nach oben

Erschienen in:

01.03.2014 | Original Article

Whole breast irradiation for small-sized breasts after conserving surgery: is the field-in-field technique optimal?

verfasst von: Dae Sik Yang, Jung Ae Lee, Won Sup Yoon, Se Young Chung, Suk Lee, Chul Yong Kim, Young Je Park, Gil Soo Son

Erschienen in: Breast Cancer | Ausgabe 2/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

To determine the optimal whole breast irradiation technique in patients with small-sized breasts, tangential and field-in-field IMRT (FIF) techniques were compared.

Methods

Sixteen patients with ≤3 cm breast height and ≤350 cc volume were included. Seven patients had 4D CTs performed. The planning target volumes (PTV), editing 5 and 2 mm from the surface on the whole breast, were delineated and called PTV(5) and PTV(2), respectively. Dose–volume histograms of tangential techniques with open beam (OT) and wedge filter (WT), conventional FIF (cFIF), and modified FIF (mFIF) blocking out the lung were produced. Various dose–volume parameters, the dose heterogeneity index (DHtrI), dose homogeneity index (DHmI), and PTV dose improvement (PDI) were calculated.

Results

OT compared with WT showed a significantly favorable V ₉₀ of the heart and lung, and PTV(5)-dose distribution. Comparing OT and cFIF, OT showed significant improvement in the V ₉₅ of PTV(2), whereas cFIF showed significant improvement in the V ₉₅, DHtrI, DHmI, and PDI of the PTV(5). In comparing cFIF and mFIF, mFIF showed improved dose distributions of the heart and lung, while cFIF presented the better V ₉₅, DHtrI, DHmI, and PDI of the PTV(5). Respiratory influences on the absolute dose were mostly within 1 %. The ratio of free breathing and each respiratory phase was similar among OT, cFIF, and mFIF.

Conclusions

cFIF has favorable dose conformity and is suggested to be an optimal method for small-sized breasts. However, OT for dose coverage close to the skin and mFIF for normal tissue may also be potential alternatives. Respiratory effects are minimal.

Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26:2085–92.CrossRefPubMed

Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007;82:254–64.CrossRefPubMed

Freedman GM, Anderson PR, Li J, Eisenberg DF, Hanlon AL, Wang L, et al. Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. Am J Clin Oncol. 2006;29:66–70.CrossRefPubMed

Freedman GM, Li T, Nicolaou N, Chen Y, Ma CC, Anderson PR. Breast intensity-modulated radiation therapy reduces time spent with acute dermatitis for women of all breast sizes during radiation. Int J Radiat Oncol Biol Phys. 2009;74:689–94.PubMedCentralCrossRefPubMed

Harsolia A, Kestin L, Grills I, Wallace M, Jolly S, Jones C, et al. Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys. 2007;68:1375–80.CrossRefPubMed

McDonald MW, Godette KD, Butker EK, Davis LW, Johnstone PA. Long-term outcomes of IMRT for breast cancer: a single-institution cohort analysis. Int J Radiat Oncol Biol Phys. 2008;72:1031–40.CrossRefPubMed

Cho BC, Schwarz M, Mijnheer BJ, Bartelink H. Simplified intensity-modulated radiotherapy using pre-defined segments to reduce cardiac complications in left-sided breast cancer. Radiother Oncol. 2004;70:231–41.CrossRefPubMed

Fong A, Bromley R, Beat M, Vien D, Dineley J, Morgan G. Dosimetric comparison of intensity modulated radiotherapy techniques and standard wedged tangents for whole breast radiotherapy. J Med Imaging Radiat Oncol. 2009;53:92–9.CrossRefPubMed

Jagsi R, Moran J, Marsh R, Masi K, Griffith KA, Pierce LJ. Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys. 2010;78:1594–603.CrossRefPubMed

10.

Moon SK, Kim YS, Kim SY, Lee MJ, Keum HS, Kim SJ, et al. A dosimetric analysis of IMRT and multistatic fields techniques for left breast radiotherapy. Med Dosim. 2011;36:276–83.CrossRefPubMed

11.

Thilmann C, Zabel A, Kuhn S, Bendl R, Rhein B, Wannenmacher M, et al. Inversely planned intensity modulated radiotherapy for irradiation of a woman with breast cancer and funnel chest. Strahlenther Onkol. 2002;178:637–43.CrossRefPubMed

12.

