Quantification of Radiation Biomarkers in Leukocytes of Breast Cancer Patients Treated with Different Modalities of 3D-CRT or IMRT

Abstract Purpose: To develop a multiple logistic regression model as normal tissue complication probability model by least absolute shrinkage and selection operator (LASSO) technique in breast cancer patients treated with three-dimensional conformal radiation therapy (3D-CRT), we focused on the changes of pulmonary function tests to achieve the optimal predictive parameters for the occurrence of symptomatic radiation pneumonitis (SRP). Materials and methods: Dosimetric and spirometry data of 60 breast cancer patients were analyzed. Pulmonary function tests were done before RT, after completion of RT, 3, and 6 months after RT. Multiple logistic regression model was used to obtain the effective predictive parameters. Forward selection method was applied in NTCP model to determine the effective risk factors from obtained different parameters. Results: Symptomatic radiation pneumonitis was observed in five patients. Significant changes in pulmonary parameters have been observed at six months after RT. The parameters of mean lung dose (MLD), bridge separation (BS), mean irradiated lung volume (ILVmean), and the percentage of the ipsilateral lung volume that received dose of 20 Gy (IV20) introduced as risk factors using the LASSO technique for SRP in a multiple normal tissue complication probability model in breast cancer patients treated with 3D-CRT. The BS, central lung distance (CLD) and ILV in tangential field have obtained as 23.5 (20.9-26.0) cm, 2.4 (1.5-3.3) cm, and 12.4 (10.6-14.3) % of lung volume in radiation field in patients without pulmonary complication, respectively. Conclusion: The results showed that if BS, CLD, and ILV are more than 23 cm, 2 cm, and 12%, respectively, so incidence of SRP in the patients will be considerable. Our multiple NTCP LASSO model for breast cancer patients treated with 3D-CRT showed that in order to have minimum probability of SRP occurrence, parameters of BS, IV20, ILV and especially MLD would be kept in minimum levels. Considering dose-volume histogram, the mean lung dose factor is most important parameter which minimizing it in treatment planning, minimizes the probability of SRP and consequently improves the quality of life in breast cancer patients.

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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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TOWARDS A LOWER HEART DOSE? IMRT VS. 3D-CRT FOR LEFT-SIDED BREAST CANCER PATIENTS TREATED WITH ABC

Radiotherapy and Oncology ◽

10.1016/s0167-8140(12)73145-6 ◽

2009 ◽

Vol 92 ◽

pp. S208-S209

Author(s):

G. Renes ◽

J. Tieben ◽

N. Tijsen ◽

M. Mast ◽

H. Rozema ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Breast Cancer Patients ◽

Heart Dose ◽

3D Crt

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Improved robustness in the junction region for postoperative breast cancer including supraclavicular nodes using hybrid VMAT

10.21203/rs.3.rs-220715/v1 ◽

2021 ◽

Author(s):

Hideharu Miura ◽

Yoshiko Doi ◽

Minoru Nakao ◽

Shuichi Ozawa ◽

Masahiko Kenjo ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Low Dose ◽

Treatment Plan ◽

Target Volume ◽

Breast Cancer Patients ◽

Junction Region ◽

Treatment Delivery ◽

Patient Motion ◽

3D Crt

Abstract Purpose To improve the hybrid VMAT treatment plan robustness for postoperative breast cancer patients considering small patient motion shifts during treatment using a 3D-CRT with a dose gradient in the junction region. Methods Locoregional supraclavicular nodes of breast cancer patients were planned using 3D-CRT and VMAT. A 3D-CRT plan with a dose gradient on the cranial side was applied by shifting the jaw to reduce hot or cold spots. The VMAT plan was optimized based on the results of the 3D-CRT plan calculation. Hybrid plans were created by the sum of the 3D-CRT and VMAT plans. To simulate patient motion, the plans were recalculated with the VMAT plan simulating isocenter superiorly (separation) or inferiorly (overlap) shifted by 1, 2, and 3 mm. The shifted plans were compared with the non-shifted plans considering the clinical target volume (CTV) (D98% or D2%). Results The D2% value of the CTV with perfectly aligned fields for the hybrid VMAT plan with high- or low-dose gradients on the 3D-CRT plan increased from 102.8%/102.9–107.2%/105.7%, 114.9%/110.9%, and 122.2%/115.5% for each 1 mm, 2 mm, and 3 mm overlapped shift, respectively. The value of D98% to the CTV with perfectly aligned fields decreased from 95.7%/95.6–90.0%/93.1%, 81.2%/88.4%, and 72.8%/83.5% for each 1 mm, 2 mm, and 3 mm separated shift, respectively. Conclusions By employing a 3D-CRT plan with a low dose gradient on the cranial side, the dose differences can be decreased. A more robust treatment delivery option can be achieved for breast cancer treatment using our proposed hybrid VMAT.

