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14.03.2016 | Original Article

Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique

Influence of flattening filter-free beams

verfasst von: Dipl.-Ing. Marzieh Bahrainy, M.Sc., Dr. rer. medic. Matthias Kretschmer, Vincent Jöst, B.Sc., Dipl.-Ing. Astrid Kasch, Prof. Dr. med. Florian Würschmidt, Dr. med. Jörg Dahle, PD Dr. med. Jörn Lorenzen

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 5/2016

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Abstract

Objective

The present study compares in silico treatment plans using hybrid plan technique during hypofractionated radiation of mammary carcinoma with simultaneous integrated boost (SIB). The influence of 6 MV photon radiation in flattening filter free (FFF) mode against the clinical standard flattening filter (FF) mode is to be examined.

Patients and methods

RT planning took place with FF and FFF radiation plans for 10 left-sided breast cancer patients. Hybrid plans were realised with two tangential IMRT fields and one VMAT field. The dose prescription was in line with the guidelines in the ARO-2010-01 study. The dosimetric verification took place with a manufacturer-independent measurement system.

Results

Required dose prescriptions for the planning target volumes (PTV) were achieved for both groups. The average dose values of the ipsi- and contralateral lung and the heart did not differ significantly. The overall average incidental dose to the left anterior descending artery (LAD) of 8.24 ± 3.9 Gy in the FFF group and 9.05 ± 3.7 Gy in the FF group (p < 0.05) were found. The dosimetric verifications corresponded to the clinical requirements. FFF-based RT plans reduced the average treatment time by 17 s/fraction.

Conclusion

In comparison to the FF-based hybrid plan technique the FFF mode allows further reduction of the average LAD dose for comparable target volume coverage without adverse low-dose exposure of contralateral structures. The combination of hybrid plan technique and 6 MV photon radiation in the FFF mode is suitable for use with hypofractionated dose schemes. The increased dose rate allows a substantial reduction of treatment time and thus beneficial application of the deep inspiration breath hold technique.

Dellas K, Vonthein R, Zimmer J et al (2014) Hypofractionation with simultaneous integrated boost for early breast cancer: results of the German multicenter phase II trial (ARO-2010-01). Strahlenther Onkol 190:646–653CrossRefPubMed

Haviland JS, Owen RJ, Dewar JA et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year-follow-up results of two randomised controlled trials. Lancet Oncol 4:1086–1094CrossRef

Dunst J, Sautter-Bihl ML, Sedlmayer F et al (2013). Strahlentherapie bei Mammakarzinom: Alternativen bei der Bestrahlung. (Radiotherapy for Breast Cancer: alternatives for radiation.) Deutsch Ärztebl 110 (Medizinreport)

Palma D, Vollans E, James K et al (2008) Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 72:996–1001CrossRefPubMed

Nicolini G, Fogliata A, Clivio A et al (2011) Planning strategies in volumetric modulated arc therapy for breast. Med Phys 38:4025–4031CrossRef

Scorsetti M, Alongi F, Fogliata A et al (2012) Phase I–II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments. Radiat Oncol 28:145CrossRef

Jin GH, Chen LX, Deng XW et al (2013) 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 8:89CrossRefPubMedPubMedCentral

Aly M, Glatting G, Jahnke L et al (2015) Comparison of breast simultaneous integrated boost (SIB) radiotherapy techniques. Radiat Oncol 10:139CrossRefPubMedPubMedCentral

Viren T, Heikkilä J, Mylloyoja K et al (2015) Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiat Oncol 10:79CrossRefPubMedPubMedCentral

10.

Jöst V, Kretschmer M, Sabatino M et al (2015) Heart dose reduction in breast cancer treatment with simultaneous integrated boost: comparison of treatment planning and dosimetry for a novel hybrid technique and 3D-CRT. Strahlenther Onkol 191:734–741CrossRefPubMed

11.

Titt U, Vasseliev ON, Pönisch F et al (2006) Monte Carlo study of backscatter in flattening filter free clinical accelerator. Med Phys 33:3270–3273CrossRefPubMed

12.

