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Sample records for prone breast radiotherapy

  1. Individual Positioning: A Comparative Study of Adjuvant Breast Radiotherapy in the Prone Versus Supine Position

    SciTech Connect

    Varga, Zoltan; Hideghety, Katalin; Mezo, Tamas; Nikolenyi, Aliz; Thurzo, Laszlo; Kahan, Zsuzsanna

    2009-09-01

    Purpose: To study breast radiotherapy in the prone vs. supine positions through dosimetry and clinical implementation. Methods and Materials: Conformal radiotherapy plans in 61 patients requiring only breast irradiation were developed for both the prone and supine positions. After evaluation of the of the first 20 plan pairs, the patients were irradiated in the prone or supine position in a randomized fashion. These cases were analyzed for repositioning accuracy and skin reactions related to treatment position and patient characteristics. Results: The planning target volume covered with 47.5-53.5 Gy in the prone vs. the supine position was 85.1% {+-} 4.2% vs. 89.2 {+-} 2.2%, respectively (p < 0.0001). Radiation exposure of the ipsilateral lung, expressed in terms of the mean lung dose and the V{sub 20Gy}, was dramatically lower in the prone vs. supine position (p < 0.0001), but the doses to the heart did not differ. There was no difference in the need to correct positioning during radiotherapy, but the extent of displacement was significantly higher in the prone vs. supine position (p = 0.021). The repositioning accuracy in the prone position exhibited an improvement over time and did not depend on any patient-related parameters. Significantly more radiodermatitis of Grade 1-2 developed following prone vs. supine irradiation (p = 0.025). Conclusions: Conformal breast radiotherapy is feasible in the prone position. Its primary advantage is the substantially lower radiation dose to the ipsilateral lung. The higher dose inhomogeneity and increased rate of Grade 1-2 skin toxicity, however, may be of concern.

  2. Simple shielding reduces dose to the contralateral breast during prone breast cancer radiotherapy.

    PubMed

    Goyal, Uma; Locke, Angela; Smith-Raymond, Lexie; Georgiev, Georgi N

    2016-01-01

    Our goal was to design a prone breast shield for the contralateral breast and study its efficacy in decreasing scatter radiation to the contralateral breast in a prone breast phantom setup receiving radiation therapy designed for breast cancer. We constructed a prone breast phantom setup consisting of (1) A thermoplastic mask with a left-sided depression created by a water balloon for a breast shape; (2) 2 plastic bags to hold water in the thermoplastic mask depression; (3) 2000mL of water to fill the thermoplastic mask depression to create a water-based false breast; (4) 1-cm thick bolus placed in the contralateral breast holder; (5) 2 lead (Pb) sheets, each 0.1-cm thick for blocking scatter radiation in the contralateral bolus-based false breast; (6) a prone breast board to hold the thermoplastic mask, water, bolus, and lead; (7) 9cm solid water on top of the breast board to simulate body; (8) a diode was used to verify dose for each treatment field of the treated water-based breast; (9) metal-oxide-semiconductor-field effect transistor (MOSFET) dosimeters to measure dose to the contralateral bolus-based breast. The phantom prone breast setup was CT simulated and treatment was designed with 95% isodose line covering the treated breast. The maximum dose was 107.1%. Megavoltage (MV) port images ensured accurate setup. Measurements were done using diodes on the treated water-based breast and MOSFET dosimeters at the medial and lateral sides of the contralateral bolus-based breast without and with the Pb shield. Five treatments were done for each of the 3 data sets and recorded individually for statistical purposes. All treatments were completed with 6MV photons at 200cGy per treatment. The dose contributions from each of the 3 data sets including 15 treatments total without and with the prone lead shield to the medial and lateral portions of contralateral bolus-based breast were averaged individually. Unshielded dose means were 37.11 and 2.94cGy, and shielded dose

  3. Whole breast radiotherapy in prone and supine position: is there a place for multi-beam IMRT?

    PubMed Central

    2013-01-01

    Background Early stage breast cancer patients are long-term survivors and finding techniques that may lower acute and late radiotherapy-induced toxicity is crucial. We compared dosimetry of wedged tangential fields (W-TF), tangential field intensity-modulated radiotherapy (TF-IMRT) and multi-beam IMRT (MB-IMRT) in prone and supine positions for whole-breast irradiation (WBI). Methods MB-IMRT, TF-IMRT and W-TF treatment plans in prone and supine positions were generated for 18 unselected breast cancer patients. The median prescription dose to the optimized planning target volume (PTVoptim) was 50 Gy in 25 fractions. Dose-volume parameters and indices of conformity were calculated for the PTVoptim and organs-at-risk. Results Prone MB-IMRT achieved (p<0.01) the best dose homogeneity compared to WTF in the prone position and WTF and MB-IMRT in the supine position. Prone IMRT scored better for all dose indices. MB-IMRT lowered lung and heart dose (p<0.05) in supine position, however the lowest ipsilateral lung doses (p<0.001) were in prone position. In left-sided breast cancer patients population averages for heart sparing by radiation dose was better in prone position; though non-significant. For patients with a PTVoptim volume ≥600 cc heart dose was consistently lower in prone position; while for patients with smaller breasts heart dose metrics were comparable or worse compared to supine MB-IMRT. Doses to the contralateral breast were similar regardless of position or technique. Dosimetry of prone MB-IMRT and prone TF-IMRT differed slightly. Conclusions MB-IMRT is the treatment of choice in supine position. Prone IMRT is superior to any supine treatment for right-sided breast cancer patients and left-sided breast cancer patients with larger breasts by obtaining better conformity indices, target dose distribution and sparing of the organs-at-risk. The influence of treatment techniques in prone position is less pronounced; moreover dosimetric differences between TF

  4. Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients

    SciTech Connect

    Lymberis, Stella C.; Wyngaert, John Keith de; Parhar, Preeti; Chhabra, Arpit M.; Fenton-Kerimian, Maria; Chang Jengwha; Hochman, Tsivia; Guth, Amber; Roses, Daniel; Goldberg, Judith D.; Formenti, Silvia C.

    2012-11-15

    Purpose: Damage to heart and lung from breast radiotherapy is associated with increased cardiovascular mortality and lung cancer development. We conducted a prospective study to evaluate which position is best to spare lung and heart from radiotherapy exposure. Methods and Materials: One hundred consecutive Stage 0-IIA breast cancer patients consented to participate in a research trial that required two computed tomography simulation scans for planning both supine and prone positions. The optimal position was defined as that which best covered the contoured breast and tumor bed while it minimized critical organ irradiation, as quantified by the in-field heart and lung volume. The trial was designed to plan the first 100 patients in each position to study correlations between in-field volumes of organs at risk and dose. Results: Fifty-three left and 47 right breast cancer patients were consecutively accrued to the trial. In all patients, the prone position was optimal for sparing lung volume compared to the supine setup (mean lung volume reduction was 93.5 cc for right and 103.6 cc for left breast cancer patients). In 46/53 (87%) left breast cancer patients best treated prone, in-field heart volume was reduced by a mean of 12 cc and by 1.8 cc for the other 7/53 (13%) patients best treated supine. As predicted, supine-prone differences in in-field volume and mean dose of heart and lung were highly correlated (Spearman's correlation coefficient for left breast cancer patients was 0.90 for heart and 0.94 for lung and 0.92 for right breast cancer patients for lung). Conclusions: Prone setup reduced the amount of irradiated lung in all patients and reduced the amount of heart volume irradiated in 87% of left breast cancer patients. In-field organ volume is a valid surrogate for predicting dose; the trial continued to the planned target of 400.

  5. Intra- and Interfractional Variations for Prone Breast Irradiation: An Indication for Image-Guided Radiotherapy

    SciTech Connect

    Morrow, Natalya V.; Stepaniak, Christopher; White, Julia; Wilson, J. Frank; Li, X. Allen

    2007-11-01

    Purpose: Intra- and interfractional errors for breast cancer patients undergoing breast irradiation in the prone position were analyzed. Methods and Materials: To assess intrafractional error resulting from respiratory motion, four-dimensional computed tomography scans were acquired for 3 prone and 3 supine patients, and the respiratory motion was compared for the two positions. To assess the interfractional error caused by daily set-up variations, daily electronic portal images of one of the treatment beams were taken for 15 prone-positioned patients. Portal images were then overlaid with images from the planning system that included the breast contour and the isocenter, treatment beam portal, and isocenter. The shift between the planned and actual isocenter was recorded for each portal image, and descriptive statistics were collected for each patient. The margins were calculated using the 2{sigma}+0.7{sigma} recipe, as well as 95% confidence interval based on the pooled standard deviation of the datasets. Results: Respiratory motion of the chest wall is drastically reduced from 2.3 {+-} 0.9 mm in supine position to -0.1 {+-} 0.4 mm in prone position. The daily set-up errors vary in magnitude from 0.0 cm to 1.65 cm and are patient dependent. The margins were defined by considering only the standard deviation to be 1.1 cm, and 2.0 cm when the systematic errors were considered using the 2{sigma}+0.7{sigma} recipe. Conclusions: Prone positioning of patients for breast irradiation significantly reduces the uncertainty introduced by intrafractional respiratory motion. The presence of large systematic error in the interfractional variations necessitates a large clinical target volume-to-planning target volume margin and indicates the importance of image guidance for partial breast irradiation in the prone position, particularly using imaging modality capable of identifying the lumpectomy cavity.

  6. Increased Skin Dose With the Use of a Custom Mattress for Prone Breast Radiotherapy

    SciTech Connect

    Becker, Stewart J. Patel, Rakesh R.; Mackie, Thomas R.

    2007-10-01

    The purpose of this study was to measure and compare the loss of buildup to the skin of the breast in the prone position due to 2 different positioning systems during tangential external beam irradiation. Two experiments were performed; one with a standard nylon-covered foam support and another with a novel helium-filled Mylar bag support. The choice of helium-filled Mylar was to reduce the contamination to as low as possible. The experiments were designed to allow a surface dose measurement and a depth dose profile with the pads placed in the path of the beam in front of the detector. All measurements were taken using a Capintec PS-033 thin-window parallel plate ionization chamber. The standard nylon-covered foam pad caused the surface dose to rise as it got closer to the skin. When the pad was directly touching the surface, the surface dose increased by 300% compared to the result when no pad was present. This loss of buildup to the surface was similar to that of a custom bolus material. The opposite effect occurred with the use of the helium-filled Mylar bag, namely the surface dose gradually decreased as the pad got closer to the phantom. When the Mylar pad was directly touching the phantom, the surface dose was decreased by 7% compared to when no pad was present. The use of a foam pad could potentially result in a significant higher dose to the skin, resulting in an enhanced acute skin reaction. Therefore, special care should be taken in this clinical scenario and further investigation of an air- or helium-based mylar support pad should be investigated in the context of definitive breast radiation treatment.

  7. Prospective Study of Cone-Beam Computed Tomography Image-Guided Radiotherapy for Prone Accelerated Partial Breast Irradiation

    SciTech Connect

    Jozsef, Gabor; DeWyngaert, J. Keith; Becker, Stewart J.; Lymberis, Stella; Formenti, Silvia C.

    2011-10-01

    Purpose: To report setup variations during prone accelerated partial breast irradiation (APBI). Methods: New York University (NYU) 07-582 is an institutional review board-approved protocol of cone-beam computed tomography (CBCT) to deliver image-guided ABPI in the prone position. Eligible are postmenopausal women with pT1 breast cancer excised with negative margins and no nodal involvement. A total dose of 30 Gy in five daily fractions of 6 Gy are delivered to the planning target volume (the tumor cavity with 1.5-cm margin) by image-guided radiotherapy. Patients are set up prone, on a dedicated mattress, used for both simulation and treatment. After positioning with skin marks and lasers, CBCTs are performed and the images are registered to the planning CT. The resulting shifts (setup corrections) are recorded in the three principal directions and applied. Portal images are taken for verification. If they differ from the planning digital reconstructed radiographs, the patient is reset, and a new CBCT is taken. Results: 70 consecutive patients have undergone a total of 343 CBCTs: 7 patients had four of five planned CBCTs performed. Seven CBCTs (2%) required to be repeated because of misalignment in the comparison between portal and digital reconstructed radiograph image after the first CBCT. The mean shifts and standard deviations in the anterior-posterior (AP), superior-inferior (SI), and medial-lateral (ML) directions were -0.19 (0.54), -0.02 (0.33), and -0.02 (0.43) cm, respectively. The average root mean squares of the daily shifts were 0.50 (0.28), 0.29 (0.17), and 0.38 (0.20). A conservative margin formula resulted in a recommended margin of 1.26, 0.73, 0.96 cm in the AP, SI, and ML directions. Conclusion: CBCTs confirmed that the NYU prone APBI setup and treatment technique are reproducible, with interfraction variation comparable to those reported for supine setup. The currently applied margin (1.5 cm) adequately compensates for the setup variation detected.

  8. Prone Hypofractionated Whole-Breast Radiotherapy Without a Boost to the Tumor Bed: Comparable Toxicity of IMRT Versus a 3D Conformal Technique

    SciTech Connect

    Hardee, Matthew E.; Raza, Shahzad; Becker, Stewart J.; Jozsef, Gabor; Lymberis, Stella C.; Hochman, Tsivia; Goldberg, Judith D.; DeWyngaert, Keith J.; Formenti, Silvia C.

    2012-03-01

    Purpose: We report a comparison of the dosimetry and toxicity of three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT) among patients treated in the prone position with the same fractionation and target of the hypofractionation arm of the Canadian/Whelan trial. Methods and Materials: An institutional review board-approved protocol identified a consecutive series of early-stage breast cancer patients treated according to the Canadian hypofractionation regimen but in the prone position. Patients underwent IMRT treatment planning and treatment if the insurance carrier approved reimbursement for IMRT; in case of refusal, a 3D-CRT plan was used. A comparison of the dosimetric and toxicity outcomes during the acute, subacute, and long-term follow-up of the two treatment groups is reported. Results: We included 97 consecutive patients with 100 treatment plans in this study (3 patients with bilateral breast cancer); 40 patients were treated with 3D-CRT and 57 with IMRT. IMRT significantly reduced the maximum dose (Dmax median, 109.96% for 3D-CRT vs. 107.28% for IMRT; p < 0.0001, Wilcoxon test) and improved median dose homogeneity (median, 1.15 for 3D-CRT vs. 1.05 for IMRT; p < 0.0001, Wilcoxon test) when compared with 3D-CRT. Acute toxicity consisted primarily of Grade 1 to 2 dermatitis and occurred in 92% of patients. Grade 2 dermatitis occurred in 13% of patients in the 3D-CRT group and 2% in the IMRT group. IMRT moderately decreased rates of acute pruritus (p = 0.03, chi-square test) and Grade 2 to 3 subacute hyperpigmentation (p = 0.01, Fisher exact test). With a minimum of 6 months' follow-up, the treatment was similarly well tolerated in either group, including among women with large breast volumes. Conclusion: Hypofractionated breast radiotherapy is well tolerated when treating patients in the prone position, even among those with large breast volumes. Breast IMRT significantly improves dosimetry but yields only a modest but

  9. Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy in Women Undergoing Breast Conservation for Early Disease Yields High Rates of Excellent to Good Cosmetic Outcomes in Patients With Large and/or Pendulous Breasts

    SciTech Connect

    Bergom, Carmen; Kelly, Tracy; Morrow, Natalya; Wilson, J. Frank; Walker, Alonzo; Xiang Qun; Ahn, Kwang Woo; White, Julia

    2012-07-01

    Purpose: To report our institution's experience using prone positioning for three-dimensional conformal radiotherapy (3D-CRT) to deliver post-lumpectomy whole breast irradiation (WBI) in a cohort of women with large and/or pendulous breasts, to determine the rate of acute and late toxicities and, more specifically, cosmetic outcomes. We hypothesized that using 3D-CRT for WBI in the prone position would reduce or eliminate patient and breast size as negative prognostic indicators for toxicities associated with WBI. Methods and Materials: From 1998 to 2006, 110 cases were treated with prone WBI using 3D-CRT. The lumpectomy, breast target volumes, heart, and lung were contoured on all computed tomography scans. A dose of 45-50 Gy was prescribed to the breast volume using standard fractionation schemes. The planning goals were {>=}95% of prescription to 95% of the breast volume, and 100% of boost dose to 95% of lumpectomy planning target volume. Toxicities and cosmesis were prospectively scored using the Common Terminology Criteria for Adverse Effects Version 3.0 and the Harvard Scale. The median follow-up was 40 months. Results: The median body mass index (BMI) was 33.6 kg/m{sup 2}, and median breast volume was 1396 cm{sup 3}. The worst toxicity encountered during radiation was Grade 3 dermatitis in 5% of our patient population. Moist desquamation occurred in 16% of patients, with only 2% of patients with moist desquamation outside the inframammary/axillary folds. Eleven percent of patients had Grade {>=}2 late toxicities, including Grade 3 induration/fibrosis in 2%. Excellent to good cosmesis was achieved in 89%. Higher BMI was associated with moist desquamation and breast pain, but BMI and breast volume did not impact fibrosis or excellent to good cosmesis. Conclusion: In patients with higher BMI and/or large-pendulous breasts, delivering prone WBI using 3D-CRT results in favorable toxicity profiles and high excellent to good cosmesis rates. Higher BMI was

  10. Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy in Women Undergoing Breast Conservation for Early Disease Yields High Rates of Excellent to Good Cosmetic Outcomes in Patients With Large and/or Pendulous Breasts

    PubMed Central

    Bergom, Carmen; Kelly, Tracy; Morrow, Natalya; Wilson, J. Frank; Walker, Alonzo; Xiang, Qun; Ahn, Kwang Woo; White, Julia

    2013-01-01

    Purpose To report our institution’s experience using prone positioning for three-dimensional conformal radiotherapy (3D-CRT) to deliver post-lumpectomy whole breast irradiation (WBI) in a cohort of women with large and/or pendulous breasts, to determine the rate of acute and late toxicities and, more specifically, cosmetic outcomes. We hypothesized that using 3D-CRT for WBI in the prone position would reduce or eliminate patient and breast size as negative prognostic indicators for toxicities associated with WBI. Methods and Materials From 1998 to 2006, 110 cases were treated with prone WBI using 3D-CRT. The lumpectomy, breast target volumes, heart, and lung were contoured on all computed tomography scans. A dose of 45–50 Gy was prescribed to the breast volume using standard fractionation schemes. The planning goals were ≥95% of prescription to 95% of the breast volume, and 100% of boost dose to 95% of lumpectomy planning target volume. Toxicities and cosmesis were prospectively scored using the Common Terminology Criteria for Adverse Effects Version 3.0 and the Harvard Scale. The median follow-up was 40 months. Results The median body mass index (BMI) was 33.6 kg/m2, and median breast volume was 1396 cm3. The worst toxicity encountered during radiation was Grade 3 dermatitis in 5% of our patient population. Moist desquamation occurred in 16% of patients, with only 2% of patients with moist desquamation outside the inframammary/axillary folds. Eleven percent of patients had Grade ≥2 late toxicities, including Grade 3 induration/fibrosis in 2%. Excellent to good cosmesis was achieved in 89%. Higher BMI was associated with moist desquamation and breast pain, but BMI and breast volume did not impact fibrosis or excellent to good cosmesis. Conclusion In patients with higher BMI and/or large–pendulous breasts, delivering prone WBI using 3D-CRT results in favorable toxicity profiles and high excellent to good cosmesis rates. Higher BMI was associated with moist

  11. The Role of a Prone Setup in Breast Radiation Therapy

    PubMed Central

    Huppert, Nelly; Jozsef, Gabor; DeWyngaert, Keith; Formenti, Silvia Chiara

    2011-01-01

    Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of patient setup. This review describes some of the available techniques for prone breast radiotherapy and the available experience in their application. The NYU prone breast radiotherapy approach is discussed, including a summary of the results from several prospective trials. PMID:22655240

  12. A Dosimetric Comparison of Accelerated Partial Breast Irradiation Techniques: Multicatheter Interstitial Brachytherapy, Three-Dimensional Conformal Radiotherapy, and Supine Versus Prone Helical Tomotherapy

    SciTech Connect

    Patel, Rakesh R. . E-mail: patel@humonc.wisc.edu; Becker, Stewart J.; Das, Rupak K.; Mackie, Thomas R.

    2007-07-01

    Purpose: To compare dosimetrically four different techniques of accelerated partial breast irradiation (APBI) in the same patient. Methods and Materials: Thirteen post-lumpectomy interstitial brachytherapy (IB) patients underwent imaging with preimplant computed tomography (CT) in the prone and supine position. These CT scans were then used to generate three-dimensional conformal radiotherapy (3D-CRT) and prone and supine helical tomotherapy (PT and ST, respectively) APBI plans and compared with the treated IB plans. Dose-volume histogram analysis and the mean dose (NTD{sub mean}) values were compared. Results: Planning target volume coverage was excellent for all methods. Statistical significance was considered to be a p value <0.05. The mean V100 was significantly lower for IB (12% vs. 15% for PT, 18% for ST, and 26% for 3D-CRT). A greater significant differential was seen when comparing V50 with mean values of 24%, 43%, 47%, and 52% for IB, PT, ST, and 3D-CRT, respectively. The IB and PT were similar and delivered an average lung NTD{sub mean} dose of 1.3 Gy{sub 3} and 1.2 Gy{sub 3}, respectively. Both of these methods were statistically significantly lower than the supine external beam techniques. Overall, all four methods yielded similar low doses to the heart. Conclusions: The use of IB and PT resulted in greater normal tissue sparing (especially ipsilateral breast and lung) than the use of supine external beam techniques of 3D-CRT or ST. However, the choice of APBI technique must be tailored to the patient's anatomy, lumpectomy cavity location, and overall treatment goals.

  13. Tumor Bed Delineation for Partial Breast and Breast Boost Radiotherapy Planned in the Prone Position: What Does MRI Add to X-ray CT Localization of Titanium Clips Placed in the Excision Cavity Wall?

    SciTech Connect

    Kirby, Anna M. Yarnold, John R.; Evans, Philip M.; Morgan, Veronica A.; Schmidt, Maria A.; Scurr, Erica D.; Souza, Nandita de

    2009-07-15

    Purpose: To compare tumor bed (TB) volumes delineated using magnetic resonance imaging plus computed tomography and clips (MRCT) with those delineated using CT and clips (CT/clips) alone in postlumpectomy breast cancer patients positioned prone and to determine the value of MRCT for planning partial breast irradiation (PBI). Methods and Materials: Thirty women with breast cancer each had 6 to 12 titanium clips secured in the excision cavity walls at lumpectomy. Patients underwent CT imaging in the prone position, followed by MRI (T{sub 1}-weighted [standard and fat-suppressed] and T{sub 2}-weighted sequences) in the prone position. TB volumes were delineated separately on CT and on fused MRCT datasets. Clinical target volumes (CTV) (where CTV = TB + 15 mm) and planning target volumes (PTV) (where PTV = CTV + 10 mm) were generated. Conformity indices between CT- and MRCT-defined target volumes were calculated (ratio of the volume of agreement to total delineated volume). Discordance was expressed as a geographical miss index (GMI) (where the GMI = the fraction of total delineated volume not defined by CT) and a normal tissue index (the fraction of total delineated volume designated as normal tissue on MRCT). PBI dose distributions were generated to cover CT-defined CTV (CTV{sub CT}) with {>=}95% of the reference dose. The percentage of MRCT-defined CTV (CTV{sub MRCT}) receiving {>=}95% of the reference dose was measured. Results: Mean conformity indices were 0.54 (TB), 0.84 (CTV), and 0.89 (PTV). For TB volumes, the GMI was 0.37, and the NTI was 0.09. Median percentage volume coverage of CTV{sub CT} was 97.1% (range, 95.3%-100.0%) and of CTV{sub MRCT} was 96.5% (range, 89.0%-100.0%). Conclusions: Addition of MR to CT/clip data generated TB volumes that were discordant with those based on CT/clips alone. However, clinically satisfactory coverage of CTV{sub MRCT} by CTV{sub CT}-based tangential PBI fields provides support for CT/clip-based TB delineation remaining the

  14. Acceptance testing prone stereotactic breast biopsy units.

    PubMed

    Kimme-Smith, C; Solberg, T

    1994-07-01

    When the Mammography Quality Standards Act becomes law in October, 1994, stereotactic breast biopsy units may require yearly physicist calibration. Upright stereotactic units can be easily tested using conventional mammography procedures and a gelatin phantom containing simulated calcifications, but prone units are difficult to assess because of the under-table tube configuration. The two current manufacturers of these units have made different design decisions which affect each unit's calibration. There are a number of important distinctions between screening and prone biopsy units. For the two currently available prone units, a pronounced heel effect makes ion chamber position critical. Focal spot measurements are particularly difficult on one unit because there is no light field. The fixed grid on the other unit must be tested with a flood film. Physicists who inspect these units before their clinical use should be aware of variations needed by this equipment for specific acceptance tests. PMID:7968854

  15. Whole-breast irradiation: a subgroup analysis of criteria to stratify for prone position treatment

    SciTech Connect

    Ramella, Sara; Trodella, Lucio; Ippolito, Edy; Fiore, Michele; Cellini, Francesco; Stimato, Gerardina; Gaudino, Diego; Greco, Carlo; Ramponi, Sara; Cammilluzzi, Eugenio; Cesarini, Claudio; Piermattei, Angelo; Cesario, Alfredo; D'Angelillo, Rolando Maria

    2012-07-01

    To select among breast cancer patients and according to breast volume size those who may benefit from 3D conformal radiotherapy after conservative surgery applied with prone-position technique. Thirty-eight patients with early-stage breast cancer were grouped according to the target volume (TV) measured in the supine position: small ({<=}400 mL), medium (400-700 mL), and large ({>=}700 ml). An ad-hoc designed and built device was used for prone set-up to displace the contralateral breast away from the tangential field borders. All patients underwent treatment planning computed tomography in both the supine and prone positions. Dosimetric data to explore dose distribution and volume of normal tissue irradiated were calculated for each patient in both positions. Homogeneity index, hot spot areas, the maximum dose, and the lung constraints were significantly reduced in the prone position (p < 0.05). The maximum heart distance and the V{sub 5Gy} did not vary consistently in the 2 positions (p = 0.06 and p = 0.7, respectively). The number of necessary monitor units was significantly higher in the supine position (312 vs. 232, p < 0.0001). The subgroups analysis pointed out the advantage in lung sparing in all TV groups (small, medium and large) for all the evaluated dosimetric constraints (central lung distance, maximum lung distance, and V{sub 5Gy}, p < 0.0001). In the small TV group, a dose reduction in nontarget areas of 22% in the prone position was detected (p = 0.056); in the medium and high TV groups, the difference was of about -10% (p = NS). The decrease in hot spot areas in nontarget tissues was 73%, 47%, and 80% for small, medium, and large TVs in the prone position, respectively. Although prone breast radiotherapy is normally proposed in patients with breasts of large dimensions, this study gives evidence of dosimetric benefit in all patient subgroups irrespective of breast volume size.

  16. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Five-year Results of 100 Patients

    SciTech Connect

    Formenti, Silvia C.; Hsu, Howard; Fenton-Kerimian, Maria; Roses, Daniel; Guth, Amber; Jozsef, Gabor; Goldberg, Judith D.; DeWyngaert, J. Keith

    2012-11-01

    Purpose: To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position. Methods and Materials: Postmenopausal patients with Stage I breast cancer with nonpalpable tumors <2 cm, negative margins and negative nodes, positive hormone receptors, and no extensive intraductal component were eligible. The trial was offered only after eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone setup. 3D-CRT was delivered at a dose of 30 Gy in five 6-Gy/day fractions over 10 days with port film verification at each treatment. Rates of ipsilateral breast failure, ipsilateral nodal failure, contralateral breast failure, and distant failure were estimated using the cumulative incidence method. Rates of disease-free, overall, and cancer-specific survival were recorded. Results: One hundred patients were enrolled in this institutional review board-approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation, and another patient elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients were evaluable for toxicity, and, in 1 case, both breasts were treated with partial breast irradiation. Median patient age was 68 years (range, 53-88 years); in 55% of patients the tumor size was <1 cm. All patients had hormone receptor-positive cancers: 87% of patients underwent adjuvant antihormone therapy. At a median follow-up of 64 months (range, 2-125 months), there was one local recurrence (1% ipsilateral breast failure) and one contralateral breast cancer (1% contralateral breast failure). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (one breast edema, one transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36

  17. Intraoperative radiotherapy for breast cancer

    PubMed Central

    Williams, Norman R.; Pigott, Katharine H.; Brew-Graves, Chris

    2014-01-01

    Intra-operative radiotherapy (IORT) as a treatment for breast cancer is a relatively new technique that is designed to be a replacement for whole breast external beam radiotherapy (EBRT) in selected women suitable for breast-conserving therapy. This article reviews twelve reasons for the use of the technique, with a particular emphasis on targeted intra-operative radiotherapy (TARGIT) which uses X-rays generated from a portable device within the operating theatre immediately after the breast tumour (and surrounding margin of healthy tissue) has been removed. The delivery of a single fraction of radiotherapy directly to the tumour bed at the time of surgery, with the capability of adding EBRT at a later date if required (risk-adaptive technique) is discussed in light of recent results from a large multinational randomised controlled trial comparing TARGIT with EBRT. The technique avoids irradiation of normal tissues such as skin, heart, lungs, ribs and spine, and has been shown to improve cosmetic outcome when compared with EBRT. Beneficial aspects to both institutional and societal economics are discussed, together with evidence demonstrating excellent patient satisfaction and quality of life. There is a discussion of the published evidence regarding the use of IORT twice in the same breast (for new primary cancers) and in patients who would never be considered for EBRT because of their special circumstances (such as the frail, the elderly, or those with collagen vascular disease). Finally, there is a discussion of the role of the TARGIT Academy in developing and sustaining high standards in the use of the technique. PMID:25083504

  18. Cardiac Side-effects From Breast Cancer Radiotherapy.

    PubMed

    Taylor, C W; Kirby, A M

    2015-11-01

    Breast cancer radiotherapy reduces the risk of cancer recurrence and death. However, it usually involves some radiation exposure of the heart and analyses of randomised trials have shown that it can increase the risk of heart disease. Estimates of the absolute risks of radiation-related heart disease are needed to help oncologists plan each individual woman's treatment. The risk for an individual woman varies according to her estimated cardiac radiation dose and her background risk of ischaemic heart disease in the absence of radiotherapy. When it is known, this risk can then be compared with the absolute benefit of the radiotherapy. At present, many UK cancer centres are already giving radiotherapy with mean heart doses of less than 3 Gy and for most women the benefits of the radiotherapy will probably far outweigh the risks. Technical approaches to minimising heart dose in breast cancer radiotherapy include optimisation of beam angles, use of multileaf collimator shielding, intensity-modulated radiotherapy, treatment in a prone position, treatment in deep inspiration (including the use of breath-hold and gating techniques), proton therapy and partial breast irradiation. The multileaf collimator is suitable for many women with upper pole left breast cancers, but for women with central or lower pole cancers, breath-holding techniques are now recommended in national UK guidelines. Ongoing work aims to identify ways of irradiating pan-regional lymph nodes that are effective, involve minimal exposure of organs at risk and are feasible to plan, deliver and verify. These will probably include wide tangent-based field-in-field intensity-modulated radiotherapy or arc radiotherapy techniques in combination with deep inspiratory breath-hold, and proton beam irradiation for women who have a high predicted heart dose from intensity-modulated radiotherapy. PMID:26133462

  19. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    SciTech Connect

    Osa, Etin-Osa O.; DeWyngaert, Keith; Roses, Daniel; Speyer, James; Guth, Amber; Axelrod, Deborah; Fenton Kerimian, Maria; Goldberg, Judith D.; Formenti, Silvia C.

    2014-07-15

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm{sup 3}, mean 19.65 cm{sup 3}. In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm{sup 3}, mean 1.59 cm{sup 3}. There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and

  20. Differences in breast tissue oxygenation following radiotherapy.

    PubMed

    Dornfeld, Ken; Gessert, Charles E; Renier, Colleen M; McNaney, David D; Urias, Rodolfo E; Knowles, Denise M; Beauduy, Jean L; Widell, Sherry L; McDonald, Bonita L

    2011-08-01

    Tissue perfusion and oxygenation changes following radiotherapy may result from and/or contribute to the toxicity of treatment. Breast tissue oxygenation levels were determined in the treated and non-treated breast 1 year after radiotherapy for breast conserving treatment. Transcutaneous oxygenation varied between subjects in both treated and non-treated breast. Subjects without diabetes mellitus (n=16) had an average oxygenation level of 64.8 ± 19.9mmHg in the irradiated breast and an average of 72.3 ± 18.1mmHg (p=0.018) at the corresponding location in the control breast. Patients with diabetes (n=4) showed a different oxygenation pattern, with lower oxygenation levels in control tissue and no decrease in the irradiated breast. This study suggests oxygenation levels in normal tissues vary between patients and may respond differently after radiotherapy. PMID:21356563

  1. Radiotherapy in the management of early breast cancer

    SciTech Connect

    Wang, Wei

    2013-03-15

    Radiotherapy is an indispensible part of the management of all stages of breast cancer. In this article, the common indications for radiotherapy in the management of early breast cancer (stages 0, I, and II) are reviewed, including whole-breast radiotherapy as part of breast-conserving treatment for early invasive breast cancer and pre-invasive disease of ductal carcinoma in situ, post-mastectomy radiotherapy, locoregional radiotherapy, and partial breast irradiation. Key clinical studies that underpin our current practice are discussed briefly.

  2. [Prophylactic axillary radiotherapy for breast cancer].

    PubMed

    Rivera, S; Louvel, G; Rivin Del Campo, E; Boros, A; Oueslati, H; Deutsch, É

    2015-06-01

    Adjuvant radiotherapy, after breast conserving surgery or mastectomy for breast cancer, improves overall survival while decreasing the risk of recurrence. However, prophylactic postoperative radiotherapy of locoregional lymph nodes for breast cancer, particularly of the axillary region, is still controversial since the benefits and the risks due to axillary irradiation have not been well defined. To begin with, when performing conformal radiotherapy, volume definition is crucial for the analysis of the risk-benefit balance of any radiation treatment. Definition and contouring of the axillary lymph node region is discussed in this work, as per the recommendations of the European Society for Radiotherapy and Oncology (ESTRO). Axillary recurrences are rare, and the recent trend leads toward less aggressive surgery with regard to the axilla. In this literature review we present the data that lead us to avoid adjuvant axillary radiotherapy in pN0, pN0i+ and pN1mi patients even without axillary clearance and to perform it in some other situations. Finally, we propose an update about the potential toxicity of adjuvant axillary irradiation, which is essential for therapeutic decision-making based on current evidence, and to guide us in the evolution of our techniques and indications of axillary radiotherapy. PMID:26044178

  3. Breast cellulitis after conservative surgery and radiotherapy

    SciTech Connect

    Rescigno, J.; McCormick, B.; Brown, A.E.; Myskowski, P.L. )

    1994-04-30

    Cellulitis is a previously unreported complication of conservative surgery and radiation therapy for early stage breast cancer. Patients who presented with breast cellulitis after conservative therapy are described. Eleven patients that developed cellulitis of the breast over a 38-month period of observation are the subject of this report. Clinical characteristics of patients with cellulitis and their treatment and outcome are reported. Potential patient and treatment-related correlates for the development of cellulitis are analyzed. The risk of cellulitis persists years after initial breast cancer therapy. The clinical course of the patients was variable: some patients required aggressive, long-duration antibiotic therapy, while others had rapid resolution with antibiotics. Three patients suffered from multiple episodes of cellulitis. Patients with breast cancer treated with conservative surgery and radiotherapy are at risk for breast cellulitis. Systematic characterization of cases of cellulitis may provide insight into diagnosis, prevention, and more effective therapy for this uncommon complication. 15 refs., 1 fig., 2 tabs.

  4. Contemporary Breast Radiotherapy and Cardiac Toxicity.

    PubMed

    Yeboa, Debra Nana; Evans, Suzanne Buckley

    2016-01-01

    Long-term cardiac effects are an important component of survivorship after breast radiotherapy. The pathophysiology of cardiotoxicity, history of breast radiotherapy, current methods of cardiac avoidance, modern outcomes, context of historical outcomes, quantifying cardiac effects, and future directions are reviewed in this article. Radiation-induced oxidative stress induces proinflammatory cytokines and is a process that potentiates late effects of fibrosis and intimal proliferation in endothelial vasculature. Breast radiation therapy has changed substantially in recent decades. Several modern technologies exist to improve cardiac avoidance such as deep inspiration breath hold, gating, accelerated partial breast irradiation, and use of modern 3-dimensional planning. Modern outcomes may vary notably from historical long-term cardiac outcomes given the differences in cardiac dose with modern techniques. Methods of quantifying radiation-related cardiotoxicity that correlate with future cardiac risks are needed with current data exploring techniques such as measuring computed tomography coronary artery calcium score, single-photon emission computed tomography imaging, and biomarkers. Placing historical data, dosimetric correlations, and relative cardiac risk in context are key when weighing the benefits of radiotherapy in breast cancer control and survival. Estimating present day cardiac risk in the modern treatment era includes challenges in length of follow-up and the use of confounding cardiotoxic agents such as evolving systemic chemotherapy and targeted therapies. Future directions in both multidisciplinary management and advancing technology in radiation oncology may provide further improvements in patient risk reduction and breast cancer survivorship. PMID:26617212

  5. Prone breast tumor imaging using vertical axis-of-rotation (VAOR) SPECT systems: An initial study

    SciTech Connect

    Wang, Huili; Scarfone, C.; Greer, K.L.; Coleman, R.E.

    1996-12-31

    We propose the use of a single photon emission computed tomography (SPECT) system equipped with multiple cameras revolving around a vertical axis-of-rotation (VAOR) to image tumors in a prone-dependent breast. This innovative breast imaging approach has the advantages of a small attenuation volume between breast lesions and gamma detector as well as a minimal radius-of-rotation compared to conventional (horizontal axis-of-rotation) breast SPECT. Small attenuation volume results in improved detected counts and minimal radius-of-rotation leads to increased collimator resolution. Because of no VAOR SPECT system currently available, we conducted our experiments on a conventional SPECT system using an isolated breast phantom to investigate the proposed VAOR breast SPECT. Our experimental setup simulated a VAOR SPECT study with a prone-dependent breast in the camera`s field-of-view. The results of our experiment indicate that VAOR breast SPECT with Trionix LESR parallel hole collimator is capable of detecting a breast lesion with a diameter of 10 mm and a lesion-to-background concentration ratio of 6 to 1. The results also demonstrate that VAOR breast SPECT provides improved lesion visualization over planar scintimammography and conventional breast SPECT.

  6. Orthosis reduces breast pain and mechanical forces through natural and augmented breast tissue in women lying prone

    PubMed Central

    2014-01-01

    Background Breast implant displacement or rupture can cause aesthetic problems and serious medical complications. Activities with prone positioning and loading of the anterior chest wall, such as massage, chiropractic or osteopathic therapies may increase the risk of implant failure and can also cause discomfort in women with natural breast tissue. Here we test the effectiveness of a newly developed orthosis on pain, mechanical pressure and displacement of breast tissue in women with cosmetic augmentation, post-mastectomy reconstruction, lactating or natural breast tissue. Methods Thirty-two females volunteers, aged 25–56 years with augmented, reconstructed, natural or lactating breast tissue and cup sizes B-F, participated in this open-label clinical trial. We measured pain perception, peak pressure, maximum force, and breast tissue displacement using different sizes of the orthosis compared to no orthosis. Different densities of the orthosis were also tested in a subgroup of women (n = 7). Pain perception was rated using a validated 11-point visual-analogue scale. Peak pressure and maximum force were assessed using a bilateral set of capacitance-pliance® sensor strips whilst participants were load bearing in a prone position, and breast displacement was measured by magnetic-resonance-imaging. Results The orthosis significantly reduced pain, breast displacement and mechanical pressures in women with natural and augmented breast tissue in prone position. Greater relief of pain and greater reduction in mechanical forces were found with increased size and density of the orthosis. Use of the orthosis improved overall comfort by 64-100%, lowered peak pressure by up to 85% and maximum force by up to 96%. Medio-lateral displacement of breast tissue was reduced by 16%, resulting in a 51% desirable increase of breast tissue height. Conclusion Our study demonstrated that the newly developed orthosis significantly reduced pain, mechanical pressure and breast tissue

  7. Leukemia risk following radiotherapy for breast cancer

    SciTech Connect

    Curtis, R.E.; Boice, J.D. Jr.; Stovall, M.; Flannery, J.T.; Moloney, W.C.

    1989-01-01

    To evaluate further the relationship between high-dose radiotherapy and leukemia incidence, a nested case-control study was conducted in a cohort of 22,753 women who were 18-month survivors of invasive breast cancer diagnosed from 1935 to 1972. Women treated for breast cancer after 1973 were excluded to minimize the possible confounding influence of treatment with chemotherapeutic agents. The cases had histologically confirmed leukemia reported to the Connecticut Tumor Registry (CTR) between 1935 and 1984. A total of 48 cases of leukemia following breast cancer were included in the study. Two controls were individually matched to each leukemia case on the basis of age, calendar year when diagnosed with breast cancer, and survival time. Leukemia diagnoses were verified by one hematologist. Radiation dose to active bone marrow was estimated by medical physicists on the basis of the original radiotherapy records of study subjects. Local radiation doses to each of the 16 bone marrow components for each patient were reconstructed; the dose averaged over the entire body was 530 rad (5.3 Gy). Based on this dosage and assuming a linear relationship between dose and affect, a relative risk (RR) in excess of 10 would have been expected. However, there was little evidence that radiotherapy increased the overall risk of leukemia (RR = 1.16; 90% confidence interval (CI), 0.6 to 2.1). The risk of chronic lymphocytic leukemia, one of the few malignancies without evidence for an association with ionizing radiation, was not significantly increased (RR = 1.8; n = 10); nor was the risk for all other forms of leukemia (RR = 1.0; n = 38). There was no indication that risk varied over categories of radiation dose.

  8. Optical measurement of dimensional parameters of the breast with subjects in prone position

    PubMed Central

    Roessler, Ann-Christin; Althoff, Felix; Jaeger, Florian; Kalender, Willi; Wenkel, Evelyn

    2015-01-01

    Abstract. Various applications require information on breast parameters, such as breast length and volume. An optical system was designed and tested for measuring these parameters with subjects in a prone position. The study results were used for optimizing patient positioning and handling for a future breast computed tomography (BCT) system. Measurements were conducted using an optical measurement system. To test the functionality and accuracy of the system, measurements were performed using reference phantoms. Additionally, 20 women and 5 men were examined to calculate breast parameters in alternative positions and breathing states. The results of the optical measurements were compared with magnetic resonance imaging (MRI) measurements. Volume and length of the reference phantoms were determined with errors below 2%. The patient study demonstrated a mean breast volume of 530.7 ml for women during normal breathing. During an exhalation state, breast volume increased significantly by 17.7 ml in comparison with normal breathing. Differences with MRI measurements were found to be 3% for breast length and 9% for breast volume on average. The proposed optical measurement system was found to be suitable for measuring the dimensional parameters of the breast in a prone position and provides a tool for evaluating breast coverage for BCT. PMID:26240833

  9. Radiotherapy Issues in Elderly Breast Cancer Patients

    PubMed Central

    Kunkler, Ian

    2012-01-01

    Summary Breast cancer in the elderly is a rising health care challenge. Under-treatment is common. While the proportion of older patients receiving adjuvant radiotherapy (RT) is rising, the proportion undergoing breast-conserving surgery without irradiation has also risen. The evidence base for loco-regional treatment is limited, reflecting the historical exclusion of older patients from randomised trials. The 2011 Oxford overview shows that the risk of first recurrence is halved in all age groups by adjuvant RT after breast-conserving surgery, although the absolute benefit in older ‘low-risk’ patients is small. There is level 1 evidence that a breast boost after breast-conserving surgery and whole-breast irradiation reduces local recurrence in older as in younger women, although in the former the absolute reduction is modest. Partial breast irradiation (external beam or intraoperative or postoperative brachytherapy) is potentially an attractive option for older patients, but the evidence base is insufficient to recommend it routinely. Similarly, shortened (hypofractionated) dose fraction schedules may be more convenient for older patients and are supported by level 1 evidence. There remains uncertainty about whether there is a subgroup of older low-risk patients in whom postoperative RT can be omitted after breast-conserving surgery. Biomarkers of ‘low risk’ are needed to refine the selection of patients for the omission of adjuvant RT. The role of postmastectomy irradiation is well established for ‘high-risk’ patients but uncertain in the intermediate-risk category of patients with 1–3 involved axillary nodes or node-negative patients with other risk factors where its role is investigational. PMID:24715826

  10. Osteoradionecrosis of the Ribs following Breast Radiotherapy

    PubMed Central

    Nicholls, Luke; Gorayski, Peter; Harvey, Jennifer

    2015-01-01

    Introduction Osteoradionecrosis (ORN) of the chest wall is a rare complication after whole-breast radiotherapy (RT). Herein, we report a case of ORN involving the underlying ribs following adjuvant whole-breast RT using standard fractionation and conduct a review of the literature. Case Report A previously well 43-year-old female with right-sided, early-stage, node-negative breast cancer was treated with breast-conserving surgery. She subsequently underwent adjuvant whole-breast RT receiving 50 Gy in 25 fractions over 5 weeks using standard tangential photon fields with 6 MV photons followed by an electron boost of 10 Gy in 5 fractions according to International Commission on Radiation Units (ICRU) requirements. Eleven months after RT, the patient developed right lateral chest wall pain, with magnetic resonance imaging (MRI) demonstrating two fractures involving the underlying right fifth and sixth ribs associated with fatty marrow changes in the second to sixth ribs, thus raising the possibility of ORN. Treatments including hyperbaric oxygen, pentoxifylline and vitamin E were used with symptomatic improvements. There was demonstrable resolution on follow-up MRI at 2.5 years. Conclusion The incidence of ORN utilising modern RT techniques and standard fractionation is rare. Numerous treatments are available, with variable response rates. Emerging evidence of predictive gene profiling to estimate the risk of radiation sensitivity may assist in individualising preventative strategies to mitigate the risk of ORN. PMID:26351442

  11. Inflammatory breast carcinoma treated by radical radiotherapy

    SciTech Connect

    Chu, A.M.; Wood, W.C.; Doucette, J.A.

    1980-06-01

    Sixty-two patients with localized clinical inflammatory breast carcinoma were treated with curative, radical radiotherapy doses to the breast and draining lymphatics. Fifty patients have died from disease, 7 are alive with disease, and 5 are free of disease at time of reporting, thus indicating the fulminant nature of this rare form of breast cancer. Median survival is approximately 18 months. A five-year actuarial survival and relapse-free survival of 14% and 6%, respectively, are obtained. Local and regional recurrence was noted in 43 of 62 patients (69%). Twelve patients (19%) failed in the locally irradiated area only, 31 patients (50%) failed in both local, regional, and distant sites, and 14 patients (23%) failed with distant metastases only. Due to the complex dosimetry required in the treatment of breast cancer, retrospective analysis was made of actual tumor doses delivered before 1972. The breast was oftentimes calculated to receive 20 to 35% less than the stated dose. Doses in excess of 6000 rads tumor dose seem necessary since 14 of the 15 patients with persistent disesase had received less than this dose. However, once tumor exceeded 10 cm increasing dose within clinical therapeutic ranges failed to control disease, although the recurrence-free interval was somewhat prolonged. Since 1976, twice-a-day fractionation has been used in larger tumors, and this appears to have decreased the local recurrence rate to 33% (2/6) patients. Preliminary results of adjuvant multiple drug therapy appear encouraging.

  12. Intraoperative Radiotherapy Versus Whole-Breast External Beam Radiotherapy in Early-Stage Breast Cancer

    PubMed Central

    Zhang, Li; Zhou, Zhirui; Mei, Xin; Yang, Zhaozhi; Ma, Jinli; Chen, Xingxing; Wang, Junqi; Liu, Guangyu; Yu, Xiaoli; Guo, Xiaomao

    2015-01-01

    Abstract There has not been a clear answer about the efficacy of intraoperative radiotherapy (IORT) for women with early-stage breast cancer. The aim of this meta-analysis was to summarize the available evidence comparing the efficacy and safety of IORT with those of whole-breast external beam radiotherapy (EBRT) for women with early-stage breast cancer. MEDLINE, EMBASE, the Web of Science, and the Cochrane Library were searched up to October 2014. Two authors independently conducted the literature selection and data extraction. Studies that compared IORT with whole-breast EBRT were included in the systematic review. IORT was defined as a single dose of irradiation to the tumor bed during breast-conserving surgery rather than whole-breast irradiation. Qualities of RCTs were evaluated according to the PEDro scale. Qualities of non-RCTs were evaluated according to the Methodological Index for Non-Randomized Studies (MINORS). The risk ratios (RRs) of ipsilateral breast tumor recurrence, overall mortality, breast cancer mortality, non-breast cancer mortality, and distant metastasis were pooled using a random-effects model. Four studies with 5415 patients were included in this meta-analysis, including 2 randomized controlled trials (RCTs) and 2 non-RCTs. Ipsilateral breast tumor recurrence was significantly higher in patients with IORT compared to those with whole-breast EBRT (RR 2.83, 95% CI 1.23–6.51), but with significant heterogeneity (I2 = 58.5%, P = 0.065). Comparing IORT with whole-breast EBRT, the pooled RRs for overall mortality, breast cancer mortality, non-breast cancer mortality, and distant metastasis were 0.88 (95% CI: 0.66–1.17), 1.20 (95% CI: 0.77–1.86), 0.76 (95% CI: 0.44–1.31), and 0.95 (95% CI: 0.61–1.49), respectively. IORT had a significantly higher risk of ipsilateral breast tumor recurrence than whole-breast EBRT. Overall mortality did not differ significantly. IORT should be used in conjunction with the prudent selection of

  13. SU-E-T-538: Does Abdominal Compression Through Prone Patient Position Reduce Respiratory Motion in Lung Cancer Radiotherapy?

