scholarly journals Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

2021 ◽  
Vol 27 (3) ◽  
pp. 201-206
Author(s):  
Özlem Mermut ◽  
Aysun Ozsoy Ata ◽  
Didem Can Trabulus
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Organs At Risk ◽  
Bilateral Breast Cancer ◽  
Radiotherapy Planning ◽  
Conformity Index ◽  
Treatment Unit ◽  
Significant Difference ◽  
Synchronous Bilateral Breast Cancer ◽  
The Right

Abstract Objective: We compared mono-isocenter and dual-isocenter plans in synchronous bilateral breast cancer (SBBC), which is defined as tumours occurring simultaneously in both breasts, and evaluated the effects of these differences in plans on organs-at-risk (OARs). Materials and methods: We evaluated 10 women with early stage, nod negative (Tis-2N0M0) SBBC. The treatment dose was determined to be 50 Gy. We used mean dose and VXGy to evaluate the OARs. To evaluate the effectiveness of treatment plans, Homogeneity index (HI), conformity index (CI) and sigma index (SI) and monitor units (MU) of monoisocenter (MIT) and dual-isocenter (DIT) plans were compared. During bilateral breast planning, for the single-centre plan, the isocenter was placed at the center of both breasts at a depth of 3-4 cm. For the two-center plan, dual-isocenters were placed on the right and left breasts. Results: No significant difference between the techniques in terms of the scope of the target volume was observed. Statistically significant results were not achieved in MIT and DIT plans for OARs. Upon comparing MIT and DIT, the right-side monitor unit (MU) value in DIT (p = 0.011) was statistically significantly lower than that in MIT. Upon comparing right-left side MIT and DIT, the MU value (p = 0.028) was significantly lower in DIT than MIT. Conclusion: SBBC irradiation is more complex than unilateral breast radiotherapy. No significant difference between both techniques and OARs was observed. However, we recommend MIT as a priority technique due to the ability to protect OARs, ease of administration during treatment, and the fact that the patient stays in the treatment unit for a shorter period of time.

scholarly journals A comparative dosemetric study of bilateral breast cancer after modified radical mastectomy with HT and VMAT

2021 ◽  
Author(s):  
Xuhong Liu ◽  
Yaoxiong Xia ◽  
Li Chang ◽  
Xiao Chen
Keyword(s):  
Breast Cancer ◽  
Spinal Cord ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Bilateral Breast Cancer ◽  
Radical Mastectomy ◽  
Target Volume ◽  
Conformity Index ◽  
Modified Radical Mastectomy ◽  
Synchronous Bilateral Breast Cancer

Abstract Background: The purpose of this study was to compare the dosimetric differences in helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) plans of bilateral breast cancer after modified radical mastectomy.Methods: Ten patients with synchronous bilateral breast cancer (SBBC) who received modified radical mastectomy were selected for study. Two radiotherapy treatment plans, including HT and VMAT, were created for each patient. The prescribed doses of bilateral breast cancer and dual target volumes were given 25 times at 50Gy. The dosemetric parameters of planning target volume (PTV) and organs at risk (OARs) between HT and VMAT plans were compared and evaluated. Results: For PTV, HT had a higher V95 than that of VMAT plans (99.23 ± 0.61 % vs 98.17± 1.08 %, p=0.024). The conformity index (CI) between two techniques was statistically equivalent (0.812 ± 0.03 vs 0.793 ± 0.04, p=0.322) and the homogeneity index (HI) was reduced from 0.127 to 0.105 (p=0.007) when compared with that of VMAT. For OARs, HT had significantly lower Dmax for spinal cord and V5 for heart when compared with those of VMAT plans (16.68 Gy and 20.93% vs 38.82 Gy and 30.26%, respectively) (p<0.001). HT plans showed significantly lower V5, V10 and V20, that resulted in lower Dmean for the lungs (13.38 Gy vs 14.28Gy, p=0.013). However, VMAT showed specific advantages on V10, V20 and V30 for the heart and V5 and V10 for the liver when compared with those of HT plans (p<0.01). The Dmean for the heart and liver between the two techniques was not significantly different (p>0.05). HT plans also showed greater monitor units (MUs) and beam on time. Conclusion: HT had better PTV coverage and HI and showed better protections for the spinal cord and lungs compared with those of VMAT plans. HT plans effectively reduced the low-dose volume (V5) of the heart, while VMAT plans reduced V10, V20 and V30 for the heart. Both HT and VMAT plans exhibited similar Dmean for the heart and liver. The treatment efficiency of VMAT is higher than that of HT plans, and therefore, physicians need to choose a reasonable radiotherapy plan according to patient's conditions.

