nach oben

Strahlentherapie und Onkologie

Erschienen in:

09.08.2022 | Original Article

Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients—comparative analysis of dose distribution and estimation of projected secondary cancer risk

verfasst von: Iga Racka, Karolina Majewska, Janusz Winiecki

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 1/2023

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study was to compare two techniques of irradiation of left-sided breast cancer patients who underwent breast-conserving surgery, three-dimensional conformal radiotherapy technique (3D-CRT) and volumetric modulated arc therapy (VMAT), in terms of dose distribution in the planning target volume (PTV) and organs at risk (OARs). The second aim of the study was estimation of the projected risk of radiation-induced secondary cancer for both radiotherapy techniques.

Materials and methods

For 25 patients who underwent CT simulation in deep inspiration breath-hold (DIBH), three treatment plans were generated: one using a three-dimensional conformal radiotherapy technique and two using volumetric modulated arc therapy. First VMAT-DIBH geometry consisted of three partial arcs (ARC-DIBH 3A) and second consisted of four partial arcs (ARC-DIBH 4A). Cumulative dose–volume histograms (DVHs) were used to compare dose distributions within the PTV and OARs (heart, left anterior descending coronary artery [LAD], ipsilateral and contralateral lung [IL, CL], and contralateral breast [CB]). Normal tissue complication probabilities (NTCPs) and organ equivalent doses (OEDs) were calculated using the differential DVHs. Excess absolute risks (EARs) for second cancers were estimated using Schneider’s full mechanistic dose–response model.

Results

All plans fulfilled the criterium for PTV V95% ≥ 95%. The PTV coverage, homogeneity, and conformity indices were significantly better for VMAT-DIBH. VMAT showed a significantly increased mean dose and V5Gy for all OARs, but reduced LAD D_max by 15 Gy. For IL, CL, and CB, the 3D-CRT DIBH method achieved the lowest values of EAR: 28.38 per 10,000 PYs, 2.55 per 10,000 PYs, and 4.48 per 10,000 PYs (p < 0.001), compared to 40.29 per 10,000 PYs, 15.62 per 10,000 PYs, and 23.44 per 10,000 PYs for ARC-DIBH 3A plans and 41.12 per 10,000 PYs, 15.59 per 10,000 PYs, and 22.73 per 10,000 PYs for ARC-DIBH 4A plans. Both techniques provided negligibly low NTCPs for all OARs.

Conclusion

The study shows that VMAT-DIBH provides better OAR sparing against high doses. However, the large low-dose-bath (≤ 5 Gy) is still a concern due to the fact that a larger volume of normal tissues exposed to lower doses may increase a radiation-induced risk of secondary cancer.

Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660CrossRef

World Health Organization (2021) Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer. Accessed 23 Feb 2022

Stump-Sutliff KA (2020) Breast cancer survival rates. https://www.webmd.com/breast-cancer/guide/breast-cancer-survival-rates. Accessed 23 Feb 2022

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P et al (2011) Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378(9804):1707–1716. https://doi.org/10.1016/s0140-6736(11)61629-2CrossRef

Lee CH, Zhang JF, Yuan KSP et al (2019) Risk of cardiotoxicity induced by adjuvant anthracycline-based chemotherapy and radiotherapy in young and old Asian women with breast cancer. Strahlenther Onkol 195:629–639. https://doi.org/10.1007/s00066-019-01428-7CrossRef

Henson KE, McGale P, Taylor C, Darby SC (2013) Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer 108(1):179–182. https://doi.org/10.1038/bjc.2012.575CrossRef

Morgan EA, Kozono DE, Wang Q et al (2012) Cutaneous radiation-associated angiosarcoma of the breast: poor prognosis in a rare secondary malignancy. Ann Surg Oncol 19(12):3801–3808. https://doi.org/10.1245/s10434-012-2563-4CrossRef

Kirova YM, Gambotti L, De Rycke Y, Vilcoq JR, Asselain B, Fourquet A (2007) Risk of second malignancies after adjuvant radiotherapy for breast cancer: a large-scale, single-institution review. Int J Radiat Oncol Biol Phys 68(2):359–363. https://doi.org/10.1016/j.ijrobp.2006.12.011CrossRef

Duma MN, Baumann R, Budach W et al (2019) Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol 195:861–871. https://doi.org/10.1007/s00066-019-01495-wCrossRef

10.