    SciTech Connect

    Catron, T; Rosu, M; Weiss, E

    2014-06-01

    Purpose: This study assesses the effect of physiological abdominal compression from prone positioning by comparing respiratory-induced tumor movements in supine and prone positions. Methods: 19 lung cancer patients underwent repeated supine and prone free-breathing 4DCT scans. The effect of patient position on motion magnitude was investigated for tumors, lymph nodes (9 cases), and subgroups of central (11 cases), peripheral (8 cases) and small peripheral tumors (5 cases), by evaluating the population average excursions, absolute and relative to a carina-point. Results: Absolute motion analysis: In prone, motion increased by ~20% for tumors and ~25% for lymph nodes. Central tumors moved more compared to peripheral tumors in both supine and prone (~22%, and ~4% respectively). Central tumors movement increased by ~12% in prone. For peripheral tumors the increase in prone position was ~25% (~40% and 29% changes on along RL and AP directions). Motion relative to carina-point analysis: Overall, tumor excursions relative to carina-point increased by ~17% in prone. Lymph node relative magnitudes were lower by ~4%. Likewise, the central tumors moved ~7% less in prone. The subgroup of peripheral tumors exhibited increased amplitudes by ~44%; the small peripheral tumors had even larger relative displacements in prone (~46%). Conclusion: Tumor and lymph node movement in the patient population from this study averaged to be higher in prone than in supine position. Results from carina analysis also suggest that peripheral tissues have more physiologic freedom of motility when placed in the prone position, regardless of size. From these observations we should continue to avoid prone positioning for all types of primary lung tumor, suggesting that patients should receive radiotherapy for primary lung cancer in supine position to minimize target tissue mobility during normal respiratory effort. Further investigation will include more patients with peripheral tumors to validate our

  14. Respiratory Motion, Anterior Heart Displacement and Heart Dosimetry: Comparison Between Prone (Pr) and Supine (Su) Whole Breast Irradiation.

    PubMed

    Lakosi, Ferenc; Gulyban, Akos; Janvary, Levente; Simoni, Selma Ben-Mustapha; Jansen, Nicolas; Seidel, Laurence; Kovacs, Arpad; Vavassis, Peter; Coucke, Philippe

    2015-09-01

    To analyze respiratory motion of surgical clips, chest wall (CW) and the anterior displacement of the heart and its impact on heart dosimetry between prone (Pr) and supine (Su) positions during whole breast radiotherapy after breast conserving surgery. Sixteen patients underwent 4D-CT for radiotherapy planning in Pr and Su positions. Maximum inhale and maximum exhale phases were analyzed. Mean 3D vectorial displacements ± standard deviations (SD) of the surgical clips were measured. Volumetric changes of the CW were recorded and compared. Cardiac displacement was assessed by a volume between the inner surface of CW and the myocardium of the heart (CW/H-V). For left-sided cases, comparative dosimetry was performed in each position simulating no- (Pr-noC, Su-noC) versus daily correction protocols (Pr-C, Su-C). The movements of 81 surgical clips were analyzed. Prone positioning significantly reduced both the mean 3D vectorial displacements (1.1 ± 0.6 (Pr) vs. 2.0 ± 0.9 mm (Su), p < 0.01) and their variability (0.3 ± 0.2 vs. 0.5 ± 0.3 mm, p = 0.01). Respiration-induced volumetric changes of CW were also significantly lower in Pr (2.3 ± 4.9 vs. 9.6 ± 7.1 cm(3), p < 0.01). The CW/H-V was significantly smaller in Pr than in Su (39.9 ± 14.6 vs. 64.3 ± 28.2 cm(3), p < 0.01). Besides identical target coverage heart, left-anterior-descending coronary artery (LADCA) and ipsilateral lung dose parameters were lowered with Pr-C compared to Pr-noC, Su-C and Su-noC. Prone position significantly reduced respiration-related surgical clip movements, their variability as well as CW movements. Significant anterior heart displacement was observed in Pr. Prone position with daily online correction could maximize the heart and LADCA protection. PMID:25840562

  15. Long-term Clinical Outcomes of Whole-Breast Irradiation Delivered in the Prone Position

    SciTech Connect

    Stegman, Lauren D.; Beal, Katherine P.; Hunt, Margie A.; Fornier, Monica N.; McCormick, Beryl . E-mail: mccormib@mskcc.org

    2007-05-01

    Purpose: The aim of this study was to evaluate retrospectively the effectiveness and toxicity of post-lumpectomy whole-breast radiation therapy delivered with prone positioning. Methods and Materials: Between September 1992 and August 2004, 245 women with 248 early-stage invasive or in situ breast cancers were treated using a prone breast board. Photon fields treated the whole breast to 46 to 50.4 Gy with standard fractionation. The target volume was clinically palpable breast tissue; no attempt was made to irradiate chest wall lymphatics. Tumor bed boosts were delivered in 85% of cases. Adjuvant chemotherapy and hormonal therapy were administered to 42% and 62% of patients, respectively. Results: After a median follow-up of 4.9 years, the 5 year actuarial true local and elsewhere ipsilateral breast tumor recurrence rates were 4.8% and 1.3%, respectively. The 5-year actuarial rates of regional nodal recurrence and distant metastases were 1.6% and 7.4%. Actuarial disease-free, disease-specific, and overall survival rates at 5 years were 89.4%, 97.3%, and 93%, respectively. Treatment breaks were required by 2.4% of patients. Grade 3 acute dermatitis and edema were each limited to 2% of patients. Only 4.9% of patients complained of acute chest wall discomfort. Chronic Grade 2 to 3 skin and subcutaneous tissue toxicities were reported in 4.4% and 13.7% of patients, respectively. Conclusions: Prone position breast radiation results in similar long-term disease control with a favorable toxicity profile compared with standard supine tangents. The anatomic advantages of prone positioning may contribute to improving the therapeutic ratio of post-lumpectomy radiation by improving dose homogeneity and minimizing incidental cardiac and lung dose.

  16. Development of three-dimensional radiotherapy techniques in breast cancer

    NASA Astrophysics Data System (ADS)

    Coles, Charlotte E.

    Radiotherapy following conservation surgery decreases local relapse and death from breast cancer. Currently, the challenge is to minimise the morbidity caused by this treatment without losing efficacy. Despite many advances in radiation techniques in other sites of the body, the majority of breast cancer patients are still planned and treated using 2-dimensional simple radiotherapy techniques. In addition, breast irradiation currently consumes 30% of the UK's radiotherapy workload. Therefore, any change to more complex treatment should be of proven benefit. The primary objective of this research is to develop and evaluate novel radiotherapy techniques to decrease irradiation of normal structures and improve localisation of the tumour bed. I have developed a forward-planned intensity modulated (IMRT) breast radiotherapy technique, which has shown improved dosimetry results compared to standard breast radiotherapy. Subsequently, I have developed and implemented a phase III randomised controlled breast IMRT trial. This National Cancer Research Network adopted trial will answer an important question regarding the clinical benefit of breast IMRT. It will provide DNA samples linked with high quality clinical outcome data, for a national translational radiogenomics study investigating variation in normal tissue toxicity. Thus, patients with significant late normal tissue side effects despite good dose homogeneity will provide the best model for finding differences due to underlying genetics. I evaluated a novel technique using high definition free-hand 3-dimensional (3D) ultrasound in a phantom study, and the results suggested that this is an accurate and reproducible method for tumour bed localisation. I then compared recognised methods of tumour bed localisation with the 3D ultrasound method in a clinical study. The 3D ultrasound technique appeared to accurately represent the shape and spatial position of the tumour cavity. This tumour bed localisation research

  17. Alternated Prone and Supine Whole-Breast Irradiation Using IMRT: Setup Precision, Respiratory Movement and Treatment Time

    SciTech Connect

    Veldeman, Liv; De Gersem, Werner; Speleers, Bruno; Truyens, Bart; Van Greveling, Annick; Van den Broecke, Rudy; De Neve, Wilfried

    2012-04-01

    Purpose: The objective of this study was to compare setup precision, respiration-related breast movement and treatment time between prone and supine positions for whole-breast irradiation. Methods and Materials: Ten patients with early-stage breast carcinoma after breast-conserving surgery were treated with prone and supine whole breast-irradiation in a daily alternating schedule. Setup precision was monitored using cone-beam computed tomography (CBCT) imaging. Respiration-related breast movement in the vertical direction was assessed by magnetic sensors. The time needed for patient setup and for the CBCT procedure, the beam time, and the length of the whole treatment slot were also recorded. Results: Random and systematic errors were not significantly different between positions in individual patients for each of the three axes (left-right, longitudinal, and vertical). Respiration-related movement was smaller in prone position, but about 80% of observations showed amplitudes <1 mm in both positions. Treatment slots were longer in prone position (21.2 {+-} 2.5 min) than in supine position (19.4 {+-} 0.8 min; p = 0.044). Conclusion: Comparison of setup precision between prone and supine position in the same patient showed no significant differences in random and systematic errors. Respiratory movement was smaller in prone position. The longer treatment slots in prone position can probably be attributed to the higher repositioning need.

  18. A nonlinear biomechanical model based registration method for aligning prone and supine MR breast images.

    PubMed

    Han, Lianghao; Hipwell, John H; Eiben, Björn; Barratt, Dean; Modat, Marc; Ourselin, Sebastien; Hawkes, David J

    2014-03-01

    Preoperative diagnostic magnetic resonance (MR) breast images can provide good contrast between different tissues and 3-D information about suspicious tissues. Aligning preoperative diagnostic MR images with a patient in the theatre during breast conserving surgery could assist surgeons in achieving the complete excision of cancer with sufficient margins. Typically, preoperative diagnostic MR breast images of a patient are obtained in the prone position, while surgery is performed in the supine position. The significant shape change of breasts between these two positions due to gravity loading, external forces and related constraints makes the alignment task extremely difficult. Our previous studies have shown that either nonrigid intensity-based image registration or biomechanical modelling alone are limited in their ability to capture such a large deformation. To tackle this problem, we proposed in this paper a nonlinear biomechanical model-based image registration method with a simultaneous optimization procedure for both the material parameters of breast tissues and the direction of the gravitational force. First, finite element (FE) based biomechanical modelling is used to estimate a physically plausible deformation of the pectoral muscle and the major deformation of breast tissues due to gravity loading. Then, nonrigid intensity-based image registration is employed to recover the remaining deformation that FE analyses do not capture due to the simplifications and approximations of biomechanical models and the uncertainties of external forces and constraints. We assess the registration performance of the proposed method using the target registration error of skin fiducial markers and the Dice similarity coefficient (DSC) of fibroglandular tissues. The registration results on prone and supine MR image pairs are compared with those from two alternative nonrigid registration methods for five breasts. Overall, the proposed algorithm achieved the best registration

  19. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

    SciTech Connect

    Wen Bixiu; Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080 ; Hsu, Howard; Formenti-Ujlaki, George F.; Lymberis, Stella; Magnolfi, Chiara; Zhao Xuan; Chang Jenghwa; DeWyngaert, J. Keith; Jozsef, Gabor; Formenti, Silvia C.

    2012-11-15

    Purpose: The dosimetric results from our institution's trials of prone accelerated partial breast irradiation are compared with the dosimetric requirements of RTOG-0413. Methods and Materials: Trial 1 and Trial 2 are 2 consecutive trials of prone-accelerated partial breast irradiation. Eligible for both trials were stage I breast cancer patients with negative margins after breast-conserving surgery. The planning target tumor volume (PTV) was created by extending the surgical cavity 2.0 cm for Trial 1 and 1.5 cm for Trial 2, respectively. Contralateral breast, heart, lungs, and thyroid were contoured. Thirty Gray was delivered in five daily fractions of 6 Gy by a three-dimensional conformal radiation therapy technique in Trial 1 and were by image-guided radiation therapy/intensity-modulated radiation therapy in Trial 2. Dosimetric results from the trials are reported and compared with RTOG 0413 requirements. Results: One hundred forty-six consecutive plans were analyzed: 67 left and 79 right breast cancers. The plans from the trials complied with the required >90% of prescribed dose covering 90% of PTV{sub E}VAL (=generated from the PTV by cropping 0.5 cm from the skin edge and excluding the chest wall): V90% was 98.1 {+-} 3.0% (with V100% and V95%, 89.4 {+-} 12.8%, 96.4 {+-} 5.1%, respectively). No significant difference between laterality was found (Student's t test). The dose constraints criteria of the RTOG-0413 protocol for ipsilateral and contralateral lung (V30 <15% and Dmax <3%), heart (V5 <40%), and thyroid (Dmax <3%) were satisfied because the plans showed an average V5% of 0.6% (range, 0-13.4) for heart, an average V30% of 0.6% (range, 0-9.1%) for ipsilateral lung, and <2% maximum dose to the thyroid. However, our partial breast irradiation plans demonstrated a higher dose to contralateral breast than that defined by RTOG constraints, with a median value of maximum doses of 4.1% (1.2 Gy), possibly as a result of contouring differences. Conclusions: Our

  20. [3rd Hungarian Breast Cancer Consensus Conference - Radiotherapy Guidelines].

    PubMed

    Polgár, Csaba; Kahán, Zsuzsanna; Csejtei, András; Gábor, Gabriella; Landherr, László; Mangel, László; Mayer, Árpád; Fodor, János

    2016-09-01

    The radiotherapy expert panel revised and updated the radiotherapy (RT) guidelines accepted in 2009 at the 2nd Hungarian Breast Cancer Consensus Conference based on new scientific evidence. Radiotherapy of the conserved breast is indicated in ductal carcinoma in situ (St. 0), as RT decreases the risk of local recurrence by 60%. In early stage (St. I-II) invasive breast cancer RT remains a standard treatment following breast conserving surgery. However, in elderly (≥70 years) patients with stage I, hormone receptor positive tumour hormonal therapy without RT can be considered. Hypofractionated (15×2.67 Gy) whole breast irradiation and for selected cases accelerated partial breast irradiation are validated treatment alternatives of conventional (25×2 Gy) whole breast irradiation. Following mastectomy RT significantly decreases the risk of locoregional recurrence and improves overall survival of patients having 1 to 3 (pN1a) or ≥4 (pN2a, pN3a) positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes axillary dissection can be omitted and substituted with axillary RT. After neoadjuvant chemotherapy (NAC) followed by breast conserving surgery whole breast irradiation is mandatory, while after NAC followed by mastectomy locoregional RT should be given in cases of initial stage III-IV and ypN1 axillary status. PMID:27579722

  1. Lactation following conservation surgery and radiotherapy for breast cancer

    SciTech Connect

    Varsos, G.; Yahalom, J. )

    1991-02-01

    A 38-year-old woman with early stage invasive breast cancer was treated with wide excision of the tumor, axillary lymph node dissection, and breast irradiation. Three years later, she gave birth to a normal baby. She attempted breast feeding and had full lactation from the untreated breast. The irradiated breast underwent only minor changes during pregnancy and postpartum but produced small amounts of colostrum and milk for 2 weeks postpartum. There are only a few reports of lactation after breast irradiation. These cases are reviewed, and possible factors affecting breast function after radiotherapy are discussed. Because of scant information available regarding its safety for the infant, nursing from the irradiated breast is not recommended.

  2. Frontiers in Radiotherapy for Early-Stage Invasive Breast Cancer

    PubMed Central

    Fisher, Christine M.; Rabinovitch, Rachel

    2014-01-01

    The development of breast-conserving treatment for early-stage breast cancer is one of the most important success stories in radiation oncology in the latter half of the twentieth century. Lumpectomy followed by radiotherapy provides an appealing alternative to mastectomy for many women. In recent years, there has been a shift in clinical investigational focus toward refinements in the methods of delivering adjuvant radiotherapy that provide shorter, more convenient schedules of external-beam radiotherapy and interstitial treatment. Expedited courses of whole-breast treatment have been demonstrated to be equivalent to traditional lengthier courses in terms of tumor control and cosmetic outcome and to provide an opportunity for cost efficiencies. PMID:25113764

  3. Risk Factors of Developing Long-Lasting Breast Pain After Breast Cancer Radiotherapy

    SciTech Connect

    Lundstedt, Dan; Gustafsson, Magnus; Steineck, Gunnar; Malmstroem, Per; Alsadius, David; Sundberg, Agnetha; Wilderaeng, Ulrica; Holmberg, Erik; Johansson, Karl-Axel; Karlsson, Per

    2012-05-01

    Purpose: Postoperative radiotherapy decreases breast cancer mortality. However, studies have revealed a long-lasting breast pain among some women after radiotherapy. The purpose of this study was to identify risk factors that contribute to breast pain after breast cancer radiotherapy. Methods and Materials: We identified 1,027 recurrence-free women in two cohorts of Swedish women treated for breast cancer. The women had breast-conserving surgery and postoperative radiotherapy, the breast was treated to 48 Gy in 2.4-Gy fractions or to 50 Gy in 2.0-Gy fractions. Young women received a boost of up to 16 Gy. Women with more than three lymph node metastases had locoregional radiotherapy. Systemic treatments were given according to health-care guidelines. Three to 17 years after radiotherapy, we collected data using a study-specific questionnaire. We investigated the relation between breast pain and potential risk modifiers: age at treatment, time since treatment, chemotherapy, photon energy, fractionation size, boost, loco-regional radiotherapy, axillary surgery, overweight, and smoking. Results: Eight hundred seventy-seven women (85%) returned the questionnaires. Among women up to 39 years of age at treatment, 23.1% had breast pain, compared with 8.7% among women older than 60 years (RR 2.66; 95% CI 1.33-5.36). Higher age at treatment (RR 0.96; 95% CI 0.94-0.98, annual decrease) and longer time since treatment (RR 0.93; 95% CI 0.88-0.98, annual decrease) were related to a lower occurrence of breast pain. Chemotherapy increased the occurrence of breast pain (RR 1.72; 95% CI 1.19-2.47). In the multivariable model only age and time since treatment were statistically significantly related to the occurrence of breast pain. We found no statistically significant relation between breast pain and the other potential risk modifiers. Conclusions: Younger women having undergone breast-conserving surgery with postoperative radiotherapy report a higher occurrence of long

  4. Blood lymphocyte subpopulations in breast cancer patients following radiotherapy.

    PubMed Central

    Petrini, B; Wasserman, J; Blomgren, H; Baral, E

    1977-01-01

    Both T and non-T lymphocytes decreased immediately following radiotherapy in breast cancer patients. The relative depletion of non-T lymphocytes, however, was more marked than that of T cells. 3 years later the number and the proportion of non-T lymphocytes was higher than immediately after radiotherapy, while T lymphocytes were still depressed. The proportion of cells with membrane-associated Ig was higher in patients 3 years following radiotherapy than in non-treated patients and healthy controls. There was no difference in the proportion of T and non-T lymphocytes between patients with and without metastases, respectively. PMID:330065

  5. Body radiation exposure in breast cancer radiotherapy: Impact of breast IMRT and virtual wedge compensation techniques

    SciTech Connect

    Woo, Tony; Pignol, Jean-Philippe . E-mail: Jean-Philippe.Pignol@sw.ca; Rakovitch, Eileen; Vu, Toni; Hicks, Deanna; O'Brien, Peter; Pritchard, Kathleen

    2006-05-01

    Purpose: Recent reports demonstrate a dramatically increased rate of secondary leukemia for breast cancer patients receiving adjuvant high-dose anthracycline and radiotherapy, and that radiation is an independent factor for the development of leukemia. This study aimed to evaluate the radiation body exposure during breast radiotherapy and to characterize the factors associated with an increased exposure. Patients and Methods: In a prospective cohort of 120 women, radiation measurements were taken from four sites on the body at the time of adjuvant breast radiotherapy. Multiple regression analysis was performed to analyze patient and treatment factors associated with the amount of scattered radiation. Results: For standard 50 Gy breast radiotherapy, the minimal dose received by abdominal organs is on average 0.45 Gy, ranging from 0.06 to 1.55 Gy. The use of physical wedges as a compensation technique was the most significant factor associated with increased scattered dose (p < 0.001), resulting in approximately three times more exposure compared with breast intensity-modulated radiation therapy (IMRT) and dynamic wedge. Conclusions: The amount of radiation that is scattered to a patient's body is consistent with exposure reported to be associated with excess of leukemia. In accordance with the As Low As Reasonably Achievable (ALARA) principle, we recommend using breast IMRT or virtual wedging for the radiotherapy of breast cancer receiving high-dose anthracycline chemotherapy.

  6. Reducing scatter radiation to the contralateral breast with a mobile, conformal shield during breast cancer radiotherapy.

    PubMed

    Macklis, R M; Crownover, R L; Crowe, J; Willoughby, T; Sohn, J

    1999-08-01

    During a standard course of breast radiotherapy, the contralateral breast generally receives approximately 2.5 to 6.0 Gy of scattered radiation. Although most studies have not found an overall increase in metachronous contralateral breast cancers in patients undergoing radiotherapy, a cohort of younger women may be genetically more susceptible to radiation-induced breast cancers and may thus be adversely affected by the scattered radiation. We are attempting to develop a simple, convenient, effective mechanism for minimizing the scattered radiation to the contralateral breast during the process of clinical breast radiotherapy. We therefore designed a conformal, platform-based breast shield consisting of 2.5 cm of molded lead in a mobile counterweighted polystyrene casing. This shield was intended to serve as a physical barrier to prevent both low and high energy scattered photons from the medial and lateral tangential fields. We conducted a prospective trial of 20 women, each woman serving as her own control. Each woman received breast radiotherapy with and without shield, and an array of thermoluminescent dosimeters was positioned across the contralateral breast to evaluate the in vivo dosimetry and the impact of the breast shield on surface absorption of scattered radiation. We found that the use of the breast shield reduced the median dose of scattered radiation by approximately 60% (p < 0.0001). This represented a median dose reduction of approximately 300 cGy at the nipple. The shield was easily positioned and added < 1 min to daily setup time. We conclude that the use of this sort of surface barrier shielding technique was feasible, effective, and practical for clinical use. The degree of scatter reduction accomplished through the use of this breast shield may be biologically significant, especially for those patients with biologic or epidemiologic risk factors that may predispose them to the development of radiogenic breast cancers. PMID:10440204

  7. Assessment and Minimization of Contralateral Breast Dose for Conventional and Intensity Modulated Breast Radiotherapy

    SciTech Connect

    Burmeister, Jay Alvarado, Nicole; Way, Sarah; McDermott, Patrick; Bossenberger, Todd; Jaenisch, Harriett; Patel, Rajiv; Washington, Tara

    2008-04-01

    Breast radiotherapy is associated with an increased risk of contralateral breast cancer (CBC) in women under age 45 at the time of treatment. This risk increases with increasing absorbed dose to the contralateral breast. The use of intensity modulated radiotherapy (IMRT) is expected to substantially reduce the dose to the contralateral breast by eliminating scattered radiation from physical beam modifiers. The absorbed dose to the contralateral breast was measured for 5 common radiotherapy techniques, including paired 15 deg. wedges, lateral 30 deg. wedge only, custom-designed physical compensators, aperture based (field-within-field) IMRT with segments chosen by the planner, and inverse planned IMRT with segments chosen by a leaf sequencing algorithm after dose volume histogram (DVH)-based fluence map optimization. Further reduction in contralateral breast dose through the use of lead shielding was also investigated. While shielding was observed to have the most profound impact on surface dose, the radiotherapy technique proved to be most important in determining internal dose. Paired wedges or compensators result in the highest contralateral breast doses (nearly 10% of the prescription dose on the medial surface), while use of IMRT or removal of the medial wedge results in significantly lower doses. Aperture-based IMRT results in the lowest internal doses, primarily due to the decrease in the number of monitor units required and the associated reduction in leakage dose. The use of aperture-based IMRT reduced the average dose to the contralateral breast by greater than 50% in comparison to wedges or compensators. Combined use of IMRT and 1/8-inch-thick lead shielding reduced the dose to the interior and surface of the contralateral breast by roughly 60% and 85%, respectively. This reduction may warrant the use of IMRT for younger patients who have a statistically significant risk of contralateral breast cancer associated with breast radiotherapy.

  8. Partial Breast Irradiation Versus Whole Breast Radiotherapy for Early-Stage Breast Cancer: A Decision Analysis

    SciTech Connect

    Sher, David J.; Wittenberg, Eve; Taghian, Alphonse G.; Bellon, Jennifer R.; Punglia, Rinaa S.

    2008-02-01

    Purpose: To compare the quality-adjusted life expectancy between women treated with partial breast irradiation (PBI) vs. whole breast radiotherapy (WBRT) for estrogen receptor-positive early-stage breast cancer. Methods and Materials: We developed a Markov model to describe health states in the 15 years after radiotherapy for estrogen receptor-positive early-stage breast cancer. Breast cancer recurrences were separated into local recurrences and elsewhere failures. Ipsilateral breast tumor recurrence (IBTR) risk was extracted from the Oxford overview, and rates and utilities were adapted from the literature. We studied two cohorts of women (aged 40 and 55 years), both of whom received adjuvant tamoxifen. Results: Assuming a no evidence of disease (NED)-PBI utility of 0.93, quality-adusted life expectancy after PBI (and WBRT) was 12.61 (12.57) and 12.10 (12.06) years for 40-year-old and 55-year-old women, respectively. The NED-PBI utility thresholds for preferring PBI over WBRT were 0.923 and 0.921 for 40-year-old and 55-year-old women, respectively, both slightly greater than the NED-WBRT utility. Outcomes were sensitive to the utility of NED-PBI, the PBI hazard ratio for local recurrence, the baseline IBTR risk, and the percentage of IBTRs that were local. Overall the degree of superiority of PBI over WBRT was greater for 55-year-old women than for 40-year-old women. Conclusions: For most utility values of the NED-PBI health state, PBI was the preferred treatment modality. This result was highly sensitive to patient preferences and was also dependent on patient age, PBI efficacy, IBTR risk, and the fraction of IBTRs that were local.

  9. Comparison of prone versus supine 18F-FDG-PET of locally advanced breast cancer: Phantom and preliminary clinical studies

    SciTech Connect

    Williams, Jason M.; Rani, Sudheer D.; Li, Xia; Whisenant, Jennifer G.; Abramson, Richard G.; Arlinghaus, Lori R.; Lee, Tzu-Cheng; MacDonald, Lawrence R.; Partridge, Savannah C.; Kang, Hakmook; Linden, Hannah M.; Kinahan, Paul E.; Yankeelov, Thomas E.

    2015-07-15

    Purpose: Previous studies have demonstrated how imaging of the breast with patients lying prone using a supportive positioning device markedly facilitates longitudinal and/or multimodal image registration. In this contribution, the authors’ primary objective was to determine if there are differences in the standardized uptake value (SUV) derived from [{sup 18}F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in breast tumors imaged in the standard supine position and in the prone position using a specialized positioning device. Methods: A custom positioning device was constructed to allow for breast scanning in the prone position. Rigid and nonrigid phantom studies evaluated differences in prone and supine PET. Clinical studies comprised 18F-FDG-PET of 34 patients with locally advanced breast cancer imaged in the prone position (with the custom support) followed by imaging in the supine position (without the support). Mean and maximum values (SUV{sub peak} and SUV{sub max}, respectively) were obtained from tumor regions-of-interest for both positions. Prone and supine SUV were linearly corrected to account for the differences in 18F-FDG uptake time. Correlation, Bland–Altman, and nonparametric analyses were performed on uptake time-corrected and uncorrected data. Results: SUV from the rigid PET breast phantom imaged in the prone position with the support device was 1.9% lower than without the support device. In the nonrigid PET breast phantom, prone SUV with the support device was 5.0% lower than supine SUV without the support device. In patients, the median (range) difference in uptake time between prone and supine scans was 16.4 min (13.4–30.9 min), which was significantly—but not completely—reduced by the linear correction method. SUV{sub peak} and SUV{sub max} from prone versus supine scans were highly correlated, with concordance correlation coefficients of 0.91 and 0.90, respectively. Prone SUV{sub peak} and SUV{sub max} were

  10. SU-E-T-588: Characterization and Clinical Validation of the Varian Pivotal™ Treatment Solution for Prone Breast Care

    SciTech Connect

    Dewyngaert, K; Jozsef, G; Formenti, S

    2014-06-01

    Purpose: To report on the clinical validation of the Varian Pivotal™ Treatment Solution for Prone Breast Care: a platform for prone breast radiation therapy. Methods: Patients treated using Breast Conserving Radiation Therapy may benefit from treatment in the prone position with the breast tissue falling freely away from the body. This geometry allows the breast tissue to be treated while avoiding the lung and heart tissue. Eighteen patients simulated and treated using the Varian Medical Systems Pivotal™ Treatment Solution for Prone Breast Care were monitored over the course of treatment for positioning integrity and reproducibility. As this carbon-fiber platform actually replaces a portion of the couch top, indexing is inherent to its design. Patients were positioned on the couch and aligned using fiducial markers and lateral SSD to the breast fiducial point. The daily couch coordinates then serves as indicators for positioning variability with this system. Results: The variations in couch vertical, longitudinal and lateral positions were centered on a mean value of zero with standard deviations of 0.44cm, 0.75cm and 0.79cm respectively. Other factors explored were variations in distance of mid-sternum to table edge and patient rotation into the opening. The median rotation of the chest wall was found to be 11.5 degrees at CT-Simulation with a median distance of 2.5cm from midsternum to support opening. Patient rotation was not associated with either breast size or distance from edge of platform. Conclusion: The Pivotal™ Treatment solution consists of a couch top that replaces the standard top and as such is open from beneath without obstruction. This is a distinction from all other solutions which rely on a platform positioned above and indexed to the treatment couch. We found the reproducibility to be consistent with our historical measures while offering benefits of an integrated solution as stated above. supported by Professional Services Agreeement with

  11. Cardiotoxicity of concomitant radiotherapy and trastuzumab for early breast cancer

    PubMed Central

    Marinko, Tanja; Dolenc, Jure; Bilban-Jakopin, Cvetka

    2014-01-01

    Background Trastuzumab therapy given in combination with one of several chemotherapy regimens is currently considered the standard of care for the treatment of early-stage, human epidermal growth factor receptor-2 (HER2) -positive breast cancer. The treatment with trastuzumab is due to a significant impact on the survival part of the standard adjuvant treatment of patients with HER2-positive breast cancer. Patients treated with postoperative breast or chest wall irradiation receive trastuzumab concomitant with radiotherapy. In a small proportion of patients trastuzumab causes cardiotoxicity. Preclinical findings indicate a radiosensibilizing effect of trastuzumab in breast cancer cells, but it is not yet clear whether it radiosensibilizes cells of healthy tissues too. Conclusions Special attention is required when left breast or left thoracic wall is irradiated in patient receiving trastuzumab, because long-term effects of the concurrent treatment with trastuzumab and radiotherapy are not yet known. In an era where more patients are surviving a diagnosis of breast cancer, better understanding and earlier detection of therapy-induced cardiac toxicity will be of paramount importance. PMID:24991199

  12. Intensity-modulated radiotherapy in the treatment of breast cancer.

    PubMed

    Dayes, I; Rumble, R B; Bowen, J; Dixon, P; Warde, P

    2012-09-01

    Intensity-modulated radiotherapy (IMRT) is a newer method of radiotherapy that uses beams with multiple intensity levels for any single beam, allowing concave dose distributions and tighter margins than those possible using conventional radiotherapy. IMRT is ideal for treating complex treatment volumes and avoiding close proximity organs at risk that may be dose limiting and provides increased tumour control through an escalated dose and reduces normal tissue complications through organ at risk sparing. Given the potential advantages of IMRT and the availability of IMRT-enabled treatment planning systems and linear accelerators, IMRT has been introduced in a number of disease sites. This systematic review examined the evidence for IMRT in the treatment of breast cancer to quantify the potential benefits of this new technology and to make recommendations for radiation treatment programmes considering adopting this technique. Providing that avoidance of acute adverse effects associated with radiation is an outcome of interest, then IMRT is recommended over tangential radiotherapy after breast-conserving surgery, based on a review of six published reports including 2012 patients. There were insufficient data to recommend IMRT over standard tangential radiotherapy for reasons of oncological outcomes or late toxicity. Future research should focus on studies with longer follow-up and provide data on late toxicity and disease recurrence rates. PMID:22748561

  13. Five Year Outcome of 145 Patients With Ductal Carcinoma In Situ (DCIS) After Accelerated Breast Radiotherapy

    SciTech Connect

    Ciervide, Raquel; Dhage, Shubhada; Guth, Amber; Shapiro, Richard L.; Axelrod, Deborah M.; Roses, Daniel F.; Formenti, Silvia C.

    2012-06-01

    Background: Accelerated whole-breast radiotherapy (RT) with tumor bed boost in the treatment of early invasive breast cancer has demonstrated equivalent local control and cosmesis when compared with standard RT. Its efficacy in the treatment of ductal carcinoma in situ (DCIS) remains unknown. Methods and Materials: Patients treated for DCIS with lumpectomy and negative margins were eligible for 2 consecutive hypofractionated whole-breast RT clinical trials. The first trial (New York University [NYU] 01-51) prescribed to the whole breast 42 Gy (2.8 Gy in 15 fractions) and the second trial (NYU 05-181) 40.5 Gy (2.7 Gy in 15 fractions) with an additional daily boost of 0.5 Gy to the surgical cavity. Results: Between 2002 and 2009, 145 DCIS patients accrued, 59 to the first protocol and 86 to the second trial. Median age was 56 years and 65% were postmenopausal at the time of treatment. Based on optimal sparing of normal tissue, 79% of the patients were planned and treated prone and 21% supine. At 5 years' median follow-up (60 months; range 2.6-105.5 months), 6 patients (4.1%) experienced an ipsilateral breast recurrence in all cases of DCIS histology. In 3/6 patients, recurrence occurred at the original site of DCIS and in the remaining 3 cases outside the original tumor bed. New contralateral breast cancers arose in 3 cases (1 DCIS and 2 invasive carcinomas). Cosmetic self-assessment at least 2 years after treatment is available in 125 patients: 91% reported good-to-excellent and 9% reported fair-to-poor outcomes. Conclusions: With a median follow-up of 5 years, the ipsilateral local recurrence rate is 4.1%, comparable to that reported from the NSABP (National Surgical Adjuvant Breast and Bowel Project) trials that employed 50 Gy in 25 fractions of radiotherapy for DCIS. There were no invasive recurrences. These results provide preliminary evidence that accelerated hypofractionated external beam radiotherapy is a viable option for DCIS.

  14. Radiotherapy for breast cancer and erythrokeratodermia variabilis.

    PubMed

    Pernin, V; Kirova, Y; Campana, F

    2014-12-01

    We report the first case report indicating that locoregional radiotherapy provide acceptable early and late toxicities in patient with erythrokeratodermia variabilis after 2 years of follow-up. However, preclinical data showing radiation-induced tumor genesis in case of deficiency of some connexins point out the need of a careful surveillance of these patients. PMID:25306447

  15. Rapid onset of cutaneous angiosarcoma after radiotherapy for breast carcinoma

    SciTech Connect

    Otis, C.N.; Peschel, R.; McKhann, C.; Merino, M.J.; Duray, P.H.

    1986-06-01

    Malignant neoplasms known to develop following external beam radiation include squamous cell carcinoma, osteosarcoma, chondrosarcoma, malignant fibrous histiocytoma, mixed mullerian tumors, malignant schwannoma, myelogenous leukemia and angiosarcoma. Latency periods of many years characterize the onset of these tumors following the exposure. Cutaneous angiosarcoma following radiotherapy for breast carcinoma has been rarely documented, occurring up to 13 years postirradiation. Two cases of this entity are reported occurring 37 months postradiotherapy at the site of mastectomy performed for mammary duct carcinoma.

  16. Effects of Setup Errors and Shape Changes on Breast Radiotherapy

    SciTech Connect

    Mourik, Anke van; Kranen, Simon van; Hollander, Suzanne den; Sonke, Jan-Jakob; Herk, Marcel van; Vliet-Vroegindeweij, Corine van

    2011-04-01

    Purpose: The purpose of the present study was to quantify the robustness of the dose distributions from three whole-breast radiotherapy (RT) techniques involving different levels of intensity modulation against whole patient setup inaccuracies and breast shape changes. Methods and Materials: For 19 patients (one computed tomography scan and five cone beam computed tomography scans each), three treatment plans were made (wedge, simple intensity-modulated RT [IMRT], and full IMRT). For each treatment plan, four dose distributions were calculated. The first dose distribution was the original plan. The other three included the effects of patient setup errors (rigid displacement of the bony anatomy) or breast errors (e.g., rotations and shape changes of the breast with respect to the bony anatomy), or both, and were obtained through deformable image registration and dose accumulation. Subsequently, the effects of the plan type and error sources on target volume coverage, mean lung dose, and excess dose were determined. Results: Systematic errors of 1-2 mm and random errors of 2-3 mm (standard deviation) were observed for both patient- and breast-related errors. Planning techniques involving glancing fields (wedge and simple IMRT) were primarily affected by patient errors ({approx}6% loss of coverage near the dorsal field edge and {approx}2% near the skin). In contrast, plan deterioration due to breast errors was primarily observed in planning techniques without glancing fields (full IMRT, {approx}2% loss of coverage near the dorsal field edge and {approx}4% near the skin). Conclusion: The influences of patient and breast errors on the dose distributions are comparable in magnitude for whole breast RT plans, including glancing open fields, rendering simple IMRT the preferred technique. Dose distributions from planning techniques without glancing open fields were more seriously affected by shape changes of the breast, demanding specific attention in partial breast

  17. Benefit of Radiation Boost After Whole-Breast Radiotherapy

    SciTech Connect

    Livi, Lorenzo; Borghesi, Simona; Saieva, Calogero; Fambrini, Massimiliano; Iannalfi, Alberto; Greto, Daniela; Paiar, Fabiola; Scoccianti, Silvia; Simontacchi, Gabriele; Bianchi, Simonetta; Cataliotti, Luigi; Biti, Giampaolo

    2009-11-15

    Purpose: To determine whether a boost to the tumor bed after breast-conserving surgery (BCS) and radiotherapy (RT) to the whole breast affects local control and disease-free survival. Methods and Materials: A total of 1,138 patients with pT1 to pT2 breast cancer underwent adjuvant RT at the University of Florence. We analyzed only patients with a minimum follow-up of 1 year (range, 1-20 years), with negative surgical margins. The median age of the patient population was 52.0 years (+-7.9 years). The breast cancer relapse incidence probability was estimated by the Kaplan-Meier method, and differences between patient subgroups were compared by the log rank test. Cox regression models were used to evaluate the risk of breast cancer relapse. Results: On univariate survival analysis, boost to the tumor bed reduced breast cancer recurrence (p < 0.0001). Age and tamoxifen also significantly reduced breast cancer relapse (p = 0.01 and p = 0.014, respectively). On multivariate analysis, the boost and the medium age (45-60 years) were found to be inversely related to breast cancer relapse (hazard ratio [HR], 0.27; 95% confidence interval [95% CI], 0.14-0.52, and HR 0.61; 95% CI, 0.37-0.99, respectively). The effect of the boost was more evident in younger patients (HR, 0.15 and 95% CI, 0.03-0.66 for patients <45 years of age; and HR, 0.31 and 95% CI, 0.13-0.71 for patients 45-60 years) on multivariate analyses stratified by age, although it was not a significant predictor in women older than 60 years. Conclusion: Our results suggest that boost to the tumor bed reduces breast cancer relapse and is more effective in younger patients.

  18. Clinical Outcomes and Toxicity of Proton Radiotherapy for Breast Cancer.

    PubMed

    Verma, Vivek; Shah, Chirag; Mehta, Minesh P

    2016-06-01

    Proton beam radiotherapy (PBT) represents a rapidly expanding modality for the treatment of several malignancies. We examined the current state of PBT for breast cancer to evaluate its role in the modern era of breast radiotherapy. Systematic searches were performed using PubMed, EMBASE, and abstracts from the American Society for Radiation Oncology, American Society of Clinical Oncology, and Particle Therapy Co-Operative Group of North America annual meetings, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Nine original investigations were analyzed. Despite the dearth of overall data, skin toxicity after PBT might be equivalent or better than that of photons. Conventionally fractionated breast/chest wall PBT produces grade 1 dermatitis rates of approximately 25% and grade 2 dermatitis in 71% to 75%. This is comparable or improved over the published rates for photons. The incidence of esophagitis was decreased if the target coverage was compromised in the medial supraclavicular volume, a finding that echoes previous results with photon radiotherapy. The rates of esophagitis were also comparable to the previous data for photons. Using PBT-based accelerated partial breast irradiation, the rates of seroma/hematoma and fat necrosis were comparable to those reported in the existing data. Radiation pneumonitis and rib fractures remain rare. PBT offers excellent potential to minimize the risk of cardiac events, keeping the mean heart dose at ≤ 1 Gy. However, definitive clinical experiences remain sparse. The recently begun randomized trial of protons versus photons will further aid in providing robust conclusions. PMID:26995159

  19. Prospective Trial of Accelerated Partial Breast Intensity-Modulated Radiotherapy

    SciTech Connect

    Leonard, Charles . E-mail: charles.leonard@usoncology.com; Carter, Dennis; Kercher, Jane; Howell, Kathryn; Henkenberns, Phyllis; Tallhamer, Michael; Cornish, Patricia C.; Hunter, Kari C.; Kondrat, Janis

    2007-04-01

    Purpose: To examine the feasibility and acute toxicities of an accelerated, partial breast, intensity-modulated radiotherapy (IMRT) protocol. Methods and Materials: Between February 2004 and August 2005, 55 patients with Stage I breast cancer and initial follow-up were enrolled at four facilities on a HealthONE and Western institutional review board-approved accelerated partial breast IMRT protocol. All patients were treated in 10 equal fractions delivered twice daily within 5 consecutive days. The first 7 patients were treated to 34 Gy, and the remaining 48 patients were treated to 38.5 Gy. Results: The median follow-up after IMRT was 10 months (range, <1-19) and after diagnosis was 11.5 months (range, 2-21). No local or distant recurrences developed. The T stage distribution was as follows: T1a in 11 patients, T1b in 24, and T1c in 20. The median tumor size was 9 mm (range, 1-20 mm). Breast cosmesis was judged by the patient as poor by 2, good by 12, and excellent by 40 (1 patient was legally blind) and by the physician as poor for 1, good for 10, and excellent for 44 patients. Breast pain, as judged by patient, was none in 34, mild in 19, moderate in 2, and severe in 0 patients. There was a single report of telangiectasia but no incidents of significant edema. Compared with historic controls for whom three-dimensional treatment planning techniques were used, IMRT provided similar dose delivery to the target while reducing the volume of normal breast included in the 100%, 75%, and 50% isodose lines. Conclusion: This initial report prospectively explored the feasibility of accelerated partial breast IMRT. After short-term follow-up, the dose delivery and clinical outcomes were very acceptable. We believe this regimen deserves additional investigation under institutional review board guidance.

  20. STAT3-survivin signaling mediates a poor response to radiotherapy in HER2-positive breast cancers

    PubMed Central

    Seong, Min-Ki; Seol, Hyesil; Oh, Jeong Su; Kim, Eun-Kyu; Chang, Jong Wook; Hwang, Sang-Gu; Noh, Woo Chul

    2016-01-01

    Although radiotherapy resistance is associated with locoregional recurrence and distant metastasis in breast cancers, clinically relevant molecular markers and critical signaling pathways of radioresistant breast cancer are yet to be defined. Herein, we show that HER2-STAT3-survivin regulation is associated with radiotherapy resistance in HER2-positive breast cancers. Depletion of HER2 by siRNA sensitized HER2-positive breast cancer cells to irradiation by decreasing STAT3 activity and survivin, a STAT3 target gene, expression in HER2-positive breast cancer cells. Furthermore, inhibition of STAT3 activation or depletion of survivin also sensitized HER2-positive breast cancer cells to irradiation, suggesting that the HER2-STAT3-survivin axis is a key pathway in radiotherapy resistance of HER2-positive breast cancer cells. In addition, our clinical analysis demonstrated the association between HER2-positive breast cancers and radiotherapy resistance. Notably, we found that increased expression of phosphorylated STAT3, STAT3, and survivin correlated with a poor response to radiotherapy in HER2-positive breast cancer tissues. These findings suggest that the HER2-STAT3-survivin axis might serve as a predictive marker and therapeutic target to overcome radiotherapy resistance in HER2-positive breast cancers. PMID:26755645

  1. Sequence of Radiotherapy and Chemotherapy in Breast Cancer After Breast-Conserving Surgery

    SciTech Connect

    Jobsen, Jan J.; Palen, Job van der; Brinkhuis, Marieel; Ong, Francisca; Struikmans, Henk

    2012-04-01

    Purpose: The optimal sequence of radiotherapy and chemotherapy in breast-conserving therapy is unknown. Methods and Materials: From 1983 through 2007, a total of 641 patients with 653 instances of breast-conserving therapy (BCT), received both chemotherapy and radiotherapy and are the basis of this analysis. Patients were divided into three groups. Groups A and B comprised patients treated before 2005, Group A radiotherapy first and Group B chemotherapy first. Group C consisted of patients treated from 2005 onward, when we had a fixed sequence of radiotherapy first, followed by chemotherapy. Results: Local control did not show any differences among the three groups. For distant metastasis, no difference was shown between Groups A and B. Group C, when compared with Group A, showed, on univariate and multivariate analyses, a significantly better distant metastasis-free survival. The same was noted for disease-free survival. With respect to disease-specific survival, no differences were shown on multivariate analysis among the three groups. Conclusion: Radiotherapy, as an integral part of the primary treatment of BCT, should be administered first, followed by adjuvant chemotherapy.

  2. Long-Term Breast Cancer Patient Outcomes After Adjuvant Radiotherapy Using Intensity-Modulated Radiotherapy or Conventional Tangential Radiotherapy.

    PubMed

    Yang, Jen-Fu; Lee, Meei-Shyuan; Lin, Chun-Shu; Chao, Hsing-Lung; Chen, Chang-Ming; Lo, Cheng-Hsiang; Fan, Chao-Yueh; Tsao, Chih-Cheng; Huang, Wen-Yen

    2016-03-01

    The aim of the article is to analyze breast cancer patient clinical outcomes after long-term follow-up using intensity-modulated radiotherapy (IMRT) or conventional tangential radiotherapy (cRT). We retrospectively reviewed patients with stage 0-III breast cancer who received breast conserving therapy between April 2004 and December 2007. Of the 234 patients, 103 (44%) were treated with IMRT and 131 (56%) were treated with cRT. A total prescription dose of 45 to 50 Gy (1.8-2 Gy per fraction) was delivered to the whole breast. A 14 Gy boost dose was delivered in 7 fractions. The median follow-up was 8.2 years. Five of 131 (3.8%) cRT-treated patients and 2 of 103 (1.9%) IMRT-treated patients had loco-regional failure. The 8-year loco-regional failure-free survival rates were 96.7% and 97.6% (P = 0.393) in the cRT and IMRT groups, respectively, whereas the 8-year disease-free survival (DFS) rates were 91.2% and 93.1%, respectively (P = 0.243). Patients treated with IMRT developed ≥ grade 2 acute dermatitis less frequently than patients treated with cRT (40.8% vs 56.5%; P = 0.017). There were no differences in late toxicity. IMRT reduces ≥ grade 2 acute skin toxicity. Local control, DFS, and overall survival were equivalent with IMRT and cRT. IMRT can be considered a standard technique for breast cancer treatment. PMID:26986158

  3. Long-Term Breast Cancer Patient Outcomes After Adjuvant Radiotherapy Using Intensity-Modulated Radiotherapy or Conventional Tangential Radiotherapy

    PubMed Central

    Yang, Jen-Fu; Lee, Meei-Shyuan; Lin, Chun-Shu; Chao, Hsing-Lung; Chen, Chang-Ming; Lo, Cheng-Hsiang; Fan, Chao-Yueh; Tsao, Chih-Cheng; Huang, Wen-Yen

    2016-01-01

    Abstract The aim of the article is to analyze breast cancer patient clinical outcomes after long-term follow-up using intensity-modulated radiotherapy (IMRT) or conventional tangential radiotherapy (cRT). We retrospectively reviewed patients with stage 0–III breast cancer who received breast conserving therapy between April 2004 and December 2007. Of the 234 patients, 103 (44%) were treated with IMRT and 131 (56%) were treated with cRT. A total prescription dose of 45 to 50 Gy (1.8–2 Gy per fraction) was delivered to the whole breast. A 14 Gy boost dose was delivered in 7 fractions. The median follow-up was 8.2 years. Five of 131 (3.8%) cRT-treated patients and 2 of 103 (1.9%) IMRT-treated patients had loco-regional failure. The 8-year loco-regional failure-free survival rates were 96.7% and 97.6% (P = 0.393) in the cRT and IMRT groups, respectively, whereas the 8-year disease-free survival (DFS) rates were 91.2% and 93.1%, respectively (P = 0.243). Patients treated with IMRT developed ≥ grade 2 acute dermatitis less frequently than patients treated with cRT (40.8% vs 56.5%; P = 0.017). There were no differences in late toxicity. IMRT reduces ≥ grade 2 acute skin toxicity. Local control, DFS, and overall survival were equivalent with IMRT and cRT. IMRT can be considered a standard technique for breast cancer treatment. PMID:26986158

  4. In vivo skin dose measurement in breast conformal radiotherapy

    PubMed Central

    Soleymanifard, Shokouhozaman; Noghreiyan, Atefeh Vejdani; Ghorbani, Mahdi; Jamali, Farideh; Davenport, David

    2016-01-01

    Aim of the study Accurate skin dose assessment is necessary during breast radiotherapy to assure that the skin dose is below the tolerance level and is sufficient to prevent tumour recurrence. The aim of the current study is to measure the skin dose and to evaluate the geometrical/anatomical parameters that affect it. Material and methods Forty patients were simulated by TIGRT treatment planning system and treated with two tangential fields of 6 MV photon beam. Wedge filters were used to homogenise dose distribution for 11 patients. Skin dose was measured by thermoluminescent dosimeters (TLD-100) and the effects of beam incident angle, thickness of irradiated region, and beam entry separation on the skin dose were analysed. Results Average skin dose in treatment course of 50 Gy to the clinical target volume (CTV) was 36.65 Gy. The corresponding dose values for patients who were treated with and without wedge filter were 35.65 and 37.20 Gy, respectively. It was determined that the beam angle affected the average skin dose while the thickness of the irradiated region and the beam entry separation did not affect dose. Since the skin dose measured in this study was lower than the amount required to prevent tumour recurrence, application of bolus material in part of the treatment course is suggested for post-mastectomy advanced breast radiotherapy. It is more important when wedge filters are applied to homogenize dose distribution. PMID:27358592

  5. Patient Preferences and Physician Practice Patterns Regarding Breast Radiotherapy

    SciTech Connect

    Hoopes, David J.; Kaziska, David; Chapin, Patrick; Weed, Daniel; Smith, Benjamin D.; Hale, E. Ronald; Johnstone, Peter A.