scholarly journals Radiation dose to the heart with hypofractionation in patients with left breast cancer

2021 ◽  
Vol 2 ◽  
Author(s):  
Budhi Singh Yadav ◽  
Deepak Kumar Das ◽  
Narendra Kumar ◽  
Manphool Singhal ◽  
Ngangom Robert
Keyword(s):  
Breast Cancer ◽  
Radiation Dose ◽  
Organs At Risk ◽  
Breast Conservation ◽  
Left Lung ◽  
Left Breast ◽  
Breast Conservation Surgery ◽  
Study Planning ◽  
Significant Difference ◽  
The Right

Abstract Introduction In this study we compared radiation dose received by organs at risk (OARs) after breast conservation surgery(BCS) and mastectomy in patients with left breast cancer. Materials and methods Total 30 patients, 15 each of BCS and mastectomy were included in this study. Planning Computerised Tomography (CT) was done for each patient. Chest wall, whole breast, heart, lungs, LAD, proximal and distal LAD, and contra lateral breast was contoured for each patient. Radiotherapy plans were made by standard tangent field. Dose prescribed was 40Gy/16#/3 weeks. Mean heart dose, LAD, proximal and distal LAD, mean and V5 of right lung, and mean, V5, V10 and V20 of left lung, mean dose and V2 of contra lateral breast were calculated for each patient and compared between BCS and mastectomy patients using student’s T test. Results Mean doses to the heart, LAD, proximal LAD and distal LAD were 3.364Gy, 16.06Gy, 2.7Gy, 27.5Gy; and 4.219Gy, 14.653Gy, 4.306Gy, 24.6Gy, respectively for mastectomy and BCS patients. Left lung mean dose, V5, V10 and V20 were 5.96Gy, 16%, 14%, 12.4%; and 7.69Gy, 21%, 18% and 16% in mastectomy and BCS patients, respectively. There was no statistical significant difference in the doses to the heart and left lung between mastectomy and BCS. Mean dose to the right lung was significantly less in mastectomy as compared to BCS, 0.29Gy vs. 0.51Gy, respectively (p = 0.007). Mean dose to the opposite breast was significantly lower in patients with mastectomy than BCS (0.54Gy Vs 0.37Gy, p = 0.007). The dose to the distal LAD was significantly higher than proximal LAD both in BCS (24.6Gy Vs 4.3Gy, p = <0.0001) and mastectomy (27.5Gy Vs 2.7Gy, p = <0.0001) patients. Conclusion There was no difference in doses received by heart and left lung between BCS and mastectomy patients. Mean doses to the right lung and breast were significantly less in mastectomy patients.

scholarly journals Synchronous Bilateral Breast Cancer: Implications for Adjuvant Radiation

2019 ◽  
pp. 1-3
Author(s):  
Susanna Nguy ◽  
Naamit K. Gerber
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Bilateral Breast Cancer ◽  
Left Breast ◽  
Adjuvant Radiation ◽  
Axillary Lymph ◽  
Nodal Disease ◽  
Excellent Teaching ◽  
Synchronous Bilateral Breast Cancer ◽  
Nodal Burden

We present the case of a 55-year old postmenopausal female with bilateral early stage clinically node negative breast cancer who was treated with bilateral lumpectomy with axillary lymph node dissection revealing N1a nodal disease in her right breast with extra-nodal extension and micrometastatic disease in her left breast. Given the controversy in management for low nodal burden for macroscopic and microscopic nodal disease, we review the key trials in regional nodal management that have included patients with low nodal burden to explain our reasoning for treatment decisions. Our patient was treated with both hypofractionation and conventional treatment. She is an excellent teaching case to demonstrate how much of an impact the decision regarding fractionation can have on long term breast cosmesis and toxicity.

