left ventricular ejection fraction, radiotherapy, and palliative-intent chemotherapy were associated with an increased risk of HF. Intensive cardiac monitoring in breast cancer patients with an increased risk of HF should be advised to prevent undesired cardiac outcomes.

scholarly journals Lesion-Based Bone Metastasis Detection in Chest Bone Scintigraphy Images of Prostate Cancer Patients Using Pre-Train, Negative Mining, and Deep Learning

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 518
Author(s):  
Da-Chuan Cheng ◽  
Te-Chun Hsieh ◽  
Kuo-Yang Yen ◽  
Chia-Hung Kao
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Deep Learning ◽  
Bone Metastasis ◽  
Cancer Patients ◽  
Bone Scintigraphy ◽  
Breast Cancer Patients ◽  
Location Detection ◽  
The Mean ◽  
Mean Sensitivity

This study aimed to explore efficient ways to diagnose bone metastasis early using bone scintigraphy images through negative mining, pre-training, the convolutional neural network, and deep learning. We studied 205 prostate cancer patients and 371 breast cancer patients and used bone scintigraphy data from breast cancer patients to pre-train a YOLO v4 with a false-positive reduction strategy. With the pre-trained model, transferred learning was applied to prostate cancer patients to build a model to detect and identify metastasis locations using bone scintigraphy. Ten-fold cross validation was conducted. The mean sensitivity and precision rates for bone metastasis location detection and classification (lesion-based) in the chests of prostate patients were 0.72 ± 0.04 and 0.90 ± 0.04, respectively. The mean sensitivity and specificity rates for bone metastasis classification (patient-based) in the chests of prostate patients were 0.94 ± 0.09 and 0.92 ± 0.09, respectively. The developed system has the potential to provide pre-diagnostic reports to aid in physicians’ final decisions.

Sign in / Sign up

Export Citation Format

Share Document