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Dosimetric evaluation of 3 and/or 4 field radiation therapy of breast cancers: clinical experience

Published online by Cambridge University Press:  09 July 2020

Ernest Osei Open the ORCID record for Ernest Osei [Opens in a new window] ,
Susan Dang ,
Johnson Darko ,
Katrina Fleming  and
Ramana Rachakonda
Ernest Osei*
Affiliation:
Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
Susan Dang
Affiliation:
Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada
Johnson Darko
Affiliation:
Department of Physics and Astronomy, University of Waterloo, Waterloo, ON, Canada Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
Katrina Fleming
Affiliation:
Department of Radiation Therapy, Grand River Regional Cancer Centre, Kitchener, ON, Canada
Ramana Rachakonda
Affiliation:
Department of Radiation Oncology, Grand River Regional Cancer Centre, Kitchener, ON, Canada
*
Author for correspondence: Ernest Osei, Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, ON, Canada. E-mail: ernest.osei@grhosp.on.ca
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Abstract

Background:

Breast cancer is the most commonly diagnosed cancer among women and the second leading cause of cancer-related death in Canadian women. Surgery is often the first line of treatment for low-risk early stage patients, followed by adjuvant radiation therapy to reduce the risk of local recurrence and prevent metastasis after lumpectomy or mastectomy. For high-risk patients with node positive disease or are at greater risk of nodal metastasis, radiation therapy will involve treatment of the intact breast or chest-wall as well as the regional lymph nodes.

Materials and methods:

We retrospectively evaluated the treatment plans of 354 patients with breast cancer with nodes positive or were at high risk of nodal involvement treated at our cancer centre. All patients were treated with a prescription dose of 50 Gy in 25 fractions to the intact breast or chest-wall and 50 Gy in 25 fractions to the supraclavicular region and, based on patient suitability and tolerance, were treated either using the deep inspiration breath hold (DIBH) or free-breathing (FB) techniques.

Results:

Based on patient suitability and tolerance, 130 (36·7%) patients were treated with DIBH and 224 (63·3%) with FB techniques. There were 169 (47·7%) patients treated with intact breast, whereas 185 (52·3%) were treated for post-mastectomy chest-wall. The mean PTV_eval V92%, V95%, V100% and V105% for all patients are 99·4 ± 0·7, 97·6 ± 1·6, 74·8 ± 7·9 and 1·5 ± 3·2%, respectively. The mean ipsilateral lung V10Gy, V20Gy and V30Gy are 30·0 ± 5·3, 22·4 ± 4·7 and 18·4 ± 4·3% for intact breast and 30·9 ± 5·8, 23·5 ± 5·4 and 19·4 ± 5·0% for post-mastectomy patients with FB, respectively. The corresponding values for patients treated using DIBH are 26·3 ± 5·9, 18·9 ± 5·0 and 15·6 ± 4·7% for intact breast and 27·5 ± 6·5, 20·6 ± 5·7 and 17·1 ± 5·2% for post-mastectomy patients, respectively. The mean heart V10Gy, V20Gy, is 1·8 ± 1·7, 0·9 ± 1·0 for intact breast and 3·1 ± 2·2, 1·7 ± 1·6 for post-mastectomy patients with FB, respectively. The corresponding values with the DIBH are 0·5 ± 0·7, 0·1 ± 0·4 for intact breast and 1·1 ± 1·4, 0·4 ± 0·7 for post-mastectomy patients, respectively.

Conclusion:

The use of 3 and/or 4 field hybrid intensity-modulated radiation therapy technique for radiation therapy of high-risk node positive breast cancer patients provides an efficient and reliable method for achieving superior dose uniformity, conformity and homogeneity in the breast or post-mastectomy chest-wall volume with minimal doses to the organs at risk. The development and implementation of a consistent treatment plan acceptability criteria in radiotherapy programmes would establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that would reduce significant variations in the acceptability of treatment plans.