    2012-02-01

    Purpose: There are multiple current strategies for breast radiotherapy (RT). The alignment of physician practice patterns with best evidence and patient preferences will enhance patient autonomy and improve cancer care. However, there is little information describing patient preferences for breast RT and physician practice patterns. Methods and Materials: Using a reliable and valid instrument, we assessed the preferences of 5,000 randomly selected women (with or without cancer) undergoing mammography. To assess practice patterns, 2,150 randomly selected physician-members of American Society for Radiation Oncology were surveyed. Results: A total of 1,807 women (36%) and 363 physicians (17%) provided usable responses. The 95% confidence interval is < {+-}2.3% for patients and < {+-}5.3% for physicians. Patient preferences were hypofractionated whole breast irradiation (HF-WBI) 62%, partial breast irradiation (PBI) 28%, and conventionally fractionated whole breast irradiation (CF-WBI) 10%. By comparison, 82% of physicians use CF-WBI for more than 2/3 of women and 56% never use HF-WBI. With respect to PBI, 62% of women preferred three-dimensional (3D)-PBI and 38% favor brachytherapy-PBI, whereas 36% of physicians offer 3D-PBI and 66% offer brachytherapy-PBI. 70% of women prefer once-daily RT over 10 days vs. twice-daily RT over 5 days. 55% of physicians who use PBI do not offer PBI on clinical trial. Conclusions: HF-WBI, while preferred by patients and supported by evidence, falls behind the unproven and less preferred strategy of PBI in clinical practice. There is a discrepancy between women's preferences for PBI modality and type of PBI offered by physicians. Further alignment is needed between practice patterns, patient preferences, and clinical evidence.

  6. Cardiac Exposures in Breast Cancer Radiotherapy: 1950s-1990s

    SciTech Connect

    Taylor, Carolyn W. Nisbet, Andrew; McGale, Paul; Darby, Sarah C.

    2007-12-01

    Purpose: To estimate the doses to the heart and coronary arteries from common breast cancer radiotherapy (RT) regimens used worldwide from the 1950s to the 1990s. Methods and Materials: Virtual simulation and computed tomography planning were used to reconstruct the megavoltage and electron regimens. Manual planning was used for the orthovoltage and brachytherapy regimens. Several sources of variability associated with the dose estimates were assessed. Results: Breast or chest wall RT resulted in whole heart doses of 0.9-14 Gy for left-sided and of 0.4-6 Gy for right-sided irradiation. Internal mammary chain RT delivered heart doses of 3-17 Gy and 2-10 Gy for left- and right-sided irradiation, respectively. For most regimens, the dose to the left anterior descending coronary artery was greater than the heart dose. Scar boost, supraclavicular fossa, and axillary RT delivered mean cardiac doses of {<=}3 Gy. The greatest source of variability in estimating dose from a given regimen was patient anatomy. Conclusion: For most techniques, the greatest radiation doses were received by the anterior part of the heart and the left anterior descending coronary artery, a common site of atherosclerosis causing myocardial infarction. Irradiation of these structures might have contributed to the excess risk of death from heart disease seen after some past breast cancer RT regimens.

  7. Hypofractionated radiotherapy in the treatment of early breast cancer

    PubMed Central

    Plataniotis, George

    2010-01-01

    Radiotherapy (RT) after tumorectomy in early breast cancer patients is an established treatment modality which conventionally takes 6-7 wk to complete. Shorter RT schedules have been tested in large multicentre randomized trials and have shown equivalent results to that of standard RT (50 Gy in 25 fractions) in terms of local tumor control, patient survival and late post-radiation effects. Some of those trials have now completed 10 years of follow-up with encouraging results for treatments of 3-4 wk and a total RT dose to the breast of 40-42.5 Gy with or without boost. A reduction of 50% in treatment time makes those RT schedules attractive for both patients and health care providers and would have a significant impact on daily RT practice around the world, as it would accelerate patient turnover and save health care resources. However, in hypofractionated RT, a higher (than the conventional 1.8-2 Gy) dose per fraction is given and should be managed with caution as it could result in a higher rate of late post-radiation effects in breast, heart, lungs and the brachial plexus. It is therefore advisable that both possible dose inhomogeneity and normal tissue protection should be taken into account and the appropriate technology such as three-dimensional/intensity modulated radiation therapy employed in clinical practice, when hypofractionation is used. PMID:21160631

  8. Clinical Experience With Image-Guided Radiotherapy in an Accelerated Partial Breast Intensity-Modulated Radiotherapy Protocol

    SciTech Connect

    Leonard, Charles E.; Tallhamer, Michael M.S.; Johnson, Tim; Hunter, Kari C.M.D.; Howell, Kathryn; Kercher, Jane; Widener, Jodi; Kaske, Terese; Paul, Devchand; Sedlacek, Scot; Carter, Dennis L.

    2010-02-01

    Purpose: To explore the feasibility of fiducial markers for the use of image-guided radiotherapy (IGRT) in an accelerated partial breast intensity modulated radiotherapy protocol. Methods and Materials: Nineteen patients consented to an institutional review board approved protocol of accelerated partial breast intensity-modulated radiotherapy with fiducial marker placement and treatment with IGRT. Patients (1 patient with bilateral breast cancer; 20 total breasts) underwent ultrasound guided implantation of three 1.2- x 3-mm gold markers placed around the surgical cavity. For each patient, table shifts (inferior/superior, right/left lateral, and anterior/posterior) and minimum, maximum, mean error with standard deviation were recorded for each of the 10 BID treatments. The dose contribution of daily orthogonal films was also examined. Results: All IGRT patients underwent successful marker placement. In all, 200 IGRT treatment sessions were performed. The average vector displacement was 4 mm (range, 2-7 mm). The average superior/inferior shift was 2 mm (range, 0-5 mm), the average lateral shift was 2 mm (range, 1-4 mm), and the average anterior/posterior shift was 3 mm (range, 1 5 mm). Conclusions: This study shows that the use of IGRT can be successfully used in an accelerated partial breast intensity-modulated radiotherapy protocol. The authors believe that this technique has increased daily treatment accuracy and permitted reduction in the margin added to the clinical target volume to form the planning target volume.

  9. Imaging dose in breast radiotherapy: does breast size affect the dose to the organs at risk and the risk of secondary cancer to the contralateral breast?

    SciTech Connect

    Batumalai, Vikneswary; Quinn, Alexandra; Jameson, Michael; Delaney, Geoff; Holloway, Lois

    2015-03-15

    Correct target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy. Planning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). The mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast. The highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI. For breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account.

  10. Effect of Bra Use during Radiotherapy for Large-Breasted Women: Acute Toxicity and Treated Heart and Lung Volumes

    PubMed Central

    Keller, Lanea; Cohen, Randi; Sopka, Dennis M; Li, Tianyu; Li, Linna; Anderson, Penny R; Fowble, Barbara L.; Freedman, Gary M

    2012-01-01

    Purpose Large breast size presents special problems during radiation simulation, planning and patient treatment, including increased skin toxicity, in women undergoing breast-conserving surgery and radiotherapy (BCT). We report our experience using a bra during radiation in large-breasted women and its effect on acute toxicity and heart and lung dosimetry. Materials and methods From 2001 to 2006, 246 consecutive large-breasted women (bra size ≥ 38 and/or ≥ D cup) were treated with BCT using either 3D conformal (3D-CRT) or Intensity Modulated Radiation (IMRT). In 58 cases, at the physicians’ discretion, a custom-fit bra was used during simulation and treatment. Endpoints were acute radiation dermatitis, and dosimetric comparison of heart and lung volumes in a subgroup of 12 left-sided breast cancer patients planned with and without a bra. Results The majority of acute skin toxicities were grade 2 and were experienced by 90% of patients in a bra compared to 70% of patients not in a bra (p=0.003). On multivariate analysis significant predictors of grade 2/3 skin toxicity included 3D-CRT instead of IMRT (OR=3.9, 95% CI:1.8-8.5) and the use of a bra (OR=5.5, 95% CI:1.6-18.8). For left-sided patients, use of a bra was associated with a volume of heart in the treatment fields decreased by 63.4% (p=0.002), a volume of left lung decreased by 18.5% (p=0.25), and chest wall separation decreased by a mean of 1 cm (p=0.03). Conclusions The use of a bra to augment breast shape and position in large-breasted women is an alternative to prone positioning and associated with reduced chest wall separation and reduced heart volume within the treatment field. PMID:23459714

  11. Current role of modern radiotherapy techniques in the management of breast cancer

    PubMed Central

    Ozyigit, Gokhan; Gultekin, Melis

    2014-01-01

    Breast cancer is the most common type of malignancy in females. Advances in systemic therapies and radiotherapy (RT) provided long survival rates in breast cancer patients. RT has a major role in the management of breast cancer. During the past 15 years several developments took place in the field of imaging and irradiation techniques, intensity modulated RT, hypofractionation and partial-breast irradiation. Currently, improvements in the RT technology allow us a subsequent decrease in the treatment-related complications such as fibrosis and long-term cardiac toxicity while improving the loco-regional control rates and cosmetic results. Thus, it is crucial that modern radiotherapy techniques should be carried out with maximum care and efficiency. Several randomized trials provided evidence for the feasibility of modern radiotherapy techniques in the management of breast cancer. However, the role of modern radiotherapy techniques in the management of breast cancer will continue to be defined by the mature results of randomized trials. Current review will provide an up-to-date evidence based data on the role of modern radiotherapy techniques in the management of breast cancer. PMID:25114857

  12. Quantifying intra- and inter-fractional motion in breast radiotherapy

    SciTech Connect

    Jones, Scott; Fitzgerald, Rhys; Owen, Rebecca; Ramsay, Jonathan

    2015-03-15

    The magnitude of intra- and inter-fractional variation in the set up of breast cancer patients treated with tangential megavoltage photon beams was investigated using an electronic portal imaging device (EPID). Daily cine-EPID images were captured during delivery of the tangential fields for ten breast cancer patients treated in the supine position. Measurements collected from each image included the central lung distance (CLD), central flash distance (CFD), superior axial measurement (SAM) and the inferior axial measurement (IAM). The variation of motion within a fraction (intra-fraction) and the variation between fractions (inter-fraction) was analysed to quantify set up variation and motion due to respiration. Altogether 3775 EPID images were collected from 10 patients. The effect of respiratory motion during treatment was <0.1 cm standard deviation (SD) in the anterior–posterior (AP) direction. The inter-fraction movement caused by variations in daily set up was larger at 0.28 cm SD in the AP direction. Superior–inferior (SI) variation was more difficult to summarise and proved unreliable as the measurements were taken to an ambiguous point on the images. It was difficult to discern true SI movement from that implicated by AP movement. There is minimal intra-fractional chest wall motion due to respiration during treatment. Inter-fractional variation was larger, however, on average it remained within departmental tolerance (0.5 cm) for set up variations. This review of our current breast technique provides confidence in the feasibility of utilising advanced treatment techniques (field-in-field, intensity modulated radiotherapy or volumetric modulated arc therapy) following a review of the current imaging protocol.

  13. Dosimetric evaluation of breast radiotherapy in a dynamic phantom

    NASA Astrophysics Data System (ADS)

    Menon, Geetha; Pudney, Delia; Smith, Wendy

    2011-12-01

    This phantom study quantifies changes in delivered dose due to respiratory motion for four breast radiotherapy planning techniques: three intensity-modulated techniques (forward-planned, surface-compensated and hybrid intensity-modulated radiation therapy (IMRT)); using a combination of open fields and inverse planned IMRT) and a 2D conventional technique. The plans were created on CT images of a wax breast phantom with a cork lung insert, and dose distributions were measured using films inserted through slits in the axial and sagittal planes. Films were irradiated according to each plan under a static (modeling breathhold) and three dynamic conditions—isocenter set at mid-respiratory cycle with motion amplitudes of 1 and 2 cm and at end-cycle with 2 cm motion amplitude (modeling end-exhale). Differences between static and moving deliveries were most pronounced for the more complex planning techniques with hot spots of up to 107% appearing in the anterior portion of all three IMRT plans at the largest motion at the end-exhale set-up. The delivered dose to the moving phantom was within 5% of that to the static phantom for all cases, while measurement accuracy was ±3%. The homogeneity index was significantly decreased only for the 2 cm motion end-exhale set-up; however, this same motion increased the equivalent uniform dose because of improved posterior breast coverage. Overall, the study demonstrates that the effect of respiratory motion is negligible for all planning techniques except in occasional instances of large motion.

  14. Estimating Cardiac Exposure From Breast Cancer Radiotherapy in Clinical Practice

    SciTech Connect

    Taylor, C.W. McGale, P.; Povall, J.M.; Thomas, E.; Kumar, S.; Dodwell, D.; Darby, S.C.

    2009-03-15

    Purpose: To assess the value of maximum heart distance (MHD) in predicting the dose and biologically effective dose (BED) to the heart and the left anterior descending (LAD) coronary artery for left-tangential breast or chest wall irradiation. Methods and Materials: A total of 50 consecutive breast cancer patients given adjuvant left-tangential irradiation at a large U.K. radiotherapy center during 2006 were selected. For each patient, the following were derived using three-dimensional computed tomography (CT) planning: (1) mean dose and BED to the heart, (2) mean dose and BED to the LAD coronary artery, (3) MHD, (4) position of the CT slice showing the maximum area of the irradiated heart relative to the mid-plane slice, and (5) sternal and contralateral breast thickness (measures of body fat). Results: A strong linear correlation was found between the MHD and the mean heart dose. For every 1-cm increase in MHD, the mean heart dose increased by 2.9% on average (95% confidence interval 2.5-3.3). A strong linear-quadratic relationship was seen between the MHD and the mean heart BED. The mean LAD coronary artery dose and BED were also correlated with the MHD but the associations were weaker. These relationships were not affected by body fat. The mid-plane CT slice did not give a reliable assessment of cardiac irradiation. Conclusion: The MHD is a reliable predictor of the mean heart dose and BED and gives an approximate estimate of the mean LAD coronary artery dose and BED. Doses predicted by the MHD could help assess the risk of radiation-induced cardiac toxicity where individual CT-based cardiac dosimetry is not possible.

  15. SU-E-J-223: A BOLD Contrast Imaging Sequence to Evaluate Oxygenation Changes Due to Breath Holding for Breast Radiotherapy: A Pilot Study

    SciTech Connect

    Adamson, J; Chang, Z; Cai, J; Palta, M; Horton, J; Yin, F; Blitzblau, R

    2015-06-15

    Purpose: To develop a robust MRI sequence to measure BOLD breath hold induced contrast in context of breast radiotherapy. Methods: Two sequences were selected from prior studies as candidates to measure BOLD contrast attributable to breath holding within the breast: (1) T2* based Gradient Echo EPI (TR/TE = 500/41ms, flip angle = 60°), and (2) T2 based Single Shot Fast Spin Echo (SSFSE) (TR/TE = 3000/60ms). We enrolled ten women post-lumpectomy for breast cancer who were undergoing treatment planning for whole breast radiotherapy. Each session utilized a 1.5T GE MRI and 4 channel breast coil with the subject immobilized prone on a custom board. For each sequence, 1–3 planes of the lumpectomy breast were imaged continuously during a background measurement (1min) and intermittent breath holds (20–40s per breath hold, 3–5 holds per sequence). BOLD contrast was quantified as correlation of changes in per-pixel intensity with the breath hold schedule convolved with a hemodynamic response function. Subtle motion was corrected using a deformable registration algorithm. Correlation with breath-holding was considered significant if p<0.001. Results: The percentage of the breast ROI with positive BOLD contrast measured by the two sequences were in agreement with a correlation coefficient of R=0.72 (p=0.02). While both sequences demonstrated areas with strong BOLD response, the response was more systematic throughout the breast for the SSFSE (T2) sequence (% breast with response in the same direction: 51.2%±0.7% for T2* vs. 68.1%±16% for T2). In addition, the T2 sequence was less prone to magnetic susceptibility artifacts, especially in presence of seroma, and provided a more robust image with little distortion or artifacts. Conclusion: A T2 SSFSE sequence shows promise for measuring BOLD contrast in the context of breast radiotherapy utilizing a breath hold technique. Further study in a larger patient cohort is warranted to better refine this novel technique.

  16. Intraoperative Radiotherapy for Breast Cancer: The Lasting Effects of a Fleeting Treatment

    PubMed Central

    Rosenberg, Anne L.

    2014-01-01

    In well-selected patients who choose to pursue breast conservation therapy (BCT) for early-stage breast cancer, partial breast irradiation (PBI) delivered externally or intraoperatively, may be a viable alternative to conventional whole breast irradiation. Two large, contemporary randomized trials have demonstrated breast intraoperative radiotherapy (IORT) to be noninferior to whole breast external beam radiotherapy (EBRT) when assessing for ipsilateral breast tumor recurrence in select patients. Additionally, IORT and other PBI techniques are likely to be more widely adopted in the future because they improve patient convenience by offering an accelerated course of treatment. Coupled with these novel techniques for breast radiotherapy (RT) are distinct toxicity profiles and unique cosmetic alterations that differ from conventional breast EBRT and have the potential to impact disease surveillance and patient satisfaction. This paper will review the level-one evidence for treatment efficacy as well as important secondary endpoints like RT toxicity, breast cosmesis, quality of life, patient satisfaction, and surveillance mammography following BCT with IORT. PMID:25180098

  17. [Axillary treatment in breast cancer: surgery, radiotherapy, or none of these?].

    PubMed

    Boersma, Liesbeth J; van der Sangen, Maurice J C

    2015-01-01

    The AMAROS trial showed that substituting axillary lymph node dissection by radiotherapy of the axillary and periclavicular nodes (ART) in patients with sentinel node (SN) metastases results in less lymphoedema, without a significant difference in the 5-year axillary recurrence rate (ARR). Three surgical studies showed no increase in ARR after omitting axillary treatment in cases of limited SN metastases, provided that adjuvant systemic therapy and tangential breast radiotherapy were applied. On the other hand, several recent radiotherapy trials, including a meta-analysis by the Early Breast Cancer Trialists' Collaborative Group, showed that regional radiotherapy improves disease-free survival where there are positive axillary nodes. In view of the low ARR and good overall survival with contemporary breast cancer treatments, limiting axillary treatment and its associated morbidity is a logical development. However, it is too early to omit axillary treatment in all SN-positive patients. ART is a safe next step in reducing axillary treatment. PMID:26488194

  18. Double-edged sword of radiotherapy: a cause of secondary angiosarcoma after breast conservation therapy.

    PubMed

    Iqbal, Fahad Mujtaba; Ahmed, Balen; Vidya, Raghavan

    2016-01-01

    Angiosarcomas are rare and aggressive malignant tumours of vascular or endothelial origin that can originate in the breast. They can be classified as primary or secondary, with the latter most commonly due to postoperative radiotherapy as part of breast conservation therapy (wide local excision and adjuvant radiotherapy) for breast cancer. We report a case of postirradiation secondary angiosarcoma in a 56-year-old woman, alongside a review of the current literature, to inform clinicians of its clinical presentation and characteristics as a high index of clinical suspicion is required for an accurate diagnosis. PMID:27113794

  19. Automated beam placement for breast radiotherapy using a support vector machine based algorithm

    SciTech Connect

    Zhao Xuan; Kong, Dewen; Jozsef, Gabor; Chang, Jenghwa; Wong, Edward K.; Formenti, Silvia C.; Wang Yao

    2012-05-15

    Purpose: To develop an automated beam placement technique for whole breast radiotherapy using tangential beams. We seek to find optimal parameters for tangential beams to cover the whole ipsilateral breast (WB) and minimize the dose to the organs at risk (OARs). Methods: A support vector machine (SVM) based method is proposed to determine the optimal posterior plane of the tangential beams. Relative significances of including/avoiding the volumes of interests are incorporated into the cost function of the SVM. After finding the optimal 3-D plane that separates the whole breast (WB) and the included clinical target volumes (CTVs) from the OARs, the gantry angle, collimator angle, and posterior jaw size of the tangential beams are derived from the separating plane equation. Dosimetric measures of the treatment plans determined by the automated method are compared with those obtained by applying manual beam placement by the physicians. The method can be further extended to use multileaf collimator (MLC) blocking by optimizing posterior MLC positions. Results: The plans for 36 patients (23 prone- and 13 supine-treated) with left breast cancer were analyzed. Our algorithm reduced the volume of the heart that receives >500 cGy dose (V5) from 2.7 to 1.7 cm{sup 3} (p = 0.058) on average and the volume of the ipsilateral lung that receives >1000 cGy dose (V10) from 55.2 to 40.7 cm{sup 3} (p = 0.0013). The dose coverage as measured by volume receiving >95% of the prescription dose (V95%) of the WB without a 5 mm superficial layer decreases by only 0.74% (p = 0.0002) and the V95% for the tumor bed with 1.5 cm margin remains unchanged. Conclusions: This study has demonstrated the feasibility of using a SVM-based algorithm to determine optimal beam placement without a physician's intervention. The proposed method reduced the dose to OARs, especially for supine treated patients, without any relevant degradation of dose homogeneity and coverage in general.

  20. Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

    PubMed Central

    Richters, Lisa; Fridrich, Claudius; Markiefka, Birgid; Bongartz, Rudolf; Semrau, Robert; Mallmann, Peter; Kraemer, Stefan

    2014-01-01

    Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than “tumor not touching ink” leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT) can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy) in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer. PMID:25587453

  1. Postmastectomy radiotherapy for locally advanced breast cancer receiving neoadjuvant chemotherapy.

    PubMed

    Meattini, Icro; Cecchini, Sara; Di Cataldo, Vanessa; Saieva, Calogero; Francolini, Giulio; Scotti, Vieri; Bonomo, Pierluigi; Mangoni, Monica; Greto, Daniela; Nori, Jacopo; Orzalesi, Lorenzo; Casella, Donato; Simoncini, Roberta; Fambrini, Massimiliano; Bianchi, Simonetta; Livi, Lorenzo

    2014-01-01

    Neoadjuvant chemotherapy (NAC) is widely used in locally advanced breast cancer (BC) treatment. The role of postmastectomy radiotherapy (PMRT) after NAC is strongly debated. The aim of our analysis was to identify major prognostic factors in a single-center series, with emphasis on PMRT. From 1997 to 2011, 170 patients were treated with NAC and mastectomy at our center; 98 cases (57.6%) underwent PMRT and 72 cases (42.4%) did not receive radiation. At a median follow-up period of 7.7 years (range 2-16) for the whole cohort, median time to locoregional recurrence (LRR) was 3.3 years (range 0.7-12.4). The 5-year and 10-year actuarial LRR rate were 14.5% and 15.9%, respectively. At the multivariate analysis the factors that significantly correlated with survival outcome were ≥ 4 positive nodes (HR 5.0, 1.51-16.52; P = 0.035), extracapsular extension (HR 2.18, 1.37-3.46; P = 0.009), and estrogen receptor positive disease (HR 0.57, 0.36-0.90; P = 0.003). Concerning LRR according to use of radiation, PMRT reduced LRR for patient with clinical T3 staged disease (P = 0.015). Our experience confirmed the impact of pathological nodal involvement on survival outcome. PMRT was found to improve local control in patients presenting with clinical T3 tumors, regardless of the response to chemotherapy. PMID:25045694

  2. Intraoperative Radiotherapy Versus Whole-Breast External Beam Radiotherapy in Early-Stage Breast Cancer: A Systematic Review and Meta-Analysis.

    PubMed

    Zhang, Li; Zhou, Zhirui; Mei, Xin; Yang, Zhaozhi; Ma, Jinli; Chen, Xingxing; Wang, Junqi; Liu, Guangyu; Yu, Xiaoli; Guo, Xiaomao

    2015-07-01

    There has not been a clear answer about the efficacy of intraoperative radiotherapy (IORT) for women with early-stage breast cancer.The aim of this meta-analysis was to summarize the available evidence comparing the efficacy and safety of IORT with those of whole-breast external beam radiotherapy (EBRT) for women with early-stage breast cancer.MEDLINE, EMBASE, the Web of Science, and the Cochrane Library were searched up to October 2014. Two authors independently conducted the literature selection and data extraction.Studies that compared IORT with whole-breast EBRT were included in the systematic review. IORT was defined as a single dose of irradiation to the tumor bed during breast-conserving surgery rather than whole-breast irradiation.Qualities of RCTs were evaluated according to the PEDro scale. Qualities of non-RCTs were evaluated according to the Methodological Index for Non-Randomized Studies (MINORS). The risk ratios (RRs) of ipsilateral breast tumor recurrence, overall mortality, breast cancer mortality, non-breast cancer mortality, and distant metastasis were pooled using a random-effects model.Four studies with 5415 patients were included in this meta-analysis, including 2 randomized controlled trials (RCTs) and 2 non-RCTs. Ipsilateral breast tumor recurrence was significantly higher in patients with IORT compared to those with whole-breast EBRT (RR 2.83, 95% CI 1.23-6.51), but with significant heterogeneity (I = 58.5%, P = 0.065). Comparing IORT with whole-breast EBRT, the pooled RRs for overall mortality, breast cancer mortality, non-breast cancer mortality, and distant metastasis were 0.88 (95% CI: 0.66-1.17), 1.20 (95% CI: 0.77-1.86), 0.76 (95% CI: 0.44-1.31), and 0.95 (95% CI: 0.61-1.49), respectively.IORT had a significantly higher risk of ipsilateral breast tumor recurrence than whole-breast EBRT. Overall mortality did not differ significantly. IORT should be used in conjunction with the prudent selection of suitable patients. It is

  3. Association between adjuvant regional radiotherapy and cognitive function in breast cancer patients treated with conservation therapy

    PubMed Central

    Shibayama, Osamu; Yoshiuchi, Kazuhiro; Inagaki, Masatoshi; Matsuoka, Yutaka; Yoshikawa, Eisho; Sugawara, Yuriko; Akechi, Tatsuo; Wada, Noriaki; Imoto, Shigeru; Murakami, Koji; Ogawa, Asao; Akabayashi, Akira; Uchitomi, Yosuke

    2014-01-01

    Although protracted cognitive impairment has been reported to occur after radiotherapy even when such therapy is not directed to brain areas, the mechanism remains unclear. This study investigated whether breast cancer patients exposed to local radiotherapy showed lower cognitive function mediated by higher plasma interleukin (IL)-6 levels than those unexposed. We performed the Wechsler Memory Scale-Revised (WMS-R) and measured plasma IL-6 levels for 105 breast cancer surgical patients within 1 year after the initial therapy. The group differences in each of the indices of WMS-R were investigated between cancer patients exposed to adjuvant regional radiotherapy (n = 51) and those unexposed (n = 54) using analysis of covariance. We further investigated a mediation effect by plasma IL-6 levels on the relationship between radiotherapy and the indices of WMS-R using the bootstrapping method. The radiotherapy group showed significantly lower Immediate Verbal Memory Index and Delayed Recall Index (P = 0.001, P = 0.008, respectively). Radiotherapy exerted an indirect effect on the lower Delayed Recall Index of WMS-R through elevation of plasma IL-6 levels (bootstrap 95% confidence interval = −2.6626 to −0.0402). This study showed that breast cancer patients exposed to adjuvant regional radiotherapy in conservation therapy might have cognitive impairment even several months after their treatment. The relationship between the therapy and the cognitive impairment could be partially mediated by elevation of plasma IL-6 levels. PMID:24756915

  4. Baseline Utilization of Breast Radiotherapy Before Institution of the Medicare Practice Quality Reporting Initiative

    SciTech Connect

    Smith, Benjamin D. Smith, Grace L.; Roberts, Kenneth B.; Buchholz, Thomas A.

    2009-08-01

    Purpose: In 2007, Medicare implemented the Physician Quality Reporting Initiative (PQRI), which provides financial incentives to physicians who report their performance on certain quality measures. PQRI measure no. 74 recommends radiotherapy for patients treated with conservative surgery (CS) for invasive breast cancer. As a first step in evaluating the potential impact of this measure, we assessed baseline use of radiotherapy among women diagnosed with invasive breast cancer before implementation of PQRI. Methods and Materials: Using the SEER-Medicare data set, we identified women aged 66-70 diagnosed with invasive breast cancer and treated with CS between 2000 and 2002. Treatment with radiotherapy was determined using SEER and claims data. Multivariate logistic regression tested whether receipt of radiotherapy varied significantly across clinical, pathologic, and treatment covariates. Results: Of 3,674 patients, 94% (3,445) received radiotherapy. In adjusted analysis, the presence of comorbid illness (odds ratio [OR] 1.69; 95% confidence interval [CI], 1.19-2.42) and unmarried marital status were associated with omission of radiotherapy (OR 1.65; 95% CI, 1.22-2.20). In contrast, receipt of chemotherapy was protective against omission of radiotherapy (OR 0.25; 95% CI, 0.16-0.38). Race and geographic region did not correlate with radiotherapy utilization. Conclusions: Utilization of radiotherapy following CS was high for patients treated before institution of PQRI, suggesting that at most 6% of patients could benefit from measure no. 74. Further research is needed to determine whether institution of PQRI will affect radiotherapy utilization.

  5. Treatment of Breast and Prostate Cancer by Hypofractionated Radiotherapy: Potential Risks and Benefits.

    PubMed

    Ray, K J; Sibson, N R; Kiltie, A E

    2015-07-01

    Breast cancer and prostate cancer are the most common cancers diagnosed in women and men, respectively, in the UK, and radiotherapy is used extensively in the treatment of both. In vitro data suggest that tumours in the breast and prostate have unique properties that make a hypofractionated radiotherapy treatment schedule advantageous in terms of therapeutic index. Many clinical trials of hypofractionated radiotherapy treatment schedules have been completed to establish the extent to which hypofractionation can improve patient outcome. Here we present a concise description of hypofractionation, the mathematical description of converting between conventional and hypofractionated schedules, and the motivation for using hypofractionation in the treatment of breast and prostate cancer. Furthermore, we summarise the results of important recent hypofractionation trials and highlight the limitations of a hypofractionated treatment regimen. PMID:25752244

  6. Treatment of Breast and Prostate Cancer by Hypofractionated Radiotherapy: Potential Risks and Benefits

    PubMed Central

    Ray, K.J.; Sibson, N.R.; Kiltie, A.E.

    2015-01-01

    Breast cancer and prostate cancer are the most common cancers diagnosed in women and men, respectively, in the UK, and radiotherapy is used extensively in the treatment of both. In vitro data suggest that tumours in the breast and prostate have unique properties that make a hypofractionated radiotherapy treatment schedule advantageous in terms of therapeutic index. Many clinical trials of hypofractionated radiotherapy treatment schedules have been completed to establish the extent to which hypofractionation can improve patient outcome. Here we present a concise description of hypofractionation, the mathematical description of converting between conventional and hypofractionated schedules, and the motivation for using hypofractionation in the treatment of breast and prostate cancer. Furthermore, we summarise the results of important recent hypofractionation trials and highlight the limitations of a hypofractionated treatment regimen. PMID:25752244

  7. Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast.

    PubMed

    Correa, C; McGale, P; Taylor, C; Wang, Y; Clarke, M; Davies, C; Peto, R; Bijker, N; Solin, L; Darby, S

    2010-01-01

    Individual patient data were available for all four of the randomized trials that began before 1995, and that compared adjuvant radiotherapy vs no radiotherapy following breast-conserving surgery for ductal carcinoma in situ (DCIS). A total of 3729 women were eligible for analysis. Radiotherapy reduced the absolute 10-year risk of any ipsilateral breast event (ie, either recurrent DCIS or invasive cancer) by 15.2% (SE 1.6%, 12.9% vs 28.1% 2 P <.00001), and it was effective regardless of the age at diagnosis, extent of breast-conserving surgery, use of tamoxifen, method of DCIS detection, margin status, focality, grade, comedonecrosis, architecture, or tumor size. The proportional reduction in ipsilateral breast events was greater in older than in younger women (2P < .0004 for difference between proportional reductions; 10-year absolute risks: 18.5% vs 29.1% at ages <50 years, 10.8% vs 27.8% at ages ≥ 50 years) but did not differ significantly according to any other available factor. Even for women with negative margins and small low-grade tumors, the absolute reduction in the 10-year risk of ipsilateral breast events was 18.0% (SE 5.5, 12.1% vs 30.1%, 2P = .002). After 10 years of follow-up, there was, however, no significant effect on breast cancer mortality, mortality from causes other than breast cancer, or all-cause mortality. PMID:20956824

  8. Postmastectomy Radiotherapy for Locally Advanced Breast Cancer Receiving Neoadjuvant Chemotherapy

    PubMed Central

    Meattini, Icro; Di Cataldo, Vanessa; Saieva, Calogero; Francolini, Giulio; Scotti, Vieri; Bonomo, Pierluigi; Mangoni, Monica; Greto, Daniela; Nori, Jacopo; Orzalesi, Lorenzo; Casella, Donato; Simoncini, Roberta; Fambrini, Massimiliano; Bianchi, Simonetta; Livi, Lorenzo

    2014-01-01

    Neoadjuvant chemotherapy (NAC) is widely used in locally advanced breast cancer (BC) treatment. The role of postmastectomy radiotherapy (PMRT) after NAC is strongly debated. The aim of our analysis was to identify major prognostic factors in a single-center series, with emphasis on PMRT. From 1997 to 2011, 170 patients were treated with NAC and mastectomy at our center; 98 cases (57.6%) underwent PMRT and 72 cases (42.4%) did not receive radiation. At a median follow-up period of 7.7 years (range 2–16) for the whole cohort, median time to locoregional recurrence (LRR) was 3.3 years (range 0.7–12.4). The 5-year and 10-year actuarial LRR rate were 14.5% and 15.9%, respectively. At the multivariate analysis the factors that significantly correlated with survival outcome were ≥4 positive nodes (HR 5.0, 1.51–16.52; P = 0.035), extracapsular extension (HR 2.18, 1.37–3.46; P = 0.009), and estrogen receptor positive disease (HR 0.57, 0.36–0.90; P = 0.003). Concerning LRR according to use of radiation, PMRT reduced LRR for patient with clinical T3 staged disease (P = 0.015). Our experience confirmed the impact of pathological nodal involvement on survival outcome. PMRT was found to improve local control in patients presenting with clinical T3 tumors, regardless of the response to chemotherapy. PMID:25045694

  9. Impact of radiotherapy in the risk of esophageal cancer as subsequent primary cancer after breast cancer

    SciTech Connect

    Salminen, Eeva K. . E-mail: eevsal@utu.fi; Pukkala, Eero; Kiel, Krys D.; Hakulinen, Timo T.

    2006-07-01

    Purpose: To assess the risk of esophageal cancer as second cancer among breast-cancer patients treated with radiotherapy. Methods and Materials: The records of the Finnish Cancer Registry from 1953 to 2000 were used to assess the risk of esophageal cancer as second cancer among 75,849 breast-cancer patients. Patients were treated with surgery (n = 33,672), radiotherapy (n = 35,057), chemotherapy and radiotherapy (n = 4673), or chemotherapy (n = 2,447). The risk of a new primary cancer was expressed as standardized incidence ratio (SIR), defined as the ratio of observed to expected cases. Results: By the end of 2000, the number of observed cases esophageal cancers was 80 vs. 72 expected cases (standardized incidence ratio (SIR) = 1.1, 95% Confidence Interval (CI) = 0.9 to 1.5). Among patients followed for 15 years and treated with radiotherapy, the SIR for esophageal cancer was 2.3 (95% CI = 1.4 to 5.4). No increase in risk was seen for patients treated without radiotherapy. The risk of esophageal cancer was increased among patients diagnosed during 1953 to 1974, although age at the treatment did not have marked effect on the risk estimate. Conclusion: Increased risk of second cancer in the esophagus was observed for breast-cancer patients in Finland, especially among patients with over 15 years of follow-up and treated in the earliest period, which may relate to the type of radiotherapy.

  10. Intraoperative radiotherapy in early stage breast cancer: potential indications and evidence to date

    PubMed Central

    Kirby, A M

    2015-01-01

    Following early results of recent studies of intraoperative radiotherapy (IORT) in the adjuvant treatment of patients with early breast cancer, the clinical utility of IORT is a subject of much recent debate within the breast oncology community. This review describes the intraoperative techniques available, the potential indications and the evidence to date pertaining to local control and toxicity. We also discuss any implications for current practice and future research. PMID:25734489

  11. Image guidance during breast radiotherapy: a phantom dosimetry and radiation-induced second cancer risk study

    NASA Astrophysics Data System (ADS)

    Quinn, A.; Holloway, L.; Metcalfe, P.

    2013-06-01

    Imaging procedures utilised for patient position verification during breast radiotherapy can add a considerable dose to organs surrounding the target volume on top of therapeutic scatter dose. This study investigated the dose from a breast kilovoltage cone-beam CT (kV-CBCT), a breast megavoltage fan-beam CT (MV-FBCT), and a TomoDirectTM breast treatment. Thermoluminescent dosimeters placed within a female anthropomorphic phantom were utilised to measure the dose to various organs and tissues. The contralateral breast, lungs and heart received 0.40 cGy, 0.45 cGy and 0.40 cGy from the kV-CBCT and 1.74 cGy, 1.39 cGy and 1.73 cGy from the MV-FBCT. In comparison to treatment alone, daily imaging would increase the contralateral breast, contralateral lung and heart dose by a relative 12%, 24% and 13% for the kV-CBCT, and 52%, 101% and 58% for the MV-FBCT. The impact of the imaging dose relative to the treatment dose was assessed with linear and linear-quadratic radiation-induced secondary cancer risk models for the contralateral breast. The additional imaging dose and risk estimates presented in this study should be taken into account when considering an image modality and frequency for patient position verification protocols in breast radiotherapy.

  12. A Dosimetric Analysis of IMRT and Multistatic Fields Techniques for Left Breast Radiotherapy

    SciTech Connect

    Moon, Seong Kwon; Kim, Yeon Sil; Kim, Soo Young; Lee, Mi Jo; Keum, Hyun Sup; Kim, Seung Jin; Youn, Seon Min

    2011-10-01

    The purpose of this study was to analyze the dosimetric difference between intensity-modulated radiation therapy (IMRT) using 3 or 5 beams and multistatic field technique (MSF) in radiotherapy of the left breast. We made comparative analysis of two kinds of radiotherapy that can achieve improved dose homogeneity. First is a MSF that uses both major and small irradiation fields at the same time. The other is IMRT using 3 or 5 beams with an inverse planning system using multiple static multileaf collimators. We made treatment plans for 16 early left breast cancer patients who were randomly selected and had undergone breast conserving surgery and radiotherapy, and analyzed them in the dosimetric aspect. For the mean values of V{sub 95} and dose homogeneity index, no statistically significant difference was observed among the three therapies. Extreme hot spots receiving >110% of prescribed dose were not found in any of the three methods. Using Tukey's test, IMRT showed a significantly larger increase in exposure dose to the ipsilateral lung and the heart than MSF in the low-dose area, but in the high-dose area, MSF showed a slight increase. To improve dose homogeneity, the application of MSF, which can be easily planned and applied more widely, is considered optimal as an alternative to IMRT for radiotherapy of early left breast cancer.

  13. Application of radiation physics to improve dosimetry in early breast cancer radiotherapy

    SciTech Connect

    Donovan, Ellen Mary

    2005-07-15

    Radiotherapy for early breast cancer has been shown to be a highly effective treatment in a number of long term studies. The radiation dose uniformity of the current standard treatments is often poor, however, with dose variations across the breast much higher than those recommended in international guidelines. This work aimed to explore methods for improving this aspect of the radiation dosimetry of early breast cancer radiotherapy. An experimental method was validated by applying it to computed tomography data from 14 patients with a variety of breast shapes and sizes. The volume of the breast receiving the desired dose levels increased by a mean of 6.9% (range -0.8% to 15.9%) and this benefit was shown to increase with breast volume. The quality of reference images in the verification of treatments was improved by introducing differential filtering to the imaging beams on a radiotherapy simulator. The positive results from the first two studies were applied in a clinical trial (which used the experimental technique). The unique set of data from the trial was analyzed and confirmation of dosimetric improvement, and the increased benefit, for larger breasted women were found. In addition, an analysis of the position of high doses showed these occurred in the upper or lower third of the breast and affected 46% and 30% of patients, respectively, with standard treatment but only 1% of patients with the improved method. Other published methods for improving breast dosimetry were explored by building a simple physical model and carrying out a comparative planning study. The physical model was shown to be effective in predicting the dosimetric consequences of each method. The planning study showed that there was little difference between the methods generally but dosimetric improvement could be increased for larger breast volumes by an appropriate choice of technique. A final study explored how breathing control could be used to reduce cardiac doses in patients with

  14. Dosimetric Comparison Between 3-Dimensional Conformal and Robotic SBRT Treatment Plans for Accelerated Partial Breast Radiotherapy.

    PubMed

    Goggin, L M; Descovich, M; McGuinness, C; Shiao, S; Pouliot, J; Park, C

    2016-06-01

    Accelerated partial breast irradiation is an attractive alternative to conventional whole breast radiotherapy for selected patients. Recently, CyberKnife has emerged as a possible alternative to conventional techniques for accelerated partial breast irradiation. In this retrospective study, we present a dosimetric comparison between 3-dimensional conformal radiotherapy plans and CyberKnife plans using circular (Iris) and multi-leaf collimators. Nine patients who had undergone breast-conserving surgery followed by whole breast radiation were included in this retrospective study. The CyberKnife planning target volume (PTV) was defined as the lumpectomy cavity + 10 mm + 2 mm with prescription dose of 30 Gy in 5 fractions. Two sets of 3-dimensional conformal radiotherapy plans were created, one used the same definitions as described for CyberKnife and the second used the RTOG-0413 definition of the PTV: lumpectomy cavity + 15 mm + 10 mm with prescription dose of 38.5 Gy in 10 fractions. Using both PTV definitions allowed us to compare the dose delivery capabilities of each technology and to evaluate the advantage of CyberKnife tracking. For the dosimetric comparison using the same PTV margins, CyberKnife and 3-dimensional plans resulted in similar tumor coverage and dose to critical structures, with the exception of the lung V5%, which was significantly smaller for 3-dimensional conformal radiotherapy, 6.2% when compared to 39.4% for CyberKnife-Iris and 17.9% for CyberKnife-multi-leaf collimator. When the inability of 3-dimensional conformal radiotherapy to track motion is considered, the result increased to 25.6%. Both CyberKnife-Iris and CyberKnife-multi-leaf collimator plans demonstrated significantly lower average ipsilateral breast V50% (25.5% and 24.2%, respectively) than 3-dimensional conformal radiotherapy (56.2%). The CyberKnife plans were more conformal but less homogeneous than the 3-dimensional conformal radiotherapy plans. Approximately 50% shorter

  15. Breast-Conserving Therapy: Radiotherapy Margins for Breast Tumor Bed Boost

    SciTech Connect

    Topolnjak, Rajko; Vliet-Vroegindeweij, Corine van; Sonke, Jan-Jakob; Minkema, Danny; Remeijer, Peter; Nijkamp, Jasper; Elkhuizen, Paula

    2008-11-01

    Purpose: To quantify the interfraction position variability of the excision cavity (EC) and to compare the rib and breast surface as surrogates for the cavity. Additionally, we sought to determine the required margin for on-line, off-line and no correction protocols in external beam radiotherapy. Methods and Materials: A total of 20 patients were studied who had been treated in the supine position for 28 daily fractions. Cone-beam computed tomography scans were regularly acquired according to a shrinking action level setup correction protocol based on bony anatomy registration of the ribs and sternum. The position of the excision area was retrospectively analyzed by gray value cone-beam computed tomography-to-computed tomography registration. Subsequently, three setup correction strategies (on-line, off-line, and no corrections) were applied, according to the rib and breast surface registrations, to estimate the residual setup errors (systematic [{sigma}] and random [{sigma}]) of the excision area. The required margins were calculated using a margin recipe. Results: The image quality of the cone-beam computed tomography scans was sufficient for localization of the EC. The margins required for the investigated setup correction protocols and the setup errors for the left-right, craniocaudal and anteroposterior directions were 8.3 mm ({sigma} = 3.0, {sigma} = 2.6), 10.6 mm ({sigma} = 3.8, {sigma} = 3.2), and 7.7 mm ({sigma} = 2.7, {sigma} = 2.9) for the no correction strategy; 5.6 mm ({sigma} = 2.0, {sigma} = 1.8), 6.5 mm ({sigma} = 2.3, {sigma} = 2.3), and 4.5 mm ({sigma} = 1.5, {sigma} = 1.9) for the on-line rib strategy; and 5.1 mm ({sigma} = 1.8, {sigma} = 1.7), 4.8 mm ({sigma} = 1.7, {sigma} = 1.6), and 3.3 mm ({sigma} = 1.1, {sigma} = 1.6) for the on-line surface strategy, respectively. Conclusion: Considerable geometric uncertainties in the position of the EC relative to the bony anatomy and breast surface have been observed. By using registration of the breast

  16. Left-sided breast cancer irradiation using rotational and fixed-field radiotherapy

    SciTech Connect

    Qi, X. Sharon; Liu, Tian X.; Liu, Arthur K.; Newman, Francis; Rabinovitch, Rachel; Kavanagh, Brian; Hu, Y. Angie

    2014-10-01

    The 3-dimensional conformal radiotherapy (3DCRT) technique is the standard for breast cancer radiotherapy. During treatment planning, not only the coverage of the planning target volume (PTV) but also the minimization of the dose to critical structures, such as the lung, heart, and contralateral breast tissue, need to be considered. Because of the complexity and variations of patient anatomy, more advanced radiotherapy techniques are sometimes desired to better meet the planning goals. In this study, we evaluated external-beam radiation treatment techniques for left breast cancer using various delivery platforms: fixed-field including TomoDirect (TD), static intensity-modulated radiotherapy (sIMRT), and rotational radiotherapy including Elekta volumetric-modulated arc therapy (VMAT) and tomotherapy helical (TH). A total of 10 patients with left-sided breast cancer who did or did not have positive lymph nodes and were previously treated with 3DCRT/sIMRT to the entire breast were selected, their treatment was planned with Monaco VMAT, TD, and TH. Dosimetric parameters including PTV coverage, organ-at-risk (OAR) sparing, dose-volume histograms, and target minimum/maximum/mean doses were evaluated. It is found that for plans providing comparable PTV coverage, the Elekta VMAT plans were generally more inhomogeneous than the TH and TD plans. For the cases with regional node involvement, the average mean doses administered to the heart were 9.2 (± 5.2) and 8.8 (± 3.0) Gy in the VMAT and TH plans compared with 11.9 (± 6.4) and 11.8 (± 9.2) Gy for the 3DCRT and TD plans, respectively, with slightly higher doses given to the contralateral lung or breast or both. On average, the total monitor units for VMAT plans are 11.6% of those TH plans. Our studies have shown that VMAT and TH plans offer certain dosimetric advantages over fixed-field IMRT plans for advanced breast cancer requiring regional nodal treatment. However, for early-stage breast cancer fixed

  17. Tangential Radiotherapy Without Axillary Surgery in Early-Stage Breast Cancer: Results of a Prospective Trial

    SciTech Connect

    Wong, Julia S.; Winer, Eric P.

    2008-11-01

    Purpose: To determine the risk of regional-nodal recurrence in patients with early-stage, invasive breast cancer, with clinically negative axillary nodes, who were treated with breast-conserving surgery, 'high tangential' breast radiotherapy, and hormonal therapy, without axillary surgery or the use of a separate nodal radiation field. Methods and Materials: Between September 1998 and November 2003, 74 patients who were {>=}55 years of age with Stage I-II clinically node-negative, hormone-receptor-positive breast cancer underwent tumor excision to negative margins without axillary surgery as a part of a multi-institutional prospective study. Postoperatively, all underwent high-tangential, whole-breast radiotherapy with a boost to the tumor bed, followed by 5 years of hormonal therapy. Results: For the 74 patients enrolled, the median age was 74.5 years, and the median pathologic tumor size was 1.2 cm. Lymphatic vessel invasion was present in 5 patients (7%). At a median follow-up of 52 months, no regional-nodal failures or ipsilateral breast recurrences had been identified (95% confidence interval, 0-4%). Eight patients died, one of metastatic disease and seven of other causes. Conclusion: In this select group of mainly older patients with early-stage hormone-responsive breast cancer and clinically negative axillary nodes, treatment with high-tangential breast radiotherapy and hormonal therapy, without axillary surgery, yielded a low regional recurrence rate. Such patients might be spared more extensive axillary treatment (axillary surgery, including sentinel node biopsy, or a separate nodal radiation field), with its associated time, expense, and morbidity.

  18. High-Grade Breast Epithelioid Angiosarcoma Secondary to Radiotherapy Metastasizing to the Contralateral Lymph Node: Unusual Presentation and Potential Pitfall.

    PubMed

    Cunha, Ana Luísa; Amendoeira, Isabel

    2011-01-01

    BACKGROUND: Breast angiosarcoma is a rare disease occurring as primary tumour or secondary to lymphoedema or radiotherapy. The more frequent use of breast-conserving therapy and radiotherapy for breast carcinoma explains the increasing diagnosis of these tumours. CASE REPORT: We report a case of a breast epithelioid angiosarcoma which metastasized to the contralateral axillary lymph node, occurring 4 years after breast-conserving therapy with axillary lymph node dissection and radiotherapy. The patient presented skin lesions and an axillary lump (clinically diagnosed as carcinoma relapse and lymph node metastasis). Fine-needle cytology on both lesions and a core needle biopsy of the axillary lump were carried out. Differential diagnosis included carcinoma, malignant melanoma, and angiosarcoma. Immunohistochemistry confirmed the diagnosis of angiosarcoma. CONCLUSIONS: Breast angiosarcoma is a challenge - clinically, radiologically and pathologically - and requires a high index of suspicion in susceptible patients. PMID:21779229

  19. Predictors for Clinical Outcomes After Accelerated Partial Breast Intensity-Modulated Radiotherapy

    SciTech Connect

    Reeder, Reed; Carter, Dennis L. Howell, Kathryn; Henkenberns, Phyllis; Tallhamer, Michael; Johnson, Tim; Kercher, Jane; Widner, Jodi; Kaske, Terese; Paul, Devchand; Sedlacek, Scot; Leonard, Charles E.

    2009-05-01

    Purpose: To correlate the treatment planning parameters with the clinical outcomes in patients treated with accelerated partial breast intensity-modulated radiotherapy. Methods and Materials: A total of 105 patients with Stage I breast cancer were treated between February 2004 and March 2007 in a Phase II prospective trial and had detailed information available on the planning target volume (PTV), ipsilateral breast volume (IBV), PTV/IBV ratio, lung volume, chest wall volume, surgery to radiotherapy interval, follow-up interval, breast pain, and cosmesis. The first 7 of these patients were treated to 34 Gy, and the remaining 98 were treated to 38.5 Gy. All patients were treated twice daily for 5 consecutive days. Univariate and multivariate analyses were performed. Results: The median follow-up was 13 months. No recurrences or deaths were observed. Of the 105 patients, 30 reported mild or moderate breast pain in their most recently recorded follow-up visit. The irradiated lung volume (p < 0.05) and chest wall volume receiving >35 Gy (p < 0.01) were associated with pain. The PTV, but not the PTV/IBV ratio, also correlated with pain (p < 0.01 and p = 0.42, respectively). A total of 72 patients reported excellent, 32 reported good, and 1 reported poor cosmesis. Physician-rated cosmesis reported 90 excellent and 15 good. None of the tested variables correlated with the cosmetic outcomes. Conclusion: Radiotherapy to the chest wall (chest wall volume receiving >35 Gy) and to lung correlated with reports of mild pain after accelerated partial breast intensity-modulated radiotherapy. Also, the PTV, but not the PTV/IBV ratio, was predictive of post-treatment reports of pain.

