Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T21:12:20.513Z Has data issue: false hasContentIssue false
  • English
  • Français

Breast boost vector: a new metric proposed to optimise isocentre location in an fIMRT–VMAT hybrid technique for a simultaneous integrated boost in breast radiotherapy

Published online by Cambridge University Press:  20 April 2020

Víctor de la Llana Open the ORCID record for Víctor de la Llana [Opens in a new window] ,
Ángel del Castillo ,
Carlos Andrés ,
Laura Gómez ,
Manuel Agulla ,
María Luisa del Valle ,
María Iglesias  and
Ricardo Torres
Víctor de la Llana*
Affiliation:
Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Ángel del Castillo
Affiliation:
Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Carlos Andrés
Affiliation:
Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Laura Gómez
Affiliation:
Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Manuel Agulla
Affiliation:
Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
María Luisa del Valle
Affiliation:
Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
María Iglesias
Affiliation:
Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Ricardo Torres
Affiliation:
Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
*
Author for correspondence: Víctor de la Llana, Servicio de Radiofísica y Protección Radiológica, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. Tel: +34687683864. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose:

Evaluating the improvements of placing the treatment isocentre at the boost centre of mass (CoM) in a hybrid treatment for breast cancer radiotherapy.

Material and methods:

Twenty-two patients were planned in two isocentre locations with two forward intensity-modulated radiation therapy (fIMRT) tangentials to the breast and a volumetric-modulated arc therapy (VMAT) to the boost. A simultaneous integrated boost technique was used. Breast Boost (BB) Vector was investigated as a criterion for selecting an appropriate isocentre placement. Various metrics for boost, breast and hybrid plans were analysed using analysis of variance statistics.

Results:

Comparing hybrid plans at the boost CoM vs. hybrid plans at the breast CoM, no significant differences were found. Analysis of relative variations of planning target volume (PTV) boost coverage vs. BB Vector indicated an upgrade in boost CoM isocentre strategy. Dose to organs at risk was comparable: V5Gy (26·24 vs. 25·69%, p = 0·8), V20Gy (14·66 vs. 14·58%, p = 0·959) and the mean dose (7·37 Gy vs. 7·26 Gy, p = 0·879) to ipsilateral lung; V5Gy (15·60 vs. 15·22%, p = 0·903), and the mean dose (4·91 Gy vs. 4·86 Gy, p = 0·950) to heart and dose to free breast of boost (46·71 Gy vs. 46·62 Gy, p = 0·408).

Findings:

The hybrid fIMRT–VMAT technique centred at the boost CoM resulted equivalent to plans centred at the breast CoM, while benefiting from an enhancement in PTV boost coverage for patients with BB Vector superior to 5.

