Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-30T23:54:35.220Z Has data issue: false hasContentIssue false

The impact of breast size on mean lung dose for patients receiving tangential radiotherapy to the whole breast

Published online by Cambridge University Press:  04 April 2016

Ashley Schembri
Affiliation:
Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
Susan Mercieca
Affiliation:
Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
Nick Courtier
Affiliation:
Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
Francis Zarb*
Affiliation:
Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
*
Correspondence to: Francis Zarb, Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, MSD 2090, Malta. Tel: 00356 2340 1833. E-mail: [email protected]

Abstract

Purpose

To explore the impact of breast size on mean lung dose (MLD) for patients receiving breast radiotherapy.

Methodology

Chest wall separation (CWS), volume of tissue receiving 95% isodose and MLD were measured on 80 radiotherapy treatment plans of patients receiving tangential radiotherapy treatment to the whole breast. Breast size was categorised as small (CWS<25 cm and planned target volume (PTV)<1,500 cm3) and large (CWS>25 cm and PTV>1500 cm3). Pearson’s correlation and independent sample t-test were used to analyse data.

Results

MLD was not affected by CWS (r=−0·13, p=0·24) nor volume of tissue receiving 95% isodose (r=−0·08, p=0·49). Significant variation between small and large breasts was noted for CWS (t=8·24, p=0·00) and volume of tissue receiving 95% isodose (t=5·68, p=0·00). No significant variation was noted between small and large breast for MLD (t=−0·26, p=0·80) and between left and right breasts for CWS (t=1·42, p=0·16) and volume of tissue receiving 95% isodose (t=−1·08, p=0·28). Significant difference between left (18–808 cGy) and right breast (325–365 cGy) was demonstrated for MLD (t=3·03, p=0·00).

Conclusion

This study demonstrated lack of correlation between breast size and MLD. Further research is recommended for justification of alternative techniques for this subgroup of patients to provide optimised radiotherapy delivery.