Non-coplanar VMAT improves plan quality for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes

2020 ◽  
Author(s):  
Yuan Xu ◽  
Pan Ma ◽  
Zhihu Hu ◽  
Yuan Tian ◽  
Kuo Men ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Organs At Risk ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Conformity Index ◽  
Internal Mammary Nodes ◽  
Significant Difference ◽  
Internal Mammary ◽  
The Mean

Abstract Purpose A planning study was performed to evaluate the feasibility of non-coplanar volume modulated arc therapy (ncVMAT) for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes. Methods and materials Ten patients with left-sided breast cancer after breast conserving surgery were retrospectively studied. The planning target volumes (PTV) were contoured encompassing the whole breast/chestwall, internal mammary nodes (IMN) and supraclavicular nodal (SCN) region. For each patient, ncVMAT plan with 4 partial arcs composing of two coplanar arcs and two non-coplanar arcs with couch rotating to 90˚ was generated. The prescription dose was normalized to cover 95% of PTV with 50 Gy delivering in 25 fractions. For each ncVMAT plan, dosimetric parameters were compared with coplanar VMAT (coVMAT) plan optimizing with identical coplanar beam angle arrangement. Results With ncVMAT, the mean conformity index of the whole PTV increased from 0.82±0.02 to 0.86±0.01 (p=0.005), and there was no significant difference for the homogeneity index. The mean coverage of internal mammary target volume (PTVimn) with ncVMAT increased from 88.77±3.07% to 91.67±3.84% comparing with coVMAT (p=0.005). Meanwhile, the V55 in PTVscn and PTVimn decreased significantly from 5.76±6.03%, 13.73±7.77% to 2.94±3.93%, 3.75±3.36%, separately (p<0.01). For organs at risk, the average V30, V20, V10, V5 and Dmean of heart decreased from 5.13±3.22%, 12.18±7.29%, 33.98±15.73%, 72.03±16.79% and 10.47±2.97 Gy to 4.86±2.54%, 9.35±5.43%, 25.16±12.42%, 62.27±13.18% and 9.08±2.34 Gy, separately (p<0.01). Furthermore, ncVMAT significantly reduced the mean V20, V10, V5, Dmean of left lung, and V10, V5, Dmean of contralateral lung (p<0.01). A better sparing of LAD descending coronary artery and right breast were also shown with ncVMAT (p<0.01). Conclusions Compared to coVMAT, ncVMAT provides better conformity, lower V55 in PTVscn and PTVimn, better coverage of PTVimn, better dose sparing in heart, bilateral lung, LAD and right breast for locoregional radiotherapy of left-sided breast cancer with internal mammary nodes, which potentially increase the local control in IMN and reduce the risk of deleterious effects.

Contribution of Magnetic Resonance Imaging in Determining Lumpectomy Cavity in Breast Radiotherapy

2020 ◽  
Vol 16 (8) ◽  
pp. 997-1003
Author(s):  
Ozlem Demircioglu ◽  
Huseyin Tepetam ◽  
Ayfer Ay Eren ◽  
Zerrin Ozgen ◽  
Fatih Demircioglu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Supine Position ◽  
Radiotherapy Planning ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Lumpectomy Cavity ◽  
Breast Cancer Radiotherapy ◽  
Significant Difference ◽  
Mean Diameter ◽  
Ct And Mri

