Abstract
Background
The purpose of this study is to evaluate the dosimetric benefits of whole breast radiotherapy (WBRT) using the field-in-field technique compared with conventional tangential field radiotherapy with physical wedges for WBRT.
Methods
In this planning study, 20 patients were included. For each patient, two different treatment plans were created for the entire treated breast. The dosimetric parameters of the planning target volume for dose evaluation and the organs at risk for each planning technique were compared. In the clinical outcome, acute skin toxicity for each treatment technique was compared.
Results
The field-in-field technique significantly reduced the maximum dose, the volumes receiving >107% of the prescription dose, and homogeneity index for the planning target volume for dose evaluation compared with the tangential field technique. For each dosimetry of the organs at risk, excluding the contralateral breast, the field-in-field technique significantly reduced the maximum dose and the volumes receiving >10, 30, and 50 Gy of the prescribed dose. The volume receiving <1 Gy of the prescription dose for the contralateral breast was significantly decreased using the field-in-field technique. In addition, the dose distribution using the field-in-field technique in the target volume was less sensitive to the effects of breast motion during normal breathing. In the clinical outcome, the field-in-field technique significantly reduced Radiation Therapy Oncology Group (RTOG) grade II acute skin toxicity compared with the tangential field technique (3.1 vs. 10.6%).
Conclusions
WBRT using the field-in-field technique improved dose distribution in the treated breast and decreased RTOG grade II acute skin toxicity compared with conventional tangential field radiotherapy with physical wedges.
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References
ICRU Report No. 50 (1993) Prescribing, recording and reporting photon beam therapy. ICRU Bethesda, Maryland
Buchholdz TA, Gurgoze E, Bice WS et al (1997) Dosimetric analysis of intact breast irradiation in off-axis planes. Int J Radiat Oncol Biol Phys 39:261–267
Cheng CW, Das IJ, Baldassarre S (1994) The effect of the number of computed tomographic slices on dose distributions and evaluation of treatment planning systems for radiation therapy of intact breast. Int J Radiat Oncol Biol Phys 30:183–195
Chin LM, Cheng CW, Siddon RL et al (1989) Three-dimensional photon dose distributions with, and without lung corrections for tangential breast intact treatments. Int J Radiat Oncol Biol Phys 17:1327–1335
Fraass BA, Lichter AS, McShan DL et al (1988) The influence of lung density corrections on the treatment planning for primary breast cancer. Int J Radiat Oncol Biol Phys 14:179–190
Das IJ, Cheng CW, Fein DA et al (1997) Patterns of dose variability in radiation prescription of breast cancer. Radiother Oncol 44:83–89
Gray JR, McMormick B, Cox L et al (1991) Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys 21:347–354
Moody AM, Mayles WP, Bliss JM et al (1994) The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 33:106–112
Taylor ME, Perez CA, Halverson KJ et al (1995) Factors influencing cosmetic results after conversation therapy for breast cancer. Int J Radiat Oncol Biol Phys 31:753–764
Das IJ, Cheng CW, Fosmire H et al (1993) Tolerances in setup and dosimetric errors in the radiation treatment of breast cancer. Int J Radiat Oncol Biol Phys 26:883–890
Neal AJ, Torr M, Helyer S et al (1995) Correlation of breast heterogeneity with breast size using 3D CT planning and dose volume histograms. Radiother Oncol 34:210–218
Asbury L, Luttrell L, Lake D (1989) Achieving uniform dose with the use of a custom tissue compensator and a leveled beam for tangential breast fields. Med Dosim 14:161–171
Johnson JM, Potish RA, Kahn FM (1996) Improved dose distribution with a universal acryl breast compensator. Med Dosim 21:127–132
Mayles WPM, Yarnold JR, Webb S (1991) Improved dose homogeneity in the breast using tissue compensators. Radiother Oncol 22:248–251
Valdagni R, Ciocca M, Busana L et al (1992) Beam modifying devices in the treatment of early breast cancer: 3D stepped compensating technique. Radiother Oncol 23:192–195
VanAken ML, Brememan JC, Elson HR et al (1998) Incorporation of patient immobilization, tissue compensation and matchline junction technique for three field breast treatment. Med Dosim 13:131–135
Fogliata A, Bolsi A, Cozzi L (2002) Critical appraisal of treatment techniques based on conventional photon beams, intensity modulated photon beams and proton beams for therapy of intact breast. Radiother Oncol 62:137–145