  20. Intensity-Modulated Radiotherapy Results in Significant Decrease in Clinical Toxicities Compared With Conventional Wedge-Based Breast Radiotherapy

    SciTech Connect

    Harsolia, Asif; Kestin, Larry; Grills, Inga; Wallace, Michelle; Jolly, Shruti; Jones, Cortney; Lala, Moinaktar; Martinez, Alvaro; Schell, Scott; Vicini, Frank A. . E-mail: fvicini@beaumont.edu

    2007-08-01

    Purpose: We have previously demonstrated that intensity-modulated radiotherapy (IMRT) with a static multileaf collimator process results in a more homogenous dose distribution compared with conventional wedge-based whole breast irradiation (WBI). In the present analysis, we reviewed the acute and chronic toxicity of this IMRT approach compared with conventional wedge-based treatment. Methods and Materials: A total of 172 patients with Stage 0-IIB breast cancer were treated with lumpectomy followed by WBI. All patients underwent treatment planning computed tomography and received WBI (median dose, 45 Gy) followed by a boost to 61 Gy. Of the 172 patients, 93 (54%) were treated with IMRT, and the 79 patients (46%) treated with wedge-based RT in a consecutive fashion immediately before this cohort served as the control group. The median follow-up was 4.7 years. Results: A significant reduction in acute Grade 2 or worse dermatitis, edema, and hyperpigmentation was seen with IMRT compared with wedges. A trend was found toward reduced acute Grade 3 or greater dermatitis (6% vs. 1%, p = 0.09) in favor of IMRT. Chronic Grade 2 or worse breast edema was significantly reduced with IMRT compared with conventional wedges. No difference was found in cosmesis scores between the two groups. In patients with larger breasts ({>=}1,600 cm{sup 3}, n = 64), IMRT resulted in reduced acute (Grade 2 or greater) breast edema (0% vs. 36%, p <0.001) and hyperpigmentation (3% vs. 41%, p 0.001) and chronic (Grade 2 or greater) long-term edema (3% vs. 30%, p 0.007). Conclusion: The use of IMRT in the treatment of the whole breast results in a significant decrease in acute dermatitis, edema, and hyperpigmentation and a reduction in the development of chronic breast edema compared with conventional wedge-based RT.

  1. Breast cancer after radiotherapy for skin hemangioma in infancy

    SciTech Connect

    Lundell, M.; Mattsson, A.; Hakulinen, T.; Holm, L.E.

    1996-02-01

    Between 1920 and 1959, 9675 women were irradiated in infancy for skin hemangioma at Radiumhemmet, Stockholm. They were exposed to low to moderate doses of ionizing radiation. The mean age at first exposure was 6 months and the mean absorbed dose to the breast anlage was 0.39 Gy (range < 0.01-35.8 Gy). The breast cancer incidence was analyzed by record linkage with the Swedish Cancer Register for the period 1958-1986. Seventy-five breast cancers were found after a mean absorbed dose of 1.5 Gy in the breasts with cancer. The analyses showed a significant dose-response relationship with a linear model estimate for the excess relative risk (ERR) of 0.38 at 1 Gy (95% CI 0.09-0.85). This relationship was not modified significantly by age at exposure or by dose to the ovaries. The ERR increased significantly with time after exposure and for > 50 years after exposure the ERR at 1 Gy was 2.25 (95% CI 0.59-5.62). The fitted excess absolute risk (EAR) was 22.9 per 10{sup 4} breast-year gray. The breast absorbed dose and time after exposure were important risk determinants for breast cancer excess risk. Forty to 50 years of follow-up was necessary for the excess risk to be expressed. The study confirms previous findings that the breast anlage of female infants is sensitive to ionizing radiation. 17 refs., 6 figs.

  2. Toxicity of Three-Dimensional Conformal Radiotherapy for Accelerated Partial Breast Irradiation

    SciTech Connect

    Hepel, Jaroslaw T.; Tokita, Mari; MacAusland, Stephanie G.; Evans, Suzanne B.; Hiatt, Jessica R.; Price, Lori Lyn; DiPetrillo, Thomas; Wazer, David E.

    2009-12-01

    Purpose: To assess the incidence and severity of late normal tissue toxicity using three-dimensional conformal radiotherapy to deliver accelerated partial breast irradiation. Methods and Materials: A total of 60 patients were treated with three-dimensional conformal radiotherapy for accelerated partial breast irradiation. Treatment planning and delivery were in strict accordance with the technique and specified dose-volume constraints of the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 protocol. Late toxicity was evaluated according to the Radiation Therapy Oncology Group grading schema. The cosmetic outcome was scored using the Harvard criteria. Univariate logistic regression analysis was performed to evaluate the correlation of dosimetric variables with outcome. Results: At a median follow-up of 15 months, moderate-to-severe late toxicity developed in 10% of patients. The most pronounced late toxicity was subcutaneous fibrosis: 25% Grade 2-4 and 8.3% Grade 3-4. The modified planning tumor volume/whole breast volume ratio, ratio of the volume of breast tissue receiving 5%, 20%, 50%, and 80% of the prescription dose to the whole breast volume, and maximal dose within the breast correlated with the development of fibrosis (p = .10, p = .03, p = .04, p = .06, p = .09, and p = .046, respectively). The overall cosmetic outcome was good to excellent in 81.7%, fair in 11.7%, and poor in 6.7%. The presence of subcutaneous fibrosis, modified planning tumor volume/whole breast volume ratio, ratio of the volume of breast tissue receiving 5% and 20% of the prescription dose to the whole breast volume, and pathologic specimen volume correlated with the risk of a fair/poor cosmetic outcome (p < .001, p = .02, p = .05, p = .04, p = .01, respectively). Conclusion: The three-dimensional conformal radiotherapy technique for accelerated partial breast irradiation as specified in the National Surgical Adjuvant Breast and Bowel Project

  3. GammaPod-A new device dedicated for stereotactic radiotherapy of breast cancer

    SciTech Connect

    Yu, Cedric X.; Shao Xinyu; Deng Jianchun; Duan Zhengcheng; Zhang Jin; Zheng, Mike; Yu, Ying S.; Regine, William

    2013-05-15

    Purpose: This paper introduces a new external beam radiotherapy device named GammaPod that is dedicated for stereotactic radiotherapy of breast cancer. Methods: The design goal of the GammaPod as a dedicated system for treating breast cancer is the ability to deliver ablative doses with sharp gradients under stereotactic image guidance. Stereotactic localization of the breast is achieved by a vacuum-assisted breast immobilization cup with built-in stereotactic frame. Highly focused radiation is achieved at the isocenter due to the cross-firing from 36 radiation arcs generated by rotating 36 individual Cobalt-60 beams. The dedicated treatment planning system optimizes an optimal path of the focal spot using an optimization algorithm borrowed from computational geometry such that the target can be covered by 90%-95% of the prescription dose and the doses to surrounding tissues are minimized. The treatment plan is intended to be delivered with continuous motion of the treatment couch. In this paper the authors described in detail the gamma radiation unit, stereotactic localization of the breast, and the treatment planning system of the GammaPod system. Results: A prototype GammaPod system was installed at University of Maryland Medical Center and has gone through a thorough functional, geometric, and dosimetric testing. The mechanical and functional performances of the system all meet the functional specifications. Conclusions: An image-guided breast stereotactic radiotherapy device, named GammaPod, has been developed to deliver highly focused and localized doses to a target in the breast under stereotactic image guidance. It is envisioned that the GammaPod technology has the potential to significantly shorten radiation treatments and even eliminate surgery by ablating the tumor and sterilizing the tumor bed simultaneously.

  4. Characterization of Target Volume Changes During Breast Radiotherapy Using Implanted Fiducial Markers and Portal Imaging

    SciTech Connect

    Harris, Emma J. Donovan, Ellen M.; Yarnold, John R.; Coles, Charlotte E.; Evans, Philip M.

    2009-03-01

    Purpose: To determine target volume changes by using volume and shape analysis for patients receiving radiotherapy after breast conservation surgery and to compare different methods of automatically identifying changes in target volume, position, size, and shape during radiotherapy for use in adaptive radiotherapy. Methods and Materials: Eleven patients undergoing whole breast radiotherapy had fiducial markers sutured into the excision cavity at the time of surgery. Patients underwent imaging using computed tomography (for planning and at the end of treatment) and during treatment by using portal imaging. A marker volume (MV) was defined by using the measured marker positions. Changes in both individual marker positions and MVs were identified manually and using six automated similarity indices. Comparison of the two types of analysis (manual and automated) was undertaken to establish whether similarity indices can be used to automatically detect changes in target volumes. Results: Manual analysis showed that 3 patients had significant MV reduction. This analysis also showed significant changes between planning computed tomography and the start of treatment for 9 patients, including single and multiple marker movement, deformation (shape change), and rotation. Four of the six similarity indices were shown to be sensitive to the observed changes. Conclusions: Significant changes in size, shape, and position occur to the fiducial marker-defined volume. Four similarity indices can be used to identify these changes, and a protocol for their use in adaptive radiotherapy is suggested.

  5. Radiation Pneumonitis After Conventional Radiotherapy For Breast Cancer: A Prospective Study

    PubMed Central

    Isiah, Rajesh; Subhashini, J; Backianathan, Selvamani; Thangakunam, Balamugesh; Christopher, Devasagayam J

    2015-01-01

    Background Loco-regional radiotherapy is an important treatment modality in breast cancer and radiation pneumonitis (RP) is one of the early toxicities. Aim To study the occurrence, correlation of RP with patient and radiotherapy related factors and the effects on pulmonary function following conventional radiotherapy in breast cancer. Settings and Design Prospective study, from a tertiary hospital in a developing country. Materials and Methods Prospective analysis of clinical symptoms, pulmonary function and radiologic changes was done prior to and 12 weeks after adjuvant radiotherapy (n=46). Statistical analysis was done using SPSS version 10 software. Results Radiological and clinical RP was seen in 45.65% (n=21) and 19.56% (n=9) respectively. RP was significantly higher with age >50 years (OR 4.4), chest wall irradiation with electrons, (electrons 83.3% vs cobalt60 32.4%, p=0.02) and supraclavicular field treatment with 6 MV photons (p= 0.011). There was significant relationship between Inferior Lung Distance (ILD) and RP (p=0.013). The fall in Total Lung Capacity (TLC) was significantly more in those with RP (p=0.02). Conclusion Clinical RP occurs in almost one-fifth of breast cancer patients treated with conventional radiotherapy. Chest wall irradiation with electrons, supraclavicular field irradiation with 6 MV photons, higher ILD and age >50 years was associated with increased RP. The pulmonary function parameter most affected was TLC. The factors associated with increased RP should be considered when adjuvant radiotherapy is planned to minimize its likelihood and intervene appropriately. PMID:26393189

  6. Incidence of new primary cancers after adjuvant tamoxifen therapy and radiotherapy for early breast cancer

    SciTech Connect

    Andersson, M.; Storm, H.H.; Mouridsen, H.T. )

    1991-07-17

    The incidence of new primary cancers was evaluated in 3538 postmenopausal patients who had received surgical treatment for primary breast cancer. Of these patients, 1828 with a low risk of recurrence received no further treatment. High-risk patients were randomly assigned to one of two groups. The first group (n = 846) received postoperative radiotherapy, while the second group (n = 864) received radiotherapy plus tamoxifen at a dose of 30 mg given daily for 48 weeks. The median observation time was 7.9 years. In comparison with the number of new cancers in the general population, the number of new cancers in the three groups was elevated mostly due to a high number of cancers of the contralateral breast and of colorectal cancers in the high-risk groups. The cumulative risk of nonlymphatic leukemia was increased among patients who received postoperative radiotherapy (P = .04). Cancer incidence in the high-risk tamoxifen-treated group relative to that in the high-risk group not treated with tamoxifen was not significant (1.3). No protective effect of tamoxifen on the opposite breast was seen (rate ratio for breast cancer = 1.1), but a tendency to an elevated risk of endometrial cancer was observed (rate ratio = 3.3; 95% confidence interval = 0.6-32.4). Continued and careful follow-up of women treated with tamoxifen is necessary to clarify the potential cancer-suppressive or cancer-promoting effects of this drug.

  7. Bilateral orbital metastases from breast cancer: a case report of successful palliation using stereotactic radiotherapy.

    PubMed

    Kim, Jin Ho; Choi, Sang Yul; Cho, Chul Koo; Yang, Kwang Mo; Noh, Woo Chul; Kim, Mi-Sook

    2011-01-01

    Of ophthalmic involvement from metastatic breast cancer, extraocular/intraorbital metastases are extremely rare. External beam radiotherapy has been a mainstay palliation for symptomatic orbital metastases. We present a case of bilateral orbital metastases from breast cancer successfully treated with stereotactic radiotherapy (SRT). A 38-year-old woman presented with decreased vision in the right eye for 3 weeks. Eight months previously, she underwent whole-brain radiotherapy for multiple brain metastases from breast cancer. Visual acuity was hand motion, and the eyelid closed incompletely in the affected eye. Computed tomography scans showed a 3-cm extraconal mass in the right orbit. She underwent temporary tarsorrhaphy followed by SRT. A total dose of 39 Gy was delivered to the right orbital mass in three daily fractions. Four months later, her visual function was normal in both eyes and the right orbital mass disappeared. A new lesion was detected in the left orbit. She underwent SRT for the left orbital lesion using the same dose-fractionation schedule. No radiation-related toxicities were observed. She died 19 months after the first SRT. Our case suggests that SRT may be an effective and safe treatment option in patients with orbital metastases from breast cancer. PMID:21999613

  8. The choice of multi-beam IMRT for whole breast radiotherapy in early-stage right breast cancer.

    PubMed

    Haciislamoglu, Emel; Colak, Fatma; Canyilmaz, Emine; Zengin, Ahmet Yasar; Yilmaz, Ahmet Hakan; Yoney, Adnan; Bahat, Zumrut

    2016-01-01

    The aim of this study was to identify a rational strategy for the selection of multi-beam IMRT in patients with right breast cancer through the comparison of dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) using five different radiotherapy modalities. This was a retrospective study using computed tomography scans from ten patients with early-stage right breast cancer who had been treated previously. Three dimensional conformal radiotherapy (3DCRT), forward-planned IMRT (for-IMRT), inverse-planned IMRT (inv-IMRT), helical tomotherapy (HT), and volumetric-modulated arc therapy (VMAT) were planned for each patient. The plans were compared according to dose-volume histogram analysis. The most significant impact of inverse-planned multi-beam modalities for right breast cancer was the reduction of Dmax, Dmean, V53.5 and prescribed dose volume (cc) outside of the PTV (breast) (OB-V50) of the PTV. HT decreased the ipsilateral OAR volumes receiving higher doses. In exchange, HT also increased the volumes receiving low doses, which is known to lead to an increased rate of radiation-induced secondary malignancies. The heart, LAD, and contralateral doses for 3DCRT and for-IMRT were significantly lower than those for inv-IMRT, HT, and VMAT. In addition, inv-IMRT demonstrated an increase in exposed volume of heart, LAD, ipsilateral lung, and contralateral lung compared with those parameters for HT or VMAT. Although it is known to reduce cardiac toxicity with breath hold technique in left sided breast cancer, similarly it is possible for 3DCRT and for-IMRT techniques in right sided breast cancer even in free breathing. PMID:27350922

  9. A Phase II Study of Radiotherapy and Concurrent Paclitaxel Chemotherapy in Breast-Conserving Treatment for Node-Positive Breast Cancer

    SciTech Connect

    Chen, William C.; Kim, Janice; Kim, Edward; Silverman, Paula; Overmoyer, Beth; Cooper, Brenda W.; Anthony, Sue; Shenk, Robert; Leeming, Rosemary; Hanks, Shelli H.; Lyons, Janice A.

    2012-01-01

    Purpose: Administering adjuvant chemotherapy before breast radiotherapy decreases the risk of systemic recurrence, but delays in radiotherapy could yield higher local failure. We assessed the feasibility and efficacy of placing radiotherapy earlier in the breast-conserving treatment course for lymph node-positive breast cancer. Methods and Materials: Between June 2000 and December 2004, 44 women with node-positive Stage II and III breast cancer were entered into this trial. Breast-conserving surgery and 4 cycles of doxorubicin (60 mg/m{sup 2})/cyclophosphamide (600 mg/m{sup 2}) were followed by 4 cycles of paclitaxel (175 mg/m{sup 2}) delivered every 3 weeks. Radiotherapy was concurrent with the first 2 cycles of paclitaxel. The breast received 39.6 Gy in 22 fractions with a tumor bed boost of 14 Gy in 7 fractions. Regional lymphatics were included when indicated. Functional lung volume was assessed by use of the diffusing capacity for carbon monoxide as a proxy. Breast cosmesis was evaluated with the Harvard criteria. Results: The 5-year actuarial rate of disease-free survival is 88%, and overall survival is 93%. There have been no local failures. Median follow-up is 75 months. No cases of radiation pneumonitis developed. There was no significant change in the diffusing capacity for carbon monoxide either immediately after radiotherapy (p = 0.51) or with extended follow-up (p = 0.63). Volume of irradiated breast tissue correlated with acute cosmesis, and acute Grade 3 skin toxicity developed in 2 patients. Late cosmesis was not adversely affected. Conclusions: Concurrent paclitaxel chemotherapy and radiotherapy after breast-conserving surgery shortened total treatment time, provided excellent local control, and was well tolerated.

  10. Dose calculation accuracies in whole breast radiotherapy treatment planning: a multi-institutional study.

    PubMed

    Hatanaka, Shogo; Miyabe, Yuki; Tohyama, Naoki; Kumazaki, Yu; Kurooka, Masahiko; Okamoto, Hiroyuki; Tachibana, Hidenobu; Kito, Satoshi; Wakita, Akihisa; Ohotomo, Yuko; Ikagawa, Hiroyuki; Ishikura, Satoshi; Nozaki, Miwako; Kagami, Yoshikazu; Hiraoka, Masahiro; Nishio, Teiji

    2015-07-01

    Our objective in this study was to evaluate the variation in the doses delivered among institutions due to dose calculation inaccuracies in whole breast radiotherapy. We have developed practical procedures for quality assurance (QA) of radiation treatment planning systems. These QA procedures are designed to be performed easily at any institution and to permit comparisons of results across institutions. The dose calculation accuracy was evaluated across seven institutions using various irradiation conditions. In some conditions, there was a >3 % difference between the calculated dose and the measured dose. The dose calculation accuracy differs among institutions because it is dependent on both the dose calculation algorithm and beam modeling. The QA procedures in this study are useful for verifying the accuracy of the dose calculation algorithm and of the beam model before clinical use for whole breast radiotherapy. PMID:25646770

  11. Skin-sparing Helical Tomotherapy vs 3D-conformal Radiotherapy for Adjuvant Breast Radiotherapy: In Vivo Skin Dosimetry Study

    SciTech Connect

    Capelle, Lisa; Warkentin, Heather; MacKenzie, Marc; Joseph, Kurian; Gabos, Zsolt; Pervez, Nadeem; Tankel, Keith; Chafe, Susan; Amanie, John; Ghosh, Sunita; Parliament, Matthew; Abdulkarim, Bassam

    2012-08-01

    Purpose: We investigated whether treatment-planning system (TPS)-calculated dose accurately reflects skin dose received for patients receiving adjuvant breast radiotherapy (RT) with standard three-dimensional conformal RT (3D-CRT) or skin-sparing helical tomotherapy (HT). Methods and Materials: Fifty patients enrolled in a randomized controlled trial investigating acute skin toxicity from adjuvant breast RT with 3D-CRT compared to skin-sparing HT, where a 5-mm strip of ipsilateral breast skin was spared. Thermoluminescent dosimetry or optically stimulated luminescence measurements were made in multiple locations and were compared to TPS-calculated doses. Skin dosimetric parameters and acute skin toxicity were recorded in these patients. Results: With HT there was a significant correlation between calculated and measured dose in the medial and lateral ipsilateral breast (r = 0.67, P<.001; r = 0.44, P=.03, respectively) and the medial and central contralateral breast (r = 0.73, P<.001; r = 0.88, P<.001, respectively). With 3D-CRT there was a significant correlation in the medial and lateral ipsilateral breast (r = 0.45, P=.03; r = 0.68, P<.001, respectively); the medial and central contralateral breast (r = 0.62, P=.001; r = 0.86, P<.001, respectively); and the mid neck (r = 0.42, P=.04, respectively). On average, HT-calculated dose overestimated the measured dose by 14%; 3D-CRT underestimated the dose by 0.4%. There was a borderline association between highest measured skin dose and moist desquamation (P=.05). Skin-sparing HT had greater skin homogeneity (homogeneity index of 1.39 vs 1.65, respectively; P=.005) than 3D-CRT plans. HT plans had a lower skin{sub V50} (1.4% vs 5.9%, respectively; P=.001) but higher skin{sub V40} and skin{sub V30} (71.7% vs 64.0%, P=.02; and 99.0% vs 93.8%, P=.001, respectively) than 3D-CRT plans. Conclusion: The 3D-CRT TPS more accurately reflected skin dose than the HT TPS, which tended to overestimate dose received by 14% in patients

  12. Conservative surgery followed by radical radiotherapy in the management of stage I carcinoma of the breast

    SciTech Connect

    Baeza, M.R.; Arraztoa, J.; Sole, J.; Rodriguez, R.

    1982-10-01

    Since October 1976, the treatment policy in our Radiotherapy Center for Stage I carcinoma of the breast has been excision of the tumor mass, when it was cosmetically suitable, followed by irradiation to the breast and peripheral lymphatics. Eighty-three patients were admitted between October 1976 and March 1980. They underwent local excision of the tumor and then received 5000 rad in 5 weeks to the breast, supraclavicular, axillary and internal mammary chain lymph nodes. Each field was treated every day. A boost was then given to the scar, bringing the dose up to 6500 rad, calculated at maximum tumor depth, depending upon the size of the tumor prior to surgery. Cosmetic results were quite good, and the local control rate at 54 months is 98%. The survival with no evidence of disease (NED) at 54 months (acturarial) is 83%. There have been 10 failures: 8 distant, 1 local (in axilla, controlled by surgery, actually NED), and 1 local and distant (scar and brain). Both failures were found with 12 months after treatment, and 8/10 of the failures within 24 months. Twenty-one out of 83 patients have had complications (25.3%); of these, 28.8% were surgical and the remainder resulted from radiotherapy after surgery, either from radiotherapy alone or from combination of treatments. Of the total of 21 complications 18 were mild and 3 were serious. Of those 3 serious complications (3.6%), 2 were a result of radiotherapy, and one because an ill-advised axillary dissection prior to radiotherapy gave a negative axilla and a serious arm edema and painful shoulder. This was the worst complication in the total of 83 patients. These results compare favorably with the results achieved in the same Hospital with radical surgery as far as local tumor control and survival with no evidence of disease (NED) is concerned.

  13. Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

    SciTech Connect

    Vaidya, Jayant S.; Baum, Michael; Tobias, Jeffrey S.; Wenz, Frederik; Massarut, Samuele; Keshtgar, Mohammed; Hilaris, Basil; Saunders, Christobel; Williams, Norman R.; Brew-Graves, Chris; Corica, Tammy; Roncadin, Mario; Kraus-Tiefenbacher, Uta; Suetterlin, Marc; Bulsara, Max; Joseph, David

    2011-11-15

    Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

  14. Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

    PubMed Central

    KÜHNÖL, JULIA; KÜHNÖL, CASPAR; VORDERMARK, DIRK

    2016-01-01

    Brain metastases (BM) from breast cancer are associated with high morbidity and a poor prognosis. The aim of this study was to analyse the role of radiotherapy in treatment of BM from breast cancer in the context of modern local therapy modalities, current systemic treatment options and prognostic factors. A retrospective analysis of 86 consecutive female patients treated with radiotherapy for BM from breast cancer between 2000 and 2010 was conducted. Patient and treatment characteristics were registered and survival data calculated. All patients received whole-brain radiotherapy (WBRT) with a median dose of 36 Gy, and 19 patients were treated with an additional boost; this included fractionated schemes (median dose, 18 Gy) and radiosurgery (5 and 17 Gy). The median overall survival time from the start of WBRT was 4.1 months in the present cohort. Patients receiving a boost survived 19.7 months in comparison to 3.1 months for patients treated with WBRT alone (P<0.001). Other factors that improved overall survival, based on a univariate analysis, were dose of WBRT and number of BM. There was no statistical evidence for the influence of the human epidermal growth factor receptor 2 status on survival in the current study. The administration of boost treatment following WBRT was also identified as a significant factor influencing survival on multivariate analysis (P=0.030). In conclusion, radiotherapy affects the survival time of patients with BM from breast cancer. In particular, the implementation of boost treatment following WBRT in selected patients seems to extend survival time. PMID:27123095

  15. Morbidity of ischemic heart disease in early breast cancer 15-20 years after adjuvant radiotherapy

    SciTech Connect

    Gyenes, G.; Rutqvist, L.E. ); Fornander, T.; Carlens, P.

    1994-03-30

    The purpose of this study was to assess the cardiac side effects, primarily the occurrence of ischemic heart disease, in symptom-free patients with early breast cancer treated with radiotherapy. Thirty-seven survivors of a former randomized study of early breast cancer were examined. Twenty patients irradiated pre- or postoperatively for left sided disease (study group patients) were compared with 17 controls who were either treated for right sided disease, or were nonirradiated patients. Radiotherapy was randomized in the original study; either tangential field [sup 60]Co, or electron-therapy was delivered. Echocardiography and bicycle ergometry stress test with [sup 99m]Tc SestaMIBI myocardial perfusion scintigraphy were carried out and the patients' major risk factors for ischemic heart disease were also listed. Our results showed a significant difference between the scintigraphic findings of the two groups. Five of the 20 study group patients (25%), while none of the 17 controls exhibited some kind of significant defects on scintigraphy, indicating ischemic heart disease (p < 0.05). No deterioration in left ventricular systolic and/or diastolic function could be detected by echocardiography. Radiotherapy for left sided breast cancer with the mentioned treatment technique may present as an independent risk factor in the long-term development of ischemic heart disease, while left ventricular dysfunction could not be related to the previous irradiation. The authors emphasize the need to optimize adjuvant radiotherapy for early breast cancer by considering the dose both to the heart as well as the cancer. 39 refs., 4 tabs.

  16. MR-guided breast radiotherapy: feasibility and magnetic-field impact on skin dose

    NASA Astrophysics Data System (ADS)

    van Heijst, Tristan C. F.; den Hartogh, Mariska D.; Lagendijk, Jan J. W.; Desirée van den Bongard, H. J. G.; van Asselen, Bram

    2013-09-01

    The UMC Utrecht MRI/linac (MRL) design provides image guidance with high soft-tissue contrast, directly during radiotherapy (RT). Breast cancer patients are a potential group to benefit from better guidance in the MRL. However, due to the electron return effect, the skin dose can be increased in presence of a magnetic field. Since large skin areas are generally involved in breast RT, the purpose of this study is to investigate the effects on the skin dose, for whole-breast irradiation (WBI) and accelerated partial-breast irradiation (APBI). In ten patients with early-stage breast cancer, targets and organs at risk (OARs) were delineated on postoperative CT scans co-registered with MRI. The OARs included the skin, comprising the first 5 mm of ipsilateral-breast tissue, plus extensions. Three intensity-modulated RT techniques were considered (2× WBI, 1× APBI). Individual beam geometries were used for all patients. Specially developed MRL treatment-planning software was used. Acceptable plans were generated for 0 T, 0.35 T and 1.5 T, using a class solution. The skin dose was augmented in WBI in the presence of a magnetic field, which is a potential drawback, whereas in APBI the induced effects were negligible. This opens possibilities for developing MR-guided partial-breast treatments in the MRL.

  17. Integrin α6/Akt/Erk signaling is essential for human breast cancer resistance to radiotherapy.

    PubMed

    Hu, Ting; Zhou, Rui; Zhao, Yanxia; Wu, Gang

    2016-01-01

    Integrin α6 (ITGA6), a transmembrane glycoprotein adhesion receptor protein, is widely upregulated in many types of tumors and promotes migration and invasion in cancer cells. However, the role that the ITGA6-associated signaling network plays in radiosensitivity in breast cancer has not been described. The expression of ITGA6 was examined in human breast cancer and normal breast cell lines using western blot analysis. We also explored the role of ITGA6 in the regulation of radiation sensitivity in breast cancer using the colony formation assays, cell cycle analyses, apoptosis assays and immunofluorescence analyses. The results showed that the protein and mRNA expression levels of ITGA6 was higher in breast cancer cells than in normal cells. ITGA6 protectived responses to radiotherapy in breast cancer cells by altering cell apoptosis, DNA damage repair and cell-cycle regulation. Furthermore, ITGA6 enhanced radiation resistance via PI3K/Akt and MEK/Erk signaling. In addition, overexpressing ITGA6 promoted radiation resistance in cells, and this effect was neutralized by the PI3K inhibitor LY294002 and MEK inhibitor U0126. Taken together, these findings indicate that ITGA6 might be involved in a mechanism that underlies radiation resistance and that ITGA6 could be a potential target for therapies aimed at overcoming radiation resistance in breast cancer. PMID:27624978

  18. Ultrashort courses of adjuvant breast radiotherapy: wave of the future or a fool's errand?

    PubMed

    Khan, Atif J; Dale, Roger G; Arthur, Douglas W; Haffty, Bruce G; Todor, Dorin A; Vicini, Frank A

    2012-04-15

    In accelerated partial breast irradiation (APBI), the most commonly used fractionation schemes include 340 or 385 centigrays delivered in a twice daily administration. A further progression of the APBI literature has been the recent interest in extremely short courses of adjuvant radiotherapy, usually delivered by intraoperative radiotherapy techniques. This newer area of single-fraction radiotherapy approaches remains highly contentious. In particular, the recently reported TARGIT trial has been the subject of both praise and scorn, and a critical examination of the trial data and the underlying hypotheses is warranted. Short-term outcomes of the related Italian ELIOT approach have also been reported. Although the assumptions of linear quadratic formalism are likely to hold true in the range of 2 to 8 grays, equating different schedules beyond this range is problematic. A major problem of current single-fraction approaches is that the treatment doses are chosen empirically, or are based on tolerability, or on the physical dose delivery characteristics of the chosen technology rather than radiobiological rationale. This review article summarizes the current data on ultrashort courses of adjuvant breast radiotherapy and highlights both the promise and the potential pitfalls of the abbreviated treatment. PMID:22009259

  19. Heterozygous PALB2 c.1592delT mutation channels DNA double-strand break repair into error-prone pathways in breast cancer patients.

    PubMed

    Obermeier, K; Sachsenweger, J; Friedl, T W P; Pospiech, H; Winqvist, R; Wiesmüller, L

    2016-07-21

    Hereditary heterozygous mutations in a variety of DNA double-strand break (DSB) repair genes have been associated with increased breast cancer risk. In the Finnish population, PALB2 (partner and localizer of BRCA2) represents a major susceptibility gene for female breast cancer, and so far, only one mutation has been described, c.1592delT, which leads to a sixfold increased disease risk. PALB2 is thought to participate in homologous recombination (HR). However, the effect of the Finnish founder mutation on DSB repair has not been investigated. In the current study, we used a panel of lymphoblastoid cell lines (LCLs) derived from seven heterozygous female PALB2 c.1592delT mutation carriers with variable health status and six wild-type matched controls. The results of our DSB repair analysis showed that the PALB2 mutation causes specific changes in pathway usage, namely increases in error-prone single-strand annealing (SSA) and microhomology-mediated end-joining (MMEJ) compared with wild-type LCLs. These data indicated haploinsufficiency regarding the suppression of error-prone DSB repair in PALB2 mutation carriers. To the contrary, neither reduced HR activities, nor impaired RAD51 filament assembly, nor sensitization to PARP inhibition were consistently observed. Expression of truncated mutant versus wild-type PALB2 verified a causal role of PALB2 c.1592delT in the shift to error-prone repair. Discrimination between healthy and malignancy-presenting PALB2 mutation carriers revealed a pathway shift particularly in the breast cancer patients, suggesting interaction of PALB2 c.1592delT with additional genomic lesions. Interestingly, the studied PALB2 mutation was associated with 53BP1 accumulation in the healthy mutation carriers but not the patients, and 53BP1 was limiting for error-prone MMEJ in patients but not in healthy carriers. Our study identified a rise in error-prone DSB repair as a potential threat to genomic integrity in heterozygous PALB2 mutation carriers

  20. Heterozygous PALB2 c.1592delT mutation channels DNA double-strand break repair into error-prone pathways in breast cancer patients

    PubMed Central

    Obermeier, K; Sachsenweger, J; Friedl, T W P; Pospiech, H; Winqvist, R; Wiesmüller, L

    2016-01-01

    Hereditary heterozygous mutations in a variety of DNA double-strand break (DSB) repair genes have been associated with increased breast cancer risk. In the Finnish population, PALB2 (partner and localizer of BRCA2) represents a major susceptibility gene for female breast cancer, and so far, only one mutation has been described, c.1592delT, which leads to a sixfold increased disease risk. PALB2 is thought to participate in homologous recombination (HR). However, the effect of the Finnish founder mutation on DSB repair has not been investigated. In the current study, we used a panel of lymphoblastoid cell lines (LCLs) derived from seven heterozygous female PALB2 c.1592delT mutation carriers with variable health status and six wild-type matched controls. The results of our DSB repair analysis showed that the PALB2 mutation causes specific changes in pathway usage, namely increases in error-prone single-strand annealing (SSA) and microhomology-mediated end-joining (MMEJ) compared with wild-type LCLs. These data indicated haploinsufficiency regarding the suppression of error-prone DSB repair in PALB2 mutation carriers. To the contrary, neither reduced HR activities, nor impaired RAD51 filament assembly, nor sensitization to PARP inhibition were consistently observed. Expression of truncated mutant versus wild-type PALB2 verified a causal role of PALB2 c.1592delT in the shift to error-prone repair. Discrimination between healthy and malignancy-presenting PALB2 mutation carriers revealed a pathway shift particularly in the breast cancer patients, suggesting interaction of PALB2 c.1592delT with additional genomic lesions. Interestingly, the studied PALB2 mutation was associated with 53BP1 accumulation in the healthy mutation carriers but not the patients, and 53BP1 was limiting for error-prone MMEJ in patients but not in healthy carriers. Our study identified a rise in error-prone DSB repair as a potential threat to genomic integrity in heterozygous PALB2 mutation carriers

  1. Intact Mre11/Rad50/Nbs1 Complex Predicts Good Response to Radiotherapy in Early Breast Cancer

    SciTech Connect

    Soederlund, Karin . E-mail: karin.soderlund@ibk.liu.se; Stal, Olle; Skoog, Lambert; Rutqvist, Lars Erik; Askmalm, Marie Stenmark

    2007-05-01

    Purpose: To investigate the expression and predictive role of the Mre11/Rad50/Nbs1 (MRN) complex and the ataxia-telangiectasia mutated protein (ATM) for the outcome of radiotherapy in breast cancer patients. Methods and Materials: The protein expression of ATM and the DNA repair proteins in the MRN complex were investigated using immunohistochemistry in tumors from 224 women with early breast cancer, who were randomized to receive postoperative radiotherapy or adjuvant chemotherapy. Results: Compared with normal breast tissue, the staining intensity of Mre11, Rad50, Nbs1, and ATM was reduced in a majority of the tumors. Weak expression of the MRN complex was correlated with high histologic grade and estrogen receptor negativity (p = 0.01 and p 0.0001, respectively). Radiotherapy significantly reduced the risk of local recurrence as compared with chemotherapy (p = 0.04). The greatest benefit of radiotherapy was seen in patients with moderate/strong expression of the MRN complex (relative risk = 0.27, 95% confidence interval = 0.098-0.72, p 0.009), whereas patients with negative/weak MRN expression had no benefit of radiotherapy compared with adjuvant chemotherapy. These results suggest that an intact MRN complex is important for the tumor cell eradicating effect of radiotherapy. Conclusions: Reduced expression of the MRN complex predicts a poor effect of radiotherapy in patients with early breast cancer.

  2. Three-Dimensional Conformal Simultaneously Integrated Boost Technique for Breast-Conserving Radiotherapy

    SciTech Connect

    Laan, Hans Paul van der

    2007-07-15

    Purpose: To compare the target coverage and normal tissue dose with the simultaneously integrated boost (SIB) and the sequential boost technique in breast cancer, and to evaluate the incidence of acute skin toxicity in patients treated with the SIB technique. Methods and Materials: Thirty patients with early-stage left-sided breast cancer underwent breast-conserving radiotherapy using the SIB technique. The breast and boost planning target volumes (PTVs) were treated simultaneously (i.e., for each fraction, the breast and boost PTVs received 1.81 Gy and 2.3 Gy, respectively). Three-dimensional conformal beams with wedges were shaped and weighted using forward planning. Dose-volume histograms of the PTVs and organs at risk with the SIB technique, 28 x (1.81 + 0.49 Gy), were compared with those for the sequential boost technique, 25 x 2 Gy + 8 x 2 Gy. Acute skin toxicity was evaluated for 90 patients treated with the SIB technique according to Common Terminology Criteria for Adverse Events, version 3.0. Results: PTV coverage was adequate with both techniques. With SIB, more efficiently shaped boost beams resulted in smaller irradiated volumes. The mean volume receiving {>=}107% of the breast dose was reduced by 20%, the mean volume outside the boost PTV receiving {>=}95% of the boost dose was reduced by 54%, and the mean heart and lung dose were reduced by 10%. Of the evaluated patients, 32.2% had Grade 2 or worse toxicity. Conclusion: The SIB technique is proposed for standard use in breast-conserving radiotherapy because of its dose-limiting capabilities, easy implementation, reduced number of treatment fractions, and relatively low incidence of acute skin toxicity.

  3. SU-E-J-160: Comparing the Setup Accuracy of Non-Ionizing Patient Localization Systems with CBCT to Reduce Imaging Dose in Prone Breast Treatments

    SciTech Connect

    Chung, E; Yamamoto, T; Mayadev, J; Dieterich, S

    2014-06-01

    Purpose: CBCT is the current gold standard to verify prone breast patient setup. We investigated in a phantom if non-ionizing localization systems can replace ionizing localization systems for prone breast treatments. Methods: An anthropomorphic phantom was positioned on a prone breast board. Electromagnetic transponders were attached on the left chest surface. The CT images of the phantom were imported to the treatment planning system. The isocenter was set to the center of the transponders. The positions of the isocenter and transponders transferred to the transponder tracking system. The posterior phantom surface was contoured and exported to the optical surface tracking system. A CBCT was taken for the initial setup alignment on the treatment machine. Using the electromagnetic and optical localization systems, the deviation of the phantom setup from the original CT images was measured. This was compared with the difference between the original CT and kV-CBCT images. Results: For the electromagnetic localization system, the phantom position deviated from the original CT in 1.5 mm, 0.0 mm and 0.5 mm in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions. For the optical localization system, the phantom position deviated from the original CT in 2.0 mm, −2.0 mm and 0.1 mm in the AP, SI and LR directions. For the CBCT, the phantom position deviated from the original CT in 4.0 mm, 1.0 mm and −1.0 mm in the AP, SI and LR directions. The measured values from the non-ionizing localization systems differed from those with the CBCT less than 3.0 mm in all directions. Conclusions: This phantom study showed the feasibility of using a combination of non-ionizing localization systems to achieve a similar setup accuracy as CBCT for prone breast patients. This could potentially eliminate imaging dose. As a next step, we are expanding this study to actual patients. This work has been in part supported by Departmental Research Award RODEPT1-JS

  4. Comparing Relaxation Programs for Breast Cancer Patients Receiving Radiotherapy

    Cancer.gov

    In this study, women with breast cancer who have had surgery and are scheduled to undergo radiation therapy will be randomly assigned to one of two different stretching and relaxation programs or to a control group that will receive usual care.

  5. Ipsilateral Breast Tumor Relapse: Local Recurrence Versus New Primary Tumor and the Effect of Whole-Breast Radiotherapy on the Rate of New Primaries

    SciTech Connect

    Gujral, Dorothy M.; Sumo, Georges; Owen, John R.; Ashton, Anita; Bliss, Judith M.; Haviland, Joanne; Yarnold, John R.

    2011-01-01

    Purpose: The justification for partial breast radiotherapy after breast conservation surgery assumes that ipsilateral breast tumor relapses (IBTR) outside the index quadrant are mostly new primary (NP) tumors that develop despite radiotherapy. We tested the hypothesis that whole-breast radiotherapy (WBRT) is ineffective in preventing NP by comparing development rates in irradiated and contralateral breasts after tumor excision and WBRT. Methods and Materials: We retrospectively reviewed 1,410 women with breast cancer who were entered into a prospective randomized trial of radiotherapy fractionation and monitored annually for ipsilateral breast tumor relapses (IBTR) and contralateral breast cancer (CLBC). Cases of IBTR were classified into local recurrence (LR) or NP tumors based on location and histology and were subdivided as definite or likely depending on clinical data. Rates of ipsilateral NP and CLBC were compared over a 15-year period of follow-up. Results: At a median follow-up of 10.1 years, there were 150 documented cases of IBTR: 118 (79%) cases were definite or likely LR; 27 (18%) cases were definite or likely NP; and 5 (3%) cases could not be classified. There were 71 cases of CLBC. The crude proportion of definite-plus-likely NP was 1.9% (27/1,410) patients compared with 5% (71/1,410) CLBC patients. Cumulative incidence rates at 5, 10, and 15 years were 0.8%, 2.0%, and 3.5%, respectively, for definite-plus-likely NP and 2.4%, 5.8%, and 7.9%, respectively for CLBC, suggesting a difference in the rates of NP and CLBC. Conclusions: This analysis suggests that WBRT reduces the rate of ipsilateral NP tumors. The late presentation of NP has implications for the reporting of trials that are testing partial breast radiotherapy.

  6. The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy

    PubMed Central

    Bantema-Joppe, E J; de Bock, G H; Woltman-van Iersel, M; Busz, D M; Ranchor, A V; Langendijk, J A; Maduro, J H; van den Heuvel, E R

    2015-01-01

    Background: The purpose of the study was to determine the impact of young age on health-related quality of life (HRQoL) by comparing HRQoL of younger and older breast cancer patients, corrected for confounding, and of young patients and a general Dutch population. Methods: The population consisted of breast cancer survivors (stage 0-III) after breast-conserving surgery and radiotherapy. Health-related quality of life was prospectively assessed using the EORTC QLQ-C30 and QLQ-BR23 questionnaires. The association between age (⩽50; 51–70; ⩾70 years) and HRQoL over time was analysed with mixed modelling. The clinical relevance of differences between/within age groups was estimated with Cohen's D and consensus-based guidelines. The HRQoL data from the young patient cohort were compared with Dutch reference data at 3 years after radiotherapy. Results: A total of 1420 patients completed 3200 questionnaires. Median follow-up was 34 (range 6–70) months. Median age was 59 (range 28–85) years. Compared with older subjects, young women reported worse HRQoL in the first year after radiotherapy, but clinical relevance was limited. Three years after radiotherapy, HRQoL values in the younger group were equal to those in the reference population. Pain and fatigue after radiotherapy improved, with medium clinical relevance. Conclusions: Three years after radiotherapy for breast cancer, young age was not a risk factor for decreased HRQoL. PMID:25602967

  7. Tattoo allergy in patients receiving adjuvant radiotherapy for breast cancer.

    PubMed

    Sewak, S; Graham, P; Nankervis, J

    1999-11-01

    Tattooing is routinely employed prior to radiotherapy treatment but allergies to tattoos are rare. New information on the incidence of tattoo allergy at St George Hospital is presented with details of two clinical cases. The literature on tattoo allergy has been unable to estimate the incidence of allergic reaction to tattoos because the total number of patients treated is unknown and not all patients were followed up. Our radiation oncology population for the first time has provided a known denominator, but wide confidence intervals prevent an accurate estimate of the incidence. Salient issues about tattoo allergy are highlighted based on a review of the published literature from 1966 to 1998. PMID:10901983

  8. TU-A-12A-06: Intra-Observer Variability in Delineation of Target Volumes in Breast Radiotherapy and Its Effect On Accuracy of Deformation Measurements

    SciTech Connect

    Juneja, P; Harris, E; Bonora, M; Evans, P

    2014-06-15

    Purpose: In breast radiotherapy, the target volume may change during treatment and need adaptation of the treatment plan. This is possible for both tumour bed (TB) and whole breast (WB) target volumes. Delineation of the target (to detect changes) is also subject to uncertainty due to intra- and inter-observer variability. This work measured the uncertainty, due to intraobserver variability, in the quantification of tissue deformation. Methods: Datasets consisting of paired prone and supine CT scans of three patients were used. Significant deformation in target volumes is expected between prone and supine patient positions. The selected cases had 1) no seroma, 2) some seroma, and 3) large seroma. The TB and WB were outlined on each dataset three times by one clinician. Delineation variability was defined as the standard deviations of the distances between observer outlines. For each target volume and each case, tissue deformation between prone and supine delineations was quantified using the Dice similarity coefficient (DSC) and the average surface distance (ASD). The uncertainty in the tissue deformation (due to delineation variability) was quantified by measuring the ranges of DSC and ASD using all combinations of pairs of outlines (9 pairs). Results: For the TB, the range of delineation variability was 0.44-1.16 mm. The deformation, DSC and ASD, (and uncertainty in measurement) of the TB between prone and supine position of the cases were: 1) 0.21 (0.17-0.28) and 12.4 mm (11.8-13 mm); 2) 0.54 (0.51-0.57) and 3.3 mm (3.1-3.5 mm); 3) 0.62 (0.61-0.64) and 4.9 mm (4.6-5.2 mm). WB deformation measurements were subject to less uncertainty due to delineation variability than TB deformation measurements. Conclusion: For the first time, the uncertainty, due to observer variability, in the measurement of the deformation of breast target volumes was investigated. Deformations in these ranges would be difficult to detect. This work was supported in part by Cancer Research

  9. Cardiac Dose From Tangential Breast Cancer Radiotherapy in the Year 2006

    SciTech Connect

    Taylor, Carolyn W. Povall, Julie M.; McGale, Paul; Nisbet, Andrew; Dodwell, David; Smith, Jonathan T.; Darby, Sarah C.

    2008-10-01

    Purpose: To quantify the radiation doses received by the heart and coronary arteries from contemporary tangential breast or chest wall radiotherapy. Methods and Materials: Fifty consecutive patients with left-sided breast cancer and 5 consecutive patients with right-sided breast cancer treated at a large United Kingdom radiotherapy center during the year 2006 were selected. All patients were irradiated with 6- or 8-MV tangential beams to the breast or chest wall. For each dose plan, dose-volume histograms for the heart and left anterior descending (LAD) coronary artery were calculated. For 5 of the left-sided and all 5 right-sided patients, dose-volume histograms for the right and circumflex coronary arteries were also calculated. Detailed spatial assessment of dose to the LAD coronary artery was performed for 3 left-sided patients. Results: For the 50 patients given left-sided irradiation, the average mean (SD) dose was 2.3 (0.7) Gy to the heart and 7.6 (4.5) Gy to the LAD coronary artery, with the distal LAD receiving the highest doses. The right and circumflex coronary arteries received approximately 2 Gy mean dose. Part of the heart received >20 Gy in 22 left-sided patients (44%). For the 5 patients given right-sided irradiation, average mean doses to all cardiac structures were in the range 1.2 to 2 Gy. Conclusions: Heart dose from left-tangential radiotherapy has decreased considerably over the past 40 years, but part of the heart still receives >20 Gy for approximately half of left-sided patients. Cardiac dose for right-sided patients was generally from scattered irradiation alone.

  10. Target Volume Delineation for Partial Breast Radiotherapy Planning: Clinical Characteristics Associated with Low Interobserver Concordance

    SciTech Connect

    Petersen, Ross P.; Truong, Pauline T. Kader, Hosam A.; Berthelet, Eric; Lee, Junella C.; Hilts, Michelle L.; Kader, Adam S.; Beckham, Wayne A.; Olivotto, Ivo A.

    2007-09-01

    Purpose: To examine variability in target volume delineation for partial breast radiotherapy planning and evaluate characteristics associated with low interobserver concordance. Methods and Materials: Thirty patients who underwent planning CT for adjuvant breast radiotherapy formed the study cohort. Using a standardized scale to score seroma clarity and consensus contouring guidelines, three radiation oncologists independently graded seroma clarity and delineated seroma volumes for each case. Seroma geometric center coordinates, maximum diameters in three axes, and volumes were recorded. Conformity index (CI), the ratio of overlapping volume and encompassing delineated volume, was calculated for each case. Cases with CI {<=}0.50 were analyzed to identify features associated with low concordance. Results: The median time from surgery to CT was 42.5 days. For geometric center coordinates, variations from the mean were 0.5-1.1 mm and standard deviations (SDs) were 0.5-1.8 mm. For maximum seroma dimensions, variations from the mean and SDs were predominantly <5 mm, with the largest SDs observed in the medial-lateral axis. The mean CI was 0.61 (range, 0.27-0.84). Five cases had CI {<=}0.50. Conformity index was significantly associated with seroma clarity (p < 0.001) and seroma volume (p < 0.002). Features associated with reduced concordance included tissue stranding from the surgical cavity, proximity to muscle, dense breast parenchyma, and benign calcifications that may be mistaken for surgical clips. Conclusion: Variability in seroma contouring occurred in three dimensions, with the largest variations in the medial-lateral axis. Awareness of clinical features associated with reduced concordance may be applied toward training staff and refining contouring guidelines for partial breast radiotherapy trials.

  11. Dose to the Contralateral Breast From Radiotherapy and Risk of Second Primary Breast Cancer in the WECARE Study

    SciTech Connect

    Stovall, Marilyn Smith, Susan A.; Langholz, Bryan M.; Boice, John D.; Shore, Roy E.; Andersson, Michael; Buchholz, Thomas A.; Capanu, Marinela; Bernstein, Leslie; Lynch, Charles F.; Malone, Kathleen E.; Anton-Culver, Hoda; Haile, Robert W.; Rosenstein, Barry S.