Pedersen AN, Korreman S, Nyström H, Specht L (2004) Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold. Radiother Oncol 72(1):53–60. https://doi.org/10.1016/j.radonc.2004.03.012CrossRef

11.

Schönecker S, Heinz C, Söhn M et al (2016) Reduction of cardiac and coronary artery doses in irradiation of left-sided breast cancer during inspiration breath hold. Strahlenther Onkol 192:750–758. https://doi.org/10.1007/s00066-016-1039-zCrossRef

12.

Hepp R, Ammerpohl M, Morgenstern C et al (2015) Deep inspiration breath-hold (DIBH) radiotherapy in left-sided breast cancer. Strahlenther Onkol 191:710–716. https://doi.org/10.1007/s00066-015-0838-yCrossRef

13.

Vikström J, Hjelstuen MH, Wasbø E, Mjaaland I, Dybvik KI (2018) A comparison of conventional and dynamic radiotherapy planning techniques for early-stage breast cancer utilizing deep inspiration breath-hold. Acta Oncol 57(10):1325–1330. https://doi.org/10.1080/0284186x.2018.1497294CrossRef

14.

Moon SH, Shin KH, Kim TH et al (2009) Dosimetric comparison of four different external beam partial breast irradiation techniques: three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, helical tomotherapy, and proton beam therapy. Radiother Oncol 90(1):66–73. https://doi.org/10.1016/j.radonc.2008.09.027CrossRef

15.

Beckham WA, Popescu CC, Patenaude VV, Wai ES, Olivotto IA (2007) Is multibeam IMRT better than standard treatment for patients with left-sided breast cancer? Int J Radiat Oncol Biol Phys 69(3):918–924. https://doi.org/10.1016/j.ijrobp.2007.06.060CrossRef

16.

Haciislamoglu E, Cinar Y, Gurcan F, Canyilmaz E, Gungor G, Yoney A (2019) Secondary cancer risk after whole-breast radiation therapy: field-in-field versus intensity modulated radiation therapy versus volumetric modulated arc therapy. Br J Radiol 92(1102):20190317. https://doi.org/10.1259/bjr.20190317CrossRef

17.

Lee B, Lee S, Sung J, Yoon M (2014) Radiotherapy-induced secondary cancer risk for breast cancer: 3D conformal therapy versus IMRT versus VMAT. J Radiol Prot 34(2):325–331. https://doi.org/10.1088/0952-4746/34/2/325CrossRef

18.

Schneider U (2011) Modeling the risk of secondary malignancies after radiotherapy. Genes (Basel) 2(4):1033–1049. https://doi.org/10.3390/genes2041033CrossRef

19.

Schneider U (2009) Mechanistic model of radiation-induced cancer after fractionated radiotherapy using the linear-quadratic formula. Med Phys 36(4):1138–1143. https://doi.org/10.1118/1.3089792CrossRef

20.

Schneider U, Sumila M, Robotka J (2011) Site-specific dose-response relationships for cancer induction from the combined Japanese A‑bomb and Hodgkin cohorts for doses relevant to radiotherapy. Theor Biol Med Model 8:27. https://doi.org/10.1186/1742-4682-8-27CrossRef

21.

Feng M, Moran JM, Koelling T et al (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79(1):10–18. https://doi.org/10.1016/j.ijrobp.2009.10.058CrossRef

22.

Offersen BV, Boersma LJ, Kirkove C et al (2016) ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer, version 1.1. Radiother Oncol 118(1):205–208. https://doi.org/10.1016/j.radonc.2015.12.027CrossRef

23.

Kutcher GJ, Burman C (1989) Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys 16(6):1623–1630. https://doi.org/10.1016/0360-3016(89)90972-3CrossRef

24.

Källman P, Agren A, Brahme A (1992) Tumour and normal tissue responses to fractionated non-uniform dose delivery. Int J Radiat Biol 62(2):249–262. https://doi.org/10.1080/09553009214552071CrossRef

25.

Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122. https://doi.org/10.1016/0360-3016(91)90171-yCrossRef

26.