Nicolini G, Fogliata A, Cozzi L (2005) Critical appraisal of a non-coplanar technique for radiotherapy of breast minimizing lung involvement. Radiother Oncol 76:319–325
Fogliata A, Clivio A, Nicolini G et al (2007) A treatment planning study using non-coplanar static fields and coplanar arcs for whole breast radiotherapy of patients with concave geometry. Radiother Oncol 85:346–354
Kestin LK, Sharpe MB, Frazier RC et al (2000) Intensity modulation to improve dose uniformity with tangential breast radiotherapy: initial clinical experience. Int J Radiat Oncol Biol Phys 48:1559–1568
Krueger EA, Fraass BA, McShan DL et al (2003) Potential gains for irradiation of chest wall and regional nodes with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 56:1023–1037
Mayo CS, Urie MM, Fitzgerald TJ (2005) Hybrid IMRT plans - concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time. Int J Radiat Oncol Biol Phys 61:922–932
Lomax AJ, Cella L, Weber D et al (2003) Potential role of intensity-modulated photons and protons in the treatment of the breast and regional nodes. Int J Radiat Oncol Biol Phys 55:785–792
Ahunbay EE, Chen GP, Thatcher S et al (2007) Direct aperture optimization-based intensity-modulated radiotherapy for whole breast irradiation. Int J Radiat Oncol Biol Phys 67:1248–1258
Wu Q, Mohan R, Morris M et al (2003) Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results. Int J Radiat Oncol Biol Phys 56:573–585
Lo YC, Yasuda G, Fitzgerald TJ et al (2000) Intensity modulation for breast treatment using static multileaf collimators. Int J Radiat Oncol Biol Phys 46:187–194
Zackrisson B, Arevarn M, Karlsson M (2000) Optimized MLC-beam arrangement for tangential breast irradiation. Radiother Oncol 54:209–212
Richmond ND, Turner RN, Dawes PJDK et al (2003) Evaluation of the dosimetric consequences of adding a single asymmetric or MLC shaped field to a tangential breast radiotherapy technique. Radiat Oncol 67:165–170
Donovan EM, Johnson U, Shentall G et al (2000) Evaluation of compensation in breast radiotherapy: a planning study using multiple static fields. Int J Radiat Biol Phys 46:671–679
Evans PM, Donovan EM, Partridge M et al (2000) The delivery of intensity modulated radiotherapy to the breast using multiple static fields. Radiother Oncol 57:79–89
Lee JW, Hong S, Choi KS et al (2008) Performance evaluation of field-in-field technique for tangential breast irradiation. Jpn J Clin Oncol 38:158–163
Herrick JS, Neill CJ, Rosser PF (2008) A comprehensive clinical 3-dimensional dosimetric analysis of forward planned IMRT and conventional wedge planned techniques for intact breast radiotherapy. Med Dosim 33:62–70
Barnett CC, Wilkinson J, Moody AM et al (2009) A randomized controlled trial of forward-planned radiotherapy (IMRT) for early breast cancer; baseline characteristics and dosimetry results. Radiother Oncol 92:34–41
Bhatnagar AK, Brandner E, Sonnik D et al (2006) Intensity modulated radiation therapy (IMRT) reduced the dose to the contralateral breast when compared to the conventional tangential fields for primary breast irradiation. Breast Cancer Res Treat 96:41–46
Woo TC, Pignol JP, Rakovitch E et al (2006) Body irradiation exposure in breast cancer radiotherapy: impact of breast IMRT and virtual wedge compensation techniques. Int J Radiat Oncol Biol Phys 1:52–58
Hall EJ, Wuu CS (2003) Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 56:83–88
Whelan T, MacKenzie R, Julian J et al (2002) Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst 94:1143–1150
The START Trialists’ Group (2008) The UK standardisation of breast radiotherapy (START) trial a of radiotherapy hypofraction for treatment of early breast cancer: a randomized trial. Lancet Oncol 9:331–341
START The Trialists’ Group (2008) The UK standardisation of breast radiotherapy (START) Trial B of radiotherapy hypofraction for treatment of early breast cancer: a randomized trial. Lancet 371:1098–1107
Xing L, Crooks S, Li JG et al (2000) Incorporating respiratory motion into the design of intensity maps in IMRT treatment of breast cancer. Int J Radiat Oncol Biol Phys 48:S99
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Sasaoka, M., Futami, T. Dosimetric evaluation of whole breast radiotherapy using field-in-field technique in early-stage breast cancer. Int J Clin Oncol 16, 250–256 (2011). https://doi.org/10.1007/s10147-010-0175-1
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DOI: https://doi.org/10.1007/s10147-010-0175-1