Background: Accurate localization of the lumpectomy cavity is important for breast cancer radiotherapy after breast-conserving surgery (BCS), but the LC localization based on CT is often difficult to delineate accurately. The study aimed to compare CT-defined LC planning to MRI-defined findings in the supine position for higher soft-tissue resolution of MRI. Methods: Fifty-nine breast cancer patients underwent radiotherapy CT planning in supine position followed by MR imaging on the same day. LC was contoured by the radiologist and radiation oncologist together by CT and MRI separately. T2 weighted MR images and tomography findings were combined and the LC volume, mean diameter and the longest axis length were measured after contouring. Subsequently, patients were divided into two groups according to seroma in LC and the above-mentioned parameters were compared. Results: We did not find any statistically significant difference in the LC volume, mean diameter and length at the longest axis between CT and MRI but based on the presence or absence of seroma, statistically significant differences were found in the LC volumes and the length at the longest axis of LC volumes. Conclusion: We believe that the supine MRI in the same position with CT will be more effective for radiotherapy planning, particularly in patients without a seroma in the surgical cavity.

scholarly journals Age-Related Biology of Early-Stage Operable Breast Cancer and Its Impact on Clinical Outcome

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1417
Author(s):  
Binafsha M. Syed ◽  
Andrew R. Green ◽  
Emad A. Rakha ◽  
David A.L. Morgan ◽  
Ian O. Ellis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Histological Grade ◽  
Survival Rates ◽  
Growth Factor Receptor ◽  
Progesterone Receptors ◽  
Biological Characteristics ◽  
Cancer Specific Survival ◽  
Age Related ◽  
Significant Difference

As age advances, breast cancer (BC) tends to change its biological characteristics. This study aimed to explore the natural progression of such changes. The study included 2383 women with clinically T0-2N0-1M0 BC, managed by primary surgery and optimal adjuvant therapy in a dedicated BC facility. Tissue micro-arrays were constructed from their surgical specimens and indirect immunohistochemistry was used for analysis of a large panel (n = 16) of relevant biomarkers. There were significant changes in the pattern of expression of biomarkers related to luminal (oestrogen receptor (ER), progesterone receptors (PgR), human epidermal growth factor receptor (HER-2), E-cadherin, MUC1, bcl2 CK7/8, CK18 and bcl2) and basal (CK5/6, CK14, p53 and Ki67) phenotypes, lymph node stage, histological grade and pathological size when decade-wise comparison was made (p < 0.05). The ages of 40 years and 70 years appeared to be the milestones marking a change of the pattern. There were significantly higher metastasis free and breast cancer specific survival rates among older women with ER positive tumours while there was no significant difference in the ER negative group according to age. Biological characteristics of BC show a pattern of change with advancing age, where 40 years and 70 years appear as important milestones. The pattern suggests <40 years as the phase with aggressive phenotypes, >70 years as the less aggressive phase and 40–70 years being the transitional phase.

Designing Personalized Treatment Plans for Breast Cancer

2021 ◽  
Author(s):  
Wei Chen ◽  
Yixin Lu ◽  
Liangfei Qiu ◽  
Subodha Kumar
Keyword(s):  
Breast Cancer ◽  
Domain Knowledge ◽  
Early Stage ◽  
Radiotherapy Planning ◽  
Breast Cancer Patients ◽  
Support Tools ◽  
Treatment Plans ◽  
Radiation Induced ◽  
Effective Decision ◽  
Effective Decision Support

Breast cancer remains the leading cause of cancer deaths among women around the world. Contemporary treatment for breast cancer is complex and involves highly specialized medical professionals collaborating in a series of information-intensive processes. This poses significant challenges to optimization of treatment plans for individual patients. We propose a novel framework that enables personalization and customization of treatment plans for early stage breast cancer patients undergoing radiotherapy. Using a series of simulation experiments benchmarked with real-world clinical data, we demonstrate that the treatment plans generated from our proposed framework consistently outperform those from the existing practices in balancing the risk of local tumor recurrence and radiation-induced adverse effects. Our research sheds new light on how to combine domain knowledge and patient data in developing effective decision-support tools for clinical use. Although our research is specifically geared toward radiotherapy planning for breast cancer, the design principles of our framework can be applied to the personalization of treatment plans for patients with other chronic diseases that typically involve complications and comorbidities.

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