Gagliardi G, Lax I, Ottolenghi A, Rutqvist LE (1996) Long-term cardiac mortality after radiotherapy of breast cancer—application of the relative seriality model. Br J Radiol 69(825):839–846. https://doi.org/10.1259/0007-1285-69-825-839CrossRef

27.

Walsh L, Hafner L, Straube U et al (2021) A bespoke health risk assessment methodology for the radiation protection of astronauts. Radiat Environ Biophys 60:213–231. https://doi.org/10.1007/s00411-021-00910-0CrossRef

28.

Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K (2007) Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res 168(1):1–64. https://doi.org/10.1667/RR0763.1CrossRef

29.

Cahoon EK, Preston DL, Pierce DA et al (2017) Lung, laryngeal and other respiratory cancer incidence among Japanese atomic bomb survivors: an updated analysis from 1958 through 2009. Radiat Res 187(5):538–548. https://doi.org/10.1667/RR14583.1CrossRef

30.

ICRP (2007) The 2007 recommendations of the international commission on radiological protection. ICRP publication 103. Ann ICRP 37(2):1–332. https://doi.org/10.1016/j.icrp.2007.10.003CrossRef

31.

United Nations Scientific Committee on the Effects of Atomic Radiation (2006) Effects of ionizing radiation, united nations scientific committee on the effects of atomic radiation (UNSCEAR) 2006 report vol I. United Nations (Report to the General Assembly, Scientific Annexes A and B)

32.

ICRU (2010) Report 83. Prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT). J ICRP. https://doi.org/10.1093/jicru_ndq002CrossRef

33.

Hall EJ (2006) Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys 65:1–7. https://doi.org/10.1016/j.ijrobp.2006.01.027CrossRef

34.

Sakthivel V, Kadirampatti Mani G, Mani S, Boopathy R, Selvaraj J (2017) Estimating second malignancy risk in intensity-modulated radiotherapy and volumetric-modulated arc therapy using a mechanistic radiobiological model in radiotherapy for carcinoma of left breast. J Med Phys 42(4):234–240. https://doi.org/10.4103/jmp.JMP_89_17CrossRef

35.

Abo-Madyan Y, Aziz MH, Aly MM et al (2014) Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiother Oncol 110(3):471–476. https://doi.org/10.1016/j.radonc.2013.12.002CrossRef

36.

Travis LB, Ng AK, Allan JM et al (2012) Second malignant neoplasms and cardiovascular disease following radiotherapy. J Natl Cancer Inst 104(5):357–370. https://doi.org/10.1093/jnci/djr533CrossRef

37.

Stovall M, Smith SA, Langholz BM et al (2008) Dose to the contralateral breast from radiotherapy and risk of second primary breast cancer in the WECARE study. Int J Radiat Oncol Biol Phys 72(4):1021–1030. https://doi.org/10.1016/j.ijrobp.2008.02.040CrossRef

38.

Fogliata A, De Rose F, Franceschini D et al (2018) Critical appraisal of the risk of secondary cancer induction from breast radiation therapy with volumetric modulated arc therapy relative to 3D conformal therapy. Int J Radiat Oncol Biol Phys 100(3):785–793. https://doi.org/10.1016/j.ijrobp.2017.10.040CrossRef

39.

Virén T, Heikkilä J, Myllyoja K et al (2015) Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiat Oncol 10:79. https://doi.org/10.1186/s13014-015-0392-xCrossRef

40.

Yu PC, Wu CJ, Nien HH, Lui LT, Shaw S, Tsai YL (2018) Tangent-based volumetric modulated arc therapy for advanced left breast cancer. Radiat Oncol 13(1):236. https://doi.org/10.1186/s13014-018-1167-yCrossRef

41.

Darby SC, Ewertz M, McGale P et al (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368(11):987–998. https://doi.org/10.1056/nejmoa1209825CrossRef

42.

Simonetto C, Rennau H, Remmele J et al (2019) Exposure of remote organs and associated cancer risks from tangential and multi-field breast cancer radiotherapy. Strahlenther Onkol 195:32–42. https://doi.org/10.1007/s00066-018-1384-1CrossRef

43.

Han EY, Paudel N, Sung J, Yoon M, Chung WK, Kim DW (2016) Estimation of the risk of secondary malignancy arising from whole breast irradiation: comparison of five radiotherapy modalities, including TomoHDA. Oncotarget 7(16):22960–22969. https://doi.org/10.18632/oncotarget.8392CrossRef

44.