    2008-11-15

    Purpose: To quantify the risk of second primary breast cancer in the contralateral breast (CB) after radiotherapy (RT) for first breast cancer. Methods and Materials: The study population included participants in the Women's Environmental, Cancer, and Radiation Epidemiology study: 708 cases (women with asynchronous bilateral breast cancer) and 1399 controls (women with unilateral breast cancer) counter-matched on radiation treatment. Participants were <55 years of age at first breast cancer. Absorbed doses to quadrants of the CB were estimated. Rate ratios (RR) and 95% confidence intervals (CI) were calculated using multivariable-adjusted conditional logistic regression models. Results: Across all patients, the mean radiation dose to the specific quadrant of the CB tumor was 1.1 Gy. Women <40 years of age who received >1.0 Gy of absorbed dose to the specific quadrant of the CB had a 2.5-fold greater risk for CB cancer than unexposed women (RR = 2.5, 95% CI 1.4-4.5). No excess risk was observed in women >40 years of age. Women <40 years of age with follow-up periods >5 years had a RR of 3.0 (95% CI 1.1-8.1), and the dose response was significant (excess RR per Gy of 1.0, 95% CI 0.1-3.0). Conclusions: Women <40 years of age who received a radiation dose >1.0 Gy to the CB had an elevated, long-term risk of developing a second primary CB cancer. The risk is inversely related to age at exposure and is dose dependent.

  12. Accuracy of a new paired imaging technique for position correction in whole breast radiotherapy.

    PubMed

    Petillion, Saskia; Verhoeven, Karolien; Weltens, Caroline; Van den Heuvel, Frank

    2015-01-01

    Image-guided position verification in breast radiotherapy is accurately performed with kilovoltage cone beam CT (kV-CBCT). The technique is, however, time-consuming and there is a risk for patient collision. Online position verification performed with orthogonal-angled mixed modality paired imaging is less time-consuming at the expense of inferior accuracy compared to kV-CBCT. We therefore investigated whether a new tangential-angled single modality paired imaging technique can reduce the residual error (RE) of orthogonal-angled mixed modality paired imaging. The latter was applied to 20 breast cancer patients. Tangential-angled single modality paired imaging was investigated in 20 breast and 20 breast cancer patients with locoregional lymph node irradiation. The central lung distance (CLD) residual error and the longitudinal residual error were determined during the first 5 treatment fractions. Off-line matching of the tangential breast field images, acquired after online position correction, was used. The mean, systematic, and random REs of each patient group were calculated. The systematic REs were checked for significant differences using the F-test. Tangential-angled single modality paired imaging significantly reduced the systematic CLD residual error of orthogonal-angled mixed modality paired imaging for the breast cancer patients, from 2.3 mm to 1.0 mm, and also significantly decreased the systematic longitudinal RE from 2.4 mm to 1.3 mm. PTV margins, which account for the residual error (PTVRE), were also calculated. The PTVRE margin needed to account for the RE of orthogonal-angled mixed modality paired imaging (i.e., 8 mm) was halved by tangential-angled single modality paired imaging. The differences between the systematic REs of tangential-angled single modality paired imaging of the breast cancer patients and the breast cancer patients with locoregional lymph node irradiation were not significant, yielding comparable PTVRE margins. In this study, we

  13. Assessment of contralateral mammary gland dose in the treatment of breast cancer using accelerated hypofractionated radiotherapy

    PubMed Central

    Tolia, Maria; Platoni, Kalliopi; Foteineas, Andreas; Kalogeridi, Maria-Aggeliki; Zygogianni, Anna; Tsoukalas, Nikolaos; Caimi, Mariangela; Margari, Niki; Dilvoi, Maria; Pantelakos, Panagiotis; Kouvaris, John; Kouloulias, Vassilis

    2011-01-01

    AIM: To measure the dose distribution, related to the treatment planning calculations, in the contralateral mammary gland of breast cancer patients treated with accelerated hypofractionated 3-dimensional conformal radiotherapy. METHODS: Thirty-four prospectively selected female patients with right breast cancer (pN0, negative surgical margins) were treated with breast-conserving surgery. A total dose of 42.5 Gy (2.66 Gy/fraction) was prescribed; it was requested that planning target volumes be covered by the 95% isodose line. The contralateral mammary gland was defined on CT simulation. The dose received was evaluated by dose volume histograms. RESULTS: The measured contralateral breast doses were: (1) Dose maximum: 290-448 cGy [Equivalent (Eq) 337-522 cGy]; (2) Mean dose: 45-70 cGy (Eq 524-815 cGy); and (3) Median dose: 29-47 cGy (337-547 cGy) for total primary breast dose of 42.5 Gy in 16 equal fractions. The spearman rho correlation showed statistical significance between the contralateral breast volume and maximum dose (P = 0.0292), as well as mean dose (P = 0.0025) and median dose (P = 0.046) to the breast. CONCLUSION: Minimizing the dose to the contralateral breast has to be one of the priorities of the radiation oncologist when using short schedules because of the radiosensitivity of this organ at risk. Further study is necessary to assess the long-term clinical impact of this schedule. PMID:22013502

  14. 3D Ultrasound Can Contribute to Planning CT to Define the Target for Partial Breast Radiotherapy

    SciTech Connect

    Berrang, Tanya S.; Truong, Pauline T. Popescu, Carmen; Drever, Laura; Kader, Hosam A.; Hilts, Michelle L.; Mitchell, Tracy; Soh, S.Y.; Sands, Letricia; Silver, Stuart; Olivotto, Ivo A.

    2009-02-01

    Purpose: The role of three-dimensional breast ultrasound (3D US) in planning partial breast radiotherapy (PBRT) is unknown. This study evaluated the accuracy of coregistration of 3D US to planning computerized tomography (CT) images, the seroma contouring consistency of radiation oncologists using the two imaging modalities and the clinical situations in which US was associated with improved contouring consistency compared to CT. Materials and Methods: Twenty consecutive women with early-stage breast cancer were enrolled prospectively after breast-conserving surgery. Subjects underwent 3D US at CT simulation for adjuvant RT. Three radiation oncologists independently contoured the seroma on separate CT and 3D US image sets. Seroma clarity, seroma volumes, and interobserver contouring consistency were compared between the imaging modalities. Associations between clinical characteristics and seroma clarity were examined using Pearson correlation statistics. Results: 3D US and CT coregistration was accurate to within 2 mm or less in 19/20 (95%) cases. CT seroma clarity was reduced with dense breast parenchyma (p = 0.035), small seroma volume (p < 0.001), and small volume of excised breast tissue (p = 0.01). US seroma clarity was not affected by these factors (p = NS). US was associated with improved interobserver consistency compared with CT in 8/20 (40%) cases. Of these 8 cases, 7 had low CT seroma clarity scores and 4 had heterogeneously to extremely dense breast parenchyma. Conclusion: 3D US can be a useful adjunct to CT in planning PBRT. Radiation oncologists were able to use US images to contour the seroma target, with improved interobserver consistency compared with CT in cases with dense breast parenchyma and poor CT seroma clarity.

  15. Radiotherapy for a benign cause of cauda equina compression in a known case of breast carcinoma

    PubMed Central

    Bhalla, Neeraj; Husband, David J; Pillay, Robin; Thorp, Nicki

    2013-01-01

    A woman underwent breast conservation surgery and axillary clearance for T1N1M0 breast carcinoma, followed by adjuvant chemotherapy, radiotherapy and hormone therapy. At 3-year follow-up she presented with lumbar back pain and developed bilateral lower limb weakness. MRI spine demonstrated an expansile lesion at L1 causing cauda equina compression. The mass, unusually, was centred on the spinous process; metastases typically involve pedicles. The patient underwent surgical decompression with complete resolution of neurological signs. Histology revealed Masson tumour (intravascular papillary endothelial hyperplasia), a benign vascular lesion. Pain recurrence 9 months later prompted imaging demonstrating recurrent mass. Preoperative embolisation and re-excision was undertaken for recurrent Masson tumour. Recurrence of these lesions is rare and it was felt residual disease was likely. Radiotherapy has been used in isolated cases; therefore, she was treated with adjuvant radiotherapy, the first reported case of radiation in management of extracranial Masson tumour, and remains well 3 years later. PMID:23784763

  16. Enhancement of radiotherapy by ceria nanoparticles modified with neogambogic acid in breast cancer cells

    PubMed Central

    Chen, Feng; Zhang, Xiao Hong; Hu, Xiao Dan; Zhang, Wei; Lou, Zhi Chao; Xie, Li Hua; Liu, Pei Dang; Zhang, Hai Qian

    2015-01-01

    Radiotherapy is one of the main strategies for cancer treatment but has significant challenges, such as cancer cell resistance and radiation damage to normal tissue. Radiosensitizers that selectively increase the susceptibility of cancer cells to radiation can enhance the effectiveness of radiotherapy. We report here the development of a novel radiosensitizer consisting of monodispersed ceria nanoparticles (CNPs) covered with the anticancer drug neogambogic acid (NGA-CNPs). These were used in conjunction with radiation in MCF-7 breast cancer cells, and the efficacy and mechanisms of action of this combined treatment approach were evaluated. NGA-CNPs potentiated the toxic effects of radiation, leading to a higher rate of cell death than either treatment used alone and inducing the activation of autophagy and cell cycle arrest at the G2/M phase, while pretreatment with NGA or CNPs did not improve the rate of radiation-induced cancer cells death. However, NGA-CNPs decreased both endogenous and radiation-induced reactive oxygen species formation, unlike other nanomaterials. These results suggest that the adjunctive use of NGA-CNPs can increase the effectiveness of radiotherapy in breast cancer treatment by lowering the radiation doses required to kill cancer cells and thereby minimizing collateral damage to healthy adjacent tissue. PMID:26316742

  17. True Local Recurrence Rate in the Conserved Breast After Magnetic Resonance Imaging-Targeted Radiotherapy

    SciTech Connect

    Whipp, Elisabeth; Beresford, Mark; Sawyer, Elinor

    2010-03-15

    Purpose: Better accuracy of local radiotherapy may substantially improve local control and thus long-term breast cancer survival. Magnetic resonance imaging (MRI) has high resolution and sensitivity in breast tissue and may depict the tumor bed more accurately than conventional planning techniques. A postoperative complex (POCx) comprises all visible changes thought to be related to surgery within the breast and acts as a surrogate for the tumor bed. This study reports on local recurrence rates after MRI-assisted radiotherapy planning to ensure adequate coverage of the POCx. Methods and Materials: Simple opposed tangential fields were defined by surface anatomy in the conventional manner in 221 consecutive patients. After MRI, fields were modified by a single radiation oncologist to ensure encompassment of the POCx with a 10-mm margin. Genetic analysis was performed on all local relapses (LRs) to distinguish true recurrences (TRs) from new primaries (NPs). Results: This was a high risk cohort at 5 years: only 9.5% were classified as low risk (St Gallen): 43.4% were Grade 3 and 19.9% had surgical margins <1 mm; 62.4% of patients received boosts. Adjustments of standard field margins were required in 69%. After a median follow-up of 5 years, there were 3 LRs (1.3%) as the site of first relapse in 221 patients, comprising two TRs (0.9%) and one NP (0.4%). Conclusions: Accurate targeting of the true tumor bed is critical. MRI may better define the tumor bed.

  18. The effect of respiratory motion on forward intensity modulated radiotherapy for breast cancer.

    PubMed

    Song, Taesoo; Suh, Chang-Ok; Lee, Ikjae; Jeong, Kyoungkeun; Keum, Kichang; Lee, Chang Geol; Seong, Jinsil; Cho, Jae Ho

    2008-06-01

    This study evaluated the effect of respiratory movement on field-in-field (FIF) forward intensity-modulated radiotherapy (IMRT) for the treatment of breast cancer. FIF forward IMRT was performed on ten patients receiving radiotherapy to the whole breast after conservation surgery. Assuming that breast motion follows a sophisticated cyclic function, the changes in hot and cold region, dose homogeneity index (DHI), and skin dose were examined at different respiration amplitudes of 1 cm, 2 cm, and 3 cm. FIF forward IMRT significantly improved the hot region, DHI, and skin dose, but slightly worsened the cold region, compared to the two wedged tangential technique (TWT). Interestingly, we found that the respiration amplitude affected the DHI and cold region but had no effect on the hot region and skin dose. The DHI was slightly improved at 1 cm of amplitude probably due to the blurring effect, remained unchanged at 2 cm of amplitude, and was worsened at 3 cm of amplitude. FIF forward IMRT significantly increased the cold region at 2 cm and 3 cm of respiration amplitude compared to the TWT. At 3 cm of respiration amplitude, an average cold region of 3.27 cm(3) was observed. In summary, our data indicate that during FIF forward IMRT, respiration movement has an important effect on various endpoints depending on the respiration amplitude of the patient. PMID:18473492

  19. A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy

    PubMed Central

    Schnur, Julie B.; Love, Bianca; Scheckner, Bari L.; Green, Sheryl; Wernicke, A. Gabriella; Montgomery, Guy H.

    2013-01-01

    During breast cancer radiotherapy, nearly all patients will experience radiodermatitis. Study objectives were to: 1) systematically review the literature on radiodermatitis and breast cancer; 2) summarize and describe patient-rated radiodermatitis measures; 3) determine whether consensus exists regarding subjective radiodermatitis measurement; and 4) provide recommendations for future research. PubMed and CINAHL were searched from their inception through August 2009. Study inclusion/exclusion criteria were: full abstract available; manuscript in English; focused on radiodermatitis resulting from breast cancer radiotherapy, and described a patient-rated empirical assessment of radiodermatitis. Three reviewers examined abstracts, and decisions about inclusion were reached by consensus. 22/237 mutually identified studies met selection criteria. Using a standardized abstraction form, three authors independently extracted relevant information. Results indicated that: 1) only 9% of the studies reviewed included a patient-rated measure; 2) generally, extant scales are very brief and focus almost exclusively on physical reactions, and 3) there is no “gold standard” measure of patient-rated radiodermatitis at this time. We conclude that significantly more research is needed to determine the best (most valid, reliable, sensitive, comprehensive) measure(s) to evaluate the experience of radiodermatitis from the patient’s perspective, and that further scale development efforts are needed. PMID:20838323

  20. Is Radiotherapy an Option for Early Breast Cancers With Complete Clinical Response After Neoadjuvant Chemotherapy?

    SciTech Connect

    Daveau, Caroline; Savignoni, Alexia; Abrous-Anane, Soumya; Pierga, Jean-Yves; Reyal, Fabien; Gautier, Chantal; Kirova, Youlia M.; Dendale, Remi; Campana, Francois; Fourquet, Alain; Bollet, Marc A.

    2011-04-01

    Purpose: To determine whether the exclusive use of radiotherapy (ERT) could be a treatment option after complete clinical response (cCR) to neoadjuvant chemotherapy (NCT) for early breast cancer (EBC). Methods and Materials: Between 1985 and 1999, 1,477 patients received NCT for EBC considered too large for primary conservative surgery. Of 165 patients with cCR, 65 patients were treated with breast surgery (with radiotherapy) and 100 patients were treated with ERT. Results: The two groups were comparable in terms of baseline characteristics, except for larger initial tumor sizes in the ERT group. There were no significant differences in overall, disease-free and metastasis-free survival rates. Five-year and 10-year overall survival rates were 91% and 77% in the no-surgery group and 82% and 79% in the surgery group, respectively (p = 0.9). However, a nonsignificant trend toward higher locoregional recurrence rates (LRR) was observed in the no-surgery group (31% vs. 17% at 10 years; p = 0.06). In patients with complete responses on mammography and/or ultrasound, LRR were not significantly different (p = 0.45, 10-year LRR: 21% in surgery vs. 26% in ERT). No significant differences were observed in terms of the rate of cutaneous, cardiac, or pulmonary toxicities. Conclusions: Surgery is a key component of locoregional treatment for breast cancers that achieved cCR to NCT.

  1. Impact of Radiation in Critical Organs in Radiotherapy Treatment of Breast and Lung Cancers

    NASA Astrophysics Data System (ADS)

    Pyakuryal, Anil; Chen, Chiu-Hao; Dhungana, Sudarshan

    2010-02-01

    Various 3D conformal radiotherapy (3DCRT) techniques are commonly used in the treatment of cancerous tumors at appropriate prescription doses (PDs). The purpose of this study was to analyze the impact of radiation in heart and lungs in left breast and left lung cancer patients treated using 3DCRT techniques. Treatment plans for the eight breast cancer patients (n=8), eight lung cancer patients at early stage (m=8), and eight lung cancer patients at stage II and III (k=8) were evaluated. Relative complication probabilities (RCPs) for the irradiated organs were computed from the plans using HART [Med. Phys. 36, p.2547 (2009)] program at PD. The RCPs were found to be (i) 2.3% (n=8, PD=56 Gy), 6.4% (m=8, PD=30.7 Gy), and 16.7% (k=8, PD=54.8 Gy) for the heart, (ii) 1% (n=6, PD=58.4 Gy) for the left lung, and (iii) 7% (m=6, PD=31 Gy) and 5.3% (k=8, PD=54.8 Gy) for the whole lung. Homogeneous target coverage and improved dose conformality were the major advantages in the treatment of breast cancer. Therefore, simple 3DCRT based whole-breast irradiation and partial lung treatment techniques can offer promising results while adequately sparing the organs in the treatment of breast and lung cancers. )

  2. A Phase I Trial of Preoperative Partial Breast Radiotherapy: Patient Selection, Target Delineation, and Dose Delivery

    PubMed Central

    Blitzblau, Rachel C.; Arya, Ritu; Yoo, Sua; Baker, Jay A.; Chang, Zheng; Palta, Manisha; Duffy, Eileen; Horton, Janet K.

    2015-01-01

    Purpose Diffusion of accelerated partial breast irradiation (APBI) into clinical practice is limited by the need for specialized equipment and training. The accessible external beam technique yields unacceptable complication rates, likely due to large post-operative target volumes. We designed a phase I trial evaluating preoperative radiotherapy to the intact tumor utilizing widely available technology. Methods Patients received 15, 18, or 21Gy in a single fraction to the breast tumor plus margin. Magnetic resonance imaging (MRI) was used in conjunction with standard computed tomography (CT)-based planning to identify contrast enhancing tumor. Skin markers and an intra-tumor biopsy marker were utilized for verification during treatment. Results MRI imaging was critical for target delineation as not all breast tumors were reliably identified on CT scan. Breast shape differences were consistently seen between CT and MRI but did not impede image registration or tumor identification. Target volumes were markedly smaller than historical post-operative volumes and normal tissue constraints were easily met. A biopsy marker within the breast proved sufficient for set up localization. Conclusions This single fraction linear-accelerator based ABPI approach can be easily incorporated at most treatment centers. In vivo targeting may improve accuracy and can reduce the dose to normal tissues. PMID:25834942

  3. Axillary radiotherapy: an alternative treatment option for adjuvant axillary management of breast cancer

    PubMed Central

    Zhang, Jie; Wang, Chuan

    2016-01-01

    Axillary lymph node dissection is standard management of axilla in invasive breast cancer. Radiotherapy also is important in local treatment. It is controversial as to whether axillary radiotherapy can displace axillary lymph node dissection. We performed a meta-analysis comparing axillary radiotherapy with axillary dissection. No significant difference was observed for disease free survival and overall survival between the radiation group and the dissection group. There was also no significant difference in either the axillary recurrence or the local recurrence between the two groups. But the axillary relapse rate in the radiation group was higher than in the surgery group at five-year follow-up while the local recurrence rate in the surgery group was higher than in the radiation group. A subgroup analysis showed that the difference in the axillary recurrence rate (RR = 0.20, P = 0.01) and local recurrence rate (RR = 4.7, P = 0.01) mainly appeared in the clinical node-positive subgroup. The edema rate in the surgery group was higher than in the radiation group (RR = 2.08, 95%: 1.71–2.54, P < 0.0001). We concluded that radiotherapy may be an alternative treatment option for adjuvant management of the axilla in selected sub-groups of patients. PMID:27212421

  4. Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

    PubMed Central

    Bartlett, Frederick R.; Colgan, Ruth M.; Donovan, Ellen M.; Carr, Karen; Landeg, Steven; Clements, Nicola; McNair, Helen A.; Locke, Imogen; Evans, Philip M.; Haviland, Joanne S.; Yarnold, John R.; Kirby, Anna M.

    2014-01-01

    Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery. PMID:25046661

  5. Dosimetric Evaluation of Different Intensity-Modulated Radiotherapy Techniques for Breast Cancer After Conservative Surgery.

    PubMed

    Zhang, Fuli; Wang, Yadi; Xu, Weidong; Jiang, Huayong; Liu, Qingzhi; Gao, Junmao; Yao, Bo; Hou, Jun; He, Heliang

    2015-10-01

    Intensity-modulated radiotherapy (IMRT) potentially leads to a more favorite dose distribution compared to 3-dimensional or conventional tangential radiotherapy (RT) for breast cancer after conservative surgery or mastectomy. The aim of this study was to compare dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) among helical tomotherapy (HT), inverse-planned IMRT (IP-IMRT), and forward-planned field in field (FP-FIF) IMRT techniques after breast-conserving surgery. Computed tomography scans from 20 patients (12 left sided and 8 right sided) previously treated with T1N0 carcinoma were selected for this dosimetric planning study. We designed HT, IP-IMRT, and FP-FIF plans for each patient. Plans were compared according to dose-volume histogram analysis in terms of PTV homogeneity and conformity indices (HI and CI) as well as OARs dose and volume parameters. Both HI and CI of the PTV showed statistically significant difference among IP-IMRT, FP-FIF, and HT with those of HT were best (P < .05). Compared to FP-FIF, IP-IMRT showed smaller exposed volumes of ipsilateral lung, heart, contralateral lung, and breast, while HT indicated smaller exposed volumes of ipsilateral lung but larger exposed volumes of contralateral lung and breast as well as heart. In addition, HT demonstrated an increase in exposed volume of ipsilateral lung (except for fraction of lung volume receiving >30 Gy and 20 Gy), heart, contralateral lung, and breast compared with IP-IMRT. For breast cancer radiotherapy (RT) after conservative surgery, HT provides better dose homogeneity and conformity of PTV compared to IP-IMRT and FP-FIF techniques, especially for patients with supraclavicular lymph nodes involved. Meanwhile, HT decreases the OAR volumes receiving higher doses with an increase in the volumes receiving low doses, which is known to lead to an increased rate of radiation-induced secondary malignancies. Hence, composite factors including dosimetric advantage

  6. Automated planning of breast radiotherapy using cone beam CT imaging

    SciTech Connect

    Amit, Guy; Purdie, Thomas G.

    2015-02-15

    Purpose: Develop and clinically validate a methodology for using cone beam computed tomography (CBCT) imaging in an automated treatment planning framework for breast IMRT. Methods: A technique for intensity correction of CBCT images was developed and evaluated. The technique is based on histogram matching of CBCT image sets, using information from “similar” planning CT image sets from a database of paired CBCT and CT image sets (n = 38). Automated treatment plans were generated for a testing subset (n = 15) on the planning CT and the corrected CBCT. The plans generated on the corrected CBCT were compared to the CT-based plans in terms of beam parameters, dosimetric indices, and dose distributions. Results: The corrected CBCT images showed considerable similarity to their corresponding planning CTs (average mutual information 1.0±0.1, average sum of absolute differences 185 ± 38). The automated CBCT-based plans were clinically acceptable, as well as equivalent to the CT-based plans with average gantry angle difference of 0.99°±1.1°, target volume overlap index (Dice) of 0.89±0.04 although with slightly higher maximum target doses (4482±90 vs 4560±84, P < 0.05). Gamma index analysis (3%, 3 mm) showed that the CBCT-based plans had the same dose distribution as plans calculated with the same beams on the registered planning CTs (average gamma index 0.12±0.04, gamma <1 in 99.4%±0.3%). Conclusions: The proposed method demonstrates the potential for a clinically feasible and efficient online adaptive breast IMRT planning method based on CBCT imaging, integrating automation.

  7. Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer

    SciTech Connect

    Donovan, E. M.; James, H.; Bonora, M.; Yarnold, J. R.; Evans, P. M.

    2012-10-15

    Purpose: To compare organ specific cancer incidence risks for standard and complex external beam radiotherapy (including cone beam CT verification) following breast conservation surgery for early breast cancer.Method: Doses from breast radiotherapy and kilovoltage cone beam CT (CBCT) exposures were obtained from thermoluminescent dosimeter measurements in an anthropomorphic phantom in which the positions of radiosensitive organs were delineated. Five treatment deliveries were investigated: (i) conventional tangential field whole breast radiotherapy (WBRT), (ii) noncoplanar conformal delivery applicable to accelerated partial beast irradiation (APBI), (iii) two-volume simultaneous integrated boost (SIB) treatment, (iv) forward planned three-volume SIB, and (v) inverse-planned three volume SIB. Conformal and intensity modulated radiotherapy methods were used to plan the complex treatments. Techniques spanned the range from simple methods appropriate for patient cohorts with a low cancer recurrence risk to complex plans relevant to cohorts with high recurrence risk. Delineated organs at risk included brain, salivary glands, thyroid, contralateral breast, left and right lung, esophagus, stomach, liver, colon, and bladder. Biological Effects of Ionizing Radiation (BEIR) VII cancer incidence models were applied to the measured mean organ doses to determine lifetime attributable risk (LAR) for ages at exposure from 35 to 80 yr according to radiotherapy techniques, and included dose from the CBCT imaging. Results: All LAR decreased with age at exposure and were lowest for brain, thyroid, liver, and bladder (<0.1%). There was little dependence of LAR on radiotherapy technique for these organs and for colon and stomach. LAR values for the lungs for the three SIB techniques were two to three times those from WBRT and APBI. Uncertainties in the LAR models outweigh any differences in lung LAR between the SIB methods. Constraints in the planning of the SIB methods ensured that

  8. Second Cancer Incidence Risk Estimates using BEIR VII Models for Standard and Complex External Beam Radiotherapy for Early Breast Cancer

    PubMed Central

    Donovan, E M; James, H; Bonora, M; Yarnold, JR; Evans, PM

    2012-01-01

    Purpose To compare organ specific cancer incidence risks for standard and complex external beam radiotherapy including cone beam CT verification following breast conservation surgery for early breast cancer. Method Doses from breast radiotherapy and kilovoltage cone beam CT (CBCT) exposures were obtained from thermoluminescent dosimeter (TLD) measurements in an anthropomorphic phantom in which the positions of radiosensitive organs were delineated. Five treatment deliveries were investigated : (i) conventional tangential field whole breast radiotherapy (WBRT), (ii) non-coplanar conformal delivery applicable to accelerated partial beast irradiation (APBI), (iii) two-volume simultaneous integrated boost (SIB) treatment, (iv) forward planned three-volume SIB, (v) inverse-planned three volume SIB. Conformal and intensity modulated radiotherapy (IMRT) methods were used to plan the complex treatments. Techniques spanned the range from simple methods appropriate for patient cohorts with a low local cancer recurrence risk to complex plans relevant to cohorts with high recurrence risk. Delineated organs at risk included brain, salivary glands, thyroid, contra-lateral breast, left and right lung, oesophagus, stomach, liver, colon and bladder. Biological Effects of Ionising Radiation (BEIR) VII cancer incidence models were applied to the measured mean organ doses to determine Lifetime Attributable Risk (LAR) for ages at exposure from 35 to 80 years according to radiotherapy techniques, and included dose from the CBCT imaging. Results All LAR decreased with age at exposure and were lowest for brain, thyroid, liver and bladder (< 0.1%). There was little dependence of LAR on radiotherapy technique for these organs and for colon and stomach. LAR values for the lungs for the three SIB techniques were two to three times those from WBRT and APBI. Uncertainties in the LAR models outweigh any differences in lung LAR between the SIB methods. Constraints in the planning of the SIB

  9. Effect of radiotherapy on the interpretation of routine follow-up mammography after conservative breast surgery: a randomized study.

    PubMed Central

    Holli, K.; Saaristo, R.; Isola, J.; Hyöty, M.; Hakama, M.

    1998-01-01

    Radiotherapy after conservative surgery causes fat necrosis, fibrosis, skin thickening and other parenchymal distortion of the breast. The interpretation of a mammogram of the irradiated breast may therefore be difficult. We studied the effect of radiotherapy on the interpretation of the routine mammography used in the follow-up of breast cancer patients. A total of 144 low-risk breast cancer patients were randomized to radiotherapy or to no further treatment after conservative surgery. The first routine follow-up mammography was performed 18 months after surgery and every 18 months after that. The number of mammography examinations was estimated per patient and per follow-up year. The number of extra diagnostic tests and the occurrence of positive findings were assessed per mammography session and per follow-up year. Further diagnostic tests prompted by difficulties in interpreting the mammogram were performed to an extent of 0.19 per mammography examination in the radiotherapy group and of 0.15 in the non-radiotherapy group, i.e. 1.3 times more often. Findings that turned out to be negative at confirmation were 2.0 times (P< 0.05) more common in the radiotherapy group. These false-positive findings were more common in the radiotherapy group than in the surgery group and only shortly after treatment. Mammography is more difficult to interpret after radiotherapy than after conservative surgery alone, especially shortly after treatment, and more often involves extra diagnostic tests and findings that will be negative at confirmation. PMID:9716041

  10. Radiation Field Design and Patterns of Locoregional Recurrence Following Definitive Radiotherapy for Breast Cancer

    SciTech Connect

    Chen, Susie A.; Schuster, David M.; Mister, Donna; Liu Tian; Godette, Karen; Torres, Mylin A.

    2013-02-01

    Purpose: Locoregional control is associated with breast cancer-specific and overall survival in select women with breast cancer. Although several patient, tumor, and treatment characteristics have been shown to contribute to locoregional recurrence (LRR), studies evaluating factors related to radiotherapy (XRT) technique have been limited. We investigated the relationship between LRR location and XRT fields and dose delivered to the primary breast cancer in women experiencing subsequent locoregional relapse. Methods and Materials: We identified 21 women who were previously treated definitively with surgery and XRT for breast cancer. All patients developed biopsy-result proven LRR and presented to Emory University Hospital between 2004 and 2010 for treatment. Computed tomography (CT) simulation scans with XRT dose files for the initial breast cancer were fused with {sup 18}F-labeled fluorodeoxyglucose positron emission tomography (FDG PET)/CT images in DICOM (Digital Imaging and Communications in Medicine) format identifying the LRR. Each LRR was categorized as in-field, defined as {>=}95% of the LRR volume receiving {>=}95% of the prescribed whole-breast dose; marginal, defined as LRR at the field edge and/or not receiving {>=}95% of the prescribed dose to {>=}95% of the volume; or out-of-field, that is, LRR intentionally not treated with the original XRT plan. Results: Of the 24 identified LRRs (3 patients experienced two LRRs), 3 were in-field, 9 were marginal, and 12 were out-of-field. Two of the 3 in-field LRRs were marginal misses of the additional boost XRT dose. Out-of-field LRRs consisted of six supraclavicular and six internal mammary nodal recurrences. Conclusions: Most LRRs in our study occurred in areas not fully covered by the prescribed XRT dose or were purposely excluded from the original XRT fields. Our data suggest that XRT technique, field design, and dose play a critical role in preventing LRR in women with breast cancer.

  11. Quantitative Ultrasonic Evaluation of Radiation-Induced Late Tissue Toxicity: Pilot Study of Breast Cancer Radiotherapy

    SciTech Connect

    Liu Tian; Zhou Jun; Yoshida, Emi J.; Woodhouse, Shermian A.; Schiff, Peter B.; Wang, Tony J.C.; Lu Zhengfeng; Pile-Spellman, Eliza; Zhang Pengpeng; Kutcher, Gerald J.

    2010-11-01

    Purpose: To investigate the use of advanced ultrasonic imaging to quantitatively evaluate normal-tissue toxicity in breast-cancer radiation treatment. Methods and Materials: Eighteen breast cancer patients who received radiation treatment were enrolled in an institutional review board-approved clinical study. Radiotherapy involved a radiation dose of 50.0 to 50.4 Gy delivered to the entire breast, followed by an electron boost of 10.0 to 16.0 Gy delivered to the tumor bed. Patients underwent scanning with ultrasound during follow-up, which ranged from 6 to 94 months (median, 22 months) postradiotherapy. Conventional ultrasound images and radio-frequency (RF) echo signals were acquired from treated and untreated breasts. Three ultrasound parameters, namely, skin thickness, Pearson coefficient, and spectral midband fit, were computed from RF signals to measure radiation-induced changes in dermis, hypodermis, and subcutaneous tissue, respectively. Ultrasound parameter values of the treated breast were compared with those of the untreated breast. Ultrasound findings were compared with clinical assessment using Radiation Therapy Oncology Group (RTOG) late-toxicity scores. Results: Significant changes were observed in ultrasonic parameter values of the treated vs. untreated breasts. Average skin thickness increased by 27.3%, from 2.05 {+-} 0.22mm to 2.61 {+-} 0.52mm; Pearson coefficient decreased by 31.7%, from 0.41 {+-} 0.07 to 0.28 {+-} 0.05; and midband fit increased by 94.6%, from -0.92 {+-} 7.35 dB to 0.87 {+-} 6.70 dB. Ultrasound evaluations were consistent with RTOG scores. Conclusions: Quantitative ultrasound provides a noninvasive, objective means of assessing radiation-induced changes to the skin and subcutaneous tissue. This imaging tool will become increasingly valuable as we continue to improve radiation therapy technique.

  12. Automated Planning of Tangential Breast Intensity-Modulated Radiotherapy Using Heuristic Optimization

    SciTech Connect

    Purdie, Thomas G.; Dinniwell, Robert E.; Letourneau, Daniel; Hill, Christine; Sharpe, Michael B.

    2011-10-01

    Purpose: To present an automated technique for two-field tangential breast intensity-modulated radiotherapy (IMRT) treatment planning. Method and Materials: A total of 158 planned patients with Stage 0, I, and II breast cancer treated using whole-breast IMRT were retrospectively replanned using automated treatment planning tools. The tools developed are integrated into the existing clinical treatment planning system (Pinnacle{sup 3}) and are designed to perform the manual volume delineation, beam placement, and IMRT treatment planning steps carried out by the treatment planning radiation therapist. The automated algorithm, using only the radio-opaque markers placed at CT simulation as inputs, optimizes the tangential beam parameters to geometrically minimize the amount of lung and heart treated while covering the whole-breast volume. The IMRT parameters are optimized according to the automatically delineated whole-breast volume. Results: The mean time to generate a complete treatment plan was 6 min, 50 s {+-} 1 min 12 s. For the automated plans, 157 of 158 plans (99%) were deemed clinically acceptable, and 138 of 158 plans (87%) were deemed clinically improved or equal to the corresponding clinical plan when reviewed in a randomized, double-blinded study by one experienced breast radiation oncologist. In addition, overall the automated plans were dosimetrically equivalent to the clinical plans when scored for target coverage and lung and heart doses. Conclusion: We have developed robust and efficient automated tools for fully inversed planned tangential breast IMRT planning that can be readily integrated into clinical practice. The tools produce clinically acceptable plans using only the common anatomic landmarks from the CT simulation process as an input. We anticipate the tools will improve patient access to high-quality IMRT treatment by simplifying the planning process and will reduce the effort and cost of incorporating more advanced planning into clinical

  13. A Qualitative Analysis of Acute Skin Toxicity among Breast Cancer Radiotherapy Patients

    PubMed Central

    Schnur, Julie B.; Ouellette, Suzanne C.; DiLorenzo, Terry A.; Green, Sheryl; Montgomery, Guy H.

    2013-01-01

    Objectives One of the most common acute side effects of breast cancer radiotherapy is treatment induced skin changes, referred to as skin toxicity. Yet no research to date has focused expressly on skin toxicity-related quality of life in breast cancer radiotherapy patients. Therefore, our aim was to use qualitative approaches to better understand the impact of skin toxicity on quality of life. Methods Semi-structured interviews were conducted with 20 women (Stage 0-III breast cancer), during their last week of external beam radiotherapy. Each interview was transcribed verbatim, and thematic analysis was performed. Results Three themes were identified based on the interview responses: First, skin changes affect multiple dimensions of quality of life. They cause physical discomfort, body image disturbance, emotional distress, and impair both day-to-day functioning and satisfaction with radiation treatment. Second, individual differences affect women’s experiences. Generally African-American women, younger women, women who are not currently in a relationship, women who are being treated during the summer, and women who are more invested in their appearance are more distressed by skin toxicity. Third, women use a variety of symptom management strategies including self-medication, complementary/alternative medicine approaches, and psychological strategies. Conclusions Implications of results are: 1) Skin toxicity affects numerous dimensions of quality of life, and assessment approaches and psychosocial interventions should address this; 2) individual differences may affect the experience of skin toxicity, and should be considered in treatment and education approaches; and 3) participants’ own creativity and problem-solving should be used to improve the treatment experience. PMID:20238306

  14. The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy

    SciTech Connect

    Motwani, Sabin B.; Strom, Eric A. . E-mail: estrom@mdanderson.org; Schechter, Naomi R.; Butler, Charles E.; Lee, Gordon K.; Langstein, Howard N.; Kronowitz, Steven J.; Meric-Bernstam, Funda; Ibrahim, Nuhad K.; Buchholz, Thomas A.

    2006-09-01

    Purpose: To quantify the impact of immediate breast reconstruction on postmastectomy radiation therapy (PMRT) planning. Methods: A total of 110 patients (112 treatment plans) who had mastectomy with immediate reconstruction followed by radiotherapy were compared with contemporaneous stage-matched patients who had undergone mastectomy without intervening reconstruction. A scoring system was used to assess optimal radiotherapy planning using four parameters: breadth of chest wall coverage, treatment of the ipsilateral internal mammary chain, minimization of lung, and avoidance of heart. An 'optimal' plan achieved all objectives or a minor 0.5 point deduction; 'moderately' compromised treatment plans had 1.0 or 1.5 point deductions; and 'major' compromised plans had {>=}2.0 point deductions. Results: Of the 112 PMRT plans scored after reconstruction, 52% had compromises compared with 7% of matched controls (p < 0.0001). Of the compromised plans after reconstruction, 33% were considered to be moderately compromised plans and 19% were major compromised treatment plans. Optimal chest wall coverage, treatment of the ipsilateral internal mammary chain, lung minimization, and heart avoidance was achieved in 79%, 45%, 84%, and 84% of the plans in the group undergoing immediate reconstruction, compared respectively with 100%, 93%, 97%, and 92% of the plans in the control group (p < 0.0001, p < 0.0001, p = 0.0015, and p = 0.1435). In patients with reconstructions, 67% of the 'major' compromised radiotherapy plans were left-sided (p < 0.16). Conclusions: Radiation treatment planning after immediate breast reconstruction was compromised in more than half of the patients (52%), with the largest compromises observed in those with left-sided cancers. For patients with locally advanced breast cancer, the potential for compromised PMRT planning should be considered when deciding between immediate and delayed reconstruction.

  15. Routine use of preoperative breast MRI for patients considered for intraoperative radiotherapy

    PubMed Central

    Small, William; Emami, Bahman

    2016-01-01

    This editorial comments on the study by Tallet et al. which reported on the incidence of ipsilateral second breast cancers (BC) detected by preoperative magnetic resonance imaging (MRI) in patients being considered for intraoperative radiotherapy (IORT). Any second BC was detected in 7% of patients; an ipsilateral BC was detected in 4% of patients, precluding them from IORT. The authors comment that in view of detection of a substantial rate of ipsilateral BCs by preoperative MRI, this exam should be used routinely for staging patients being considered for IORT. PMID:27162648

  16. Evaluation of intra- and inter-fraction motion in breast radiotherapy using electronic portal cine imaging.

    PubMed

    Kron, T; Lee, C; Perera, F; Yu, E

    2004-10-01

    Breast irradiation is one of the most challenging problems in radiotherapy due to the complex shape of the target volume, proximity of radiation sensitive normal structures and breathing motion. It was the aim of the present study to use electronic portal imaging (EPI) during treatment to determine intra- and inter-fraction motion in patients undergoing radiotherapy and to correlate the magnitude of motion with patient specific parameters. EPI cine images were acquired from the medial tangential fields of twenty radiotherapy patients on a minimum of 5 days each over the course of their treatment. The treatments were administered using 10 MV X-rays and dynamic wedges on a Varian Clinac 2100CD linear accelerator. Depending on the incident dose and the angle of the wedge, between 4 and 16 images could be acquired in one session using an EPI device based on liquid ionization chambers (Varian). The border between lung and chest-wall could be easily detected in all images and quantitative measurements were taken for the amount of lung in the field and the distance of the breast tissue from the field edges. Inter-fraction variability was found to be about twice as large as intra-fraction variability. The largest variability was detected in cranio/caudal direction (intra-fraction: 1.3 +/- 0.4 mm; inter-fraction: 2.6 +/- 1.3 mm) while the lung involvement varied by 1.1 +/- 0.2 mm and 1.8 +/- 0.6 mm intra- and inter-fraction, respectively. This indicates that the effect of breathing motion on the amount of radiated lung was not of major concern in the patients studied. Of other patient specific parameters such as body weight, breast separation, field size and location of the target, only increasing age was significantly correlated with larger inter-fraction motion. Acquisition of EPI cine loops proved to be a quick and easy technique to establish the amount of patient movement during breast radiotherapy. The relatively small variability found in the present pilot study

  17. [Radiotherapy plus concomitant systemic therapies for patients with brain metastases from breast cancer].

    PubMed

    Cao, K I; Kirova, Y M

    2014-06-01

    The incidence of brain metastases from breast cancer is increasing with diagnosis and therapeutics progress, especially with systemic therapies. The occurrence of multiple brain metastases remains a delicate situation when surgery and stereotactic radiosurgery are not indicated, nor available. Treatment strategy is based on the patient's general condition and extracranial disease status. Whole brain radiation therapy remains the gold standard local treatment but its efficacy is limited with a median overall survival of 6 months. New strategies are needed for increasing survival and patients' quality of life. Combining radiation therapy and chemotherapy has been a subject of interest. This article sums up the different radiotherapy plus concomitant systemic therapies combinations for the treatment of brain metastases from breast cancer. PMID:24731405

  18. Conservative surgery followed by radical radiotherapy in the management of stage I carcinoma of the breast

    SciTech Connect

    Baeza, M.R.; Arraztoa, J.; Sole, J.; Rodriguez, R.

    1982-10-01

    Since October 1976, the treatment policy in our Radiotheapy Center for Stage I carcinoma of the breast has been excision of the tumor mass, when it was cosmetically suitable, followed by irradiation to the breast and periphereal lymphatics. Eighty-three patients were admitted between October 1976 and March 1980. They underwent local excision of the tumor and then received 5000 rad in 5 weeks to the breast, supraclavicular, axillary and internal mammary chain lymph nodes. Each field was treated every day. A boost was then given to the scar, bringing the dose up to 6500 rad, calculated at maximum tumor depth, depending upon the size of the tumor prior to surgery. Cosmetic results were quite good, and the local control rate at 54 months is 98%. The survival with no evidence of disease (NED) at 54 months (actuarial) is 83%. Twenty-one out of 83 patients have had complications (25.3%); of these, 28.8% were surgical and the remainder results from radiotherapy after surgery, either from radiotherapy alone or from combination of treatments. Of the total of 21 complications, 18 were mild and 3 were serious.These results compare favorably with the results achieved in the same Hospital with radical surgery as far as local tumor control and survival with no evidence of disease (NED) is concerned. The results also compared with the great majority of surgical series reported in the literature, allowing us to conclude that patients treated with radiation have nothing to lose and much to gain by preserving the breast.

  19. Patient preferences regarding intraoperative versus external beam radiotherapy following breast-conserving surgery.

    PubMed

    Alvarado, Michael D; Conolly, Jay; Park, Catherine; Sakata, Theadora; Mohan, Aron J; Harrison, Brittany L; Hayes, Mitchell; Esserman, Laura J; Ozanne, Elissa M

    2014-01-01

    The TARGIT-A Trial is an international randomized, prospective trial comparing intraoperative radiotherapy (IORT) for equivalence to external beam radiotherapy (EBRT) following lumpectomy for invasive breast cancer in selected low-risk patients; early results suggest that outcomes are similar. In addition to effectiveness data and cost considerations, the preferences of patients should help inform practice. This study was undertaken to explore and quantify preference in choosing between IORT and the current standard, EBRT. Eligible subjects were current or past candidates for breast-conserving surgery and radiation being seen at the University of California, San Francisco Breast Care Center. A trade-off technique varying the risk of local recurrence for IORT was used to quantify any additional accepted risk that these patients would accept to receive either treatment. Patients were first presented with a slideshow comparing EBRT with the experimental IORT option before being asked their preferences given hypothetical 10-year local recurrence risks. Patients were then given a questionnaire on demographic, social and clinical factors. Data from 81 patients were analyzed. The median additional accepted risk to have IORT was 2.3 % (-9 to 39 %), mean 3.2 %. Only 7 patients chose to accept additional risk for EBRT; 22 accepted IORT at no additional risk; and the remaining 52 chose IORT with some additional risk. Patients weigh trade-offs of risks and benefits when presented with medical treatment choices. Our results show that the majority of breast cancer patients will accept a small increment of local risk for a simpler delivery of radiation. Further studies that incorporate outcome and side effect data from the TARGIT-A trial clarify the expected consequences of a local recurrence, and include an expanded range of radiation options that could help guide clinical decision making in this area. PMID:24292868

  20. [Quadrantectomy and adjuvant radiotherapy in carcinoma of the breast. Initial results of our cases].

    PubMed

    Gabriele, A M; Boidi Trotti, A; Tardy, A

    1987-06-01

    The conservative treatment of early breast cancer always requires irradiation of residual mammary tissue. The preliminary results obtained in 45 early breast cancer patients, who received quadrantectomy plus axillary dissection, followed by radiation of residual breast are reported. Radiation was performed by the two opposed field technique. In some cases the residual breast tissue was compressed using a special accessory provided with the Theratron 780. In addition to the tumor dose of 50 GY, 10 GY boots was added to the surgical scar using 7 MeV electrons. The 6 patients with positive axillary nodes received 6 courses of adjuvant chemotherapy (CMF) after radiotherapy. All patients are currently alive and free of disease. The 64% (29 patients) were followed up for at least 5 years, and 36% (16 patients) for at least 3 years. Only 2 cases of local recurrence were encountered (4.4%). The esthetic result was satisfactory in all cases. No side effects due to treatment were noted. PMID:3602483

  1. A review of setup error in supine breast radiotherapy using cone-beam computed tomography.

    PubMed

    Batumalai, Vikneswary; Holloway, Lois; Delaney, Geoff P

    2016-01-01

    Setup error in breast radiotherapy (RT) measured with 3-dimensional cone-beam computed tomography (CBCT) is becoming more common. The purpose of this study is to review the literature relating to the magnitude of setup error in breast RT measured with CBCT. The different methods of image registration between CBCT and planning computed tomography (CT) scan were also explored. A literature search, not limited by date, was conducted using Medline and Google Scholar with the following key words: breast cancer, RT, setup error, and CBCT. This review includes studies that reported on systematic and random errors, and the methods used when registering CBCT scans with planning CT scan. A total of 11 relevant studies were identified for inclusion in this review. The average magnitude of error is generally less than 5mm across a number of studies reviewed. The common registration methods used when registering CBCT scans with planning CT scan are based on bony anatomy, soft tissue, and surgical clips. No clear relationships between the setup errors detected and methods of registration were observed from this review. Further studies are needed to assess the benefit of CBCT over electronic portal image, as CBCT remains unproven to be of wide benefit in breast RT. PMID:27311516

  2. Biologically Effective Dose-Response Relationship for Breast Cancer Treated by Conservative Surgery and Postoperative Radiotherapy

    SciTech Connect

    Plataniotis, George A. Dale, Roger G.

    2009-10-01

    Purpose: To find a biologically effective dose (BED) response for adjuvant breast radiotherapy (RT) for initial-stage breast cancer. Methods and Materials: Results of randomized trials of RT vs. non-RT were reviewed and the tumor control probability (TCP) after RT was calculated for each of them. Using the linear-quadratic formula and Poisson statistics of cell-kill, the average initial number of clonogens per tumor before RT and the average tumor cell radiosensitivity (alpha-value) were calculated. An {alpha}/{beta} ratio of 4 Gy was assumed for these calculations. Results: A linear regression equation linking BED to TCP was derived: -ln[-ln(TCP)] = -ln(No) + {alpha}{sup *} BED = -4.08 + 0.07 * BED, suggesting a rather low radiosensitivity of breast cancer cells (alpha = 0.07 Gy{sup -1}), which probably reflects population heterogeneity. From the linear relationship a sigmoid BED-response curve was constructed. Conclusion: For BED values higher than about 90 Gy{sub 4} the radiation-induced TCP is essentially maximizing at 90-100%. The relationship presented here could be an approximate guide in the design and reporting of clinical trials of adjuvant breast RT.

  3. Real-time 3D surface-image-guided beam setup in radiotherapy of breast cancer

    SciTech Connect

    Djajaputra, David; Li Shidong

    2005-01-01

    We describe an approach for external beam radiotherapy of breast cancer that utilizes the three-dimensional (3D) surface information of the breast. The surface data of the breast are obtained from a 3D optical camera that is rigidly mounted on the ceiling of the treatment vault. This 3D camera utilizes light in the visible range therefore it introduces no ionization radiation to the patient. In addition to the surface topographical information of the treated area, the camera also captures gray-scale information that is overlaid on the 3D surface image. This allows us to visualize the skin markers and automatically determine the isocenter position and the beam angles in the breast tangential fields. The field sizes and shapes of the tangential, supraclavicular, and internal mammary gland fields can all be determined according to the 3D surface image of the target. A least-squares method is first introduced for the tangential-field setup that is useful for compensation of the target shape changes. The entire process of capturing the 3D surface data and subsequent calculation of beam parameters typically requires less than 1 min. Our tests on phantom experiments and patient images have achieved the accuracy of 1 mm in shift and 0.5 deg. in rotation. Importantly, the target shape and position changes in each treatment session can both be corrected through this real-time image-guided system.