Keywords

breast radiotherapychest-wall radiotherapyDIBHheart doselung dose
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 4 , December 2021 , pp. 380 - 394
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Brenner, DR, Weir, HK, Demers, AA, et al. for the Canadian Cancer Statistics Advisory Committee. Projected estimates of cancer in Canada in 2020. CMAJ 2020; 192 (9): E199–205. doi: 10.1503/cmaj.191292 CrossRefGoogle ScholarPubMed
Canadian Cancer Society. Breast Cancer Statistics. 2020. https://www.cancer.ca/en/cancer-information/cancer-type/breast/statistics/?region=on Accessed on 17th April 2020Google Scholar
Kagkiouzis, J, Platoni, K, Kantzou, I, et al. Review of the three-field techniques in breast cancer radiotherapy. J BUON 2017; 22 (3): 599–605.Google ScholarPubMed
Haciislamoglu, E, Colak, F, Canyilmaz, E. The choice of multi-beam IMRT for whole breast radiotherapy in early-stage right breast cancer. Springerplus 2016; 5 (1): 688; 1–13.CrossRefGoogle ScholarPubMed
Mansouri, S, Naim, A, Glaria, L, et al. Dosimetric evaluation of 3-D conformal and intensity-modulated radiotherapy for breast cancer after conservative surgery. Asian Pac J Cancer Prev 2014; 15 (11): 4727–32.CrossRefGoogle ScholarPubMed
Jin, GH, Chen, LX, Deng, XW, et al. A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, field-in-field, tangential-IMRT, multi-beam IMRT and VMAT. Radiat Oncol 2013; 8 (1): 89; pp 1–8.CrossRefGoogle ScholarPubMed
Fogliata, A, Seppälä, J, Reggiori, G, et al. Dosimetric trade-offs in breast treatment with VMAT technique. Br J Radiol 2017; 90 (1070): 20160701.CrossRefGoogle ScholarPubMed
Bahrainy, M, Kretschmer, M, Jöst, V, et al. Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique. Strahlentherapie und Onkologie 2016; 192 (5): 333–41.CrossRefGoogle ScholarPubMed
Nokhasteh, S, Nazemi, H, Hejazi, P, et al. Comparison of dosimetric parameters between field in field and conformal radiation therapy techniques in early stage of left breast cancer patients. Int J Cancer Manage 2019; 12 (2); pp 1–8.Google Scholar
Zhang, HW, Hu, B, Xie, C, et al. Dosimetric comparison of three intensity-modulated radiation therapies for left breast cancer after breast-conserving surgery. J Appl Clin Med Phy 2018; 19 (3): 79–86.CrossRefGoogle ScholarPubMed
Smith, SK, Estoesta, RP, Kader, JA, et al. Hybrid intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) technique versus three-dimensional (3D) conformal radiotherapy with SIB for breast radiotherapy: a planning comparison. J Radiother Practice 2016; 15 (2): 131–42.CrossRefGoogle Scholar
Xie, X, Ouyang, S, Wang, H, et al. Dosimetric comparison of left-sided whole breast irradiation with 3D-CRT, IP-IMRT and hybrid IMRT. Oncol Rep 2014; 31 (5): 2195–205.CrossRefGoogle ScholarPubMed
Tanaka, H, Ito, M, Yamaguchi, T, et al. High tangent radiation therapy with field-in-field technique for breast cancer. Breast Cancer 2017; 11:1178223417731297.Google ScholarPubMed
Ma, C, Zhang, W, Lu, J, et al. Dosimetric comparison and evaluation of three radiotherapy techniques for use after modified radical mastectomy for locally advanced left-sided breast cancer. Sci Rep 2015; 5:12274; pp 1–9.Google ScholarPubMed
Yim, J, Suttie, C, Bromley, R, et al. Intensity modulated radiotherapy and 3D conformal radiotherapy for whole breast irradiation: a comparative dosimetric study and introduction of a novel qualitative index for plan evaluation, the normal tissue index. J Med Radiat Sci 2015; 62 (3): 184–91.CrossRefGoogle ScholarPubMed
Tanaka, H, Hayashi, S, Kajiura, Y, et al. Evaluation of the field-in-field technique with lung blocks for breast tangential radiotherapy. Nagoya J Med Sci 2015; 77 (3): 339–345.Google ScholarPubMed
Ghadimi, B, Jabbari, N, Karimkhani, L, et al. Dosimetric outcomes of the breast field-in-field (FIF) radiotherapy technique in patients with mastectomy and lumpectomy surgeries. Int J Radiat Res 2018; 16 (1): 25–32.Google Scholar
Osei, E, Darko, J, Fleck, A, et al. Dosimetric evaluation of whole-breast radiation therapy: clinical experience. Med Dosim 2015. 40 (4): 355–365.CrossRefGoogle ScholarPubMed
Poortmans, PM, Collette, S, Kirkove, C, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med 2015; 373 (4): 317–27.CrossRefGoogle ScholarPubMed