Type
Original Articles
Copyright
© Cambridge University Press 2016 

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

1.Ferlay, J, Soerjomataram, I, Ervik, Met al. GLOBOCAN 2012 v1.1, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon: International AGENCY for Research on Cancer, 2014.Google Scholar
2.European Cancer Observatory. International agency for research on cancer. http://eco.iarc.fr/ 2012. Accessed on 23rd June 2014.Google Scholar
3.Keller, L M, Cohen, R, Sopka, D Met al. Effect of bra use during radiation therapy for large-breasted women: acute toxicity and treated heart and lung volumes. Practl Radiat Oncol 2013; 3: 915.CrossRefGoogle ScholarPubMed
4.Falahatpour, Z, Aghamiri, S, Anbiaee, R. External radiotherapy of intact breast: a comparison between 2D (single CT slice) and 3D (full CT slices) plans. Int J Radiat Res 2011; 9: 121125.Google Scholar
5.Barco, I, Chabrera, C, Font, M Get al. Comparison of screened and nonscreened breast cancer patients in relation to age: a 2-institution study. Clin Breast Cancer 2015; 15 (6): 482489.CrossRefGoogle ScholarPubMed
6.Neal, A, Torr, M, Heyler, S, Yarnold, J. Correlation of breast dose heterogeneity with breast size using 3D CT planning and dose-volume histograms. Radiother Oncol 1995; 34: 210218.CrossRefGoogle ScholarPubMed
7.Ramella, S, Trodella, L, Ippolito, Eet al. Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment. Med Dosim 2012; 37: 186191.CrossRefGoogle ScholarPubMed
8.Kunkler, B. Textbook of Radiotherapy, 6th edition. London: Churchill Livingstone, 2003.Google Scholar
9.Minor, G, Yashar, C, Spanos, Wet al. The relationship of radiation pneumonitis to treated lung volume in breast conservation therapy. Breast J 2006; 12: 4852.CrossRefGoogle ScholarPubMed
10.Intech open science. http://www.intechopen.com/ 2004 Accessed on 9th May 2015.Google Scholar
11.Bhatnagar, A, Heron, D, Deutsch, M, Brandner, E, Wu, A, Kalnicki, S. Does breast size affect the scatter dose to the ipsilateral lung, heart, or contralateral breast in primary irradiation using intensity modulated radiation therapy (IMRT)? Am J Clin Oncol 2006; 29 (1): 8084.CrossRefGoogle ScholarPubMed
12.Jagannath, K P, Lokesh, V, Thejaswini, Bet al. Study of early radiation pneumonitis in carcinoma breast and lung treated with radiotherapy. Natl J Med Res 2013; 3 (3): 236240.Google Scholar
13.Patterson, K C, Stark, M E. Pulmonary fibrosis in sarcoidosis. Clinical features and outcomes. Ann Am Thorac Soc 2013; 10 (4): 362370.CrossRefGoogle ScholarPubMed
14.Hamilton, S N, Tyldesley, S, Li, D, Olson, R, McBride, M. Second malignancies after adjuvant radiation therapy for early stage breast cancer: is there increased risk with addition of regional radiation to local radiation? Int J Radiat Oncol Biol Phys 2015; 9 (5): 977985.CrossRefGoogle Scholar
15.Iyer, R, Libshitz, H. Late sequelae after radiaton therapy for breast cancer: imaging findings. Am J Roentgenol 1997; 168: 13351338.CrossRefGoogle Scholar
16.Seppenwoolde, Y.(ed). Radiation induced lung damage. In: Comparing Different NTCP Models that Predict the Incidence of Radiation Pneumonitis. 2001; 55 (3): 6176.Google Scholar
17.Kwa, S L, Lebesque, J V, Theuws, J Cet al. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data from 540 patients. Int J Radiat Oncol Biol Phys 1998; 42: 19.CrossRefGoogle ScholarPubMed
18.Oh, Y-T, Noh, O K, Jang, Het al. The features of radiation induced lung fibrosis related with dosimetric parameters. Radiother Oncol 2012; 102 (3): 343346.CrossRefGoogle ScholarPubMed
19.Agrawal, S, Kuwar, S, Lawrence, A, Das, M K, Kumar, S. Ipsilateral lung dose volume parameters predict radiation pneumonitis in addition to classical dose volume parameters in locally advanced NSCLC treated with combined modality therapy. South Asian J Cancer 2014; 3 (1): 1315.Google ScholarPubMed
20.Wang BH, Wang XL, Yang JQ, Hua W. Analysis of V5 predicting radiation pneumonitis in patients received thoracic irradiation treatment. World J Surg Radiat Oncol 2014; 3 (4).Google Scholar
21.Halperin, E C, Perez, C A, Brady, L W. Principles and Practice of Radiation Oncology, 5th edition. Philadelphia: Lippincott, 2008.Google Scholar
22.Goldsmith, C, Haviland, J, Tsang, Y, Syndenham, M, Yarnold, J. Large breast size as a risk factor for late adverse effects of breast radiotherapy: is residual dose inhomogeneity, despite 3D treatment planning and delivery, the main explanation? Radiother Oncol 2011; 100: 236240.CrossRefGoogle ScholarPubMed
23.Eurostat. Overweight and obesity-BMI statistics. European Commission Eurostat. http://ec.europa.eu/eurostat/statistics-explained/index.php/Overweight_and_obesity_-_BMI_statistics 2014. Accessed on 16th February 2015.Google Scholar
24.Dorn, P, Corbin, K, Al-Hallaq, H, Hasan, Y, Chmura, S. Feasibility and acute toxicity of hypofractionated radiation in large-breasted patients. Int J Radiat Oncol 2012; 83 (1): 7983.CrossRefGoogle ScholarPubMed
25.Latimer, J, Beckham, W, West, M, Holloway, L, Delaney, G. Support of large breasts during tangential irradiation using a mirco-shell and minimizing the skin dose-a pilot study. Med Dosim 2005; 30 (1): 3135.CrossRefGoogle ScholarPubMed
26.International Commission on Radiation Units and Measurements, I. Prescribing, recording and reporting photon beam therapy 1999, International Commission on Radiation.Google Scholar
27.Hannan, R, Thompson, R F, Chen, Yet al. Hypofractionated whole-breast radiation therapy: dose breast size matter? Int J Radiat Oncol Biol Phys 2012; 84 (4): 894901.CrossRefGoogle ScholarPubMed
28.Kong, F-M, Klein, E E, Bradley, J Det al. The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast irradiation. Int J Radiat Oncol Biol Phys 2002; 54 (3): 963971.CrossRefGoogle Scholar
29.Heineman, T, Sabbas, A, Delamerced, M, Chiu, Y, Smith, M, Parashar, B. Impact of large breast separation on radiation dose delivery to the ipsilateral lung as result of respiratory motion quantified using free breathing and 4D CT-based planning in patients with locally advanced breast cancers. J Cancer Res Ther 2013; 9 (1): 154160.Google Scholar
30.Moody, A, Mayles, W, Bliss, Jet al. The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 1994; 33: 106112.CrossRefGoogle ScholarPubMed
31.Schunke, M, Schulte, E, Ross, L, Schumacher, U, Lamperti, E. Atlas of Anatomy Neck and Internal Organs. Stuttgart: Thieme, 2006.Google Scholar
32.Nielsen, M H, Berg, M, Pedersen, A Net al. Delineation of target volumes and organs at risk in adjuvant radiotherapy of early breast cancer: national guidelines and contouring atlas by the Danish Breast Cancer Cooperative Group. Acta Oncol 2013; 52: 18.CrossRefGoogle ScholarPubMed