  4. A support vector machine (SVM) for predicting preferred treatment position in radiotherapy of patients with breast cancer

    SciTech Connect

    Zhao Xuan; Wong, Edward K.; Wang Yao; Lymberis, Stella; Wen Bixiu; Formenti, Silvia; Chang Jenghwa

    2010-10-15

    Purpose: NYU 05-181 protocol compared the CT simulation in both supine and prone positions for 400 patients with breast cancer (200 left-breast and 200 right-breast) to identify which setup is better at sparing heart and lung involvement in the treatment process. The results demonstrated that all right-breast patients benefited from the prone treatment position, while for left-breast patients, 85% were better treated prone and 15% were better treated supine. Using the clinical data collected from this protocol, the authors aimed at developing an automated tool capable of identifying which of the left-breast cancer patients are better treated supine without obtaining a second CT scan in the supine position. Methods: Prone CT scans from 198 of the 200 left-breast cancer patients enrolled in NYU 05-181 protocol were deidentified and exported to a dedicated research planning workstation. Three-dimensional geometric features of the organs at risk and tumor bed were extracted. A two-stage classifier was used to classify patients into the prone class or the supine class. In the first stage, the authors use simple thresholding to divide the patients into two groups based on their in-field heart volume. For patients with in-field heart volume {<=}0.1 cc, the prone position was chosen as the preferred treatment position. Patients with in-field heart volume >0.1 cc will be further classified in the second stage by a weighted support vector machine (SVM). The weight parameters of the SVM were adjusted to maximize the specificity [true-supine/(true-supine+false-prone)] at the cost of lowering but still maintaining reasonable sensitivity [true-prone/(true-prone+false-supine)]. The authors used K-fold cross validations to test the performance of the SVM classifier. A feature selection algorithm was also used to identify features that give the best classification performance. Results: After the first stage, 49 of the 198 left-breast cancer patients were found to have >0.1 cc of in

  5. Breast cancer risk following Hodgkin lymphoma radiotherapy in relation to menstrual and reproductive factors

    PubMed Central

    Cooke, R; Jones, M E; Cunningham, D; Falk, S J; Gilson, D; Hancock, B W; Harris, S J; Horwich, A; Hoskin, P J; Illidge, T; Linch, D C; Lister, T A; Lucraft, H H; Radford, J A; Stevens, A M; Syndikus, I; Williams, M V; Swerdlow, A J

    2013-01-01

    Background: Women treated with supradiaphragmatic radiotherapy (sRT) for Hodgkin lymphoma (HL) at young ages have a substantially increased breast cancer risk. Little is known about how menarcheal and reproductive factors modify this risk. Methods: We examined the effects of menarcheal age, pregnancy, and menopausal age on breast cancer risk following sRT in case–control data from questionnaires completed by 2497 women from a cohort of 5002 treated with sRT for HL at ages <36 during 1956–2003. Results: Two-hundred and sixty women had been diagnosed with breast cancer. Breast cancer risk was significantly increased in patients treated within 6 months of menarche (odds ratio (OR) 5.52, 95% confidence interval (CI) (1.97–15.46)), and increased significantly with proximity of sRT to menarche (Ptrend<0.001). It was greatest when sRT was close to a late menarche, but based on small numbers and needing reexamination elsewhere. Risk was not significantly affected by full-term pregnancies before or after treatment. Risk was significantly reduced by early menopause (OR 0.55, 95% CI (0.35–0.85)), and increased with number of premenopausal years after treatment (Ptrend=0.003). Conclusion: In summary, this paper shows for the first time that sRT close to menarche substantially increases breast cancer risk. Careful consideration should be given to follow-up of these women, and to measures that might reduce their future breast cancer risk. PMID:23652303

  6. Long-Term Effects of Radiotherapy on Arterial Stiffness in Breast Cancer Women.

    PubMed

    Vallerio, Paola; Sarno, Laura; Stucchi, Miriam; Musca, Francesco; Casadei, Francesca; Maloberti, Alessandro; Lestuzzi, Chiara; Mancia, Giuseppe; Moreo, Antonella; Palazzi, Mauro; Giannattasio, Cristina

    2016-09-01

    Radiotherapy for breast cancer may expose heart and vessels to late radiation-induced complications. Although recent technical progress in radiation therapy (RT) has been associated with drastic reduction in cardiovascular (CV) mortality, the prolonged life expectancy of patients with cancer requires CV evaluation for many years. The aim of our study was to evaluate local changes in vascular and cardiac function because of previous breast RT. We enrolled 43 patients treated with RT 15 years ago for breast cancer. CV risk factors and atherosclerotic carotid damage were investigated in all women. We divided patients into 2 groups: R (n = 25) treated to right breast and L (n = 18) to left breast. All subjects were submitted to standard echocardiography and functional arteries evaluation by carotid-radial pulse-wave velocity (crPWV; Complior) and AIx (Sphygmocor; Atcor Medical). Global mean age was 69.5 ± 8 years old. CV risk factors were equally allocated in 2 groups. No patients had history of cardiac or artery disease. R had a significantly increased crPWV (9.9 ± 1.4 vs 8.9 ± 1.1, p = 0.001) on right arm compared with left arm, and in L group, crPWV was similarly higher on the left arm than on right arm (9.6 ± 1.5 vs 8.9 ± 1.4, p = 0.011). AIx was significantly increased in the ipsilateral arm only in L (32.1 ± 7.6 vs 28.3 ± 6.8, p = 0.05). Central blood pressure estimation was not different in the right and left arms. No correlations were found with hormone therapy or chemotherapy. Our data show a local arterial stiffening because of radiation that can be involved in increased CV risk in breast cancer-treated patients. PMID:27392510

  7. High-dose simultaneously integrated breast boost using intensity-modulated radiotherapy and inverse optimization

    SciTech Connect

    Hurkmans, Coen W. . E-mail: coen.hurkmans@cze.nl; Meijer, Gert J.; Vliet-Vroegindeweij, Corine van; Cassee, Jorien

    2006-11-01

    Purpose: Recently a Phase III randomized trial has started comparing a boost of 16 Gy as part of whole-breast irradiation to a high boost of 26 Gy in young women. Our main aim was to develop an efficient simultaneously integrated boost (SIB) technique for the high-dose arm of the trial. Methods and Materials: Treatment planning was performed for 5 left-sided and 5 right-sided tumors. A tangential field intensity-modulated radiotherapy technique added to a sequentially planned 3-field boost (SEQ) was compared with a simultaneously planned technique (SIB) using inverse optimization. Normalized total dose (NTD)-corrected dose volume histogram parameters were calculated and compared. Results: The intended NTD was produced by 31 fractions of 1.66 Gy to the whole breast and 2.38 Gy to the boost volume. The average volume of the PTV-breast and PTV-boost receiving more than 95% of the prescribed dose was 97% or more for both techniques. Also, the mean lung dose and mean heart dose did not differ much between the techniques, with on average 3.5 Gy and 2.6 Gy for the SEQ and 3.8 Gy and 2.6 Gy for the SIB, respectively. However, the SIB resulted in a significantly more conformal irradiation of the PTV-boost. The volume of the PTV-breast, excluding the PTV-boost, receiving a dose higher than 95% of the boost dose could be reduced considerably using the SIB as compared with the SEQ from 129 cc (range, 48-262 cc) to 58 cc (range, 30-102 cc). Conclusions: A high-dose simultaneously integrated breast boost technique has been developed. The unwanted excessive dose to the breast was significantly reduced.

  8. The Influence of Treatment Position (Prone vs. Supine) on Clip Displacement, Seroma, Tumor Bed and Partial Breast Target Volumes: Comparative Study.

    PubMed

    Lakosi, Ferenc; Gulyban, Akos; Simoni, Selma Ben-Mustapha; Nguyen, Paul Viet; Cucchiaro, Séverine; Seidel, Laurence; Janvary, Levente; Nicolas, Sophie; Vavassis, Peter; Coucke, Philippe

    2016-07-01

    To analyse the displacement of surgical clips in prone (Pr) position and assess the consequences on target volumes and integral dose of partial breast irradiation (PBI). 30 post-lumpectomy breast cancer patients underwent CT imaging in supine (Su) and Pr. Clip displacements were measured by the distances from the clips to a common fix bony reference point. On each dataset, the tumour bed (TB = clips ± seroma), clinical target volume (CTV = TB + 1.5 cm) and planning target volumes (PTV = CTV + 1 cm) for PBI were determined and the volume pairs were compared. Furthermore estimation of integral dose ratio (IDR) within the breast from tangential treatment was performed as the ratio of the irradiated breast volume and the volume encompassing all clips. Clips close to the chest wall (CW) in Su showed significantly less displacement in Pr. The mean volumes of seroma, CTV and PTV were significantly higher in Pr than in Su. The PTV volume difference (Pr-Su) was significantly higher in patients with presence of seroma, deep clips and TB location in the superior-internal-quadrant (SIQ) and at the junction of superior quadrants (jSQ). In a multivariate analysis two factors remained significant: seroma and TB localization in SIQ-jSQ. The IDR was significantly larger in Su than in Pr (7.6 vs. 4.1 p < 0.01). Clip displacements varied considerably with respect to their relative position to the CW. In selected patients Pr position potentially leads to a significant increase in target volumes of PBI. Tangential beam arrangement for PBI should be avoided, not only in Su but in Pr as well in case of clip-based target volume definition. PMID:26676979

  9. Adjuvant radiotherapy of regional lymph nodes in breast cancer - a meta-analysis of randomized trials

    PubMed Central

    2013-01-01

    Background Radiotherapy (RT) improves overall survival (OS) of breast cancer patients after breast conserving surgery and after mastectomy in patients with involved lymph nodes (LN). The contribution of RT to the regional LN to this survival benefit was poorly understood. Recently, the results of three large randomized trials addressing this question have become available. Material and methods The published abstracts (full publication pending) of the MA.20 (n=1832) and the EORTC 22922–10925 (EORTC) (n=4004) trial and the full publication of the French trial (n=1334) were basis of the meta-analysis. Main eligibility criteria were positive axillary LN (all trials), LN negative disease with high risk for recurrence (MA.20), and medial/central tumor location (French, EORTC). The MA.20 and the EORTC trial tested the effect of additional regional RT to the internal mammary (IM) LN and medial supraclavicular (MS) LN, whereas in the French trial all patients received RT to the MS-LN and solely RT to the IM-LN was randomized. Primary endpoint was OS. Secondary endpoints were disease-free survival (DFS) and distant metastasis free survival (DMFS). Results Regional RT of the MS-LN and the IM-LN (MA.20 and EORTC) resulted in a significant improvement of OS (Hazard Ratio (HR) 0.85 (95% CL 0.75 - 0.96)). Adding the results of the French trial and using the random effects model to respect the different design of the French trial, the effect on OS of regional radiotherapy was still significant (HR 0.88 (95% CL 0.80 - 0.97)). The absolute benefits in OS were 1.6% in the MA.20 trial at 5 years, 1.6% in the EORTC trial at 10 years, and 3.3% in the French trial at 10 years (not significant in single trials). Regional radiotherapy of the MS-LN and the IM-LN (MA.20 and EORTC) was associated with a significant improvement of DFS (HR 0.85 (95% CL 0.77 - 0.94)) and DMFS (HR 0.82 (95% CL 0.73 - 0.92)). The effect sizes were not significantly different between trials for any end point

  10. In Vivo Dosimetry for Single-Fraction Targeted Intraoperative Radiotherapy (TARGIT) for Breast Cancer

    SciTech Connect

    Eaton, David J.; Best, Bronagh; Brew-Graves, Chris; Duck, Stephen; Ghaus, Tabasom; Gonzalez, Regina; Pigott, Katharine; Reynolds, Claire; Williams, Norman R.; Keshtgar, Mohammed R.S.

    2012-04-01

    Purpose: In vivo dosimetry provides an independent check of delivered dose and gives confidence in the introduction or consistency of radiotherapy techniques. Single-fraction intraoperative radiotherapy of the breast can be performed with the Intrabeam compact, mobile 50 kV x-ray source (Carl Zeiss Surgical, Oberkochen, Germany). Thermoluminescent dosimeters (TLDs) can be used to estimate skin doses during these treatments. Methods and Materials: Measurements of skin doses were taken using TLDs for 72 patients over 3 years of clinical treatments. Phantom studies were also undertaken to assess the uncertainties resulting from changes in beam quality and backscatter conditions in vivo. Results: The mean measured skin dose was 2.9 {+-} 1.6 Gy, with 11% of readings higher than the prescription dose of 6 Gy, but none of these patients showed increased complications. Uncertainties due to beam hardening and backscatter reduction were small compared with overall accuracy. Conclusions: TLDs are a useful and effective method to measure in vivo skin doses in intraoperative radiotherapy and are recommended for the initial validation or any modification to the delivery of this technique. They are also an effective tool to show consistent and safe delivery on a more frequent basis or to determine doses to other critical structures as required.

  11. Supervised physical therapy in women treated with radiotherapy for breast cancer 1

    PubMed Central

    Leal, Nara Fernanda Braz da Silva; de Oliveira, Harley Francisco; Carrara, Hélio Humberto Angotti

    2016-01-01

    ABSTRACT Objective: to evaluate the effect of physical therapy on the range of motion of the shoulders and perimetry of the upper limbs in women treated with radiotherapy for breast cancer. Methods: a total of 35 participants were randomized into two groups, with 18 in the control group (CG) and 17 in the study group (SG). Both of the groups underwent three evaluations to assess the range of motion of the shoulders and perimetry of the upper limbs, and the study group underwent supervised physical therapy for the upper limbs. Results: the CG had deficits in external rotation in evaluations 1, 2, and 3, whereas the SG had deficits in flexion, abduction, and external rotation in evaluation 1. The deficit in abduction was recovered in evaluation 2, whereas the deficits in all movements were recovered in evaluation 3. No significant differences in perimetry were observed between the groups. Conclusion: the applied supervised physical therapy was effective in recovering the deficit in abduction after radiotherapy, and the deficits in flexion and external rotation were recovered within two months after the end of radiotherapy. Registration number of the clinical trial: NCT02198118. PMID:27533265

  12. Assessment of interfractional variation of the breast surface following conventional patient positioning for whole-breast radiotherapy.

    PubMed

    Padilla, Laura; Kang, Hyejoo; Washington, Maxine; Hasan, Yasmin; Chmura, Steve J; Al-Hallaq, Hania

    2014-01-01

    The purpose of this study was to quantify the variability of the breast surface position when aligning whole-breast patients to bony landmarks based on MV portal films or skin marks alone. Surface imaging was used to assess the breast surface position of 11 whole-breast radiotherapy patients, but was not used for patient positioning. On filmed fractions, AlignRT v5.0 was used to capture the patient's surface after initial positioning based on skin marks (28 "preshifts" surfaces), and after treatment couch shifts based on MV films (41 "postshifts" surfaces). Translations and rotations based on surface captures were recorded, as well as couch shifts based on MV films. For nonfilmed treatments, "daily" surface images were captured following positioning to skin marks alone. Group mean and systematic and random errors were calculated for all datasets. Pearson correlation coefficients, setup margins, and 95% limits of agreement (LOA) were calculated for preshifts translations and MV film shifts. LOA between postshifts surfaces and the filmed treatment positions were also computed. All the surface captures collected were retrospectively compared to both a DICOM reference surface created from the planning CT and to an AlignRT reference surface. All statistical analyses were performed using the DICOM reference surface dataset. AlignRT reference surface data was only used to calculate the LOA with the DICOM reference data. This helped assess any outcome differences between both reference surfaces. Setup margins for preshifts surfaces and MV films range between 8.3-12.0 mm and 5.4-13.4 mm, respectively. The largest margin is along the left-right (LR) direction for preshift surfaces, and along craniocaudal (CC) for films. LOA ranges between the preshifts surfaces and MV film shifts are large (12.6-21.9 mm); these decrease for postshifts surfaces (9.8-18.4 mm), but still show significant disagreements between the two modalities due to their focus on different anatomical

  13. Single-Fraction Intraoperative Radiotherapy for Breast Cancer: Early Cosmetic Results

    SciTech Connect

    Beal, Kathryn McCormick, Beryl; Zelefsky, Michael J.; Borgen, Patrick; Fey, Jane; Goldberg, Jessica; Sacchini, Virgilio

    2007-09-01

    Purpose: To evaluate the cosmetic outcome of patients treated with wide local excision and intraoperative radiotherapy for early-stage breast cancer. Methods and Materials: A total of 50 women were treated on a pilot study to evaluate the feasibility of intraoperative radiotherapy at wide local excision. The eligibility criteria included age >60, tumor size {<=}2.0 cm, clinically negative lymph nodes, and biopsy-established diagnosis. After wide local excision, a custom breast applicator was placed in the excision cavity, and a dose of 20 Gy was prescribed to a depth of 1 cm. After 18 patients were treated, the dose was constrained laterally to 18 Gy. The cosmetic outcome was evaluated by photographs at baseline and at 6 and 12 months postoperatively. Four examiners graded the photographs for symmetry, edema, discoloration, contour, and scarring. The grades were evaluated in relationship to the volume of irradiated tissue, tumor location, and dose at the lateral aspects of the cavity. Results: The median volume of tissue receiving 100% of the prescription dose was 47 cm{sup 3} (range, 20-97 cm{sup 3}). Patients with {<=}47 cm{sup 3} of treated tissue had better cosmetic outcomes than did the women who had >47 cm{sup 3} of treated tissue. Women who had received 18 Gy at the lateral aspects of their cavities had better cosmetic outcomes than did women who had received 20 Gy at the lateral aspects. When comparing the 6- and 12-month results, the scores remained stable for 63%, improved for 17%, and worsened for 20%. Conclusion: Intraoperative radiotherapy appears feasible for selected patients. A favorable cosmetic outcome appears to be related to a smaller treatment volume. The cosmetic outcome is acceptable, although additional follow-up is necessary.

  14. Evaluation of the field-in-field technique with lung blocks for breast tangential radiotherapy

    PubMed Central

    Tanaka, Hidekazu; Hayashi, Shinya; Kajiura, Yuichi; Kitahara, Masashi; Matsuyama, Katsuya; Kanematsu, Masayuki; Hoshi, Hiroaki

    2015-01-01

    ABSTRACT Several studies have reported the advantages of the field-in-field (FIF) technique in breast radiotherapy, including dose reduction in the lungs by using lung field blocks. We evaluated the FIF technique with lung blocks for breast tangential radiotherapy. Sixteen patients underwent free breathing (FB) computed tomography (CT), followed by two CT procedures performed during breath hold after light inhalation (IN) and light exhalation (EX). Three radiotherapy plans were created using the FIF technique based on the FB-CT images: one without lung blocks (LB0) and two with lung blocks whose monitor units (MUs) were 5 (LB5) and 10 (LB10), respectively. These plans were copied to the IN-CT and EX-CT images. V20Gy, V30Gy, and V40Gy of the ipsilateral lung and V100%, V95%, and the mean dose (Dmean) to the planning target volume (PTV) were analyzed. The extent of changes in these parameters on the IN-plan and EX-plan compared with the FB-plan was evaluated. V20Gy, V30Gy, and V40Gy were significantly smaller for FB-LB5 and FB-LB10 than for FB-LB0; similar results were obtained for the IN-plan and EX-plan. V100%, V95%, and Dmean were also significant smaller for FB-LB5 and FB-LB10 than for FB-LB0. The extent of changes in V20Gy, V30Gy, and V40Gy on the IN-plan and EX-plan compared with the FB-plan was not statistically significant. Lung blocks were useful for dose reduction in the lung and a simultaneous PTV decrease. This technique should not be applied in the general population. PMID:26412879

  15. Evaluation of the field-in-field technique with lung blocks for breast tangential radiotherapy.

    PubMed

    Tanaka, Hidekazu; Hayashi, Shinya; Kajiura, Yuichi; Kitahara, Masashi; Matsuyama, Katsuya; Kanematsu, Masayuki; Hoshi, Hiroaki

    2015-08-01

    Several studies have reported the advantages of the field-in-field (FIF) technique in breast radiotherapy, including dose reduction in the lungs by using lung field blocks. We evaluated the FIF technique with lung blocks for breast tangential radiotherapy. Sixteen patients underwent free breathing (FB) computed tomography (CT), followed by two CT procedures performed during breath hold after light inhalation (IN) and light exhalation (EX). Three radiotherapy plans were created using the FIF technique based on the FB-CT images: one without lung blocks (LB0) and two with lung blocks whose monitor units (MUs) were 5 (LB5) and 10 (LB10), respectively. These plans were copied to the IN-CT and EX-CT images. V20Gy, V30Gy, and V40Gy of the ipsilateral lung and V100%, V95%, and the mean dose (Dmean) to the planning target volume (PTV) were analyzed. The extent of changes in these parameters on the IN-plan and EX-plan compared with the FB-plan was evaluated. V20Gy, V30Gy, and V40Gy were significantly smaller for FB-LB5 and FB-LB10 than for FB-LB0; similar results were obtained for the IN-plan and EX-plan. V100%, V95%, and Dmean were also significant smaller for FB-LB5 and FB-LB10 than for FB-LB0. The extent of changes in V20Gy, V30Gy, and V40Gy on the IN-plan and EX-plan compared with the FB-plan was not statistically significant. Lung blocks were useful for dose reduction in the lung and a simultaneous PTV decrease. This technique should not be applied in the general population. PMID:26412879

  16. Adjuvant chemotherapy and acute toxicity in hypofractionated radiotherapy for early breast cancer

    PubMed Central

    Kouloulias, Vassilis; Zygogianni, Anna; Kypraiou, Efrosini; Georgakopoulos, John; Thrapsanioti, Zoi; Beli, Ivelina; Mosa, Eftychia; Psyrri, Amanta; Antypas, Christos; Armbilia, Christina; Tolia, Maria; Platoni, Kalliopi; Papadimitriou, Christos; Arkadopoulos, Nikolaos; Gennatas, Costas; Zografos, George; Kyrgias, George; Dilvoi, Maria; Patatoucas, George; Kelekis, Nikolaos; Kouvaris, John

    2014-01-01

    AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy (HFRT) schedule for breast cancer. METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0Mx. The patients received 3-D conformal radiotherapy with a total physical dose of 50.54 Gy or 53.2 Gy in 19 or 20 fractions according to stage, over 23-24 d. The last three to four fractions were delivered as a sequential tumor boost. All patients were monitored for acute skin toxicity according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group criteria. The maximum monitored value was taken as the final grading score. Multivariate analysis was performed for the contribution of age, chemotherapy and 19 vs 20 fractions to the radiation acute skin toxicity. RESULTS: The acute radiation induced skin toxicity was as following: grade I 27.6%, grade II 7.8% and grade III 2.6%. No significant correlation was noted between toxicity grading and chemotherapy (P = 0.154, χ2 test). The mean values of acute toxicity score in terms of chemotherapy or not, were 0.64 and 0.46 respectively (P = 0.109, Mann Whitney test). No significant correlation was also noted between acute skin toxicity and radiotherapy fractions (P = 0.47, χ2 test). According to univariate analysis, only chemotherapy contributed significantly to the development of acute skin toxicity but with a critical value of P = 0.05. However, in multivariate analysis, chemotherapy lost its statistical significance. None of the patients during the 2-years of follow-up presented any locoregional relapse. CONCLUSION: There is no clear evidence that chemotherapy has an impact to acute skin toxicity after an HFRT schedule. A randomized trial is needed for definite conclusions. PMID:25405195

  17. Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors

    PubMed Central

    2014-01-01

    Purpose The objective of this study is to evaluate toxicity and cosmetic outcome in breast cancer patients treated with adjuvant hypo fractionated radiotherapy to the whole breast, and to identify the risk factors for toxicity. Methods and materials Two hundred twelve women with early breast cancer underwent conserving surgery were enrolled in the study. The patients received 40.05 Gy in 15 daily fractions, 2.67 Gy per fraction. The boost to the tumor bed was administered with a total dose of 9 Gy in 3 consecutive fractions in 55 women. Physician-rated acute and late toxicity and cosmetic outcome (both subjective and objective) were prospectively assessed during and after radiotherapy. Results In our population study the mean age was 63 with the 17% (36 pts) of the women younger than 50 years. The median follow-up was 34 months. By the end of RT, 35 patients out of 212 (16%) no acute toxicity, according to the RTOG criteria, while 145 (68%) and 31 patients (15%) developed grade 1 and grade 2 acute skin toxicity, respectively. Late skin toxicity evaluation was available for all 212 patients with a minimum follow up of 8 months. The distribution of toxicity was: 39 pts (18%) with grade 1 and 2 pts (1%) with grade 2. No worse late skin toxicity was observed. Late subcutaneous grade 0-1 toxicity was recorded in 208 patients (98%) and grade 2 toxicity in 3 patients (2%), while grade 3 was observed in 1 patient only. At last follow up, a subjective and objective good or excellent cosmetic outcome was reported in 93% and 92% of the women, respectively. At univariate and multivariate analysis, the late skin toxicity was correlated with the additional boost delivery (p=0.007 and p=0.023). Regarding the late subcutaneous tissue, a correlation with diabetes was found (p=0.0283). Conclusion These results confirm the feasibility and safety of the hypofractionated radiotherapy in patients with early breast cancer. In our population the boost administration was resulted to

  18. Preoperative Single Fraction Partial Breast Radiotherapy for Early-Stage Breast Cancer

    SciTech Connect

    Palta, Manisha; Yoo, Sua; Adamson, Justus D.; Prosnitz, Leonard R.; Horton, Janet K.

    2012-01-01

    Purpose: Several recent series evaluating external beam accelerated partial breast irradiation (PBI) have reported adverse cosmetic outcomes, possibly related to large volumes of normal tissue receiving near-prescription doses. We hypothesized that delivery of external beam PBI in a single fraction to the preoperative tumor volume would be feasible and result in a decreased dose to the uninvolved breast compared with institutional postoperative PBI historical controls. Methods and Materials: A total of 17 patients with unifocal Stage T1 breast cancer were identified. Contrast-enhanced subtraction magnetic resonance images were loaded into an Eclipse treatment planning system and used to define the target volumes. A 'virtual plan' was created using four photon beams in a noncoplanar beam arrangement and optimized to deliver 15 Gy to the planning target volume. Results: The median breast volume was 1,713 cm{sup 3} (range: 1,014-2,140), and the median clinical target volume was 44 cm{sup 3} (range: 26-73). In all cases, 100% of the prescription dose covered 95% of the clinical target volume. The median conformity index was 0.86 (range: 0.70-1.12). The median percentage of the ipsilateral breast volume receiving 100% and 50% of the prescribed dose was 3.8% (range: 2.2-6.9) and 13.3% (range: 7.5-20.8) compared with 18% (range: 3-42) and 53% (range: 24-65) in the institutional historical controls treated with postoperative external beam PBI (p = .002). The median maximum skin dose was 9 Gy. The median dose to 1 and 10 cm{sup 3} of skin was 6.7 and 4.9 Gy. The doses to the heart and ipsilateral lung were negligible. Conclusion: Preoperative PBI resulted in a substantial reduction in ipsilateral breast tissue dose compared with postoperative PBI. The skin dose appeared reasonable, given the small volumes. A prospective Phase I trial evaluating this technique is ongoing.

  19. Full-dose capecitabine with local radiotherapy: one of the treatment options for inoperable T4 breast cancer.

    PubMed

    Hirowatari, Hisako; Karasawa, Kumiko; Izawa, Hiromi; Ito, Kana; Sasai, Keisuke; Furuya, Tomohisa; Ozawa, Shuichi; Arakawa, Atsushi; Orihata, Gotaro; Saito, Mitsue

    2011-04-01

    A 48-year-old woman presented with a 15-cm diameter tumor in her left breast with fixation to the chest wall and palpable axillary lymph nodes. Pathology study showed pure-type mucinous carcinoma. Pretreatment staging investigations showed multiple lung metastases, which resulted in the diagnosis of T4N2M1 breast cancer. Four cycles of cyclophosphamide 700 mg/m(2)/epirubicin 70 mg/m(2) (CE) were performed initially, but the tumors decreased only within the treatment response criteria of stable disease (SD). The second regimen of docetaxel could not continue due to drug allergy. Two more cycles of CE did not improve the situation. Then, treatment was continued with full-dose capecitabine with local radiotherapy. She received radiotherapy to the left breast and axillary region with 60 Gy/30 fractions/6 weeks and concomitant capecitabine 2400 mg/body twice daily for 21 days; the cycles were repeated every 28 days. After radiotherapy, tumors decreased in size, and the skin ulceration disappeared. She continued to receive capecitabine on the same schedule. She now has no palpable tumor in her left breast and no tumor in the axilla or lung on CT. She is alive and well 6 years after radiotherapy. PMID:21519998

  20. An imaging evaluation of the simultaneously integrated boost breast radiotherapy technique

    SciTech Connect

    Turley, Jessica; Claridge Mackonis, Elizabeth

    2015-09-15

    To evaluate in-field megavoltage (MV) imaging of simultaneously integrated boost (SIB) breast fields to determine its feasibility in treatment verification for the SIB breast radiotherapy technique, and to assess whether the current-imaging protocol and treatment margins are sufficient. For nine patients undergoing SIB breast radiotherapy, in-field MV images of the SIB fields were acquired on days that regular treatment verification imaging was performed. The in-field images were matched offline according to the scar wire on digitally reconstructed radiographs. The offline image correction results were then applied to a margin recipe formula to calculate safe margins that account for random and systematic uncertainties in the position of the boost volume when an offline correction protocol has been applied. After offline assessment of the acquired images, 96% were within the tolerance set in the current department-imaging protocol. Retrospectively performing the maximum position deviations on the Eclipse™ treatment planning system demonstrated that the clinical target volume (CTV) boost received a minimum dose difference of 0.4% and a maximum dose difference of 1.4% less than planned. Furthermore, applying our results to the Van Herk margin formula to ensure that 90% of patients receive 95% of the prescribed dose, the calculated CTV margins were comparable to the current departmental procedure used. Based on the in-field boost images acquired and the feasible application of these results to the margin formula the current CTV-planning target volume margins used are appropriate for the accurate treatment of the SIB boost volume without additional imaging.

  1. Lung dose analysis in loco-regional hypofractionated radiotherapy of breast cancer

    PubMed Central

    Attar, Mohammad A.; Bahadur, Yasir A.; Constantinescu, Camelia T.; Eltaher, Maha M.

    2016-01-01

    Objectives: To report the ipsilateral lung dosimetry data of breast cancer (BC) patients treated with loco-regional hypofractionated radiotherapy (HFRT). Methods: Treatment plans of 150 patients treated in the Radiotherapy Unit, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January 2012 and March 2015 by HFRT for BC were retrospectively reviewed. All patients received 42.4 Gy in 16 fractions by tangential and supra-clavicular fields with 6 MV, 18 MV, or mixed energies. Ipsilateral lung dosimetric data V20Gy and mean lung dose (MLD) were recorded. Correlations between lung dose, patient characteristics, and treatment delivery parameters were assessed by a logistic regression test. Results: The mean ipsilateral lung V20Gy was 24.6% and mean MLD was 11.9 Gy. A weak, but statistically significant correlation was found between lung dose and lung volume (p=0.043). The lung dose was significantly decreasing with patient separation and depth of axillary lymph node (ALN) and supra-claviculary lymph nodes (SCLN) (p<0.0001), and increasing with ALN (p=0.001) and SCLN (p=0.003) dose coverage. Lung dose significantly decreased with beam energy (p<0.0001): mean V20Gy was 27.8%, 25.4% for 6 MV, mixed energy, and 21.2% for 18 MV. The use of a low breast-board angle correlates with low lung dose. Conclusion: Our data suggest that the use of high energy photon beams and low breast-board angulation can reduce the lung dose. PMID:27279508

  2. Megavoltage cone beam CT near surface dose measurements: potential implications for breast radiotherapy

    SciTech Connect

    Quinn, Alexandra; Holloway, Lois; Cutajar, Dean; Hardcastle, Nicholas; Rosenfeld, Anatoly; Metcalfe, Peter

    2011-11-15

    Purpose: Cone beam computed tomography (CBCT) is fast becoming standard on modern linear accelerators. CBCT increases the dose to regions within and outside the treatment field, potentially increasing secondary cancer induction and toxicity. This study quantified megavoltage (MV) CBCT skin dose and compared it to skin dose delivered during standard tangential breast radiotherapy.Method: Dosimetry was performed both in- and out-of-field using thermoluminescent dosimeters (TLDs) and a metal-oxide-semiconductor-field-effect-transistor (MOSFET) detector specifically designed for skin dosimetry; these were placed superficially on a female anthropomorphic phantom. Results: The skin dose from a single treatment fraction ranged from 0.5 to 1.4 Gy on the ipsilateral breast, 0.031-0.18 Gy on the contralateral breast, and 0-0.02 Gy in the head and pelvic region. An 8 MU MV CBCT delivered a skin dose that ranged from 0.02 to 0.05 Gy in the chest region and was less than 0.01 Gy in the head and pelvis regions. One MV CBCT per fraction was found to increase the out-of-field skin dose from both the CBCT and the treatment fields by approximately 20%. The imaging dose as a percentage of treatment doses in the ipsilateral breast region was 3% for both dosimeters.Conclusion: Imaging increases the skin dose to regions outside the treatment field particularly regions immediately adjacent the target volume. This small extra dose to the breasts should be considered when developing clinical protocols and assessing dose for clinical trials.

  3. Trastuzumab improves locoregional control in HER2-positive breast cancer patients following adjuvant radiotherapy

    PubMed Central

    Cao, Lu; Cai, Gang; Xu, Fei; Yang, Zhao-Zhi; Yu, Xiao-Li; Ma, Jin-Li; Zhang, Qian; Wu, Jiong; Guo, Xiao-Mao; Chen, Jia-Yi

    2016-01-01

    Abstract The benefit of adjuvant trastuzumab in disease-free and overall survival for human epidermal receptor 2–positive (HER2+) breast cancer patients is well established. However, the effect of trastuzumab on locoregional control remains unclear, particularly in patients treated with adjuvant radiotherapy (RT). In this study, we investigated the locoregional benefit of trastuzumab in patients with HER2+ breast cancer after adjuvant RT. Using a single institutional database, we identified 278 patients with stage II/III invasive HER2+ breast tumors receiving adjuvant RT between January 2008 and July 2011. We compared the locoregional outcomes of 134 patients who received trastuzumab to 144 patients without trastuzumab within the same period. Clinical and biological factors that might impact on the locoregional benefit of trastuzumab were also assessed. At the median follow-up of 45 months, trastuzumab significantly lowered the risk of locoregional recurrence (LRR) with a 3-year LRR rate of 2.4% versus 7.5% for the cohort with and without trastuzumab (P = 0.019). Trastuzumab was associated with a more significant locoregional benefit in the hormone receptor–positive (HR+)/HER2+ subgroup, with a 3-year LRR of 0% versus 6.7% in the cohort with and without trastuzumab (P = 0.027). For HR−/HER2+ breast tumor patients, the 3-year LRR rate was still lower for the cohort with trastuzumab (4.7% vs 8.6%). However, statistical significance was not found (P = 0.179). Both univariate and multivariate analyses confirmed that trastuzumab treatment was the only significant predictive factor for LRR (hazard ratio, 4.05; 95% confidence interval, 1.07–15.35; P = 0.039). Adjuvant trastuzumab in addition to RT is associated with significant reduced LRR risk in HER2+ breast cancer. PMID:27512838

  4. A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique

    SciTech Connect

    Vass, Sylvie . E-mail: sylvie.vass@ssss.gouv.qc.ca; Bairati, Isabelle

    2005-08-01

    Purpose: To compare cosmetic results of two different radiotherapy (RT) boost techniques used in the treatment of breast cancer after whole breast radiotherapy and to identify factors affecting cosmetic outcomes. Methods and Materials: Between 1996 and 1998, 142 patients with Stage I and II breast cancer were treated with breast conservative surgery and adjuvant RT. Patients were then randomly assigned to receive a boost dose of 15 Gy delivered to the tumor bed either by iridium 192, or a combination of photons and electrons. Cosmetic evaluations were done on a 6-month basis, with a final evaluation at 36 months after RT. The evaluations were done using a panel of global and specific subjective scores, a digitized scoring system using the breast retraction assessment (BRA) measurement, and a patient's self-assessment evaluation. As cosmetic results were graded according to severity, the comparison of boost techniques was done using the ordinal logistic regression model. Adjusted odds ratios (OR) and their 95% confidence intervals (CI) are presented. Results: At 36 months of follow-up, there was no significant difference between the two groups with respect to the global subjective cosmetic outcome (OR = 1.40; 95%CI = 0.69-2.85, p = 0.35). Good to excellent scores were observed in 65% of implant patients and 62% of photon/electron patients. At 24 months and beyond, telangiectasia was more severe in the implant group with an OR of 9.64 (95%CI = 4.05-22.92, p < 0.0001) at 36 months. The only variable associated with a worse global cosmetic outcome was the presence of concomitant chemotherapy (OR = 3.87; 95%CI = 1.74-8.62). The BRA value once adjusted for age, concomitant chemotherapy, and boost volume showed a positive association with the boost technique. The BRA value was significantly greater in the implant group (p 0.03). There was no difference in the patient's final self-assessment score between the two groups. Three variables were statistically associated with

  5. Concurrent capecitabine and whole-brain radiotherapy for treatment of brain metastases in breast cancer patients.

    PubMed

    Chargari, Cyrus; Kirova, Youlia M; Diéras, Véronique; Castro Pena, Pablo; Pena, Pablo Castro; Campana, Francois; Cottu, Paul H; Pierga, JeanYves; Fourquet, Alain

    2009-07-01

    Preclinical data have demonstrated that ionizing radiation acts synergistically with capecitabine. This report retrospectively assessed the use of capecitabine concurrently with whole-brain radiotherapy (WBRT) in patients with brain metastases from breast cancer. From January 2003 to March 2005, five breast cancer patients with brain metastases were referred for WBRT with concurrent capecitabine. Median age was 44 years (range: 38-53). The median dose of capecitabine was 1,000 mg/m(2) twice daily for 14 days (day1-14). Treatment cycles were repeated every 21 days, concurrently with WBRT (30 Gy, 3 Gy per fraction, 5 days per week). Median survival after starting WBRT plus capecitabine was 6.5 months (range 1-34 months). One patient achieved a complete response. Two patients achieved partial response, including one with local control lasting until most recent follow-up. One patient had stable disease. The remaining patient was not assessable for response because of early death. Most commonly reported adverse events were nausea (n = 2) and headache (n = 2), always grade 1. Other toxicities were grade 3 hand/foot syndrome (n = 1), moderate anemia requiring transfusion and dose reduction of capecitabine (n = 1), and grade 1 mucositis (n = 1). Although promising, these preliminary data warrant further assessment of capecitabine-based chemoradiation in brain metastases from breast cancer and need to be further validated in the setting of a clinical trial. PMID:19169856

  6. Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

    SciTech Connect

    Min, Sun Young; Lee, Seung Ju; Shin, Kyung Hwan; Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won; Kim, Tae Hyun; Kang, Han-Sung; Cho, Kwan Ho

    2011-12-01

    Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

  7. Multiple Cutaneous Angiosarcomas after Breast Conserving Surgery and Bilateral Adjuvant Radiotherapy: An Unusual Case and Review of the Literature

    PubMed Central

    Meattini, Icro; Santi, Raffaella; Scartoni, Daniele; Giacomelli, Irene; De Luca Cardillo, Carla; Scotti, Vieri; Casella, Donato; Simoncini, Roberta; Orzalesi, Lorenzo; Nori, Jacopo; Paglierani, Milena; Livi, Lorenzo

    2014-01-01

    Breast angiosarcomas (BAs) are rare but serious events that may arise after radiation exposure. Disease outcome is poor, with high risk of local and distant failure. Recurrences are frequent also after resection with negative margins. The spectrum of vascular proliferations associated with radiotherapy in the setting of breast cancer has expanded, including radiation-associated atypical vascular lesions (AVLs) of the breast skin as a rare, but well-recognized, entity. Although pursuing a benign behavior, AVLs have been regarded as possible precursors of postradiation BAs. We report an unusual case of a 71-year-old woman affected by well-differentiated bilateral cutaneous BA, diagnosed 1.9 years after adjuvant RT for synchronous bilateral breast cancer. Whole-life clinical followup is of crucial importance in breast cancer patients. PMID:24744928

  8. Cardiac Motion During Deep-Inspiration Breath-Hold: Implications for Breast Cancer Radiotherapy

    SciTech Connect

    Wang Xiaochun; Pan Tinsu; Pinnix, Chelsea; Zhang, Sean X.; Salehpour, Mohammad; Sun, Tzouh Liang; Gladish, Gregory; Strom, Eric A.; Perkins, George H.; Tereffe, Welela; Woodward, Wendy; Hoffman, Karen E.; Buchholz, Thomas A.; Yu, T. Kuan

    2012-02-01

    Purpose: Many patients with left-sided breast cancer receive adjuvant radiotherapy during deep-inspiration breath hold (DIBH) to minimize radiation exposure to the heart. We measured the displacement of the left anterior descending artery (LAD) and heart owing to cardiac motion during DIBH, relative to the standard tangential fields for left breast cancer radiotherapy. Methods and Materials: A total of 20 patients who had undergone computed tomography-based coronary angiography with retrospective electrocardiographic gating were randomly selected for the present study. The patients underwent scanning during DIBH to control the influence of respiration on cardiac motion. Standard medial and lateral tangential fields were placed, and the LADs were contoured on the systolic- and diastolic-phase computed tomography data sets by the clinicians. Displacement of the LAD during cardiac contractions was calculated in three directions: toward the posterior edge of the treatment fields, left-right, and anteroposterior. Displacement of the entire heart was measured on the maximal and minimal intensity projection computed tomography images. Results: The mean displacement of the LAD from cardiac contraction without the influence of respiration for 20 patients was 2.3 mm (range, 0.7-3.8) toward the posterior edge of the treatment fields, 2.6 mm (range, 1.0-6.8) in the left-right direction, and 2.3 mm (range, 0.6-6.5) in the anteroposterior direction. At least 30% of the LAD volume was displaced >5 mm in any direction in 2 patients (10%), and <10% of the LAD volume was displaced >5 mm in 10 patients (50%). The extent of displacement of the heart periphery during cardiac motion was negligible near the treatment fields. Conclusions: Displacement of the heart periphery near the treatment fields was negligible during DIBH; however, displacement of the LAD from cardiac contraction varied substantially between and within patients. We recommend maintaining {>=}5 mm of distance between

  9. AUTOMATED SKIN SEGMENTATION IN ULTRASONIC EVALUATION OF SKIN TOXICITY IN BREAST CANCER RADIOTHERAPY

    PubMed Central

    Gao, Yi; Tannenbaum, Allen; Chen, Hao; Torres, Mylin; Yoshida, Emi; Yang, Xiaofeng; Wang, Yuefeng; Curran, Walter; Liu, Tian

    2013-01-01

    Skin toxicity is the most common side effect of breast cancer radiotherapy and impairs the quality of life of many breast cancer survivors. We, along with other researchers, have recently found quantitative ultrasound to be effective as a skin toxicity assessment tool. Although more reliable than standard clinical evaluations (visual observation and palpation), the current procedure for ultrasound-based skin toxicity measurements requires manual delineation of the skin layers (i.e., epidermis-dermis and dermis-hypodermis interfaces) on each ultrasound B-mode image. Manual skin segmentation is time consuming and subjective. Moreover, radiation-induced skin injury may decrease image contrast between the dermis and hypodermis, which increases the difficulty of delineation. Therefore, we have developed an automatic skin segmentation tool (ASST) based on the active contour model with two significant modifications: (i) The proposed algorithm introduces a novel dual-curve scheme for the double skin layer extraction, as opposed to the original single active contour method. (ii) The proposed algorithm is based on a geometric contour framework as opposed to the previous parametric algorithm. This ASST algorithm was tested on a breast cancer image database of 730 ultrasound breast images (73 ultrasound studies of 23 patients). We compared skin segmentation results obtained with the ASST with manual contours performed by two physicians. The average percentage differences in skin thickness between the ASST measurement and that of each physician were less than 5% (4.8 ± 17.8% and −3.8 ± 21.1%, respectively). In summary, we have developed an automatic skin segmentation method that ensures objective assessment of radiation-induced changes in skin thickness. Our ultrasound technology offers a unique opportunity to quantify tissue injury in a more meaningful and reproducible manner than the subjective assessments currently employed in the clinic. PMID:23993172

  10. Dosimetry and field matching for radiotherapy to the breast and superclavicular fossa

    NASA Astrophysics Data System (ADS)

    Winfield, Elizabeth

    Radiotherapy for early breast cancer aims to achieve local disease control and decrease loco-regional recurrence rates. Treatment may be directed to breast or chest wall alone or, include regional lymph nodes. When using tangential fields to treat the breast a separate anterior field directed to the axilla and supraclavicular fossa (SCF) is needed to treat nodal areas. The complex geometry of this region necessitates matching of adjacent radiation fields in three dimensions. The potential exists for zones of overdosage or underdosage along the match line. Cosmetic results may be compromised if treatment fields are not accurately aligned. Techniques for field matching vary between centres in the UK. A study of dosimetry across the match line region using different techniques, as reported in the multi-centre START Trial Quality Assurance (QA) programme, was undertaken. A custom-made anthropomorphic phantom was designed to assess dose distribution in three dimensions using film dosimetry. Methods with varying degrees of complexity were employed to match tangential and SCF beams. Various techniques combined half beam blocking and machine rotations to achieve geometric alignment. Matching of asymmetric beams allowed a single isocentre technique to be used. Where field matching was not undertaken a gap between tangential and SCF fields was employed. Results demonstrated differences between techniques in addition to variations within the same technique between different centres. Geometric alignment techniques produced more homogenous dose distributions in the match region than gap techniques or those techniques not correcting for field divergence. For this multi-centre assessment of match plane techniques film dosimetry used in conjunction with a breast shaped phantom provided relative dose information. This study has highlighted the difficulties of matching treatment fields to achieve homogenous dose distribution through the region of the match plane and the degree of

  11. Respiratory gating for proton beam scanning versus photon 3D-CRT for breast cancer radiotherapy.

    PubMed

    Flejmer, Anna M; Edvardsson, Anneli; Dohlmar, Frida; Josefsson, Dan; Nilsson, Mats; Witt Nyström, Petra; Dasu, Alexandru

    2016-05-01

    Background Respiratory gating and proton therapy have both been proposed to reduce the cardiopulmonary burden in breast cancer radiotherapy. This study aims to investigate the additional benefit of proton radiotherapy for breast cancer with and without respiratory gating. Material and methods Twenty left-sided patients were planned on computed tomography (CT)-datasets acquired during enhanced inspiration gating (EIG) and free-breathing (FB), using photon three-dimensional conformal radiation therapy (3D-CRT) and scanned proton beams. Ten patients received treatment to the whole breast only (WBO) and 10 were treated to the breast and the regional lymph nodes (BRN). Dosimetric parameters characterizing the coverage of target volumes and the cardiopulmonary burden were compared using a paired, two-tailed Student's t-test. Results Protons ensured comparable or better target coverage than photons in all patients during both EIG and FB. The heterogeneity index decreased from 12% with photons to about 5% with protons. The mean dose to the ipsilateral lung was reduced in BRN patients from 12 Gy to 7 Gy  (RBE) in EIG and from 14 Gy to 6-7 Gy (RBE) in FB, while for WBO patients all values were about 5-6 Gy (RBE). The mean dose to heart decreased by a factor of four in WBO patients [from 1.1 Gy to 0.3 Gy (RBE) in EIG and from 2.1 Gy to 0.5 Gy (RBE) in FB] and 10 in BRN patients [from 2.1 Gy to 0.2 Gy (RBE) in EIG and from 3.4 Gy to 0.3 Gy (RBE) in FB]. Similarly, the mean and the near maximum dose to the left anterior descending artery (LAD) were significantly lower (p < 0.05) with protons in comparison with photons. Conclusion Proton spot scanning has a high potential to reduce the irradiation of organs at risk and other normal tissues for most patients, beyond what could be achieved with EIG and photon therapy. The largest dose sparing has been seen for BRN patients, both in terms of cardiopulmonary burden and integral dose. PMID:27027913

  12. Comprehensive Evaluation of Personal, Clinical, and Radiation Dosimetric Parameters for Acute Skin Reaction during Whole Breast Radiotherapy

    PubMed Central

    Yang, Dae Sik; Lee, Jung Ae; Lee, Nam Kwon; Park, Young Je; Lee, Suk; Kim, Chul Yong; Son, Gil Soo

    2016-01-01

    Skin reaction is major problem during whole breast radiotherapy. To identify factors related to skin reactions during whole breast radiotherapy, various personal, clinical, and radiation dosimetric parameters were evaluated. From January 2012 to December 2013, a total of 125 patients who underwent breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients had both whole breast irradiation and boost to the tumour bed. Skin reaction was measured on the first day of boost therapy based on photography of the radiation field and medical records. For each area of axilla and inferior fold, the intensity score of erythema (score 1 to 5) and extent (score 0 to 1) were summed. The relationship of various parameters to skin reaction was evaluated using chi-square and linear regression tests. The V100 (volume receiving 100% of prescribed radiation dose, p < 0.001, both axilla and inferior fold) and age (p = 0.039 for axilla and 0.026 for inferior fold) were significant parameters in multivariate analyses. The calculated axilla dose (p = 0.003) and breast separation (p = 0.036) were also risk factors for axilla and inferior fold, respectively. Young age and large V100 are significant factors for acute skin reaction that can be simply and cost-effectively measured. PMID:27579310

  13. Comprehensive Evaluation of Personal, Clinical, and Radiation Dosimetric Parameters for Acute Skin Reaction during Whole Breast Radiotherapy.

    PubMed

    Yang, Dae Sik; Lee, Jung Ae; Yoon, Won Sup; Lee, Nam Kwon; Park, Young Je; Lee, Suk; Kim, Chul Yong; Son, Gil Soo

    2016-01-01

    Skin reaction is major problem during whole breast radiotherapy. To identify factors related to skin reactions during whole breast radiotherapy, various personal, clinical, and radiation dosimetric parameters were evaluated. From January 2012 to December 2013, a total of 125 patients who underwent breast conserving surgery and adjuvant whole breast irradiation were retrospectively reviewed. All patients had both whole breast irradiation and boost to the tumour bed. Skin reaction was measured on the first day of boost therapy based on photography of the radiation field and medical records. For each area of axilla and inferior fold, the intensity score of erythema (score 1 to 5) and extent (score 0 to 1) were summed. The relationship of various parameters to skin reaction was evaluated using chi-square and linear regression tests. The V 100 (volume receiving 100% of prescribed radiation dose, p < 0.001, both axilla and inferior fold) and age (p = 0.039 for axilla and 0.026 for inferior fold) were significant parameters in multivariate analyses. The calculated axilla dose (p = 0.003) and breast separation (p = 0.036) were also risk factors for axilla and inferior fold, respectively. Young age and large V 100 are significant factors for acute skin reaction that can be simply and cost-effectively measured. PMID:27579310

  14. Hypofractionated and Accelerated Radiotherapy With Subcutaneous Amifostine Cytoprotection as Short Adjuvant Regimen After Breast-Conserving Surgery: Interim Report

    SciTech Connect

    Koukourakis, Michael I.

