Share This Article:

Comparative Dosimetric Study for Treating Left Sided Breast Cancer Using Three Different Radiotherapy Techniques:Tangential Wedged Fields, Forward Planned Segmented Filed, and IP-IMRT

Abstract Full-Text HTML XML Download Download as PDF (Size:646KB) PP. 308-317
DOI: 10.4236/ijmpcero.2015.44037    3,191 Downloads   3,694 Views  

ABSTRACT

Background: Radiation therapy should not only be directed to improve the local control, which has a survival benefit, but also should be directed to minimize the risk of complications, which may develop in critical organs. Several studies have reported that field-in-field (FiF) radiotherapy technique improves the dose homogeneity, decreases doses to lungs, heart and contralateral breast compared with conventional wedged technique. Purpose: compare the dosimetry for the left breast cancer radiotherapy using three different radiotherapy techniques, tangential wedged fields (TW), segmented field (FiF) and inverse planning IMRT (IP-IMRT). Material and Methods: Twenty patients have undergone left breast-conservative surgery and received a prescribed dose of 50 Gy/25 fractions. Results: The mean PTV receiving >105% (V105) dose was1.75% for IP-IMRT, 2.03% for FiF, and 4.82% for TW. The mean V95% was 92.1% for TW, 96% for FiF, and 95.1% for IP-IMRT; these differences regarding V105% and V95% are statistically significant through paired comparison between FiF vs TW and IP-IMRT vs TW, with no statistically significant difference between FiF and IP-IMRT. Better conformity and homogeneity indices for FiF and IMRT compared to TW with statistical significant difference. Regarding organs at risk, left lung and heart have higher values of V5, V10, and V20 for IP-IMRT compared to TW and FiF; the differences are statistically significant, lower coronary artery regionV30 vules for IPIMRT compared to TW and FiF but no difference in the Dmean between IPIMRT and FIF. FiF and TW decrease the contralateral breast dose significantly compared to IP IMRT. Conclusion: FiF technique is an efficient and reliable method for achieving a uniform dose throughout the whole breast resulting in improved coverage, sparing of organs at risk and reduction of acute and late toxicities.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Elzawawy, S. and Hammoury, S. (2015) Comparative Dosimetric Study for Treating Left Sided Breast Cancer Using Three Different Radiotherapy Techniques:Tangential Wedged Fields, Forward Planned Segmented Filed, and IP-IMRT. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 4, 308-317. doi: 10.4236/ijmpcero.2015.44037.

