Predictors of heart and lung dose in left-sided breast cancer treated with VMAT relative to 3D-CRT: A retrospective study

Background Before generating radiotherapy plans for breast cancer patients, the choice of plan techniques (three-dimensional conformal radiation therapy (3D-CRT) and volumetric modulated arc therapy (VMAT)) should be made. This study investigated the performance of two geometric indices in aiding the choice of 3D-CRT and VMAT plans in women undergoing left-sided whole breast radiotherapy. Materials and methods 119 patients, previously treated with left-sided breast radiotherapy (61 3D-CRT treatments and 58 VMAT treatments) from a single institution, were retrospectively studied. Two geometric indices, which were cardiac junction (CJ) index and pulmonary junction (PJ) index, were defined and the relationship between these indices and dose of organs at risk (OARs) were evaluated. Two-tailed Student’s t-test was performed to compare patient characteristics between 3D-CRT and VMAT. Linear regressions were calculated to investigate the association between geometric indices and absorbed dose of heart and left lung, including mean dose of heart (MHD), V5, V30 of heart, and mean dose of left lung (MLLD), V5, V10, V20, V30, V40 of left lung. Results The CJ index was strongly correlated with the MHD in 3D-CRT group and VMAT group. The linear regression formulas were MHD = 4826.59 ×CJ Index+310.48 (R = 0.857, F = 163.77, P = 0.000) in 3D-CRT plans and MHD = 1789.29×CJ Index+437.50 (R = 0.45, F = 14.23, P = 0.000) in VMAT plans. The intersection of the two formulas was CJ index = 4.2% and MHD = 512.33 cGy. The PJ index demonstrated a strongly positive correlation with MLLD in 3D-CRT group and VMAT group as well. The linear regression formulas were MLLD = 2879.54×PJ Index+999.79 (R = 0.697, F = 55.86, P = 0.000) in 3D-CRT plans and MLLD = 1411.79×PJ Index+1091.88 (R = 0.676, F = 47.11, P = 0.000) in VMAT plans, the intersection of the two formulas was PJ index = 6.3% and MLLD = 1180.46 cGy. Conclusions CJ index and PJ index could be used as a practical tool to select 3D-CRT or VMAT before generating plans. We recommend that VMAT plan is preferable when CJ index is greater than 4.2% and/or PJ index is greater than 14.6%, while 3D-CRT plan is the first choice in the opposite.

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Predictors of Heart and Lung Dose in Left-sided Breast Cancer Treated with VMAT Relative to 3D-CRT：A Retrospective Study

10.21203/rs.3.rs-153146/v1 ◽

2021 ◽

Author(s):

Zheng Kang ◽

Sijia Chen ◽

Liwan Shi ◽

Yipeng He ◽

Xiang Gao

Keyword(s):

Breast Cancer ◽

Linear Regression ◽

Organs At Risk ◽

Left Lung ◽

Breast Radiotherapy ◽

Pi Index ◽

Whole Breast Radiotherapy ◽

First Choice ◽

Structural Metrics ◽

3D Crt

Abstract Background Before radiotherapy for breast cancer patients, the choice of three-dimensional conformal radiation therapy (3D-CRT) and volumetric modulated arc therapy (VMAT) should be made. This study investigates the performance of two structural metrics in aiding the choice of 3D-CRT and VMAT plans in women undergoing left-sided whole breast radiotherapy. Materials and methods 119 patients previously treated with left-sided breast radiotherapy (61 3D-CRT treatments and 58 VMAT treatments) from a single institution were retrospectively studied. Two structural metrics, which are cardiac intersetion (CI) index and pulmonary intersection (PI) index, were defined and the relationship between these metrics and dose of organs at risk (OARs) were evaluated. Two-tailed Student’s t-test was performed to compare patient characteristics between 3D-CRT and VMAT. Linear regressions were calculated to investigate the association between structural metrics and absorbed dose of heart and left lung, including MHD, V5, V30 of heart, and MLLD, V5, V10, V20, V30, V40 of left lung. Results The CI index was strongly correlated with the mean dose of heart (MHD) in 3D-CRT group and VMAT group, the linear regression formulas were MHD = 4826.59 ×CI Index + 310.48 (R = 0.857, F = 163.77, P = 0.000) in 3D-CRT plans and MHD = 1789.29×CI Index + 437.50 (R = 0.45, F = 14.23, P = 0.000) in VMAT plans, the intercept of these formulas was CI index = 4.2% and MHD = 512.33 cGy. The PI index demonstrated a strongly positive correlation with mean dose of left lung (MLLD) in 3D-CRT group and VMAT group as well, the linear regression formulas were MLLD = 2879.54×PI Index + 999.79 (R = 0.697, F = 55.86, P = 0.000) in 3D-CRT plans and MLLD = 1411.79×PI Index + 1091.88 (R = 0.676, F = 47.11, P = 0.000) in VMAT plans, the intercept of these formulas was PI index = 6.3% and MLLD = 1180.46 cGy. Conclusions CI index and PI index could serve as a practical tool of choosing either 3D-CRT or VMAT before the plan was generated. We recommend that VMAT plan is preferable when CI index is greater than 4.2% and PI index is greater than 14.6%, while 3D-CRT plan is the first choice in the opposite.