    2009-07-15

    Purpose: Short radiotherapy schedules might be more convenient for patients and overloaded radiotherapy departments, provided late toxicity is not increased. We evaluated the efficacy and toxicity of a hypofractionated and highly accelerated radiotherapy regimen supported with cytoprotection provided by amifostine in breast cancer patients treated with breast-conserving surgery. Methods and Materials: A total of 92 patients received 12 consecutive fractions of radiotherapy (3.5 Gy/fraction for 10 fractions) to the breast and/or axillary/supraclavicular area and 4 Gy/fraction for 2 fractions to the tumor bed). Amifostine at a dose of 1,000 mg/d was administered subcutaneously. The follow-up of patients was 30-60 months (median, 39). Results: Using a dose individualization algorithm, 77.1% of patients received 1,000 mg and 16.3% received 750 mg of amifostine daily. Of the 92 patients, 13% interrupted amifostine because of fever/rash symptoms. Acute Grade 2 breast toxicity developed in 6.5% of patients receiving 1,000 mg of amifostine compared with 46.6% of the rest of the patients (p < .0001). The incidence of Grade 2 late sequelae was less frequent in the high amifostine dose group (3.2% vs. 6.6%; p = NS). Grade 1 lung fibrosis was infrequent (3.3%). The in-field relapse rate was 3.3%, and an additional 2.2% of patients developed a relapse in the nonirradiated supraclavicular area. c-erbB-2 overexpression was linked to local control failure (p = .01). Distant metastasis appeared in 13% of patients, and this was marginally related to more advanced T/N stage (p = .06). Conclusion: Within a minimal follow-up of 2.5 years after therapy, hypofractionated and accelerated radiotherapy with subcutaneous amifostine cytoprotection has proved a well-tolerated and effective regimen. Longer follow-up is required to assess the long-term late sequelae.

  15. Targeted Intraoperative Radiotherapy for Breast Cancer in Patients in Whom External Beam Radiation Is Not Possible

    SciTech Connect

    Keshtgar, Mohammed R.S.; Joseph, David; Stacey, Chris; Metaxas, Marinos G.; Corica, Tammy; Williams, Norman R.; Baum, Michael

    2011-05-01

    Purpose: External beam radiation therapy (EBRT) following wide local excision of the primary tumor is the standard treatment in early breast cancer. In some circumstances this procedure is not possible or is contraindicated or difficult. The purpose of this study was to determine the safety and efficacy of targeted intraoperative radiotherapy (TARGIT) when EBRT is not feasible. Methods and Materials: We report our experience with TARGIT in three centers (Australia, Germany, and the United Kingdom) between 1999 and 2008. Patients at these centers received a single radiation dose of 20 Gy to the breast tissue in contact with the applicator (or 6 Gy at 1-cm distance), as they could not be given EBRT and were keen to avoid mastectomy. Results: Eighty patients were treated with TARGIT. Reasons for using TARGIT were 21 patients had previously received EBRT, and 31 patients had clinical reasons such as systemic lupus erythematosus, motor neuron disease, Parkinson's disease, ankylosing spondylitis, morbid obesity, and cardiovascular or severe respiratory disease. Three of these patients received percutaneous radiotherapy without surgery; 28 patients were included for compelling personal reasons, usually on compassionate grounds. After a median follow-up of 38 months, only two local recurrences were observed, an annual local recurrence rate of 0.75% (95% confidence interval, 0.09%-2.70%). Conclusions: While we await the results of the randomized trial (over 2,000 patients have already been recruited), TARGIT is an acceptable option but only in highly selected cases that cannot be recruited in the trial and in whom EBRT is not feasible/possible.

  16. Outcome of treatment by tumorectory and radiotherapy of patients with operable breast cancer

    SciTech Connect

    Vilcoq, J.R.; Calle, R.; Stacey, P.; Ghossein, N.A.

    1981-10-01

    We performed a retrospective study on 314 patients treated for a localized breast cancer by tumorectomy and radiotherapy to determine the overall survival, incidence of loco-regional failure and outcome of salvage surgery. All patients were followed for at least three years. Two hundred and fourteen patients had tumors less than or equal to 3 cm and 74 had tumors less than or equal to 6 cm. The three and five years absolute survival, free of disease (NED), is 88% (276/314) and 84% (190/225). The incidence of loco-regional failures was not dependent on tumor size and did not exceed 10% for the entire group. Recurrences were common (35%) in young patients (less than or equal to30). No patient older than 50 had recurrences. Eighty-one percent of failures appeared within three years. Salvage surgery was performed on 78% (14/18) of patients with recurrences; 57% (8/14) were free of disease (NED). Local failure in this group was not necessarily associated with disseminated cancer. Tumorectomy followed by radiotherapy is an acceptable alternative to mastectomy, particularly since salvage surgery can usually be successfully performed for recurrences.

  17. The Risk of Early and Late Lung Sequelae After Conformal Radiotherapy in Breast Cancer Patients

    SciTech Connect

    Kahan, Zsuzsanna . E-mail: kahan@onko.szote.u-szeged.hu; Csenki, Melinda; Varga, Zoltan; Szil, Elemer; Cserhati, Adrienn; Balogh, Attila; Gyulai, Zsofia; Mandi, Yvette; Boda, Krisztina; Thurzo, Laszlo

    2007-07-01

    Purpose: To study the risks of early and late radiogenic lung damage in breast cancer patients after conformal radiotherapy. Methods and Materials: Radiogenic lung sequelae were assessed prospectively in 119 patients by means of clinical signs, radiologic abnormalities, and the mean density change (MDC) of the irradiated lung on CT. Results: Significant positive associations were detected between the development of lung abnormalities 3 months or 1 year after the radiotherapy and the age of the patient, the ipsilateral mean lung dose (MLD), the radiation dose to 25% of the ipsilateral lung (D{sub 25%}) and the volume of the ipsilateral lung receiving 20 Gy (V{sub 20Gy}). The irradiation of the axillary and supraclavicular lymph nodes favored the development of pneumonitis but not that of fibrosis. No relation was found between the preradiotherapy plasma TGF-{beta} level and the presence of radiogenic lung damage. At both time points, MDC was strongly related to age. Significant positive associations were demonstrated between the risks of pneumonitis or fibrosis and the age of the patient, MLD, D{sub 25%}, and V{sub 20Gy}. A synergistic effect of MLD, D{sub 25%}, and V{sub 20Gy} with age in patients older than 59 years is suggested. Conclusion: Our analyses indicate that the risks of early and late radiogenic lung sequelae are strongly related to the age of the patient, the volume of the irradiated lung, and the dose to it.

  18. Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy.

    PubMed

    Ratcliff, Chelsea G; Milbury, Kathrin; Chandwani, Kavita D; Chaoul, Alejandro; Perkins, George; Nagarathna, Raghuram; Haddad, Robin; Nagendra, Hongasandra Ramarao; Raghuram, N V; Spelman, Amy; Arun, Banu; Wei, Qi; Cohen, Lorenzo

    2016-09-01

    Hypothesis This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.Methods Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion Yoga may provide the greatest mental-health-related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health-related QOL by increasing ability to find benefit in the cancer experience. PMID:26867802

  19. Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy

    PubMed Central

    Ratcliff, Chelsea G.; Milbury, Kathrin; Chandwani, Kavita D.; Chaoul, Alejandro; Perkins, George; Nagarathna, Raghuram; Haddad, Robin; Nagendra, Hongasandra Ramarao; Raghuram, N. V.; Spelman, Amy; Arun, Banu; Wei, Qi; Cohen, Lorenzo

    2016-01-01

    Hypothesis This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy. Methods Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience. PMID:26867802

  20. Lymphoscintigraphy Can Select Breast Cancer Patients for Internal Mammary Chain Radiotherapy

    SciTech Connect

    Hindie, Elif; Groheux, David; Hennequin, Christophe; Zanotti-Fregonara, Paolo; Vercellino, Laetitia; Berenger, Nathalie; Toubert, Marie-Elisabeth; Maylin, Claude; Vilcoq, Jacques-Robert; Espie, Marc

    2012-07-15

    Purpose: Given the risk of undesired toxicity, prophylactic internal mammary (IM) chain irradiation should be offered only to patients at high risk of occult involvement. Lymphoscintigraphy for axillary sentinel node biopsy might help in selecting these patients. Methods and Materials: We reviewed published studies with the following selection criteria: {>=}300 breast cancer patients referred for axilla sentinel node biopsy; scintigraphy performed after peritumoral or intratumoral tracer injection; IM biopsy in the case of IM drainage; and axilla staged routinely independent of IM status. Results: Six prospective studies, for a total of 3,876 patients, fulfilled the inclusion criteria. Parasternal drainage was present in 792 patients (20.4%). IM biopsy was performed in 644 patients and was positive in 111 (17.2%). Of the positive IM biopsies, 40% were associated with tumors in the lateral breast quadrants. A major difference in the IM positivity rate was found according to the axilla sentinel node status. In patients with negative axilla, the IM biopsy was positive in 7.8% of cases. In patients with positive axilla, however, the IM biopsy was positive in 41% (p < .00001). Because biopsy of multiple IM hot nodes is difficult, the true risk could be even greater, probably close to 50%. Conclusions: Patients with IM drainage on lymphoscintigraphy and a positive axilla sentinel node have a high risk of occult IM involvement. These women should be considered for IM radiotherapy.

  1. Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer

    PubMed Central

    2013-01-01

    Background To investigate the potential dosimetric and clinical benefits of Deep Inspiration Breath-Hold (DIBH) technique during radiotherapy of breast cancer compared with Free Breathing (FB). Methods Eight left-sided breast cancer patients underwent a supervised breath hold during treatment. For each patient, two CT scans were acquired with and without breath hold, and virtual simulation was performed for conventional tangential fields, utilizing 6 or 15 MV photon fields. The resulting dose–volume histograms were calculated, and the volumes of heart/lung irradiated to given doses were assessed. The left anterior descending coronary artery (LAD) mean and maximum doses were calculated, together with tumour control probability (TCP) and normal tissue complication probabilities (NTCP) for lung and heart. Results For all patients a reduction of at least 16% in lung mean dose and at least 20% in irradiated pulmonary volumes was observed when DIBH was applied. Heart and LAD maximum doses were decreased by more than 78% with DIBH. The NTCP values for pneumonitis and long term cardiac mortality were also reduced by about 11% with DIBH. The NTCP values for pericarditis were zero for both DIBH and FB. Conclusion Delivering radiation in DIBH conditions the dose to the surrounding normal structures could be reduced, in particular heart, LAD and lung, due to increased distance between target and heart, and to reduced lung density. PMID:24423396

  2. Kilovoltage Rotational External Beam Radiotherapy on a Breast Computed Tomography Platform: A Feasibility Study

    SciTech Connect

    Prionas, Nicolas D.; McKenney, Sarah E.; Stern, Robin L.; Boone, John M.

    2012-10-01

    Purpose: To demonstrate the feasibility of a dedicated breast computed tomography (bCT) platform to deliver rotational kilovoltage (kV) external beam radiotherapy (RT) for partial breast irradiation, whole breast irradiation, and dose painting. Methods and Materials: Rotational kV-external beam RT using the geometry of a prototype bCT platform was evaluated using a Monte Carlo simulator. A point source emitting 178 keV photons (approximating a 320-kVp spectrum with 4-mm copper filtration) was rotated around a 14-cm voxelized polyethylene disk (0.1 cm tall) or cylinder (9 cm tall) to simulate primary and primary plus scattered photon interactions, respectively. Simulations were also performed using voxelized bCT patient images. Beam collimation was varied in the x-y plane (1-14 cm) and in the z-direction (0.1-10 cm). Dose painting for multiple foci, line, and ring distributions was demonstrated using multiple rotations with varying beam collimation. Simulations using the scanner's native hardware (120 kVp filtered by 0.2-mm copper) were validated experimentally. Results: As the x-y collimator was narrowed, the two-dimensional dose profiles shifted from a cupped profile with a high edge dose to an increasingly peaked central dose distribution with a sharp dose falloff. Using a 1-cm beam, the cylinder edge dose was <7% of the dose deposition at the cylinder center. Simulations using 120-kVp X-rays showed distributions similar to the experimental measurements. A homogeneous dose distribution (<2.5% dose fluctuation) with a 20% decrease in dose deposition at the cylinder edge (i.e., skin sparing) was demonstrated by weighted summation of four dose profiles using different collimation widths. Simulations using patient bCT images demonstrated the potential for treatment planning and image-guided RT. Conclusions: Rotational kV-external beam RT for partial breast irradiation, dose painting, and whole breast irradiation with skin sparing is feasible on a bCT platform with

  3. Radiotherapy Timing in 4,820 Patients With Breast Cancer: University of Florence Experience

    SciTech Connect

    Livi, Lorenzo Borghesi, Simona; Saieva, Calogero; Meattini, Icro; Rampini, Andrea; Petrucci, Alessia; Detti, Beatrice; Bruni, Alessio; Paiar, Fabiola; Mangoni, Monica; Marrazzo, Livia; Agresti, Benedetta; Cataliotti, Luigi; Bianchi, Simonetta; Biti, Giampaolo

    2009-02-01

    Purpose: To analyze the relationship between a delay in radiotherapy (RT) after breast-conserving surgery and ipsilateral breast recurrence (BR). Methods and Materials: We included in our analysis 4,820 breast cancer patients who had undergone postoperative RT at University of Florence. The patients were categorized into four groups according to the interval between surgery and RT (T1, <60 days; T2, 61-120 days; T3, 121-180 days; and T4, >180 days). Results: On multivariate analysis, the timing of RT did not reach statistical significance in patients who received only postoperative RT (n = 1,935) or RT and hormonal therapy (HT) (n = 1,684) or RT, chemotherapy (CHT), and HT (n = 529). In the postoperative RT-only group, age at presentation, surgical margin status, and a boost to the tumor bed were independent prognostic factors for BR. In the RT plus HT group, age at presentation and boost emerged as independent prognostic factors for BR (p = 0.006 and p = 0.049, respectively). Finally, in the RT, CHT, and HT group, only multifocality was an independent BR predictor (p = 0.01). Only in the group of patients treated with RT and CHT (n = 672) did multivariate analysis with stepwise selection show RT timing as an independent prognostic factor (hazard ratio, 1.59; 95% confidence interval, 1.01-2.52; p = 0.045). Analyzing this group of patients, we found that most patients included had worse prognostic factors and had received CHT consisting of cyclophosphamide, methotrexate, and 5-fluorouracil before undergoing RT. Conclusion: The results of our study have shown that the timing of RT itself does not affect local recurrence, which is mainly related to prognostic factors. Thus, the 'waiting list' should be thought of as a 'programming list,' with patients scheduled for RT according to their prognostic factors.

  4. Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer

    SciTech Connect

    Korreman, Stine S. . E-mail: stine.k@rh.dk; Pedersen, Anders N.; Aarup, Lasse Rye; Nottrup, Trine J.; Specht, Lena; Nystroem, Hakan

    2006-08-01

    Purpose: Substantial reductions of cardio-pulmonary radiation doses can be achieved using voluntary deep inspiration breath-hold (DIBH) or free breathing inspiration gating (IG) in radiotherapy after conserving surgery for breast cancer. The purpose of this study is to evaluate the radiobiological implications of such dosimetric benefits. Methods and Materials: Patients from previously reported studies were pooled for a total of 33 patients. All patients underwent DIBH and free breathing (FB) scans, and 17 patients underwent an additional IG scan. Tangential conformal treatment plans covering the remaining breast, internal mammary, and periclavicular nodes were optimized for each scan, prescription dose 48 Gy. Normal tissue complication probabilities were calculated using the relative seriality model for the heart, and the model proposed by Burman et al. for the lung. Results: Previous computed tomography studies showed that both voluntary DIBH and IG provided reduction of the lung V{sub 5} (relative volume receiving more than 50% of prescription dose) on the order of 30-40%, and a 80-90% reduction of the heart V{sub 5} for left-sided cancers. Corresponding pneumonitis probability of 28.1% (range, 0.7-95.6%) for FB could be reduced to 2.6% (range, 0.1-40.1%) for IG, and 4.3% (range, 0.1-59%) for DIBH. The cardiac mortality probability could be reduced from 4.8% (range, 0.1-23.4%) in FB to 0.5% (range, 0.1-2.6%) for IG and 0.1% (range, 0-3.0%) for DIBH. Conclusions: Remarkable potential is shown for simple voluntary DIBH and free breathing IG to reduce the risk of both cardiac mortality and pneumonitis for the common technique of adjuvant tangential breast irradiation.

  5. Intraoperative Radiotherapy in Early-Stage Breast Cancer: Results of the Montpellier Phase II Trial

    SciTech Connect

    Lemanski, Claire; Azria, David; Gourgon-Bourgade, Sophie; Gutowski, Marian; Rouanet, Phillippe; Saint-Aubert, Bernard; Ailleres, Norbert; Fenoglietto, Pascal; Dubois, Jean-Bernard

    2010-03-01

    Purpose: We recently presented the intraoperative radiotherapy (IORT) technique given as a reliable alternative to conventional boost radiation after breast-conserving surgery. The low crude numbers of recurrence in elderly patients led us to investigate the feasibility and the efficacy of this procedure as a sole treatment. Methods and Materials: We included 94 patients older than 65 years in this phase II trial. Among them, 42 patients presented with all the inclusion criteria, i.e., stages pT0 to pT1 and pN0, ductal invasive unifocal carcinoma, and tumor-free margin of >2 mm. IORT was delivered using a dedicated linear accelerator. One 21-Gy fraction was prescribed and specified at the 90% isodose, using electrons. In vivo dosimetry was performed for all patients. The primary endpoint was the quality index. Secondary endpoints were quality of life, local recurrences, cosmetic results, and specific and overall rates of survival. Results: The median follow-up was 30 months (range, 12-49 months), and median age was 72 years (range, 66-80 years). The median tumor diameter was 10 mm. All patients received the total prescribed dose. No acute grade 3 toxicities were observed. Endpoints for all but one patient corresponded to acceptable quality index criteria. Pretreatment quality-of-life scores were maximal, and no significant decrease was observed during follow-up. Cosmesis was good to excellent at 6 months. Two patients experienced recurrence but underwent salvage mastectomy. Conclusion: Our results confirm that exclusive partial-breast IORT is feasible for treating early-stage breast cancer in the elderly. IORT may be considered an alternative treatment for a selected population and offers a safe one-step treatment.

  6. Incidental irradiation of internal mammary lymph nodes in breast cancer: conventional two-dimensional radiotherapy versus conformal three-dimensional radiotherapy*

    PubMed Central

    Leite, Elton Trigo Teixeira; Ugino, Rafael Tsuneki; Santana, Marco Antônio; Ferreira, Denis Vasconcelos; Lopes, Maurício Russo; Pelosi, Edilson Lopes; da Silva, João Luis Fernandes; Carvalho, Heloisa de Andrade

    2016-01-01

    Objective To evaluate incidental irradiation of the internal mammary lymph nodes (IMLNs) through opposed tangential fields with conventional two-dimensional (2D) or three-dimensional (3D) radiotherapy techniques and to compare the results between the two techniques. Materials and Methods This was a retrospective study of 80 breast cancer patients in whom radiotherapy of the IMLNs was not indicated: 40 underwent 2D radiotherapy with computed tomography for dosimetric control, and 40 underwent 3D radiotherapy. The total prescribed dose was 50.0 Gy or 50.4 Gy (2.0 or 1.8 Gy/day, respectively). We reviewed all plans and defined the IMLNs following the Radiation Therapy Oncology Group recommendations. For the IMLNs, we analyzed the proportion of the volume that received 45 Gy, the proportion of the volume that received 25 Gy, the dose to 95% of the volume, the dose to 50% of the volume, the mean dose, the minimum dose (Dmin), and the maximum dose (Dmax). Results Left-sided treatments predominated in the 3D cohort. There were no differences between the 2D and 3D cohorts regarding tumor stage, type of surgery (mastectomy, breast-conserving surgery, or mastectomy with immediate reconstruction), or mean delineated IMLN volume (6.8 vs. 5.9 mL; p = 0.411). Except for the Dmin, all dosimetric parameters presented higher mean values in the 3D cohort (p < 0.05). The median Dmax in the 3D cohort was 50.34 Gy. However, the mean dose to the IMLNs was 7.93 Gy in the 2D cohort, compared with 20.64 Gy in the 3D cohort. Conclusion Neither technique delivered enough doses to the IMLNs to achieve subclinical disease control. However, all of the dosimetric parameters were significantly higher for the 3D technique. PMID:27403017

  7. Radiation-related quality of life parameters after targeted intraoperative radiotherapy versus whole breast radiotherapy in patients with breast cancer: results from the randomized phase III trial TARGIT-A

    PubMed Central

    2013-01-01

    Background Intraoperative radiotherapy (IORT) is a new treatment approach for early stage breast cancer. This study reports on the effects of IORT on radiation-related quality of life (QoL) parameters. Methods Two hundred and thirty women with stage I-III breast cancer (age, 31 to 84 years) were entered into the study. A single-center subgroup of 87 women from the two arms of the randomized phase III trial TARGIT-A (TARGeted Intra-operative radioTherapy versus whole breast radiotherapy for breast cancer) was analyzed. Furthermore, results were compared to non-randomized control groups: n = 90 receiving IORT as a tumor bed boost followed by external beam whole breast radiotherapy (EBRT) outside of TARGIT-A (IORT-boost), and n = 53 treated with EBRT followed by an external-beam boost (EBRT-boost). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 (QLQ-C30) and BR23 (QLQ-BR23). The mean follow-up period in the TARGIT-A groups was 32 versus 39 months in the non-randomized control groups. Results Patients receiving IORT alone reported less general pain (21.3 points), breast (7.0 points) and arm (15.1 points) symptoms, and better role functioning (78.7 points) as patients receiving EBRT (40.9; 19.0; 32.8; and 60.5 points, respectively, P < 0.01). Patients receiving IORT alone also had fewer breast symptoms than TARGIT-A patients receiving IORT followed by EBRT for high risk features on final pathology (IORT-EBRT; 7.0 versus 29.7 points, P < 0.01). There were no significant differences between TARGIT-A patients receiving IORT-EBRT compared to non-randomized IORT-boost or EBRT-boost patients and patients receiving EBRT without a boost. Conclusions In the randomized setting, important radiation-related QoL parameters after IORT were superior to EBRT. Non-randomized comparisons showed equivalent parameters in the IORT-EBRT group and the control groups. PMID:23294485

  8. Early cardiac toxicity following adjuvant radiotherapy of left-sided breast cancer with or without concurrent trastuzumab

    PubMed Central

    Cao, Lu; Cai, Gang; Chang, Cai; Yang, Zhao-Zhi; Feng, Yan; Yu, Xiao-Li; Ma, Jin-Li; Wu, Jiong; Guo, Xiao-Mao; Chen, Jia-Yi

    2016-01-01

    Purpose To evaluate the influence of concurrent trastuzumab on the cardiotoxicity in patients receiving left-sided adjuvant radiotherapy. Materials and Methods Medical records of stage I-III left-sided breast cancer patients, including 64 receiving concurrent trastuzumab with radiotherapy and 73 receiving radiotherapy alone were retrospectively reviewed. All of the patients had normal LVEF after adjuvant chemotherapy. Information of doses volume to cardiac structures was collected. Cardiac events were assessed according to CTC 2.0. Results Median follow-up of LVEF and clinical assessment of cardiac function from the initiation of radiotherapy was 6.7 months (range 3–60.9) and 26 months (range 6.4–60.9), respectively. Grade 1 LVEF dysfunction occurred in 5 (7.8%) and 3 (4.1%) patients of the concurrent-trastuzumab and radiotherapy alone cohort, respectively. Trastuzumab was the only significant factor influencing absolute LVEF decrease in univariate analysis. In multivariate analysis of concurrent-trastuzumab cohort, IMC radiotherapy and start trastuzumab during radiotherapy were independent risk factors. For concurrent cohort, mean heart dose, as well as D10-D30, D50-D55, V5-V20 of the heart and D30-D45, D65-D75, V6-V15 of the LV were significantly higher in patients developing LVEF dysfunction. Conclusions Concurrent trastuzumab and left-sided radiotherapy is well tolerated in terms of cardiotoxicity in patients with normal baseline cardiac function after adjuvant chemotherapy. However, increases in mean dose and low–dose volume of cardiac structures are associated with a higher risk of acute LVEF dysfunction. PMID:26460956

  9. Breast dosimetry in transverse and longitudinal field MRI-Linac radiotherapy systems

    SciTech Connect

    Mahdavi, S. R.; Esmaeeli, A. D.; Pouladian, M.; Sardari, D.; Bagheri, S.; Monfared, A. S.

    2015-02-15

    Purpose: In the framework of developing the integration of a MRI-Linac system, configurations of MRI-Linac units were simulated in order to improve the dose distribution in tangential breast radiotherapy using transverse and longitudinal magnetic field geometries of Lorentz force for both medial and lateral tangential fields. Methods: In this work, the GEANT4 Monte Carlo (MC) code was utilized to compare dose distributions in breast radiotherapy for Linac-MR systems in the transverse and longitudinal geometries within humanoid phantoms across a range of magnetic field strengths of 0.5 and 1.5 T. The dose increment due to scattering from the coils was investigated for both geometries as well. Computed tomography images of two patients were used for MC simulations. One patient had intact breast while the other was mastectomized. In the simulations, planning and methods of chest wall irradiation were similar to the actual clinical planning. Results: In a longitudinal geometry, the magnetic field is shown to restrict the lateral spread of secondary electrons to the lung, heart, and contralateral organs, which reduced the mean dose of the ipsilateral lung and heart by means of 17.2% and 6% at 1.5 T, respectively. The transverse configuration exhibits a significant increase in tissue interface effects, which increased dose buildup in the entrance regions of the lateral and medial tangent beams to the planning target volume (PTV) and improved dose homogeneity within the PTV. The improved relative average homogeneity index for two patients to the PTV at magnetic field strength of 1.5 T with respect to no magnetic field case evaluated was 11.79% and 34.45% in the LRBP and TRBP geometries, respectively. In both geometries, the simulations show significant mean dose reductions in the contralateral breast and chest wall skin, respectively, by a mean of 16.6% and 24.9% at 0.5 T and 17.2% and 28.1% at 1.5 T in the transverse geometry, and 10.56% and 14.6% at 0.5 T and 11.3% and

  10. Long-term toxicity of an intraoperative radiotherapy boost using low energy X-rays during breast-conserving surgery

    SciTech Connect

    Kraus-Tiefenbacher, Uta . E-mail: uta.kraus-tiefenbacher@radonk.ma.uni-heidelberg.de; Bauer, Lelia; Scheda, Antonella; Fleckenstein, Katharina; Keller, Anke; Herskind, Carsten; Steil, Volker; Melchert, Frank; Wenz, Frederik

    2006-10-01

    Purpose: Intraoperative radiotherapy (IORT) as a boost for breast cancer delivers a high single dose of radiation to a late-reacting tissue; therefore late toxicity is of particular interest, and long-term follow-up is warranted. To date there are only limited data available on breast cancer patients treated with IORT using low energy X-rays. We analyzed toxicity and cosmesis after IORT as a boost with a minimum follow-up of 18 months. Methods and Materials: A total of 73 patients treated with IORT (20 Gy/50 kV X-rays; INTRABEAM [Carl Zeiss Surgical, Oberkochen, Germany]) to the tumor bed during breast-conserving surgery as a boost followed by whole-breast radiotherapy (WBRT, 46 Gy) underwent a prospective, predefined follow-up (median, 25 months; range 18-44 months), including clinical examination and breast ultrasound at 6-months and mammographies at 1-year intervals. Toxicities were documented using the common toxicity criteria (CTC)/European Organization for Research and Treatment of Cancer and the LENT-SOMA score. Cosmesis was evaluated with a score from 1 to 4. Results: The IORT in combination with WBRT was well tolerated, with no Grade 3 or 4 skin toxicities and no telangiectasias. Fibrosis of the entire breast was observed in 5% of the patients. A circumscribed fibrosis around the tumor bed was palpable in up to 27% with a peak around 18 months after therapy and a decline thereafter. The observed toxicitiy rates were not influenced by age, tumor stage, or systemic therapy. The cosmetic outcome was good to excellent in {>=}90% of cases. Conclusions: After IORT of the breast using low-energy X-rays, no unexpected toxicity rates were observed during long-term-follow-up.

  11. Detection of radiotherapy-induced myocardial changes by ultrasound tissue characterisation in patients with breast cancer.

    PubMed

    Tuohinen, Suvi Sirkku; Skyttä, Tanja; Virtanen, Vesa; Virtanen, Marko; Luukkaala, Tiina; Kellokumpu-Lehtinen, Pirkko-Liisa; Raatikainen, Pekka

    2016-05-01

    Radiotherapy (RT) in the thoracic region is associated with an increased risk of late cardiovascular morbidity and mortality. Ultrasonic tissue characterisation (UTC) is a non-invasive method of identifying changes in myocardial tissue, such as increased fibrosis. The aim of this study was to assess whether UTC can detect early RT-induced myocardial alterations. Seventy-eight eligible patients with early stage breast cancer were evaluated before and immediately after RT. Twenty patients had right-sided and 58 left-sided breast cancer. None received chemotherapy. A comprehensive echocardiographic examination included 3D measurements and UTC of the right ventricular (RV) free wall, ventricular septum and left ventricular (LV) posterior wall. Integrated backscatter calibration was done for the pericardium (cpIBS) and LV cavity (ccIBS). RT for left-sided breast cancer was associated with increased echodensity in the UTC analysis. RV free wall and ventricular septum cpIBS increased from -15.0 ± 7.3 to -13.7 ± 7.9 dB (p = 0.079) and from -18.2 ± 5.1 to -16.0 ± 6.4 dB (p = 0.002), respectively. Likewise, ccIBS in the RV free wall increased from 20.4 ± 5.9 to 22.1 ± 5.6 dB (p = 0.046), and in the LV septum from 17.3 ± 5.2 to 19.8 ± 5.5 dB (p < 0.001). In 3D echocardiography, LV mass increased from 102 ± 18 to 107 ± 18 g (p = 0.005). Patients receiving RT for right-sided breast cancer did not display these changes. Left-sided RT increased myocardial echodensity, particularly in the structures receiving the highest radiation dose. Considering the progressive nature of the RT induced damage, these early changes may help us with individual risk stratification and serve as a tool for screening. PMID:26757708

  12. Exclusive Alternating Chemotherapy and Radiotherapy in Nonmetastatic Inflammatory Breast Cancer: 20 Years of Follow-Up

    SciTech Connect

    Bourgier, Celine; Pessoa, Eduardo Lima; Dunant, Ariane; Heymann, Steve; Spielmann, Marc; Uzan, Catherine; Mathieu, Marie-Christine; Arriagada, Rodrigo; Marsiglia, Hugo

    2012-02-01

    Background: Locoregional treatment of inflammatory breast cancer (IBC) is crucial because local relapses may be highly symptomatic and are commonly associated with distant metastasis. With a median follow-up of 20 years, we report here the long-term results of a monocentric clinical trial combining primary chemotherapy (CT) with a schedule of anthracycline-based CT and an alternating split-course of radiotherapy (RT Asterisk-Operator CT) without mastectomy. Methods and Materials: From September 1983 to December 1989, 124 women with nonmetastatic IBC (T4d M0) were treated with three cycles of primary AVCMF chemotherapy (anthracycline, vincristine, cyclophosphamide, methotrexate, and 5-fluorouracil) and then an alternating RT Asterisk-Operator CT schedule followed by three cycles of FAC. Hormonal therapy was systematically administered: ovarian irradiation (12 Gy in four fractions) or tamoxifen 20 mg daily. Results: Local control was achieved in 82% of patients. The 10- and 20-year local relapse rates were 26% and 33%, respectively, but only 10% of locally controlled cases were not associated with concurrent distant metastasis. The 10- and 20-year overall survival rates were 39% and 19%, respectively. Severe fibrosis occurred in 54% of patients, grade 3 brachial plexus neuropathy in 4%, grade 2 pneumonitis in 9%. Grade 1, 2 and 3 cardiac toxicity was observed in 3.8%, 3.8% and 1.2% of cases respectively. Conclusions: This combined regimen allowed good long-term local control without surgery. Survival rates were similar to those obtained with conventional regimens (primary chemotherapy, total mastectomy, and adjuvant radiotherapy). Since IBC continues to be an entity with a dismal prognosis, this approach, safely combining preoperative or postoperative radiation therapy and systemic treatments, should be reassessed when suitable targeted agents are available.

  13. Reliability of Quantitative Ultrasonic Assessment of Normal-Tissue Toxicity in Breast Cancer Radiotherapy

    SciTech Connect

    Yoshida, Emi J.; Chen Hao; Torres, Mylin; Andic, Fundagul; Liu Haoyang; Chen Zhengjia; Sun, Xiaoyan; Curran, Walter J.; Liu Tian

    2012-02-01

    Purpose: We have recently reported that ultrasound imaging, together with ultrasound tissue characterization (UTC), can provide quantitative assessment of radiation-induced normal-tissue toxicity. This study's purpose is to evaluate the reliability of our quantitative ultrasound technology in assessing acute and late normal-tissue toxicity in breast cancer radiotherapy. Method and Materials: Our ultrasound technique analyzes radiofrequency echo signals and provides quantitative measures of dermal, hypodermal, and glandular tissue toxicities. To facilitate easy clinical implementation, we further refined this technique by developing a semiautomatic ultrasound-based toxicity assessment tool (UBTAT). Seventy-two ultrasound studies of 26 patients (720 images) were analyzed. Images of 8 patients were evaluated for acute toxicity (<6 months postradiotherapy) and those of 18 patients were evaluated for late toxicity ({>=}6 months postradiotherapy). All patients were treated according to a standard radiotherapy protocol. To assess intraobserver reliability, one observer analyzed 720 images in UBTAT and then repeated the analysis 3 months later. To assess interobserver reliability, three observers (two radiation oncologists and one ultrasound expert) each analyzed 720 images in UBTAT. An intraclass correlation coefficient (ICC) was used to evaluate intra- and interobserver reliability. Ultrasound assessment and clinical evaluation were also compared. Results: Intraobserver ICC was 0.89 for dermal toxicity, 0.74 for hypodermal toxicity, and 0.96 for glandular tissue toxicity. Interobserver ICC was 0.78 for dermal toxicity, 0.74 for hypodermal toxicity, and 0.94 for glandular tissue toxicity. Statistical analysis found significant changes in dermal (p < 0.0001), hypodermal (p = 0.0027), and glandular tissue (p < 0.0001) assessments in the acute toxicity group. Ultrasound measurements correlated with clinical Radiation Therapy Oncology Group (RTOG) toxicity scores of patients

  14. Estimating Cardiac Substructures Exposure From Diverse Radiotherapy Techniques in Treating Left-Sided Breast Cancer

    PubMed Central

    Zhang, Li; Mei, Xin; Chen, Xingxing; Hu, Weigang; Hu, Silong; Zhang, Yingjian; Shao, Zhimin; Guo, Xiaomao; Tuan, Jeffrey; Yu, Xiaoli

    2015-01-01

    Abstract The study compares the physical and biologically effective doses (BED) received by the heart and cardiac substructures using three-dimensional conformal RT (3D-CRT), intensity-modulated radiotherapy (IMRT), and simple IMRT (s-IMRT) in postoperative radiotherapy for patients with left-sided breast cancer. From October 2008 to February 2009, 14 patients with histologically confirmed left-sided breast cancer were enrolled and underwent contrast-enhanced computed tomography (CT) simulation and 18F-FDG positron emission tomography-CT to outline the left cardiac ventricle (LV) and other substructures. The linear-quadratic model was used to convert the physical doses received by critical points of inner heart to BED. The maximal dose, minimum dose, dose received by 99% of volume (D99) and dose received by 95% of volume (D95) in target areas were significantly better using IMRT and s-IMRT when compared with 3D-CRT (P < 0.05). IMRT and s-IMRT significantly reduced the maximal cardiac dose (5038.98 vs 5346.47 cGy, P = 0.002; 5146.66 vs 5346.47 cGy, P = 0.03). IMRT reduced the maximal dose to LV by 4% (P = 0.05) in comparison with 3D-CRT. The average doses to heart and LV in 3D-CRT plan were significantly lower than those in IMRT plan (P < 0.05). The average cardiac volumes receiving ≥25 Gy (V25 Gy) in IMRT, s-IMRT, and 3D-CRT plans were 73.98, 76.75, and 60.34 cm3, respectively. The average LV volumes receiving ≥25 Gy (V25 Gy) in IMRT, s-IMRT and 3D-CRT plans were 23.37, 24.68, and 17.61 cm3, respectively. In the IMRT plan, the mean BED to the critical points of inner heart located within the high physical dose area were substantially lower than in 3D-CRT or s-IMRT. Compared with 3D-CRT technique, IMRT and s-IMRT had superior target dose coverage and dose uniformity. IMRT significantly reduced the maximal RT dose to heart and LV. IMRT and s-IMRT techniques did not reduce the volume of heart and LV receiving high doses. PMID

  15. Radiotherapy.

    PubMed

    Adamietz, Irenaus A

    2010-01-01

    The intrathoracic growth of the tumor causes several severe symptoms as cough, dyspnea, chest pain, hemoptysis, hoarseness, anorexia/nausea, and dysphagia. In patients with manifest or threatening symptoms radiotherapy (RT) as an effective measure should be implemented into the management concept. Palliative RT radiotherapy prefers short hypofractionated schemas (e.g. 10 x 3 Gy, 4 x 5 Gy, 2 x 8 Gy, 1 x 10 Gy). Careful radiation planning supports the precision of palliative RT and reduces significantly the complication rate. A good response and prolonged palliation effects (6-12 months) can be achieved in many cases. However, the minimum biologically equivalent dose should not be less than 35 Gy. RT produces a good outcome in all types of metastases of lung carcinoma. In emergencies like VCSS or spinal cord compression RT should be initiated immediately. The selection of the optimal therapy for locally advanced lung carcinoma with malignant airway obstruction is difficult. Both brachytherapy and percutaneous irradiation are effective, however published results including local a sum of response, functionality and life quality demonstrates more benefit by percutaneous RT. Due to different physical properties of these two methods the combination of brachytherapy and external beam irradiation may be advantageous. PMID:19955803

  16. Postoperative radiotherapy following mastectomy for patients with left-sided breast cancer: A comparative dosimetric study

    SciTech Connect

    Wang, Jiahao; Li, Xiadong; Deng, Qinghua; Xia, Bing; Wu, Shixiu; Liu, Jian; Ma, Shenglin

    2015-10-01

    The purposes of this article were to compare the biophysical dosimetry for postmastectomy left-sided breast cancer using 4 different radiotherapy (RT) techniques. In total, 30 patients with left-sided breast cancer were randomly selected for this treatment planning study. They were planned using 4 RT techniques, including the following: (1) 3-dimensional conventional tangential fields (TFs), (2) tangential intensity-modulated therapy (T-IMRT), (3) 4 fields IMRT (4F-IMRT), and (4) single arc volumetric-modulated arc therapy (S-VMAT). The planning target volume (PTV) dose was prescribed 50 Gy, the comparison of target dose distribution, conformity index, homogeneity index, dose to organs at risk (OARs), tumor control probability (TCP), normal tissue complication probability (NTCP), and number of monitor units (MUs) between 4 plans were investigated for their biophysical dosimetric difference. The target conformity and homogeneity of S-VMAT were better than the other 3 kinds of plans, but increased the volume of OARs receiving low dose (V{sub 5}). TCP of PTV and NTCP of the left lung showed no statistically significant difference in 4 plans. 4F-IMRT plan was superior in terms of target coverage and protection of OARs and demonstrated significant advantages in decreasing the NTCP of heart by 0.07, 0.03, and 0.05 compared with TFs, T-IMRT, and S-VMAT plan. Compared with other 3 plans, TFs reduced the average number of MUs. Of the 4 techniques studied, this analysis supports 4F-IMRT as the most appropriate balance of target coverage and normal tissue sparing.

  17. Randomized, Controlled Trial of Yoga in Women With Breast Cancer Undergoing Radiotherapy

    PubMed Central

    Chandwani, Kavita D.; Perkins, George; Nagendra, Hongasandra Ramarao; Raghuram, Nelamangala V.; Spelman, Amy; Nagarathna, Raghuram; Johnson, Kayla; Fortier, Adoneca; Arun, Banu; Wei, Qi; Kirschbaum, Clemens; Haddad, Robin; Morris, G. Stephen; Scheetz, Janet; Chaoul, Alejandro; Cohen, Lorenzo

    2014-01-01

    Purpose Previous research incorporating yoga (YG) into radiotherapy (XRT) for women with breast cancer finds improved quality of life (QOL). However, shortcomings in this research limit the findings. Patients and Methods Patients with stages 0 to III breast cancer were recruited before starting XRT and were randomly assigned to YG (n = 53) or stretching (ST; n = 56) three times a week for 6 weeks during XRT or waitlist (WL; n = 54) control. Self-report measures of QOL (Medical Outcomes Study 36-item short-form survey; primary outcomes), fatigue, depression, and sleep quality, and five saliva samples per day for 3 consecutive days were collected at baseline, end of treatment, and 1, 3, and 6 months later. Results The YG group had significantly greater increases in physical component scale scores compared with the WL group at 1 and 3 months after XRT (P = .01 and P = .01). At 1, 3, and 6 months, the YG group had greater increases in physical functioning compared with both ST and WL groups (P < .05), with ST and WL differences at only 3 months (P < .02). The group differences were similar for general health reports. By the end of XRT, the YG and ST groups also had a reduction in fatigue (P < .05). There were no group differences for mental health and sleep quality. Cortisol slope was steepest for the YG group compared with the ST and WL groups at the end (P = .023 and P = .008) and 1 month after XRT (P = .05 and P = .04). Conclusion YG improved QOL and physiological changes associated with XRT beyond the benefits of simple ST exercises, and these benefits appear to have long-term durability. PMID:24590636

  18. Polymorphic Variants in Oxidative Stress Genes and Acute Toxicity in Breast Cancer Patients Receiving Radiotherapy

    PubMed Central

    Córdoba, Elisa Eugenia; Abba, Martín Carlos; Lacunza, Ezequiel; Fernánde, Eduardo; Güerci, Alba Mabel

    2016-01-01

    Purpose Reactive oxygen species (ROS) are generated as an indirect product of radiation therapy (RT). Genetic variation in genes related to ROS metabolism may influence the level of RT-induced adverse effects. We evaluated the potential association of single nucleotide polymorphism (SNP)–related response to radiotherapy injury in breast cancer patients undergoing RT. Materials and Methods Eighty patients receiving conventional RT were included. Acute effects were evaluated according to the Radiation Therapy Oncology Group (RTOG) scores. DNA was extracted from blood and buccal swab samples. SNPs were genotyped for GSTP1, GSTA1, SOD2, and NOS3 genes by polymerase chain reaction–based restriction fragment length polymorphism. Univariate analysis (odds ratios [ORs] and 95% confidence interval [CI]) and principal component analysis were used for correlation of SNPs and factors related to risk of developing ≥ grade 2 acute effects. Results Sixty-five patients (81.2%) showed side effects, 32 (40%) presented moderate to severe acute skin toxicity, and 33 (41.2%) manifested minimal acute skin reactions by the end of treatment. In both univariate and multivariate analyses, nominally significant associations were found among body mass index (OR, 3.14; 95% CI, 8.5338 to 1.1274; p=0.022), breast size (OR, 5.11; 95% CI, 17.04 to 1.54; p=0.004), and grade ≥ 2 acute radiation skin toxicity. A significant association was also observed between NOS3 G894T polymorphism (OR, 9.8; 95% CI, 211.6 to 0.45; p=0.041) and grade ≥ 2 acute radiation skin toxicity in patients with neo-adjuvant chemotherapy treatment. Conclusion The analysis of the factors involved in individual radiosensitivity contributed to the understanding of the mechanisms underlying this trait. PMID:26790968

  19. Postoperative radiotherapy following mastectomy for patients with left-sided breast cancer: A comparative dosimetric study.

    PubMed

    Wang, Jiahao; Li, Xiadong; Deng, Qinghua; Xia, Bing; Wu, Shixiu; Liu, Jian; Ma, Shenglin

    2015-01-01

    The purposes of this article were to compare the biophysical dosimetry for postmastectomy left-sided breast cancer using 4 different radiotherapy (RT) techniques. In total, 30 patients with left-sided breast cancer were randomly selected for this treatment planning study. They were planned using 4 RT techniques, including the following: (1) 3-dimensional conventional tangential fields (TFs), (2) tangential intensity-modulated therapy (T-IMRT), (3) 4 fields IMRT (4F-IMRT), and (4) single arc volumetric-modulated arc therapy (S-VMAT). The planning target volume (PTV) dose was prescribed 50Gy, the comparison of target dose distribution, conformity index, homogeneity index, dose to organs at risk (OARs), tumor control probability (TCP), normal tissue complication probability (NTCP), and number of monitor units (MUs) between 4 plans were investigated for their biophysical dosimetric difference. The target conformity and homogeneity of S-VMAT were better than the other 3 kinds of plans, but increased the volume of OARs receiving low dose (V5). TCP of PTV and NTCP of the left lung showed no statistically significant difference in 4 plans. 4F-IMRT plan was superior in terms of target coverage and protection of OARs and demonstrated significant advantages in decreasing the NTCP of heart by 0.07, 0.03, and 0.05 compared with TFs, T-IMRT, and S-VMAT plan. Compared with other 3 plans, TFs reduced the average number of MUs. Of the 4 techniques studied, this analysis supports 4F-IMRT as the most appropriate balance of target coverage and normal tissue sparing. PMID:25534167

  20. Pulmonary Changes After Radiotherapy for Conservative Treatment of Breast Cancer: A Prospective Study

    SciTech Connect

    Krengli, Marco Sacco, Mariano; Loi, Gianfranco; Masini, Laura; Ferrante, Daniela; Gambaro, Giuseppina; Ronco, Marco; Magnani, Corrado; Carriero, Alessandro

    2008-04-01

    Purpose: Radiotherapy (RT) after conservative surgery for breast cancer involves part of the pulmonary parenchyma with a potential detrimental effect of reducing the normal functional reserve. Such an effect deserves to be studied in depth, considering the given long life expectancy of these women. We prospectively analyzed high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) with correlation with dosimetric data from RT. Methods and Materials: Lung HRCT and PFTs were performed in 41 women who had undergone conservative surgery for breast cancer before and 3 and 9 months after postoperative RT. The PFTs included forced vital capacity, forced expiratory volume in 1 s, total lung capacity, maximal expiratory flow at 50% and 25% of vital capacity, and the diffusion capacity of carbon monoxide. HRCT was matched with the RT treatment plan images to analyze the dosimetric correlation. Results: At 3 months after RT, the lung alterations were classified at HRCT as follows: 46.3% were Grade 1, 24.4% Grade 2, and 7.3% Grade 3, and at 9 months, 58.5% were Grade 1, 19.5% Grade 2, and 0% Grade 3. The PFTs showed a significant decrease at 3 months, with only partial recovery at 9 months. Chemotherapy, but not hormonal therapy, was associated with PFT changes. The grade of fibrosis increased with increasing lung volume treated to a dose {>=}25 Gy. Conclusion: Lung changes, mainly related to damage to the alveolar-capillary barrier and smallest airway ramifications, were observed at 3 months, with only partial recovery at 9 months after RT. Minimizing the lung volume receiving {>=}25 Gy could reduce pulmonary toxicity.

  1. [Cutaneous angiosarcoma arising after radiotherapy treatment of a breast carcinoma. Description of a case and review of the literature].

    PubMed

    Di Tommaso, L; Fabbri, A

    2003-08-01

    Cutaneous angiosarcomas occurring as a complication of radiation therapy for breast cancer are rare. To the best of our knowledge 37 cases have been reported in English literature during the last two decades. We describe a case of angiosarcoma arising in the skin of a breast previously irradiated for breast carcinoma. The patient, a 74-year-old woman, had been treated with conservative surgery and radiotherapy for a pT1N0 infiltrating ductal carcinoma of the left breast in 1993. Nine years later a skin lesion, which was interpreted as a recurrence, arose in the same site. A biopsy obtained from the lesion, and initially considered to be negative for cancer, showed istological features consistent with those of the atypical vascular lesion. Seven months later the same lesion transformed in a 5 x 3 reddish mass which at histological examination was diagnosed as an high grad post-irradiation angiosarcoma of the skin of the breast. Data on previously reported post iradiation angiosarcoma of the breast are reviewed; further consideration on differential diagnosis between those lesions and atypical vascular lesions are presented. PMID:14577204

  2. The expression level of HJURP has an independent prognostic impact and predicts the sensitivity to radiotherapy in breast cancer

    SciTech Connect

    Hu, Zhi; Huang, Ge; Sadanandam, Anguraj; Gu, Shenda; Lenburg, Marc E; Pai, Melody; Bayani, Nora; Blakely, Eleanor A; Gray, Joe W; Mao, Jian-Hua

    2010-06-25

    Introduction: HJURP (Holliday Junction Recognition Protein) is a newly discovered gene reported to function at centromeres and to interact with CENPA. However its role in tumor development remains largely unknown. The goal of this study was to investigate the clinical significance of HJURP in breast cancer and its correlation with radiotherapeutic outcome. Methods: We measured HJURP expression level in human breast cancer cell lines and primary breast cancers by Western blot and/or by Affymetrix Microarray; and determined its associations with clinical variables using standard statistical methods. Validation was performed with the use of published microarray data. We assessed cell growth and apoptosis of breast cancer cells after radiation using high-content image analysis. Results: HJURP was expressed at higher level in breast cancer than in normal breast tissue. HJURP mRNA levels were significantly associated with estrogen receptor (ER), progesterone receptor (PR), Scarff-Bloom-Richardson (SBR) grade, age and Ki67 proliferation indices, but not with pathologic stage, ERBB2, tumor size, or lymph node status. Higher HJURP mRNA levels significantly decreased disease-free and overall survival. HJURP mRNA levels predicted the prognosis better than Ki67 proliferation indices. In a multivariate Cox proportional-hazard regression, including clinical variables as covariates, HJURP mRNA levels remained an independent prognostic factor for disease-free and overall survival. In addition HJURP mRNA levels were an independent prognostic factor over molecular subtypes (normal like, luminal, Erbb2 and basal). Poor clinical outcomes among patients with high HJURP expression werevalidated in five additional breast cancer cohorts. Furthermore, the patients with high HJURP levels were much more sensitive to radiotherapy. In vitro studies in breast cancer cell lines showed that cells with high HJURP levels were more sensitive to radiation treatment and had a higher rate of apoptosis

  3. Patterns of Utilization of Adjuvant Radiotherapy and Outcomes in Black Women After Breast Conservation at a Large Multidisciplinary Cancer Center;Black women; Breast cancer; Radiotherapy; RT; Breast conservation

    SciTech Connect

    Edwards-Bennett, Sophia M.; Jacks, Lindsay M.; McCormick, Beryl; Zhang, Zhigang; Azu, Michelle; Ho, Alice; Powell, Simon; Brown, Carol

    2011-07-15

    Purpose: Population-based studies have reported that as many of 35% of black women do not undergo radiotherapy (RT) after breast conservation surgery (BCS). The objective of the present study was to determine whether this trend persisted at a large multidisciplinary cancer center, and to identify the factors that predict for noncompliance with RT and determine the outcomes for this subset of patients. Methods and Materials: Between January 2002 and December 2007, 83 black women underwent BCS at Memorial Sloan-Kettering Cancer Center and were therefore eligible for the present study. Of the 83 women, 38 (46%) had Stage I, 38 (46%) Stage II, and 7 (8%) Stage III disease. Of the study cohort, 31 (37%) had triple hormone receptor-negative tumors. RT was recommended for 81 (98%) of the 83 patients (median dose, 60 Gy). Results: Of the 81 women, 12 (15%) did not receive the recommended adjuvant breast RT. Nonreceipt of chemotherapy (p = .003) and older age (p = .009) were associated with nonreceipt of RT. With a median follow-up of 70 months, the 3-year local control, locoregional control, recurrence-free survival, disease-free survival, and overall survival rate was 99% (actuarial 5-year rate, 97%), 96% (actuarial 5-year rate, 93%), 95% (actuarial 5-year rate, 92%), 92% (actuarial 5-year rate, 89%), and 95% (actuarial 5-year rate, 91%), respectively. Conclusion: We found a greater rate of utilization adjuvant breast RT (85%) among black women after BCS than has been reported in recent studies, indicating that excellent outcomes are attainable for black women after BCS when care is administered in a multidisciplinary cancer center.