Hjelstuen, MH, Mjaaland, I, Vikström, J, et al. Radiation during deep inspiration allows loco-regional treatment of left breast and axillary-, supraclavicular-and internal mammary lymph nodes without compromising target coverage or dose restrictions to organs at risk. Acta Oncologica 2012; 51 (3): 333–44.CrossRefGoogle ScholarPubMed
Csenki, M, Újhidy, D, Cserháti, A, et al. Radiation dose to the nodal regions during prone versus supine breast irradiation. Ther Clin Risk Manage 2014; 10:367–372.Google Scholar
Banaei, A, Hashemi, B, Bakhshandeh, M. Comparing the monoisocentric and dual isocentric techniques in chest wall radiotherapy of mastectomy patients. J Appl Clin Med Phy 2015; 16 (1): 130–8.CrossRefGoogle ScholarPubMed
Deseyne, P, Speleers, B, De Neve, W, et al. Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. Radiat Oncol 2017; 12 (1): 89; 1–12.CrossRefGoogle ScholarPubMed
Kim, J, Park, W, Kim, JH, et al. Clinical significance of lymph-node ratio in determining supraclavicular lymph-node radiation therapy in pN1 breast cancer patients who received breast-conserving treatment (KROG 14-18): A Multicenter Study. Cancers 2019; 11 (5): 680; pp 1–10.CrossRefGoogle ScholarPubMed
Surmann, K, van der Leer, J, Branje, T, et al. Elective breast radiotherapy including level i and ii lymph nodes: a planning study with the humeral head as planning risk volume. Radiat Oncol 2017; 12 (1): 22; pp 1–8.CrossRefGoogle ScholarPubMed
Rafic, KM, Peace, BT, Babu, SE, et al. A hybrid conformal planning technique with solitary dynamic portal for postmastectomy radiotherapy with regional nodes. J Med Phy 2017; 42 (3): 116–122.CrossRefGoogle ScholarPubMed
Zheng, H, Lai, YQ, Zhou, Y, et al. A comparative dosimetric study of seven radiation techniques for breast cancer after mastectomy and immediate breast reconstruction. Translational Cancer Research 2017; 6 (4): 788–97.CrossRefGoogle Scholar
Pignol, JP, Truong, P, Rakovitch, E, et al. Ten years results of the Canadian breast intensity modulated radiation therapy (IMRT) randomized controlled trial. Radiother Oncol 2016; 121 (3): 414–9.CrossRefGoogle ScholarPubMed
Dogan, N, Cuttino, L, Lloyd, R, et al. Optimized dose coverage of regional lymph nodes in breast cancer: the role of intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phy 2007; 68 (4): 1238–1250.CrossRefGoogle ScholarPubMed
Bergom, C, Currey, A, Desai, N, et al. Deep inspiration breath hold: techniques and advantages for cardiac sparing during breast cancer irradiation. Front Oncol 2018; 8:87; pp 1–10.CrossRefGoogle ScholarPubMed
D’Avenia, P, Nigro, R, Camarda, M, et al. 163. Field-in-Field versus 3D standard techniques for breast cancer: dosimetric and reproducibility study. Phys Medica 2018; 56:164–5.CrossRefGoogle Scholar
Chen, G, White, J, Vicini, FA, et al. A dosimetric planning study for hypofractionated whole breast irradiation with concurrent boost (RTOG 1005) for early stage breast cancer. Int J Radiat Oncol Biol Phy 2011; 81 (2): S248–9.CrossRefGoogle Scholar
Mamounas, EP, White, JR, Bandos, H, et al. NSABP B-51/RTOG 1304: Randomized phase III clinical trial evaluating the role of postmastectomy chest wall and regional nodal XRT (CWRNRT) and post-lumpectomy RNRT in patients (pts) with documented positive axillary (Ax) nodes before neoadjuvant chemotherapy (NC) who convert to pathologically negative Ax nodes after NC. J Clin Oncol 2014. 32 (15_suppl): TPS1141–TPS1141 CrossRefGoogle Scholar
Parulekar, WR, Berrang, T, Kong, I, Rakovitch, E, et al. Cctg MA.39 tailor RT: A randomized trial of regional radiotherapy in biomarker low-risk node-positive breast cancer (NCT03488693) J Clin Oncol 2019 37 (15_suppl): TPS602–TPS602 CrossRefGoogle Scholar
Takano, S, Omura, M, Suzuki, R, et al. 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. J Radiat Res 2019;60 (5): 694–704. doi: 10.1093/jrr/rrz052 CrossRefGoogle ScholarPubMed
Emami, B. Tolerance of normal tissue to therapeutic radiation. Rep Radiother Oncol 2013; 1: 35–48 Google Scholar
Pignol, JP, Olivotto, I, Rakovitch, E; et al. A multicenter randomized trial of breast intensity modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008; 26 (13): 2085–2092.CrossRefGoogle ScholarPubMed