Joosten A, Matzinger O, Jeanneret-Sozzi W, Bochud F, Moeckli R (2013) Evaluation of organ-specific peripheral doses after 2 dimensional, 3‑dimensional and hybrid intensity modulated radiation therapy for breast cancer based on Monte Carlo and convolution/ superposition algorithms: Implications for secondary cancer risk assessment. Radiother Oncol 106(1):33–41. https://doi.org/10.1016/j.radonc.2012.11.012CrossRef

45.

Venjakob A, Oertel M, Hering DA, Moustakis C, Haverkamp U, Eich HT (2021) Hybrid volumetric modulated arc therapy for hypofractionated radiotherapy of breast cancer: a treatment planning study. Strahlenther Onkol 197(4):296–307. https://doi.org/10.1007/s00066-020-01696-8CrossRef

46.

Lin JF, Yeh DC, Yeh HL, Chang CF, Lin JC (2015) Dosimetric comparison of hybrid volumetric-modulated arc therapy, volumetric-modulated arc therapy, and intensity-modulated radiation therapy for left-sided early breast cancer. Med Dosim 40(3):262–267. https://doi.org/10.1016/j.meddos.2015.05.003CrossRef

47.

Chen SN, Ramachandran P, Deb P (2020) Dosimetric comparative study of 3DCRT, IMRT, VMAT, Ecomp, and hybrid techniques for breast radiation therapy. Radiat Oncol J 38(4):270–281. https://doi.org/10.3857/roj.2020.00619CrossRef

48.

Guebert A, Conroy L, Weppler S et al (2018) Clinical implementation of AXB from AAA for breast: plan quality and subvolume analysis. J Appl Clin Med Phys 19(3):243–250. https://doi.org/10.1002/acm2.12329CrossRef

49.

Kumar L, Kishore V, Bhushan M et al (2020) Impact of acuros XB algorithm in deep-inspiration breath-hold (DIBH) respiratory techniques used for the treatment of left breast cancer. Rep Pract Oncol Radiother 25(4):507–514. https://doi.org/10.1016/j.rpor.2020.04.011CrossRef

50.

Corradini S, Ballhausen H, Weingandt H et al (2018) Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease: effects of modern radiotherapy techniques. Strahlenther Onkol 194:196–205. https://doi.org/10.1007/s00066-017-1213-yCrossRef

Titel: Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients—comparative analysis of dose distribution and estimation of projected secondary cancer risk
verfasst von: Iga Racka
Karolina Majewska
Janusz Winiecki
Publikationsdatum: 09.08.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 1/2023
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01979-2

Neu im Fachgebiet Onkologie

23.04.2024 | Medikamente in Schwangerschaft und Stillzeit | Nachrichten

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients—comparative analysis of dose distribution and estimation of projected secondary cancer risk

Abstract

Purpose

Materials and methods

Results

Conclusion

Neu im Fachgebiet Onkologie

ICI-Therapie in der Schwangerschaft wird gut toleriert

Krebspatienten impfen: Was? Wen? Und wann nicht?

Müde im Alter? Auch an die Nebenniere denken

Stufenschema weist Prostatakarzinom zuverlässig nach

Update Onkologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Materials and methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2023

Combined-modality treatment for locally advanced cervical cancer in a woman with Bloom-like syndrome: A case report and review of the literature

Correction to: Stereotactic radiosurgery and radiotherapy for resected brain metastases: current pattern of care in the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Association for Radiation Oncology (DEGRO)

Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability

Near-maximum rib dose is the most relevant risk factor for ipsilateral spontaneous rib fracture: a dosimetric analysis of breast cancer patients after radiotherapy

Prerequisites for the clinical implementation of a markerless SGRT-only workflow for the treatment of breast cancer patients

Most recent update of preclinical and clinical data on radioresistance and radiosensitivity of high-grade gliomas—a radiation oncologist’s perspective

Neu im Fachgebiet Onkologie

ICI-Therapie in der Schwangerschaft wird gut toleriert

Krebspatienten impfen: Was? Wen? Und wann nicht?

Müde im Alter? Auch an die Nebenniere denken

Stufenschema weist Prostatakarzinom zuverlässig nach

Update Onkologie