Keywords

breast radiotherapyhybrid techniqueisocentre positionsimultaneously integrated boostVMAT
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 2 , June 2021 , pp. 158 - 163
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). 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 randomised trials. Lancet 2005; 366: 2087–2106.CrossRefGoogle Scholar
Poortmans, P. Optimal approach in early breast cancer: radiation therapy. EJC Suppl 2013; 11 (2): 27–36.CrossRefGoogle ScholarPubMed
Franco, P, Cante, D, Sciacero, P et al. Tumor bed boost integration during whole breast radiotherapy : a review of the current evidence. Breast Care 2015; 10: 44–49.CrossRefGoogle ScholarPubMed
Fournier-bidoz, N, Kirova, YM, Campana, F, Dendale, R, Fourquet, A. Simplified field-in-field technique for a large-scale implementation in breast radiation treatment. Med Dosim 2012; 37 (2): 131−137.CrossRefGoogle ScholarPubMed
Orton, J, Halle, J, Chang, S, Artor, C. EComparison of three concomitant boost techniques for early-stage breast cancer. Int J Radiat Oncol Biol Phys 2006; 64 (1): 168–175.CrossRefGoogle Scholar
Byrne, M, Archibald-Heeren, B, Hu, Y, Fong, A, Chong, L, Teh, A. Comparison of semiautomated tangential VMAT with 3DCRT for breast or chest wall and regional nodes. J Appl Clin Med Phys 2018, 19 (5): 684–693.CrossRefGoogle ScholarPubMed
Vaegler, S, Scheibner, M, Hartwig, C et al. Evaluation of a new hybrid VMAT simultaneous integrated boost technique for breast radiotherapy. Curr Dir Biomed Eng 2017; 3 (2): 335–337.CrossRefGoogle Scholar
Virén, T, Heikkilä, J, Myllyoja, K, Koskela, K, Lahtinen, T, Seppälä, J. Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiat Oncol 2015: 10–79 Google ScholarPubMed
Scorsetti, M, Alongi, F, Fogliata, A et al. 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 2012; 7 (1): 1–8.CrossRefGoogle ScholarPubMed
Nitsche, M, Hermann, RM. Emerging role of hypofractionated radiotherapy with simultaneous integrated boost in modern radiotherapy. BreastCare 2015; 10: 320–324.Google ScholarPubMed
Askoxylakis, V, Jensen, AD, Häfner, MF et al. Simultaneous integrated boost for adjuvant treatment of breast cancer- intensity modulated vs. conventional radiotherapy: the IMRT-MC2 trial. BMC Cancer 2011; 11: 249–257.CrossRefGoogle ScholarPubMed
Aly, MMOM, Glatting, G, Jahnke, L, Wenz, F, Abo-Madyan, Y. Comparison of breast simultaneous integrated boost (SIB) radiotherapy techniques. Radiat Oncol 2015; 10 (1): 139–147.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 Pract 2016; 15 (2): 131–142.CrossRefGoogle Scholar
White, J, Tai, A, Arthur, D et al. Breast cancer atlas for radiation therapy planning: consensus definitions collaborators. Radiation Therapy Oncology Group (RTOG): 1–71,. https://www.rtog.org/CoreLab/ContouringAtlases/BreastCancerAtlas.aspx. Accessed on 18th December 2019.Google Scholar
Leeuwen, CM Van, Oei, AL, Crezee, J et al. The alfa and beta of tumours: a review of parameters of the linear-quadratic model, derived from clinical radiotherapy studies. Radiat Oncol 2018; 13: 96.CrossRefGoogle ScholarPubMed
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 (NRG ONCOLOGY RTOG 1005). https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?action=openFile&FileID=9366. Accessed on 19th December 2019.Google Scholar
Jöst, V, Kretschmer, M, Sabatino, M et al. 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. Strahlentherapie und Onkol 2015; 191 (9): 734–741.CrossRefGoogle ScholarPubMed
Mourik, AMV, Elkhuizen, PHM, Minkema, D, Duppen, JC. Multiinstitutional study on target volume delineation variation in breast radiotherapy in the presence of guidelines. Radiother Oncol 2010; 94 (3): 286–291.CrossRefGoogle Scholar
Moragues, S, Pozo, M, Casals, J. Dosimetric feasibility of an “off-breast isocenter” technique for whole-breast cancer radiotherapy. Reports Pract Oncol Radiother 2019; 21 (6): 500–507.Google Scholar
Armpilia, C, Antypas, C, Zygogianni, A, Balafouta, M, Sandilos, P. A review on radiotherapy hypofractionation schedules for breast cancer treatment. J Radiother Pract. 2011; 10 (3): 201–208.CrossRefGoogle Scholar
De Rose, F, Fogliata, A, Franceschini, D et al. Phase II trial of hypofractionated VMAT-based treatment for early stage breast cancer: 2-year toxicity and clinical results. Radiat Oncol 2016; 11 (1): 1–9.CrossRefGoogle ScholarPubMed
Fogliata, A, Seppälä, J, Reggiori, G et al. Dosimetric trade-offs in breast treatment with VMAT technique. Br J Radiol 2017; 90: 20160701.CrossRefGoogle ScholarPubMed