Replacing Manual Planning of Whole Breast Irradiation With Knowledge-Based Automatic Optimization by Virtual Tangential-Fields Arc Therapy

PurposeTo implement Knowledge Based (KB) automatic planning for right and left-sided whole breast treatment through a new volumetric technique (ViTAT, Virtual Tangential-fields Arc Therapy) mimicking conventional tangential fields (TF) irradiation.Materials and MethodA total of 193 clinical plans delivering TF with wedged or field-in-field beams were selected to train two KB-models for right(R) and left(L) sided breast cancer patients using the RapidPlan (RP) tool implemented in the Varian Eclipse system. Then, a template for ViTAT optimization, incorporating individual KB-optimized constraints, was interactively fine-tuned. ViTAT plans consisted of four arcs (6 MV) with start/stop angles consistent with the TF geometry variability within our population; the delivery was completely blocked along the arcs, apart from the first and last 20° of rotation for each arc. Optimized fine-tuned KB templates for automatic plan optimization were generated. Validation tests were performed on 60 new patients equally divided in R and L breast treatment: KB automatic ViTAT-plans (KB-ViTAT) were compared against the original TF plans in terms of OARs/PTVs dose-volume parameters. Wilcoxon-tests were used to assess the statistically significant differences.ResultsKB models were successfully generated for both L and R sides. Overall, 1(3%) and 7(23%) out of 30 automatic KB-ViTAT plans were unacceptable compared to TF for R and L side, respectively. After the manual refinement of the start/stop angles, KB-ViTAT plans well fitted TF-performances for these patients as well. PTV coverage was comparable, while PTV D1% was improved with KB-ViTAT by R:0.4/L:0.2 Gy (p < 0.05); ipsilateral OARs Dmean were similar with a slight (i.e., few % volume) improvement/worsening in the 15–35 Gy/2–15 Gy range, respectively. KB-ViTAT better spared contralateral OARs: Dmean of contralateral OARs was 0.1 Gy lower (p < 0.05); integral dose was R:5%/L:8% lower (p < 0.05) than TF. The overall time for the automatic plan optimization and final dose calculation was 12 ± 2 minutes.ConclusionsFully automatic KB-optimization of ViTAT can efficiently replace manually optimized TF planning for whole breast irradiation. This approach was clinically implemented in our institute and may be suggested as a large-scale strategy for efficiently replacing manual planning with large sparing of time, elimination of inter-planner variability and of, seldomly occurring, sub-optimal manual plans.

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OC-0334 Partial vs whole-breast irradiation for breast cancer patients in the randomized DBCG PBI trial

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)06867-5 ◽

2021 ◽

Vol 161 ◽

pp. S247

Author(s):

B. Offersen ◽

J. Alsner ◽

H.M. Nielsen ◽

E.H. Jacobsen ◽

M.H. Nielsen ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients

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Performance of a Knowledge-Based Model for Optimization of Volumetric Modulated Arc Therapy Plans for Single and Bilateral Breast Irradiation

PLoS ONE ◽

10.1371/journal.pone.0145137 ◽

2015 ◽

Vol 10 (12) ◽

pp. e0145137 ◽

Cited By ~ 26

Author(s):

Antonella Fogliata ◽

Giorgia Nicolini ◽

Celine Bourgier ◽

Alessandro Clivio ◽

Fiorenza De Rose ◽

...

Keyword(s):

Volumetric Modulated Arc Therapy ◽

Breast Irradiation ◽

Knowledge Based ◽

Arc Therapy

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252 Prospective trial for Japanese breast cancer patients treated with accelerated hypofractionated whole breast irradiation for breast conserving treatment

European Journal of Cancer Supplements ◽

10.1016/s1359-6349(10)70278-0 ◽

2010 ◽

Vol 8 (3) ◽

pp. 131-132

Author(s):

Y. Kagami ◽

A. Imai ◽

M. Morota ◽

H. Mayahara ◽

Y. Ito ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Prospective Trial ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Breast Conserving Treatment ◽

Hypofractionated Whole Breast Irradiation

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Endocrine therapy with or without whole breast irradiation in low-risk breast cancer patients after breast-conserving surgery: 10-year results of the Austrian Breast and Colorectal Cancer Study Group 8A trial

European Journal of Cancer ◽

10.1016/j.ejca.2019.11.024 ◽

2020 ◽

Vol 127 ◽

pp. 12-20 ◽

Cited By ~ 1

Author(s):

Gerd Fastner ◽

Felix Sedlmayer ◽

Joachim Widder ◽

Martina Metz ◽

Hans Geinitz ◽

...

Keyword(s):

Breast Cancer ◽

Colorectal Cancer ◽

Cancer Patients ◽

Breast Conserving Surgery ◽

Study Group ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Cancer Study Group ◽

Risk Breast Cancer

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Hydrofilm Polyurethane Films Reduce Radiation Dermatitis Severity in Hypofractionated Whole-Breast Irradiation: An Objective, Intra-Patient Randomized Dual-Center Assessment

Polymers ◽

10.3390/polym11122112 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2112 ◽

Cited By ~ 3

Author(s):

Leonard Schmeel ◽

David Koch ◽

Frederic Schmeel ◽

Bettina Bücheler ◽

Christina Leitzen ◽

...

Keyword(s):

Breast Cancer ◽

Wound Care ◽

Treatment Strategies ◽

Preventive Treatment ◽

Radiation Dermatitis ◽

Whole Breast Irradiation ◽

Breast Irradiation ◽

Breast Cancer Patients ◽

Radiation Induced ◽

Hypofractionated Whole Breast Irradiation

Radiation-induced skin injury represents the most frequent side effect in breast cancer patients undergoing whole-breast irradiation (WBI). Numerous clinical studies on systemic and topical treatments for radiation dermatitis have failed to provide sustainable treatment strategies. While protective skin products such as dressings are undoubtedly the standard of care in wound care management, their utilization as preventive treatment in radiotherapy has been somewhat neglected in recent years. In this prospective, intra-patient randomized observational study, Hydrofilm polyurethane films were prophylactically applied to either the medial or lateral breast-half of 74 patients with breast cancer undergoing hypofractionated whole-breast irradiation following breast-preserving surgery. Maximum radiation dermatitis severity was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.03 toxicity scores, photospectrometric erythema and pigmentation measurements and patient-assessed modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) scale. Phantom studies revealed a clinically negligible dose build-up of less than 0.1% with Hydrofilm. Compared to the control compartments physician-assessed radiation dermatitis severity was reduced in the hydrofilm compartments (mean 0.54 vs. 1.34; p = < 0.001). Objective photospectrometric skin measurements showed decreased erythema (p = 0.0001) and hyperpigmentation (p = 0.002) underneath Hydrofilm. Hydrofilm also completely prevented moist desquamation, and significantly reduced patients’ treatment-related symptoms of itching, burning, pain, and limitations of day-to-day-activities. Significant beneficial effects were observed in terms of radiation dermatitis severity, erythema, hyperpigmentation as well as subjective treatment-related symptom experiences, while adverse reactions were rare and minor. Therefore, a prophylactic application of Hydrofilm polyurethane films can be suggested in hypofractionated WBI.

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