  4. Dosimetric evaluation of incidental irradiation to the axilla during whole breast radiotherapy for patients with left-sided early breast cancer in the IMRT era

    PubMed Central

    Lee, Jayoung; Kim, Shin-Wook; Son, Seok Hyun

    2016-01-01

    Abstract The purpose of this study was to compare the dosimetric parameters for incidental irradiation to the axilla during whole breast radiotherapy (WBRT) with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). Twenty left breast cancer patients treated with WBRT after breast-conserving surgery (BCS) were enrolled in this study. Remnant breast tissue, 3 levels of the axilla, heart, and lung were delineated. We used 2 different radiotherapy methods: 3D-CRT with field-in-field technique and 7-field fixed-beam IMRT. The target coverage of IMRT was significantly better than that of 3D-CRT (Dmean: 49.72 ± 0.64 Gy vs 50.24 ± 0.66 Gy, P < 0.001; V45: 93.19 ± 1.40% vs 98.59 ± 0.30%, P < 0.001; V47.5: 86.43 ± 2.72% vs 95.00 ± 0.02%, P < 0.001, for 3D-CRT and IMRT, respectively). In the IMRT plan, a lower dose was delivered to a wider region of the heart and lung. Significantly lower axillary irradiation was shown throughout each level of axilla by IMRT compared to 3D-CRT (Dmean for level I: 42.58 ± 5.31 Gy vs 14.49 ± 6.91 Gy, P < 0.001; Dmean for level II: 26.25 ± 10.43 Gy vs 3.41 ± 3.11 Gy, P < 0.001; Dmean for level III: 6.26 ± 4.69 Gy vs 1.16 ± 0.51 Gy, P < 0.001; Dmean for total axilla: 33.9 ± 6.89 Gy vs 9.96 ± 5.21 Gy, P < 0.001, for 3D-CRT and IMRT, respectively). In conclusion, the incidental dose delivered to the axilla was significantly lower for IMRT compared to 3D-CRT. Therefore, IMRT, which only includes the breast parenchyma, should be cautiously used in patients with limited positive sentinel lymph nodes and who do not undergo complete axillary lymph node dissection. PMID:27368030

  5. Dosimetric evaluation of incidental irradiation to the axilla during whole breast radiotherapy for patients with left-sided early breast cancer in the IMRT era.

    PubMed

    Lee, Jayoung; Kim, Shin-Wook; Son, Seok Hyun

    2016-06-01

    The purpose of this study was to compare the dosimetric parameters for incidental irradiation to the axilla during whole breast radiotherapy (WBRT) with 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT). Twenty left breast cancer patients treated with WBRT after breast-conserving surgery (BCS) were enrolled in this study. Remnant breast tissue, 3 levels of the axilla, heart, and lung were delineated. We used 2 different radiotherapy methods: 3D-CRT with field-in-field technique and 7-field fixed-beam IMRT. The target coverage of IMRT was significantly better than that of 3D-CRT (Dmean: 49.72 ± 0.64 Gy vs 50.24 ± 0.66 Gy, P < 0.001; V45: 93.19 ± 1.40% vs 98.59 ± 0.30%, P < 0.001; V47.5: 86.43 ± 2.72% vs 95.00 ± 0.02%, P < 0.001, for 3D-CRT and IMRT, respectively). In the IMRT plan, a lower dose was delivered to a wider region of the heart and lung. Significantly lower axillary irradiation was shown throughout each level of axilla by IMRT compared to 3D-CRT (Dmean for level I: 42.58 ± 5.31 Gy vs 14.49 ± 6.91 Gy, P < 0.001; Dmean for level II: 26.25 ± 10.43 Gy vs 3.41 ± 3.11 Gy, P < 0.001; Dmean for level III: 6.26 ± 4.69 Gy vs 1.16 ± 0.51 Gy, P < 0.001; Dmean for total axilla: 33.9 ± 6.89 Gy vs 9.96 ± 5.21 Gy, P < 0.001, for 3D-CRT and IMRT, respectively). In conclusion, the incidental dose delivered to the axilla was significantly lower for IMRT compared to 3D-CRT. Therefore, IMRT, which only includes the breast parenchyma, should be cautiously used in patients with limited positive sentinel lymph nodes and who do not undergo complete axillary lymph node dissection. PMID:27368030

  6. In vivo verification of radiation dose delivered to healthy tissue during radiotherapy for breast cancer

    NASA Astrophysics Data System (ADS)

    Lonski, P.; Taylor, M. L.; Hackworth, W.; Phipps, A.; Franich, R. D.; Kron, T.

    2014-03-01

    Different treatment planning system (TPS) algorithms calculate radiation dose in different ways. This work compares measurements made in vivo to the dose calculated at out-of-field locations using three different commercially available algorithms in the Eclipse treatment planning system. LiF: Mg, Cu, P thermoluminescent dosimeter (TLD) chips were placed with 1 cm build-up at six locations on the contralateral side of 5 patients undergoing radiotherapy for breast cancer. TLD readings were compared to calculations of Pencil Beam Convolution (PBC), Anisotropic Analytical Algorithm (AAA) and Acuros XB (XB). AAA predicted zero dose at points beyond 16 cm from the field edge. In the same region PBC returned an unrealistically constant result independent of distance and XB showed good agreement to measured data although consistently underestimated by ~0.1 % of the prescription dose. At points closer to the field edge XB was the superior algorithm, exhibiting agreement with TLD results to within 15 % of measured dose. Both AAA and PBC showed mixed agreement, with overall discrepancies considerably greater than XB. While XB is certainly the preferable algorithm, it should be noted that TPS algorithms in general are not designed to calculate dose at peripheral locations and calculation results in such regions should be treated with caution.

  7. A phase III randomized study on the sequencing of radiotherapy and chemotherapy in the conservative management of early-stage breast cancer

    SciTech Connect

    Arcangeli, Giorgio . E-mail: arcangeli@ifo.it; Pinnaro, Paola; Rambone, Rita; Giannarelli, Diana; Benassi, Marcello

    2006-01-01

    Purpose: To compare two different timings of radiation treatment in patients with breast cancer who underwent conservative surgery and were candidates to receive adjuvant cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy. Methods and Materials: A total of 206 patients who had quadrantectomy and axillary dissection for breast cancer and were planned to receive adjuvant CMF chemotherapy were randomized to concurrent or sequential radiotherapy. Radiotherapy was delivered only to the whole breast through tangential fields to a dose of 50 Gy in 20 fractions over 4 weeks, followed by an electron boost of 10-15 Gy in 4-6 fractions to the tumor bed. Results: No differences in 5-year breast recurrence-free, metastasis-free, disease-free, and overall survival were observed in the two treatment groups. All patients completed the planned radiotherapy. No evidence of an increased risk of toxicity was observed between the two arms. No difference in radiotherapy and in the chemotherapy dose intensity was observed in the two groups. Conclusions: In patients with negative surgical margins receiving adjuvant chemotherapy, radiotherapy can be delayed to up to 7 months. Concurrent administration of CMF chemotherapy and radiotherapy is safe and might be reserved for patients at high risk of local recurrence, such as those with positive surgical margins or larger tumor diameters.

  8. Haplotype-Based Analysis of Genes Associated With Risk of Adverse Skin Reactions After Radiotherapy in Breast Cancer Patients

    SciTech Connect

    Suga, Tomo; Ishikawa, Atsuko; Kohda, Masakazu; Otsuka, Yoshimi; Yamada, Shigeru; Yamamoto, Naohito; Shibamoto, Yuta; Ogawa, Yoshihiro; Nomura, Kuninori; Sho, Keizen; Omura, Motoko; Sekiguchi, Kenji; Kikuchi, Yuzo; Michikawa, Yuichi; Noda, Shuhei; Sagara, Masashi; Ohashi, Jun; Yoshinaga, Shinji; Mizoe, Junetsu; Tsujii, Hirohiko

    2007-11-01

    Purpose: To identify haplotypes of single nucleotide polymorphism markers associated with the risk of early adverse skin reactions (EASRs) after radiotherapy in breast cancer patients. Methods and Materials: DNA was sampled from 399 Japanese breast cancer patients who qualified for breast-conserving radiotherapy. Using the National Cancer Institute-Common Toxicity Criteria scoring system, version 2, the patients were grouped according to EASRs, defined as those occurring within 3 months of starting radiotherapy (Grade 1 or less, n = 290; Grade 2 or greater, n = 109). A total of 999 single nucleotide polymorphisms from 137 candidate genes for radiation susceptibility were genotyped, and the haplotype associations between groups were assessed. Results: The global haplotype association analysis (p < 0.05 and false discovery rate < 0.05) indicated that estimated haplotypes in six loci were associated with EASR risk. A comparison of the risk haplotype with the most frequent haplotype in each locus showed haplotype GGTT in CD44 (odds ratio [OR] = 2.17; 95% confidence interval [CI], 1.07-4.43) resulted in a significantly greater EASR risk. Five haplotypes, CG in MAD2L2 (OR = 0.55; 95% CI, 0.35-0.87), GTTG in PTTG1 (OR = 0.48; 95% CI, 0.24-0.96), TCC (OR = 0.48; 95% CI, 0.26-0.89) and CCG (OR = 0.50; 95% CI, 0.27-0.92) in RAD9A, and GCT in LIG3 (OR = 0.46; 95% CI, 0.22-0.93) were associated with a reduced EASR risk. No significant risk haplotype was observed in REV3L. Conclusion: Individual radiosensitivity can be partly determined by these haplotypes in multiple loci. Our findings may lead to a better understanding of the mechanisms underlying the genetic variation in radiation sensitivity and resistance among breast cancer patients.

  9. Reproducibility of the external surface position in left-breast DIBH radiotherapy with spirometer-based monitoring.

    PubMed

    Fassi, Aurora; Ivaldi, Giovanni B; Meaglia, Ilaria; Porcu, Patrizia; Tabarelli de Fatis, Paola; Liotta, Marco; Riboldi, Marco; Baroni, Guido

    2014-01-01

    Deep inspiration breath hold (DIBH) in left-sided breast cancer radiotherapy treatments allows for a reduction in cardiac and pulmonary doses without compromising target coverage. The selection of the most appropriate technology for DIBH monitoring is a crucial issue. We evaluated the stability and reproducibility of DIBHs controlled by a spirometric device, by assessing the variability of the external surface position within a single DIBH (intra-DIBH) and between DIBHs performed in the same treatment session (intrafraction) or in different sessions (interfraction). The study included seven left-breast cancer patients treated with spirometer-based DIBH radiotherapy. Infrared optical tracking was used to record the 3D coordinates of seven to eleven passive markers placed on the patient's thoraco-abdominal surface during 29-43 DIBHs performed in six to eight treatment sessions. The obtained results showed displacements of the external surface between different sessions up to 6.3mm along a single direction, even at constant inspired volumes. The median value of the interfraction variability in the position of breast passive markers was 2.9 mm (range 1.9-4.8 mm) in the latero-lateral direction, 3.6 mm (range 2.2-4.6mm) in the antero-posterior direction, and 4.3mm (range 2.8-6.2 mm) in the cranio-caudal direction. There were no significant dose distribution variations for target and organs at risk with respect to the treatment plan, confirming the adequacy of the applied clinical margins (15 mm) to compensate for the measured setup uncertainties. This study demonstrates that spirometer-based control does not guarantee a stable and reproducible position of the external surface in left-breast DIBH radiotherapy, suggesting the need for more robust DIBH monitoring techniques when reduced margins and setup uncertainties are required for improving normal tissue sparing and decreasing cardiac and pulmonary toxicity. PMID:24423845

  10. Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning

    NASA Astrophysics Data System (ADS)

    Guerrero, M.; Li, X. Allen

    2003-10-01

    Numerous studies of early-stage breast cancer treated with breast conserving surgery (BCS) and radiotherapy (RT) have been published in recent years. Both external beam radiotherapy (EBRT) and/or brachytherapy (BT) with different fractionation schemes are currently used. The present RT practice is largely based on empirical experience and it lacks a reliable modelling tool to compare different RT modalities or to design new treatment strategies. The purpose of this work is to derive a plausible set of radiobiological parameters that can be used for RT treatment planning. The derivation is based on existing clinical data and is consistent with the analysis of a large number of published clinical studies on early-stage breast cancer. A large number of published clinical studies on the treatment of early breast cancer with BCS plus RT (including whole breast EBRT with or without a boost to the tumour bed, whole breast EBRT alone, brachytherapy alone) and RT alone are compiled and analysed. The linear quadratic (LQ) model is used in the analysis. Three of these clinical studies are selected to derive a plausible set of LQ parameters. The potential doubling time is set a priori in the derivation according to in vitro measurements from the literature. The impact of considering lower or higher Tpot is investigated. The effects of inhomogeneous dose distributions are considered using clinically representative dose volume histograms. The derived LQ parameters are used to compare a large number of clinical studies using different regimes (e.g., RT modality and/or different fractionation schemes with different prescribed dose) in order to validate their applicability. The values of the equivalent uniform dose (EUD) and biologically effective dose (BED) are used as a common metric to compare the biological effectiveness of each treatment regime. We have obtained a plausible set of radiobiological parameters for breast cancer: agr = 0.3 Gy-1, agr/bgr = 10 Gy and sub

  11. Planning With Intensity-Modulated Radiotherapy and Tomotherapy to Modulate Dose Across Breast to Reflect Recurrence Risk (IMPORT High Trial)

    SciTech Connect

    Donovan, Ellen M.; Ciurlionis, Laura; Fairfoul, Jamie; James, Hayley; Mayles, Helen; Manktelow, Sophie; Raj, Sanjay; Tsang, Yat; Tywman, Nicola; Yarnold, John; Coles, Charlotte

    2011-03-15

    Purpose: To establish planning solutions for a concomitant three-level radiation dose distribution to the breast using linear accelerator- or tomotherapy-based intensity-modulated radiotherapy (IMRT), for the U.K. Intensity Modulated and Partial Organ (IMPORT) High trial. Methods and Materials: Computed tomography data sets for 9 patients undergoing breast conservation surgery with implanted tumor bed gold markers were used to prepare three-level dose distributions encompassing the whole breast (36 Gy), partial breast (40 Gy), and tumor bed boost (48 or 53 Gy) treated concomitantly in 15 fractions within 3 weeks. Forward and inverse planned IMRT and tomotherapy were investigated as solutions. A standard electron field was compared with a photon field arrangement encompassing the tumor bed boost volume. The out-of-field doses were measured for all methods. Results: Dose-volume constraints of volume >90% receiving 32.4 Gy and volume >95% receiving 50.4 Gy for the whole breast and tumor bed were achieved. The constraint of volume >90% receiving 36 Gy for the partial breast was fulfilled in the inverse IMRT and tomotherapy plans and in 7 of 9 cases of a forward planned IMRT distribution. An electron boost to the tumor bed was inadequate in 8 of 9 cases. The IMRT methods delivered a greater whole body dose than the standard breast tangents. A contralateral lung volume >2.5 Gy was increased in the inverse IMRT and tomotherapy plans, although it did not exceed the constraint. Conclusion: We have demonstrated a set of widely applicable solutions that fulfilled the stringent clinical trial requirements for the delivery of a concomitant three-level dose distribution to the breast.

  12. High Mammographic Breast Density Is Independent Predictor of Local But Not Distant Recurrence After Lumpectomy and Radiotherapy for Invasive Breast Cancer

    SciTech Connect

    Park, Catherine C. Rembert, James; Chew, Karen; Moore, Dan; Kerlikowske, Karla

    2009-01-01

    Purpose: Biologically meaningful predictors for locoregional recurrence (LRR) in patients undergoing breast-conserving surgery (BCS) and radiotherapy (RT) are lacking. Tissue components, including extracellular matrix, could confer resistance to ionizing radiation. Fibroglandular and extracellular matrix components of breast tissue relative to adipose tissue can be quantified by the mammographic breast density (MBD), the proportion of dense area relative to the total breast area on mammography. We hypothesized that the MBD might be a predictor of LRR after BCS and RT for invasive breast cancer. Methods and Materials: We conducted a nested case-control study of 136 women with invasive breast cancer who had undergone BCS and RT and had had the MBD ascertained before, or at, diagnosis. Women with known recurrence were matched to women without recurrence by year of diagnosis. The median follow-up was 7.7 years. The percentage of MBD was measured using a computer-based threshold method. Results: Patients with a high MBD ({>=}75% density) vs. low ({<=}25%) were at increased risk of LRR (hazard ratio, 4.30; 95% confidence interval, 0.88-021.0; p = 0.071) but not distant recurrence. In addition, we found a complete inverse correlation between high MBD and obesity (body mass index, {>=}30 kg/m{sup 2}). In a multivariate Cox proportional hazards model, patients with MBD in the greatest quartile were at significantly greater risk of LRR (hazard ratio, 6.6; 95% confidence interval, 1.6-27.7; p = 0.01). Obesity without a high MBD also independently predicted for LRR (hazard ratio, 19.3; 95% confidence interval, 4.5-81.7; p < 0.001). Conclusion: The results of our study have shown that a high MBD and obesity are significant independent predictors of LRR after BCS and RT for invasive breast cancer. Additional studies are warranted to validate these findings.

  13. Evaluation the consistency of location of moist desquamation and skin high dose area for breast cancer patients receiving adjuvant radiotherapy after breast conservative surgery

    PubMed Central

    2013-01-01

    Background To evaluate whether the location of moist desquamation matches high dose area for breast cancer patients receiving adjuvant radiotherapy (RT) after breast conservative surgery. Methods One hundred and nine breast cancer patients were enrolled to this study. Their highest skin dose area (the hot spot) was estimated from the treatment planning. We divided the irradiated field into breast; sternal/parasternal; axillary; and inframammary fold areas. The location for moist desquamation was recorded to see if it matches the hot spot. We also analyzed other possible risk factors which may be related to the moist desquamation. Results Forty-eight patients with 65 locations developed moist desquamation during the RT course. Patients with larger breast sizes and easy to sweat are two independent risk factors for moist desquamation. The distribution of moist desquamation occurred most in the axillary area. All nine patients with the hot spots located at the axillary area developed moist desquamation at the axillary area, and six out of seven patients with the hot spots located at the inframammary fold developed moist desquamation there. The majority of patients with moist desquamation over the breast or sternal/parasternal areas had the hot spots located at these areas. Conclusions For a patient with moist desquamation, if a hot spot is located at the axillary or inframammary fold areas, it is very likely to have moist desquamation occur there. On the other hand, if moist desquamation occurs over the breast or sternal/parasternal areas, we can highly expect these two areas are also the hot spot locations. PMID:23497574

  14. Polymorphisms in oxidative stress-related genes and mortality in breast cancer patients--potential differential effects by radiotherapy?

    PubMed

    Seibold, Petra; Hall, Per; Schoof, Nils; Nevanlinna, Heli; Heikkinen, Tuomas; Benner, Axel; Liu, Jianjun; Schmezer, Peter; Popanda, Odilia; Flesch-Janys, Dieter; Chang-Claude, Jenny

    2013-10-01

    We assessed whether variants in 22 oxidative stress-related genes are associated with mortality of breast cancer patients and whether the associations differ according to radiotherapy. Using a prospective cohort of 1348 postmenopausal breast cancer patients, we estimated hazard ratios (HR) and 95% confidence intervals (CI) for 109 single nucleotide polymorphisms (SNPs) using Cox proportional hazards regression. Validation of results was attempted using two Scandinavian studies. Eleven SNPs in MT2A, NFE2L2, NQO1, PRDX1, and PRDX6 were significantly associated with overall mortality after a median follow-up of 5.7 years. Three SNPs in NQO1 (rs2917667) and in PRDX6 (rs7314, rs4916362) were consistently associated with increased risk of dying across all three study populations (pooled: HRNQO1_rs2917667 1.20, 95% CI 1.00-1.44, p = 0.051; HRPRDX6_rs7314 1.16, 95% CI 1.00-1.35, p = 0.056, HRPRDX6_rs4916362 1.14 95% CI 1.00-1.32, p = 0.062). Potential effect modification by radiotherapy was found for CAT_rs769218. In conclusion, genetic variants in NQO1 and PRDX6 may modify breast cancer prognosis. PMID:23489758

  15. Correlation between the radiation responses of fibroblasts cultured from individual patients and the risk of late reaction after breast radiotherapy.

    PubMed

    Nuta, Otilia; Somaiah, Navita; Boyle, Sue; Chua, Melvin Lee Kiang; Gothard, Lone; Yarnold, John; Rothkamm, Kai; Herskind, Carsten

    2016-05-01

    Late normal tissue toxicity varies widely between patients and limits breast radiotherapy dose. Here we aimed to determine its relationship to DNA damage responses of fibroblast cultures from individual patients. Thirty-five breast cancer patients, with minimal or marked breast changes after breast-conserving therapy consented to receive a 4 Gy test irradiation to a small skin field of the left buttock and have punch biopsies taken from irradiated and unirradiated skin. Early-passage fibroblast cultures were established by outgrowth and irradiated in vitro with 0 or 4 Gy. 53BP1 foci, p53 and p21/CDKN1A were detected by immunofluorescence microscopy. Residual 53BP1 foci counts 24 h after in vitro irradiation were significantly higher in fibroblasts from RT-sensitive versus RT-resistant patients. Furthermore, significantly larger fractions of p53- but not p21/CDKN1A-positive fibroblasts were found in cultures from RT-sensitive patients without in vitro irradiation, and 2 h and 6 d post-irradiation. Exploratory analysis showed a stronger p53 response 2 h after irradiation of fibroblasts established from patients with severe reaction. These results associate the radiation response of fibroblasts with late reaction of the breast after RT and suggest a correlation with severity. PMID:26944319

  16. Non-surgical management of early breast cancer in the United Kingdom: the role and practice of radiotherapy. Clinical Audit Sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologists, and the Joint Council for Clinical Oncology.

    PubMed

    Price, P; Yarnold, J R

    1995-01-01

    This paper reports on the delivery of radiotherapy to the primary site and lymphatic pathways in the management of early stage breast cancer. Radiotherapists were clear that their aim of locoregional radiotherapy was to reduce local recurrence. However, variation in policies for delivery were seen: 80% of radiotherapists did not always give radiotherapy routinely following wide local excision as part of breast conserving management; instead they withheld it selectively for a number of reasons. Only 66% routinely used breast boosts. There was a range of indications for giving radiotherapy to the lymphatic pathways; there was also variation in the management of incompletely or marginally excised primary tumours. Most sources of variation in the practice of radiotherapy in the management of women with early stage breast cancer appeared to arise from scientific uncertainty. However, organizational issues influenced many decisions. These scientific uncertainties and organizational issues are best addressed in the context of multidisciplinary breast clinics. PMID:8845315

  17. Factors of influence on acute skin toxicity of breast cancer patients treated with standard three-dimensional conformal radiotherapy (3D-CRT) after breast conserving surgery (BCS)

    PubMed Central

    2012-01-01

    Purpose/Objectives Standard 3D-CRT after BCS may cause skin toxicity with a wide range of intensity including acute effects like erythema or late effects. In order to reduce these side effects it is mandatory to identify potential factors of influence in breast cancer patients undergoing standard three-dimensional conformal radiation therapy (3D-CRT) of the breast and modern systemic therapy. Materials/Methods Between 2006 and 2010 a total of 211 breast cancer patients (median age 52,4 years, range 24–77) after BCS consecutively treated in our institution with 3D-CRT (50 Gy whole breast photon radiotherapy followed by 16 Gy electron boost to the tumorbed) were evaluated with special focus on documented skin toxicity at the end of the 50 Gy-course. Standardized photodocumentation of the treated breast was done in each patient lying on the linac table with arms elevated. Skin toxicity was documented according to the common toxicity criteria (CTC)-score. Potential influencing factors were classified in three groups: patient-specific (smoking, age, breast size, body mass index = BMI, allergies), tumor-specific (tumorsize) and treatment-specific factors (antihormonal therapy with tamoxifen or aromatase inhibitors, chemotherapy). Uni- and multivariate statistical analyses were done using IBM SPSS version 19. Results After 50 Gy 3D-CRT to the whole breast 28.9% of all 211 patients had no erythema, 62.2% showed erythema grade 1 (G1) and 8.5% erythema grade 2. None of the patients had grade 3/4 (G3/4) erythema. In univariate analyses a significant influence or trend on the development of acute skin toxicities (erythema G0 versus G1 versus G2) was observed for larger breast volumes (p=0,004), smoking during radiation therapy (p=0,064) and absence of allergies (p=0,014) as well as larger tumorsize (p=0,009) and antihormonal therapy (p=0.005). Neither patient age, BMI nor choice of chemotherapy showed any significant effect on higher grade toxicity. In the multivariate

  18. Variability of Target and Normal Structure Delineation for Breast Cancer Radiotherapy: An RTOG Multi-Institutional and Multiobserver Study

    SciTech Connect

    Li, X. Allen Tai, An; Arthur, Douglas W.; Buchholz, Thomas A.; Macdonald, Shannon; Marks, Lawrence B.; Moran, Jean M.; Pierce, Lori J.; Rabinovitch, Rachel; Taghian, Alphonse; Vicini, Frank; Woodward, Wendy; White, Julia R.

    2009-03-01

    Purpose: To quantify the multi-institutional and multiobserver variability of target and organ-at-risk (OAR) delineation for breast-cancer radiotherapy (RT) and its dosimetric impact as the first step of a Radiation Therapy Oncology Group effort to establish a breast cancer atlas. Methods and Materials: Nine radiation oncologists specializing in breast RT from eight institutions independently delineated targets (e.g., lumpectomy cavity, boost planning target volume, breast, supraclavicular, axillary and internal mammary nodes, chest wall) and OARs (e.g., heart, lung) on the same CT images of three representative breast cancer patients. Interobserver differences in structure delineation were quantified regarding volume, distance between centers of mass, percent overlap, and average surface distance. Mean, median, and standard deviation for these quantities were calculated for all possible combinations. To assess the impact of these variations on treatment planning, representative dosimetric plans based on observer-specific contours were generated. Results: Variability in contouring the targets and OARs between the institutions and observers was substantial. Structure overlaps were as low as 10%, and volume variations had standard deviations up to 60%. The large variability was related both to differences in opinion regarding target and OAR boundaries and approach to incorporation of setup uncertainty and dosimetric limitations in target delineation. These interobserver differences result in substantial variations in dosimetric planning for breast RT. Conclusions: Differences in target and OAR delineation for breast irradiation between institutions/observers appear to be clinically and dosimetrically significant. A systematic consensus is highly desirable, particularly in the era of intensity-modulated and image-guided RT.

  19. Constitutive gene expression profile segregates toxicity in locally advanced breast cancer patients treated with high-dose hyperfractionated radical radiotherapy

    PubMed Central

    Henríquez Hernández, Luis Alberto; Lara, Pedro Carlos; Pinar, Beatriz; Bordón, Elisa; Gallego, Carlos Rodríguez; Bilbao, Cristina; Pérez, Leandro Fernández; Morales, Amílcar Flores

    2009-01-01

    Breast cancer patients show a wide variation in normal tissue reactions after radiotherapy. The individual sensitivity to x-rays limits the efficiency of the therapy. Prediction of individual sensitivity to radiotherapy could help to select the radiation protocol and to improve treatment results. The aim of this study was to assess the relationship between gene expression profiles of ex vivo un-irradiated and irradiated lymphocytes and the development of toxicity due to high-dose hyperfractionated radiotherapy in patients with locally advanced breast cancer. Raw data from microarray experiments were uploaded to the Gene Expression Omnibus Database (GEO accession GSE15341). We obtained a small group of 81 genes significantly regulated by radiotherapy, lumped in 50 relevant pathways. Using ANOVA and t-test statistical tools we found 20 and 26 constitutive genes (0 Gy) that segregate patients with and without acute and late toxicity, respectively. Non-supervised hierarchical clustering was used for the visualization of results. Six and 9 pathways were significantly regulated respectively. Concerning to irradiated lymphocytes (2 Gy), we founded 29 genes that separate patients with acute toxicity and without it. Those genes were gathered in 4 significant pathways. We could not identify a set of genes that segregates patients with and without late toxicity. In conclusion, we have found an association between the constitutive gene expression profile of peripheral blood lymphocytes and the development of acute and late toxicity in consecutive, unselected patients. These observations suggest the possibility of predicting normal tissue response to irradiation in high-dose non-conventional radiation therapy regimens. Prospective studies with higher number of patients are needed to validate these preliminary results. PMID:19497124

  20. A clip-based protocol for breast boost radiotherapy provides clear target visualisation and demonstrates significant volume reduction over time

    SciTech Connect

    Lewis, Lorraine; Cox, Jennifer; Morgia, Marita; Atyeo, John; Lamoury, Gillian

    2015-09-15

    The clinical target volume (CTV) for early stage breast cancer is difficult to clearly identify on planning computed tomography (CT) scans. Surgical clips inserted around the tumour bed should help to identify the CTV, particularly if the seroma has been reabsorbed, and enable tracking of CTV changes over time. A surgical clip-based CTV delineation protocol was introduced. CTV visibility and its post-operative shrinkage pattern were assessed. The subjects were 27 early stage breast cancer patients receiving post-operative radiotherapy alone and 15 receiving post-operative chemotherapy followed by radiotherapy. The radiotherapy alone (RT/alone) group received a CT scan at median 25 days post-operatively (CT1rt) and another at 40 Gy, median 68 days (CT2rt). The chemotherapy/RT group (chemo/RT) received a CT scan at median 18 days post-operatively (CT1ch), a planning CT scan at median 126 days (CT2ch), and another at 40 Gy (CT3ch). There was no significant difference (P = 0.08) between the initial mean CTV for each cohort. The RT/alone cohort showed significant CTV volume reduction of 38.4% (P = 0.01) at 40 Gy. The Chemo/RT cohort had significantly reduced volumes between CT1ch: median 54 cm{sup 3} (4–118) and CT2ch: median 16 cm{sup 3}, (2–99), (P = 0.01), but no significant volume reduction thereafter. Surgical clips enable localisation of the post-surgical seroma for radiotherapy targeting. Most seroma shrinkage occurs early, enabling CT treatment planning to take place at 7 weeks, which is within the 9 weeks recommended to limit disease recurrence.

  1. Image-Guided Radiotherapy for Left-Sided Breast Cancer Patients: Geometrical Uncertainty of the Heart

    SciTech Connect

    Topolnjak, Rajko; Borst, Gerben R.; Nijkamp, Jasper

    2012-03-15

    Purpose: To quantify the geometrical uncertainties for the heart during radiotherapy treatment of left-sided breast cancer patients and to determine and validate planning organ at risk volume (PRV) margins. Methods and Materials: Twenty-two patients treated in supine position in 28 fractions with regularly acquired cone-beam computed tomography (CBCT) scans for offline setup correction were included. Retrospectively, the CBCT scans were reconstructed into 10-phase respiration correlated four-dimensional scans. The heart was registered in each breathing phase to the planning CT scan to establish the respiratory heart motion during the CBCT scan ({sigma}{sub resp}). The average of the respiratory motion was calculated as the heart displacement error for a fraction. Subsequently, the systematic ({Sigma}), random ({sigma}), and total random ({sigma}{sub tot}={radical}({sigma}{sup 2}+{sigma}{sub resp}{sup 2})) errors of the heart position were calculated. Based on the errors a PRV margin for the heart was calculated to ensure that the maximum heart dose (D{sub max}) is not underestimated in at least 90% of the cases (M{sub heart} = 1.3{Sigma}-0.5{sigma}{sub tot}). All analysis were performed in left-right (LR), craniocaudal (CC), and anteroposterior (AP) directions with respect to both online and offline bony anatomy setup corrections. The PRV margin was validated by accumulating the dose to the heart based on the heart registrations and comparing the planned PRV D{sub max} to the accumulated heart D{sub max}. Results: For online setup correction, the cardiac geometrical uncertainties and PRV margins were N-Ary-Summation = 2.2/3.2/2.1 mm, {sigma} = 2.1/2.9/1.4 mm, and M{sub heart} = 1.6/2.3/1.3 mm for LR/CC/AP, respectively. For offline setup correction these were N-Ary-Summation = 2.4/3.7/2.2 mm, {sigma} = 2.9/4.1/2.7 mm, and M{sub heart} = 1.6/2.1/1.4 mm. Cardiac motion induced by breathing was {sigma}{sub resp} = 1.4/2.9/1.4 mm for LR/CC/AP. The PRV D{sub max

  2. Blockade of MMP14 Activity in Murine Breast Carcinomas: Implications for Macrophages, Vessels, and Radiotherapy

    PubMed Central

    Ager, Eleanor I.; Kozin, Sergey V.; Kirkpatrick, Nathaniel D.; Seano, Giorgio; Kodack, David P.; Askoxylakis, Vasileios; Huang, Yuhui; Goel, Shom; Snuderl, Matija; Muzikansky, Alona; Finkelstein, Dianne M.; Dransfield, Daniel T.; Devy, Laetitia; Boucher, Yves

    2015-01-01

    Background: Matrix metalloproteinase (MMP) 14 may mediate tumor progression through vascular and immune-modulatory effects. Methods: Orthotopic murine breast tumors (4T1 and E0771 with high and low MMP14 expression, respectively; n = 5–10 per group) were treated with an anti-MMP14 inhibitory antibody (DX-2400), IgG control, fractionated radiation therapy, or their combination. We assessed primary tumor growth, transforming growth factor β (TGFβ) and inducible nitric oxide synthase (iNOS) expression, macrophage phenotype, and vascular parameters. A linear mixed model with repeated observations, with Mann-Whitney or analysis of variance with Bonferroni post hoc adjustment, was used to determine statistical significance. All statistical tests were two-sided. Results: DX-2400 inhibited tumor growth compared with IgG control treatment, increased macrophage numbers, and shifted the macrophage phenotype towards antitumor M1-like. These effects were associated with a reduction in active TGFβ and SMAD2/3 signaling. DX-2400 also transiently increased iNOS expression and tumor perfusion, reduced tissue hypoxia (median % area: control, 20.2%, interquartile range (IQR) = 6.4%-38.9%; DX-2400: 1.2%, IQR = 0.2%-3.2%, P = .044), and synergistically enhanced radiation therapy (days to grow to 800mm3: control, 12 days, IQR = 9–13 days; DX-2400 plus radiation, 29 days, IQR = 26–30 days, P < .001) in the 4T1 model. The selective iNOS inhibitor, 1400W, abolished the effects of DX-2400 on vessel perfusion and radiotherapy. On the other hand, DX-2400 was not capable of inducing iNOS expression or synergizing with radiation in E0771 tumors. Conclusion: MMP14 blockade decreased immunosuppressive TGFβ, polarized macrophages to an antitumor phenotype, increased iNOS, and improved tumor perfusion, resulting in reduced primary tumor growth and enhanced response to radiation therapy, especially in high MMP14-expressing tumors. PMID:25710962

  3. Evaluation of a Single-Isocenter Technique for Axillary Radiotherapy in Breast Cancer

    SciTech Connect

    Beek, Suzanne van Jaeger, Katrien de; Mijnheer, Ben |; Vliet-Vroegindeweij, Corine van

    2008-10-01

    The aim of this study was to develop a technique for axillary radiotherapy that minimizes the risk of radiation-induced damage to the surrounding normal tissue (i.e., arm, shoulder, lung, esophagus, and spinal cord) while keeping the risk of a nodal recurrence to a minimum. A planning study was performed in 20 breast cancer patients. The target volume of the axillary treatment encompassed the periclavicular and axillary lymph node areas. The 3-dimensional (3D) computed tomography (CT) information in this study was used to outline the lymph node areas and the organs at risk (i.e., the esophagus, spinal cord, brachial plexus, and lung). A conventional AP-PA technique (with a transmission plate placed in the AP beam) was evaluated. In addition, a new single-isocenter technique consisting of AP/PA fields using a gantry rotation of {+-}20 deg. and a medial AP segment was developed. Both techniques were compared by evaluation of the calculated dose distributions and the dose-volume histograms of the target volume and surrounding organs at risk. The field borders and humeral shielding were redefined based on the 3D anatomical references. Adapting the humeral shielding reduced the irradiated volume by 19% and might contribute to a reduction of the incidence of arm edema and impairment of shoulder function. The maximum radiation dose in the esophagus and spinal cord was reduced by more than 50% using the single-isocenter technique. The difference between both techniques with respect to the mean doses in the target volume and lung, and the maximum dose in brachial plexus, was not statistically significant. Moreover, the single-isocenter technique allowed a fast and easy treatment preparation and reduced the execution time considerably (with approximately 10 minutes per fraction)

  4. Kilovoltage cone-beam CT imaging dose during breast radiotherapy: a dose comparison between a left and right breast setup.

    PubMed

    Quinn, Alexandra; Holloway, Lois; Begg, Jarrad; Nelson, Vinod; Metcalfe, Peter

    2014-01-01

    The purpose of this study was to investigate the delivered dose from a kilovoltage cone-beam computed tomography (kV-CBCT) acquired in breast treatment position for a left and right breast setup. The dose was measured with thermoluminescent dosimeters positioned within a female anthropomorphic phantom at organ locations. Imaging was performed on an Elekta Synergy XVI system with the phantom setup on a breast board. The image protocol involved 120kVp, 140mAs, and a 270° arc rotation clockwise 0° to 270° for the left breast setup and 270° to 180° for the right breast setup (maximum arc rotations possible). The dose delivered to the left breast, right breast, and heart was 5.1mGy, 3.9mGy, and 4.0mGy for the left breast setup kV-CBCT, and 6.4mGy, 6.0mGy, and 4.8mGy for the right breast setup kV-CBCT, respectively. The rotation arc of the kV-CBCT influenced the dose delivered, with the right breast setup kV-CBCT found to deliver a dose of up to 4mGy or 105% higher to the treated breast's surface in comparison with the left breast setup. This is attributed to the kV-CBCT source being more proximal to the anterior of the phantom for a right breast setup, whereas the source is more proximal to the posterior of the patient for a left-side scan. PMID:24630912

  5. Whole breast and excision cavity radiotherapy plan comparison: Conformal radiotherapy with sequential boost versus intensity-modulated radiation therapy with a simultaneously integrated boost

    SciTech Connect

    Small, Katherine; Kelly, Chris; Beldham-Collins, Rachael; Gebski, Val

    2013-03-15

    A comparative study was conducted comparing the difference between (1) conformal radiotherapy (CRT) to the whole breast with sequential boost excision cavity plans and (2) intensity-modulated radiation therapy (IMRT) to the whole breast with simultaneously integrated boost to the excision cavity. The computed tomography (CT) data sets of 25 breast cancer patients were used and the results analysed to determine if either planning method produced superior plans. CT data sets from 25 past breast cancer patients were planned using (1) CRT prescribed to 50 Gy in 25 fractions (Fx) to the whole-breast planning target volume (PTV) and 10 Gy in 5Fx to the excision cavity and (2) IMRT prescribed to 60 Gy in 25Fx, with 60 Gy delivered to the excision cavity PTV and 50 Gy delivered to the whole-breast PTV, treated simultaneously. In total, 50 plans were created, with each plan evaluated by PTV coverage using conformity indices, plan maximum dose, lung dose, and heart maximum dose for patients with left-side lesions. CRT plans delivered the lowest plan maximum doses in 56% of cases (average CRT = 6314.34 cGy, IMRT = 6371.52 cGy). They also delivered the lowest mean lung dose in 68% of cases (average CRT = 1206.64 cGy, IMRT = 1288.37 cGy) and V20 in 88% of cases (average CRT = 20.03%, IMRT = 21.73%) and V30 doses in 92% of cases (average CRT = 16.82%, IMRT = 17.97%). IMRT created more conformal plans, using both conformity index and conformation number, in every instance, and lower heart maximum doses in 78.6% of cases (average CRT = 5295.26 cGy, IMRT = 5209.87 cGy). IMRT plans produced superior dose conformity and shorter treatment duration, but a slightly higher planning maximum and increased lung doses. IMRT plans are also faster to treat on a daily basis, with shorter fractionation.

  6. Kilovoltage cone-beam CT imaging dose during breast radiotherapy: A dose comparison between a left and right breast setup

    SciTech Connect

    Quinn, Alexandra; Holloway, Lois; Begg, Jarrad; Nelson, Vinod; Metcalfe, Peter

    2014-07-01

    The purpose of this study was to investigate the delivered dose from a kilovoltage cone-beam computed tomography (kV-CBCT) acquired in breast treatment position for a left and right breast setup. The dose was measured with thermoluminescent dosimeters positioned within a female anthropomorphic phantom at organ locations. Imaging was performed on an Elekta Synergy XVI system with the phantom setup on a breast board. The image protocol involved 120 kVp, 140 mAs, and a 270° arc rotation clockwise 0° to 270° for the left breast setup and 270° to 180° for the right breast setup (maximum arc rotations possible). The dose delivered to the left breast, right breast, and heart was 5.1 mGy, 3.9 mGy, and 4.0 mGy for the left breast setup kV-CBCT, and 6.4 mGy, 6.0 mGy, and 4.8 mGy for the right breast setup kV-CBCT, respectively. The rotation arc of the kV-CBCT influenced the dose delivered, with the right breast setup kV-CBCT found to deliver a dose of up to 4 mGy or 105% higher to the treated breast′s surface in comparison with the left breast setup. This is attributed to the kV-CBCT source being more proximal to the anterior of the phantom for a right breast setup, whereas the source is more proximal to the posterior of the patient for a left-side scan.

  7. SU-E-J-134: An Augmented-Reality Optical Imaging System for Accurate Breast Positioning During Radiotherapy

    SciTech Connect

    Nazareth, D; Malhotra, H; French, S; Hoffmann, K; Merrow, C

    2014-06-01

    Purpose: Breast radiotherapy, particularly electronic compensation, may involve large dose gradients and difficult patient positioning problems. We have developed a simple self-calibrating augmented-reality system, which assists in accurately and reproducibly positioning the patient, by displaying her live image from a single camera superimposed on the correct perspective projection of her 3D CT data. Our method requires only a standard digital camera capable of live-view mode, installed in the treatment suite at an approximately-known orientation and position (rotation R; translation T). Methods: A 10-sphere calibration jig was constructed and CT imaged to provide a 3D model. The (R,T) relating the camera to the CT coordinate system were determined by acquiring a photograph of the jig and optimizing an objective function, which compares the true image points to points calculated with a given candidate R and T geometry. Using this geometric information, 3D CT patient data, viewed from the camera's perspective, is plotted using a Matlab routine. This image data is superimposed onto the real-time patient image, acquired by the camera, and displayed using standard live-view software. This enables the therapists to view both the patient's current and desired positions, and guide the patient into assuming the correct position. The method was evaluated using an in-house developed bolus-like breast phantom, mounted on a supporting platform, which could be tilted at various angles to simulate treatment-like geometries. Results: Our system allowed breast phantom alignment, with an accuracy of about 0.5 cm and 1 ± 0.5 degree. Better resolution could be possible using a camera with higher-zoom capabilities. Conclusion: We have developed an augmented-reality system, which combines a perspective projection of a CT image with a patient's real-time optical image. This system has the potential to improve patient setup accuracy during breast radiotherapy, and could possibly be

  8. Randomized Controlled Trial of Forward-Planned Intensity Modulated Radiotherapy for Early Breast Cancer: Interim Results at 2 Years

    SciTech Connect

    Barnett, Gillian C.; Wilkinson, Jennifer S.; Moody, Anne M.; Wilson, Charles B.; Twyman, Nicola; Wishart, Gordon C.; Burnet, Neil G.; Coles, Charlotte E.

    2012-02-01

    Purpose: This single-center randomized trial was designed to investigate whether intensity-modulated radiotherapy (IMRT) reduces late toxicity in patients with early-stage breast cancer. Methods and Materials: The standard tangential plans of 1,145 nonselected patients were analyzed. The patients with inhomogeneous plans were randomized to a simple method of forward-planned IMRT or standard radiotherapy (RT). The primary endpoint was serial photographic assessment of breast shrinkage. Results: At 2 years, no significant difference was found in the development of any photographically assessed breast shrinkage between the patients randomized to the interventional or control group (odds ratio, 1.51; 95% confidence interval, 0.83-1.58; p = .41). The patients in the control group were more likely to develop telangiectasia than those in the IMRT group (odds ratio, 1.68; 95% confidence interval 1.13-2.40; p = .009). Poor baseline surgical cosmesis resulted in poor overall cosmesis at 2 years after RT. In patients who had good surgical cosmesis, those randomized to IMRT were less likely to deteriorate to a moderate or poor overall cosmesis than those in the control group (odds ratio, 0.63; 95% confidence interval, 0.39-1.03, p = .061). Conclusions: IMRT can lead to a significant reduction in telangiectasia at comparatively early follow-up of only 2 years after RT completion. An important component of breast induration and shrinkage will actually result from the surgery and not from the RT. Surgical cosmesis is an important determinant of overall cosmesis and could partially mask the longer term benefits of IMRT at this early stage.

  9. Late radiation toxicity after intraoperative radiotherapy (IORT) for breast cancer: results from the randomized phase III trial TARGIT A.

    PubMed

    Sperk, Elena; Welzel, Grit; Keller, Anke; Kraus-Tiefenbacher, Uta; Gerhardt, Axel; Sütterlin, Marc; Wenz, Frederik

    2012-08-01

    The randomized phase III trial TARGIT A showed non-inferiority regarding local control after intraoperative radiotherapy (IORT 20 Gy which was followed by whole breast radiotherapy (WBRT) in patients with risk factors only) in comparison to standard WBRT (50-56 Gy) after breast-conserving surgery in selected patients. This is the first analysis of long-term toxicities in the setting of TARGIT. Between 02/2002 and 12/2008, 305 patients were treated within TARGIT A (Arm A: n = 34 IORT, n = 20 IORT + WBRT for risk factors; Arm B WBRT: n = 55) or received IORT as a planned boost (control group: n = 196) at a single center. Toxicity was assessed according to the LENT SOMA scales. No significant differences were seen between Arm A and Arm B regarding fibrosis, breast edema, retraction, ulceration, lymphedema, hyperpigmentation, and pain. Arm A had significantly less telangiectases compared to Arm B (p = 0.049). In the subanalysis (Arm A IORT vs. Arm A IORT + WBRT vs. Arm B), fibrosis had a cumulative rate of 5.9 versus 37.5 versus 18.4 %, respectively (38.2 % IORT boost control group), at 3 years. No telangiectases were seen after IORT alone (0 % Arm A IORT vs. 17.5 % Arm A IORT + WBRT vs. 17.7 % Arm B). The hazard ratio of higher grade toxicity as first event was 0.46 (95 % CI, 0.26-0.83) for Arm A IORT as compared to Arm B (p = 0.010). No recurrences were seen after a median follow-up of 40 months (Arm A) and 42 months (Arm B). With its very low chronic skin toxicity rates and outstanding long-term results regarding toxicity and local control, IORT with 50 kV X-rays is a safe and effective method for treatment of selected breast cancer patients. PMID:22842984

  10. Outcomes of Node-Negative Breast Cancer 5 Centimeters and Larger Treated With and Without Postmastectomy Radiotherapy

    SciTech Connect

    Goulart, Jennifer; Truong, Pauline; Woods, Ryan; Speers, Caroline H.; Kennecke, Hagen; Nichol, Alan

    2011-07-01

    Purpose: The role of adjuvant postmastectomy radiotherapy (PMRT) remains controversial for the rare presentation of pT3pN0cM0 breast cancer. The present analysis examined locoregional recurrence (LRR) and breast cancer-specific survival (BCSS) in pT2 = 5.0-cm and pT3 >5.0-cm tumors treated with mastectomy, stratified by PMRT use. Materials and Methods: Between January 1, 1989 and December 31, 2000, the British Columbia provincial database yielded 100 node-negative patients with tumors {>=}5 cm of 19,846 nonmetastatic breast cancer patients (0.5%). Of these 100 patients, 44 (44%) had received adjuvant PMRT. Results: The PMRT group contained significantly more pT3 >5-cm cases (p = 0.001) and margin-positive cases (p = .03). With a median follow-up of 10 years, the cumulative 10-year LRR rate was 2.3% (95% confidence interval, 0.2-10.5) in the PMRT group vs. 8.9% (95% confidence interval, 3.2-18.2) in the no-PMRT group (p = .2). Regarding LRR in the no-PMRT group, all patients had Grade 3 histologic features (LRR 17%, 5 of 29) and had not received hormonal therapy (LRR 15%, 5 of 34). The 10-year breast cancer-specific survival rate was 85.8% (95% confidence interval 71.0-93.4) in the PMRT group vs. 74.6% (95% confidence interval 59.9-84.5) in the no-PMRT group (p = .2). On multivariate analysis, adjusted for the prognostic and predictive variables, PMRT did not significantly improve the LRR or breast cancer-specific survival rates. Conclusion: The present study demonstrated a low LRR rate for node-negative breast cancer {>=}5 cm. Our results indicate that PMRT should be considered for Grade 3 histologic features and patients not undergoing hormonal therapy.