Georg D, Knöös T, McClean B (2011) Current status and future perspective of flattening filter free photon beams. Med Phys 38:1280–1293CrossRefPubMed

13.

Cashmore J, Ramtohul M, Ford D (2010) Lowering whole-body radiation doses in pediatric intensity-modulated radiotherapy through the use of unflattened photon beams. Int J Radiat Oncol Biol Phys 15 80:1220–1227CrossRefPubMed

14.

McGarry CK, Butterworth KT, Trainor C et al (2012) In-vitro investigation of out-of-field cell survival following the delivery of conformal, intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans. Phys Med Biol 57:6635–6645CrossRefPubMed

15.

Takam R, Bezak E, Marcu LG et al (2011) Out-of-Field neutron and leakage photon exposures and the associated risk of second cancer in high-energy photon radiotherapy: current status. Radiat Res 176:508–520CrossRefPubMed

16.

Wang Y, Vassil A, Tendulkar R, Bayouth J, Xia P et al (2013) Feasibility of using nonflat photon beams for whole-breast irradiation with breath hold. J Appl Clin Med Phys 15:4397

17.

Subramaniam S, Thirumalaiswamy S, Srinivas C et al (2012) Chest wall radiotherapy with volumetric modulated arcs and the potential role of flattening filter free photon beams. Strahlenther Onkol 188:484–490CrossRefPubMed

18.

Kretschmer M, Sabatino M, Blechschmidt A et al (2013) The Impact of flattening-filter-free beam technology on 3D conformal RT. Radiat Oncol 8:133CrossRefPubMedPubMedCentral

19.

Radiation Therapy Oncology Group (2014) A phase III trial of accelerated whole breast irradiation with hypofractionation plus concurrent boost versus standard whole breast irradiation plus sequential boost for early-stage breast cancer. RTOG-Studienprotokoll 1005 Version von 31.07.2014

20.

Feng M, Moran JM, Koelling T et al (2011) Development and validation of heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79:10–18CrossRefPubMedPubMedCentral

21.

McGarry CK, O’Connell BF, Grattan MWD et al (2013) Octavius 4D characterization for flattened and flattening filter free rotational deliveries. Med Phys 40:091707CrossRefPubMed

22.

Howell R, Scarboro SB, Kry SF et al (2010) Accuracy of out-of-field dose calculations by a commercial treatment planning system. Phys Med Biol 55:6999–7008CrossRefPubMedPubMedCentral

23.

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 368:987–998CrossRefPubMed

24.

Mah D, Miller E, Godoy Scripes P et al (2011) Flattening filter free beams for 3D breast planning. Med Phys 38:3632–3632CrossRef

25.

Caudrelier JM, Meng J, Esche B et al (2014) IMRT sparing of normal tissues in locoregional treatment of breast cancer. Radiat Oncol 9:161CrossRefPubMedPubMedCentral

26.

Smyth LM, Knight KA, Aarons YK, Wasiak J et al (2015) The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review. J Med Radiat Sci 62:66–73CrossRefPubMedPubMedCentral

27.

Hayden AJ, Rains M, Tiver K (2012) Deep inspiration breath hold technique reduces heart dose from radiotherapy for left-sided breast cancer. J Med Imaging Radiat Oncol 56:464–472CrossRefPubMed

28.

Spruijt KH, Dahele M, Cuijpers JP (2013) Flattening filter free vs flattened beams for breast irradiation. Int J Radiat Oncol Biol Phys 85:506–513CrossRefPubMed

Titel: Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique
Influence of flattening filter-free beams
verfasst von: Dipl.-Ing. Marzieh Bahrainy, M.Sc.
Dr. rer. medic. Matthias Kretschmer
Vincent Jöst, B.Sc.
Dipl.-Ing. Astrid Kasch
Prof. Dr. med. Florian Würschmidt
Dr. med. Jörg Dahle
PD Dr. med. Jörn Lorenzen
Publikationsdatum: 14.03.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 5/2016
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-016-0960-5

Springer Medizin

Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique

Influence of flattening filter-free beams