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Hypofractionation is a proven safe and effective modality for postoperative whole-breast radiotherapy for early breast cancer patients

Medical Physics ◽

10.1118/1.3116462 ◽

2009 ◽

Vol 36 (6Part1) ◽

pp. 1927-1930 ◽

Cited By ~ 4

Author(s):

Stephen L. Brown ◽

Alan Rodger ◽

Colin G. Orton

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Early Breast Cancer ◽

Breast Cancer Patients ◽

Breast Radiotherapy ◽

Whole Breast Radiotherapy

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Dosimetric Comparison of Whole Breast Radiotherapy Using Field-in-Field and Volumetric Modulated Arc Therapy Techniques in Left-Sided Breast Cancer Patients

Cureus ◽

10.7759/cureus.15732 ◽

2021 ◽

Author(s):

Asmara Waheed ◽

Sumera Butt ◽

Ali Ishtiaq ◽

Muhammad Atif Mansha ◽

Sana Mehreen ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Volumetric Modulated Arc Therapy ◽

Breast Cancer Patients ◽

Breast Radiotherapy ◽

Dosimetric Comparison ◽

Whole Breast Radiotherapy ◽

Arc Therapy

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Intensity-modulated radiation therapy using TomoDirect for postoperative radiation of left-sided breast cancer including lymph node area: comparison with TomoHelical and three-dimensional conformal radiation therapy

Journal of Radiation Research ◽

10.1093/jrr/rrz052 ◽

2019 ◽

Vol 60 (5) ◽

pp. 694-704 ◽

Cited By ~ 4

Author(s):

Shoko Takano ◽

Motoko Omura ◽

Ryoko Suzuki ◽

Yumiko Tayama ◽

Kengo Matsui ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Lymph Node ◽

Cancer Patients ◽

Dose Distribution ◽

Breast Cancer Patients ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Conformal Radiation Therapy ◽

3D Crt

AbstractIntensity-modulated radiation therapy (IMRT) delivers an excellent dose distribution compared with conventional three-dimensional conformal radiation therapy (3D-CRT) for postoperative radiation including the lymph nodes in breast cancer patients. The TomoTherapy system, developed exclusively for IMRT, has two treatment modes: TomoDirect (TD) with a fixed gantry angle for beam delivery, and TomoHelical (TH) with rotational beam delivery. We compared the characteristics of TD with TH and 3D-CRT plans in the breast cancer patients. Ten consecutive women with left breast cancer received postoperative radiation therapy using TD including the chest wall/residual breast tissue and level II–III axial and supraclavicular lymph node area. Fifty percent of the planning target volume (PTV) was covered with at least 50 Gy in 25 fractions. TD, TH and 3D-CRT plans were created for each patient, with the same dosimetric constraints. TD and TH showed better dose distribution to the PTV than 3D-CRT. TD and 3D-CRT markedly suppressed low-dose spread to the lung compared with TH. Total lung V5 and V10 were significantly lower, while V20 was significantly higher in the TD and 3D-CRT plans. The mean total lung, heart and contralateral breast doses were significantly lower using TD compared with the other plans. Compared with 3D-CRT and TH, TD can provide better target dose distribution with optimal normal-organ sparing for postoperative radiation therapy including the chest wall/residual breast tissue and lymph node area in breast cancer patients. TD is thus a useful treatment modality in these patients.

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Acute side effects of intraoperative electron radiotherapy of breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.112 ◽

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.

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

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e12014 ◽

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]

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Quantifying the Mitigating Effects of Whole-Breast Radiotherapy and Systemic Treatments on Regional Recurrence Incidence Among Breast Cancer Patients

Annals of Surgical Oncology ◽

10.1245/s10434-020-08356-2 ◽

2020 ◽

Vol 27 (9) ◽

pp. 3402-3411 ◽

Cited By ~ 1

Author(s):

Julia E. C. van Steenhoven ◽

Anne Kuijer ◽

Marissa C. van Maaren ◽

Marleen Roos ◽

Sjoerd G. Elias ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Regional Recurrence ◽

Breast Cancer Patients ◽

Breast Radiotherapy ◽

Systemic Treatments ◽

Whole Breast Radiotherapy

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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

10.21203/rs.3.rs-255331/v1 ◽

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.

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Dosimetric comparison of Volumetric Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy during Post Mastectomy left chest wall Irradiation

International Journal of Cancer Research & Therapy ◽

10.33140/ijcrt/02/02/00007 ◽

2017 ◽

Vol 2 (2) ◽

Keyword(s):

Breast Cancer ◽

Volumetric Modulated Arc Therapy ◽

Three Dimensional ◽

Left Lung ◽

Conformal Radiotherapy ◽

Breast Cancer Patients ◽

Arc Therapy ◽

Three Dimensional Conformal Radiotherapy ◽

Higher Doses ◽

3D Crt

Aims: To dosimetrically evaluate the Volumetric Modulated Arc Therapy (VMAT) technique and compare it with Three-Dimensional Conformal Radiotherapy (3D-CRT) for postmastectomy breast cancer therapy. Methods and Material: Ten consecutively treated left sided breast cancer patients were selected for this study. VMAT plans were generated from each of the patients planning CT and compared with 3D-CRT plans. Statistical analysis used: Two tailed paired t test Results: The VMAT technique provided statistically significant homogenous and conformal dose distribution with mean HI of (0.1±0.02) and mean CI of (1.1±0.06) when compared mean HI of (0.3±0.02) and mean CI of (1.7±0.2) in the 3D-CRT technique. VMAT plans showed reduced V30 of the heart (10±4.54) when compared to 3D-CRT plans (15.1±8.53). Except V30, VMAT plans resulted in higher doses to heart. The mean doses received by left lung was (17.50±6.27) and was significantly higher than that of 3D-CRT plans (10.20±3.72). VMAT plans also gave higher doses to the contralateral lung and the opposite breast. Conclusions: VMAT plans in post mastectomy breast cancers provide more homogenous and conformal plans as compared to 3DCRT plans but higher doses to normal tissues.

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