Aref A, Thornton D, Youssef E, He T, Tekyi-Mensah S, Denton L, et al. Dosimetric improvements following 3D planning of tangential breast irradiation. Int J Radiat Oncol Biol Phys. 2000;48:1569–74.CrossRefPubMed

13.

Morganti AG, Cilla S, de Gaetano A, Panunzi S, Digesu C, Macchia G, et al. Forward planned intensity modulated radiotherapy (IMRT) for whole breast postoperative radiotherapy. Is it useful? When? J Appl Clin Med Phys. 2011;12:3451.PubMed

14.

Herrick JS, Neill CJ, Rosser PF. A comprehensive clinical 3-dimensional dosimetric analysis of forward planned IMRT and conventional wedge planned techniques for intact breast radiotherapy. Med Dosim. 2008;33:62–70.CrossRefPubMed

15.

Ohashi T, Takeda A, Shigematsu N, Fukada J, Sanuki N, Amemiya A, et al. Dose distribution analysis of axillary lymph nodes for three-dimensional conformal radiotherapy with a field-in-field technique for breast cancer. Int J Radiat Oncol Biol Phys. 2009;73:80–7.CrossRefPubMed

16.

Abo-Madyan Y, Polednik M, Rahn A, Schneider F, Dobler B, Wenz F, et al. Improving dose homogeneity in large breasts by IMRT: efficacy and dosimetric accuracy of different techniques. Strahlenther Onkol. 2008;184:86–92.CrossRefPubMed

17.

Rudat V, Alaradi AA, Mohamed A, Ai-Yahya K, Altuwaijri S. Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: a dosimetric comparison. Radiat Oncol. 2011;6:26.PubMedCentralCrossRefPubMed

18.

Nakamura N, Hatanaka S, Shikama N, Akahane K, Sekiguchi K. Quantification of cold spots caused by geometrical uncertainty in field-in-field techniques for whole breast radiotherapy. Jpn J Clin Oncol. 2011;41:1127–31.CrossRefPubMed

19.

Song T, Suh CO, Lee I, Jeong K, Keum K, Lee CG, et al. The effect of respiratory motion on forward intensity modulated radiotherapy for breast cancer. Technol Cancer Res Treat. 2008;7:207–15.PubMed

20.

Richter A, Sweeney R, Baier K, Flentje M, Guckenberger M. Effect of breathing motion in radiotherapy of breast cancer: 4D dose calculation and motion tracking via EPID. Strahlenther Onkol. 2009;185:425–30.CrossRefPubMed

21.

Cao J, Roeske JC, Chmura SJ, Salama JK, Shoushtari AN, Boyer AL, et al. Calculation and prediction of the effect of respiratory motion on whole breast radiation therapy dose distributions. Med Dosim. 2009;34:126–32.CrossRefPubMed

22.

Frazier RC, Vicini FA, Sharpe MB, Yan D, Fayad J, Baglan KL, et al. Impact of breathing motion on whole breast radiotherapy: a dosimetric analysis using active breathing control. Int J Radiat Oncol Biol Phys. 2004;58:1041–7.CrossRefPubMed

23.

Qi XS, White J, Rabinovitch R, Merrell K, Sood A, Bauer A, et al. Respiratory organ motion and dosimetric impact on breast and nodal irradiation. Int J Radiat Oncol Biol Phys. 2010;78:609–17.CrossRefPubMed

Titel: Whole breast irradiation for small-sized breasts after conserving surgery: is the field-in-field technique optimal?
verfasst von: Dae Sik Yang
Jung Ae Lee
Won Sup Yoon
Se Young Chung
Suk Lee
Chul Yong Kim
Young Je Park
Gil Soo Son
Publikationsdatum: 01.03.2014
Verlag: Springer Japan
Erschienen in: Breast Cancer / Ausgabe 2/2014
Print ISSN: 1340-6868
Elektronische ISSN: 1880-4233
DOI: https://doi.org/10.1007/s12282-012-0365-y

Springer Medizin

Whole breast irradiation for small-sized breasts after conserving surgery: is the field-in-field technique optimal?