Developing of predictive models for pneumonitis with forward variable selection and LASSO logistic model for breast cancer patients treated with 3D-CRT

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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Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients

PLoS ONE ◽

10.1371/journal.pone.0131736 ◽

2015 ◽

Vol 10 (7) ◽

pp. e0131736 ◽

Cited By ~ 10

Author(s):

Tsair-Fwu Lee ◽

Pei-Ju Chao ◽

Liyun Chang ◽

Hui-Min Ting ◽

Yu-Jie Huang

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Normal Tissue ◽

Radiation Pneumonitis ◽

Probability Model ◽

Normal Tissue Complication Probability ◽

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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Quantitative Assessment of Irradiated Lung Volume and Lung Mass in Breast Cancer Patients Treated with Tangential Fields in Combination with Deep Inspiration Breath Hold (DIBH)

Strahlentherapie und Onkologie ◽

10.1007/s00066-010-2064-y ◽

2010 ◽

Vol 186 (3) ◽

pp. 157-162 ◽

Cited By ~ 20

Author(s):

Brigitte Zurl ◽

Heidi Stranzl ◽

Peter Winkler ◽

Karin Sigrid Kapp

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Lung Volume ◽

Quantitative Assessment ◽

Breath Hold ◽

Deep Inspiration ◽

Breast Cancer Patients ◽

Lung Mass ◽

Deep Inspiration Breath Hold

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

Radiation Research ◽

10.1667/rr14475.1 ◽

2016 ◽

Vol 186 (5) ◽

pp. 508 ◽

Cited By ~ 4

Author(s):

Sebastian Zahnreich ◽

Anne Ebersberger ◽

Heiko Karle ◽

Bernd Kaina ◽

Heinz Schmidberger

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Breast Cancer Patients ◽

3D Crt

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Dose Distribution in the Heart and Cardiac Chambers following 4-field Radiation Therapy of Breast Cancer: a Retrospective Study

Breast Cancer Basic and Clinical Research ◽

10.4137/bcbcr.s11118 ◽

2013 ◽

Vol 7 ◽

pp. BCBCR.S11118 ◽

Cited By ~ 2

Author(s):

Safora Johansen ◽

Kristin H. Tjessem ◽

Kristian Fosså ◽

Gerhard Bosse ◽

Turi Danielsen ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Normal Tissue Complication Probability ◽

Radiation Doses ◽

Breast Cancer Patients ◽

Heart Volume ◽

Volume Percentage ◽

Dose Volume Histograms ◽

Field Radiation ◽

Whole Heart

Purpose To evaluate cardiac doses in breast cancer patients with stage II/III treated with 4-field radiotherapy based on computed tomography (CT) dose planning. Methods and Materials Based on archived CT images, whole heart and cardiac chamber radiation doses were analyzed in 216 (111 left-sided and 105 right-sided) mastectomized or lumpectomized breast cancer patients treated at a single institution, the Norwegian Radium Hospital, between 2000–2002. Individual dose volume histograms for the whole heart and for the four cardiac chambers were obtained, and mean, median and maximum doses to these structures were calculated. The dose (Gy) delivered to the 5% of the volume of each cardiac structure (D5%), and the volume percentage of each structure receiving ≥ 25 Gy (V25Gy) were reported. Normal tissue complication probability (NTCP) calculations were used to estimate the risk for ischemic heart disease (IHD). Results Cohort-based medians of the whole heart mean dose (Dmean) for left- and right-sided tumors were 3.2 Gy and 1.3 Gy, respectively, with similar ventricular but lower atrial values. The atrial doses did not differ according to laterality of the breast tumor. In 13 patients with left-sided cancer, 5% of the heart volume was exposed to >25 Gy. The NTCP estimates were generelly low, with a maximum of 2.8%. Conclusions During adjuvant CT-based locoregional radiotherapy of women with breast cancer, the cardiac radiation doses are, at the group level, below recommended threshold values (D5% < 25 Gy), though individual patients with left-sided disease may exceed these limits.

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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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Predictive parameters for selection of electronic tissue compensation radiotherapy in early-stage breast cancer patients after breast-conserving surgery

Oncotarget ◽

10.18632/oncotarget.9054 ◽

2016 ◽

Vol 7 (22) ◽

pp. 32835-32845

Author(s):

Yanbo Song ◽

Miao Zhang ◽

Lu Gan ◽

Xiaopin Chen ◽

Tao Zhang ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Early Stage ◽

Breast Conserving Surgery ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

Predictive Parameters ◽

Selection Of

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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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