References

[1] Recht, A. (2007) Breast Cancer: Stages T1 and T2. In: Gunderson, L.L. and Tepper, J.E., Eds., Clinical Radiation Oncology, 2nd Edition, Churchill Livingstone, London, 1475-1495.
[2] Veronesi, U., Marubini, E., Marian, L., Galimberti, V., Luini, A., Veronesi, P., et al. (2001) Radiotherapy after Breast Conserving Surgery in Breast Cancer: Long Term Result of Randomized Trial. Annals of Oncology, 12, 997-1003.
http://dx.doi.org/10.1023/A:1011136326943
[3] Taghian, A., Jeong, J.H., Mamounas, E., et al. (2004) Patterns of Locoregional Failure in Patients with Operable Breast Cancer Treated by Mastectomy and Adjuvant Chemotherapy with or without Tamoxifen and without Radiotherapy: Results from Five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. Journal of Clinical Oncology, 22, 4247-4254.
http://dx.doi.org/10.1200/JCO.2004.01.042
[4] Early Breast Cancer Trialists’ Collaborative Group (2005) Effects of Radiotherapy and of Differences in the Extent of Surgery for Early Breast Cancer on Local Recurrence and 15-Year Survival: An Overview of the Randomized Trials. Lancet, 366, 2087-2106.
http://dx.doi.org/10.1016/S0140-6736(05)67887-7
[5] Early Breast Cancer Trialists’ Collaborative Group (2000) Favourable and Unfavourable Effects on Long-Term Survival of Radiotherapy for Early Breast Cancer: An Overview of the Randomised Trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet, 355, 1757-1770.
http://dx.doi.org/10.1016/S0140-6736(00)02263-7
[6] Adams, M.J., Hardenbergh, P.H., Constine, L.S., et al. (2003) Radiation-Associated Cardiovascular Disease. Critical Reviews in Oncology/Hematology, 45, 55-75.
http://dx.doi.org/10.1016/S1040-8428(01)00227-X
[7] Cao, Y.D., Gao, H.D., Sun, X.C., et al. (2009) A Comparison of Doses for Conventional Radiotherapy and Intensity Modulation Radiation Therapy after Breast Conserving Operation. Journal of Medical Poster Graduates, 2, 161-164.
[8] Correa, C.R., Das, I.J., Litt, H.I., et al. (2008) Association between Tangential Beam Treatment Parameters and Cardiac Abnormalities after Definitive Radiation Treatment for Left-Sided Breast Cancer. International Journal of Radiation Oncology, Biology, Physics, 72, 508-516.
http://dx.doi.org/10.1016/j.ijrobp.2007.12.037
[9] Hooning, M.J., Botma, A., Aleman, B.M., et al. (2007) Long-Term Risk of Cardiovascular Disease in 10-Year Survivors of Breast Cancer. Journal of the National Cancer Institute, 99, 365-375. http://dx.doi.org/10.1093/jnci/djk064
[10] Hurkmans, C.W., Borger, J.H., Bos, L.J., et al. (2000) Cardiac and Lung Complication Probabilities after Breast Cancer Irradiation. Radiotherapy & Oncology, 55, 145-151.
http://dx.doi.org/10.1016/S0167-8140(00)00152-3
[11] Stovall, M., Smith, S.A., Langholz, B.M., Boice Jr., J.D., Shore, R.E., Andersson, M., et al. (2008) Dose to the Contralateral Breast from Radiotherapy and Risk of Second Primary Breast Cancer in the WECARE Study. International Journal of Radiation Oncology, Biology, Physics, 72, 1021-1030.
http://dx.doi.org/10.1016/j.ijrobp.2008.02.040
[12] Stathakis, S., Roland, T., Papanikolaou, N., Li, J.S. and Ma, C. (2009) A Prediction Study on Radiation-Induced Second Malignancies for IMRT Treatment Delivery. Technology in Cancer Research & Treatment, 8, 141-148.
http://dx.doi.org/10.1177/153303460900800207
[13] Rongsriyam, K., Rojpornpradit, P., lertbutsayanul, C., Sanghangthum, T. and Oonsiri, S. (2008) Dosimetric Study of Inverse-Planned Intensity Modulated, Forward-Planned Intensity Modulated Andconventional Tangential Techniques in Breast Conserving Radiotherapy. Journal of the Medical Association of Thailand, 91, 1571-1582.
[14] Zhang, F.L., Wang, P. and Zhen, M.M. (2008) Dosmetric Evaluation of CR, 3DCRT and IMRT for Breast Cancer after Conserving Surgery. Chinese Clinical Oncology, 13, 354-358.
[15] Xu, X.-L., Wu, H. and Han, S.-K. (2006) Dosimetry Study of Intensity Modulated Radiation Therapy for Left Side Breast Cancer. Chinese Journal of Radiation Oncology, 15, 192-195.
[16] Cavey, M.L., Bayouth, J.E., Endres, E.J., Pena, J.M., Colman, M. and Hatch, S. (2005) Dosimetric Comparison of Conventional and Forward-Planned Intensity-Modulated Techniques for Comprehensive Locoregional Irradiation of Post-Mastectomy Left Breast Cancers. Medical Dosimetry, 30, 107-116.
http://dx.doi.org/10.1016/j.meddos.2005.02.002
[17] Fuller, S.A., Haybittle, J.I., Smith, R.E. and Dobbs, H.J. (1992) Cardiac Doses in Post-Operative Breast Irradiation. Radiotherapy and Oncology, 25, 19-24.
http://dx.doi.org/10.1016/0167-8140(92)90190-6
[18] Hong, L., Hunt, M., Chui, C., Spirou, S., Forster, K., Lee, H., et al. (1999) Intensity-Modulated Tangential Beam Irradiation of the Intact Breast. International Journal of Radiation Oncology, Biology, Physics, 44, 1155-1164.
http://dx.doi.org/10.1016/S0360-3016(99)00132-7
[19] Sasaoka, M. and Futami, T. (2011) Dosimetric Evaluation of Whole Breast Radiotherapy Using Field-in-Field Technique in Early-Stage Breast Cancer. International Journal of Clinical Oncology, 16, 250-256.
http://dx.doi.org/10.1007/s10147-010-0175-1
[20] Darby, S.C., Ewertz, M., McGale, P., Bennet, A.M., Blom-Goldman, U., Brønnum, D., et al. (2013) Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer. New England Journal of Medicine, 368, 987-998.
http://dx.doi.org/10.1056/NEJMoa1209825
[21] Mert, M., Arat-Ozkan, A., Ozkan, A., Aydemir, N.A. and Babalik, E. (2003) Radition-Induced Coronary Artery Disease. Zeitschrift fur Kardiologie, 92, 682-685.
[22] Taylor, M.E., Perez, C.A., Halverson, K.J., Kuske, R.R., Philphott, G.W., Garcia, D.M., Mortimer, J.E., Myerson, R.J., Radford, D. and Rusha, C. (1995) Factors Influencing Cosmetics Results after Conservation Therapy for Breast Cancer. International Journal of Radiation Oncology, Biology, Physics, 31, 753-764.
http://dx.doi.org/10.1016/0360-3016(94)00480-3

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.