Axillary nodal irradiation practice in the sentinel lymph node biopsy era: Comparison of the contemporary available 3D and IMRT techniques.

Axillary nodal irradiation practice in the sentinel lymph node biopsy era: Comparison of the contemporary available 3D and IMRT techniques. Br J Radiol. 2020 Apr 01;:20190351 Authors: Belkacemi Y, Loganadane G, Ghith S, Li X, Majdoul S, Grellier N, Jmour O, Bret CL, Hervé ML, Hadhri A, To NH, Fayolle-Campana M, Colson-Durand L Abstract OBJECTIVE: Our study aimed to compare regional node coverage and doses to the organ at risk (OAR) using conventional technique (CT) vs "AMAROS" (AT) vs intensity-modulated radiation therapy (IMRT) techniques in patients receiving regional nodal irradiation (RNI) for breast cancer (BC). METHODS: We included 30 consecutive patients with BC who received RNI including axillary nodes. Two independent and blinded dosimetric RNI plans were generated for all patients. For target volume coverage, we analyzed the V95%, the D95%, the mean and the minimal dose within the nodal station. For hotspots within nodal target volume, we used the V105%, the V108% and the maximal doses. For OAR, lung V20, mean lung and heart doses, the maximal dose to the brachial plexus and the axillary-lateral thoracic vessel junction region were compared between the three techniques. RESULTS: Target volume coverage and hotspots: Mean V95% in stations I, II, III and IV were 35.8% and 75% respectively with CV, 22.59 and 59.9% respectively with AT technique and 45.58 and 99.6% respectively with IMRT with statistically significant diff...
Source: The British Journal of Radiology - Category: Radiology Authors: Tags: Br J Radiol Source Type: research

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The use of a specific treatment technique in radiation therapy is mainly motivated by the achievable dose conformity to the target and the overall integral dose. Proton therapy offers a highly conformal and comprehensive treatment option with a lower integral dose (reduced low-dose bath) to organs at risk (OARs). Consequently, given the proximity of cardiopulmonary structures, proton therapy has been discussed as a treatment alternative for breast cancer patients [1 –3]. Treatment planning studies, comparing 3DCRT, IMRT, and proton therapy when irradiating the breast and regional nodes showed advantages of using prot...
Source: Radiotherapy and Oncology - Category: Radiology Authors: Tags: Original Article Source Type: research
Objective: To study the dosimetric effect on special reconstruction images obtained from an electrocardiograph-gated four-dimensional computed tomography (ECG 4D-CT) series and compare it with the accumulation dose assessment of ECG 4D-CT.Methods: Fifteen patients underwent ECG 4D-CT scans to obtain a 4D-CT series. The 20 phase images of 0–95% were reconstructed at intervals of 5% of the cardiac cycle by the 4D-CT series. The 4D-CT series was specially reconstructed, and the maximum intensity projection (MIP), minimum intensity projection (MinIP), average intensity projection (AIP), and sum intensity projection (SIP)...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
Abstract OBJECTIVES: To analyze the effect of intra fractional and inter fractional motion during breast intensity modulated radiation therapy (IMRT) by calculating dose distribution based on four-dimensional computed tomography (4D-CT). METHODS: Twenty patients diagnosed with left breast cancer were enrolled. Three-dimensional (3D)-CT along with ten phases of 4D-CT were collected for each patient, with target volumes independently delineated on both 3D-CT and all phases of 4D-CT. IMRT plans were generated based on 3D-CT (43.2 Gy in 16 fractions). The plan parameters for each segment were split into ph...
Source: The British Journal of Radiology - Category: Radiology Authors: Tags: Br J Radiol Source Type: research
Adjuvant radiation therapy decreases breast cancer mortality.1 Recent rotational techniques, such as volumetric modulated arc therapy (VMAT) and helical tomotherapy, additionally spare the heart.2,3 Hypofractionated breast rotational intensity modulated radiation therapy (IMRT) was well tolerated in prospective trials,4-6 but follow-up is insufficient and late cardiotoxicity remains unclear. With this in mind, we compared corrected mean doses to cardiac substructure between hypo- and normofractionated breast rotational IMRT.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Brief Report Source Type: research
ConclusionsThe review of the benchmark and rapid review QA submissions indicates that acceptable variations or unacceptable deviations for the ipsilateral lung and heart dose constraints were the most commonly observed cause of benchmark QA failure, and unacceptable deviations in target contouring, rather than normal structure contouring, were the most common cause of rapid review QA failure. These findings suggest that a rigorous QA process is necessary for high quality and homogeneity in radiation therapy in multi-institutional trials of breast cancer to ensure that the benefits of radiation therapy far outweigh the risks.
Source: Practical Radiation Oncology - Category: Cancer & Oncology Source Type: research
Conclusions: IMPT plans improve both the target coverage and the OARs sparing, especially for the heart, cardiac substructures (LAD and LV), lungs and normal tissue, in synchronous bilateral breast radiotherapy. VMAT and HT could be selected as suboptimal techniques for SBBC patients.
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
ConclusionUsing robust optimization for skin flash in breast intensity modulated radiation therapy planning is feasible. Further investigation is warranted to confirm the clinical effectiveness of this novel approach.
Source: Practical Radiation Oncology - Category: Cancer & Oncology Source Type: research
AbstractObjectiveThe aim of this study was to assess the feasibility of flattening filter-free (FFF) photon beams in hybrid intensity-modulated radiation therapy (H-IMRT) and hybrid volumetric modulated arc therapy (H-VMAT) for left-sided whole-breast radiation therapy with a  boost volume (RT) using a hypofractionated dose regimen.Patients and methodsRT plans of 25  patients with left-sided early-stage breast cancer were created with H‑IMRT and H‑VMAT techniques under breath-hold conditions using 6‑MV FFF beams. In hybrid techniques, three-dimensional conformal radiotherapy (3DCRT) plans were kept as ...
Source: Strahlentherapie und Onkologie - Category: Cancer & Oncology Source Type: research
Introduction. Adjuvant breast radiation therapy is standard of care after breast conserving surgery in early breast cancer, improving disease free survival and overall survival (OS)1. Benefit of lymph node irradiation [internal mammary chain (IMC) and supra and infra clavicular nodes (SN)] in patients with axillary lymph node involvement or at high risk of relapse has been shown by a meta-analysis of three randomised trials 2. In recent years, intensity modulated radiation therapy (IMRT) has been developed to lessen organs at risk (OAR) exposure to high doses.
Source: Physica Medica: European Journal of Medical Physics - Category: General Medicine Authors: Source Type: research
ConclusionWhen using the Eclipse TPS for breast cancer, AXB should be used instead of the AAA algorithm, bearing in mind that the AXB may still overestimate all OARs doses.
Source: Journal of Radiation Oncology - Category: Cancer & Oncology Source Type: research
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