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PO-1425: Secondary cancer risk in breast cancer patients treated with protons compared to 3D-CRT and VMAT

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)01443-2 ◽

2020 ◽

Vol 152 ◽

pp. S757

Author(s):

F. Tommasino ◽

G. Cartechini ◽

F. Fracchiolla ◽

L. Menegotti ◽

E. Scifoni ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Risk ◽

Cancer Patients ◽

Secondary Cancer ◽

Breast Cancer Patients ◽

Secondary Cancer Risk ◽

3D Crt

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So sánh các thông số liều lượng của kỹ thuật vmat và 3d-crt trong xạ trị ung thư vú trái và hạch vùng

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2020.59.9 ◽

2020 ◽

Author(s):

Đình Long Nguyễn

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Volumetric Modulated Arc Therapy ◽

Left Lung ◽

Conformal Radiotherapy ◽

Left Breast ◽

Three Dimension ◽

Breast Cancer Patients ◽

Arc Therapy ◽

3D Crt

COMPARISON OF DOSIMETRIC PARAMETERS OF VOLUMETRIC MODULATED ARC THERAPY AND THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY FOR LEFT SIDE BREAST AND REGIONAL NODES Objective: Comparative study of dose parameters of Volumetric modulated arc therapy (VMAT) and three-dimension radiotherapy (3D-CRT) in patients after left breast surgery with radiation therapy with regional lymph nodes. Materials and Methods: Twenty-four plans of 12 left-breast cancer patients were treated with VMAT with 4 partial arc and 3D-CRT plans were added to compare each other, from 1/2018 to 3/2019 at the Vinmec TimesCity International Hospital. Results: The average coverage dose to the treatment volume (PTV) of VMAT plans is better than the 3D-CRT plan (99.10 ± 0.17 % compared to 98.7 ± 0.34 %; p = 0.01). Conformity index (CI), homogeneity index (HI) for VMAT plans also better results CI: 0.99 vs. 0.98; p = 0.26 and HI: 0.096 compared to 0.119; p = 0.02). Organs at risk, at low doses V5Gy, V10Gy VMAT plans do not avoid good doses by 3D-CRT plans: V5Gy for left lung (78.8 ± 4.6 % compared to 55.37 ± 4.38 %) and heart (77.15 ± 9.52 % compared to 19.15 ± 7.93 %) (p <0.001). However, at high doses, 3D-CRT plans are much higher than VMAT: Dose to left lung V20Gy (36.22 ± 3.9 % compared to 22.62 ± 2.43 %), V30Gy (30.6 ± 5.97 % compared to 11.77 ± 2.53 %) and V40Gy (24.73 ± 8.59 % compared to 3.63 ± 2.02 %) (P <0.001). Similarly, the cardiac arrival dose of the 3D-CRT plan is higher than that of VMAT: V20Gy (11.54 ± 5.83 % compared to 9.49 ± 6.00 %, p> 0.05), V30Gy (9.25 ± 5.56 % compared to 2.13 ± 1.89 %) and V40 Gy (7.54 ± 5.03 % compared with 0.2 ± 0.25 %). Dose to coronary arteries also decreased significantly for VMAT plans compared to 3D-CRT: V20Gy (0.8 ± 1.01 % compared to 27.29 ± 15.19 %) V30Gy (0.00 % compared to 23.09 ± 10.73 %). Conclusion: VMAT is dosimetrically superior to the 3D-CRT for left‑sided breast cancer patients with regional nodes by dose coverage to PTV and good ability to avoid heart and lung and coronary arteries than. Key words: Breast cancer, Postmastectomy radiotherapy, Three-dimension conformal radiotherapy, Volumetric modulated arc therapy.

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Advantage of Deep Inspiration Breath Hold in Left-sided Breast Cancer Patients Treated with 3D Conformal Radiotherapy

Tumori Journal ◽

10.5301/tj.5000563 ◽

2016 ◽

Vol 103 (1) ◽

pp. 72-75 ◽

Cited By ~ 2

Author(s):

Luciana Lastrucci ◽

Simona Borghesi ◽

Silvia Bertocci ◽

Chiara Gasperi ◽

Andrea Rampini ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Left Lung ◽

Conformal Radiotherapy ◽

Breath Hold ◽

Deep Inspiration ◽

Breast Cancer Patients ◽

Deep Inspiration Breath Hold ◽

Treatment Plans ◽

3D Crt

Purpose To compare 3D-conformal radiotherapy (3D-CRT) treatment plans based on free-breathing (FB) and deep inspiration breath hold (DIBH) and investigated whether DIBH technique enables a decrease of cardiac left anterior descending coronary artery (LADCA) and lungs dose with respect to the FB. Methods Twenty-three left-sided breast cancer patients referred for breast radiotherapy were included. The planning target volume (PTV) encompassed the breast and organs at risk including heart, LADCA, lungs, and contralateral breast, which were contoured in FB and DIBH CT scans. Dose to PTV was 50 Gy in 25 fractions. Two treatment plans were generated for each patient: FB-3D-CRT and DIBH-3D-CRT. Dosimetry parameters were obtained from dose volume histograms. Data were compared using the paired-sample Wilcoxon signed rank test. Results For heart, LADCA, and left lung, a significant dose reduction was found using DIBH technique. By using DIBH, an average reduction of 25% was observed in LADCA for the volume receiving 20 Gy and of 48% considering the mean heart dose. Conclusions The DIBH technique results in a significant decrease of dose to the heart, LADCA, and left lung compared to FB.

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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

Tumori Journal ◽

10.1177/0300891620914164 ◽

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.

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