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Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 10/2012

01-10-2012 | Research Article

Intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in a patient with left breast cancer and pectus excavatum

Authors: Ricardo Cendales, Jaider Vasquez, Juan Carlos Arbelaez, Ivan Bobadilla, Ricardo Espanol, Felipe Torres, Armando Gaitan

Published in: Clinical and Translational Oncology | Issue 10/2012

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Abstract

Introduction

Pectus excavatum is a frequent anomaly. It represents a challenge for adjuvant radiotherapy in the conservative treatment of breast cancer. Primary objective of this study is to compare dosimetric outcomes, normal tissue complication probability (NTCP), and integral dose using four radiation techniques. Secondary objective is to describe acute toxicity and setup errors.

Methods and materials

A 57-year-old female patient with an inner quadrant, left breast, ductal carcinoma in situ, was identified. Whole breast was prescribed with 50 Gy in 25 fractions. Boost planning target volume (PTV) was prescribed with 60 Gy in 30 fractions for sequential boost (SB) plans or 57.5 Gy in 25 fractions in the simultaneous integrated boost (SIB) plan. All plans were normalized to deliver 47.5 Gy to 95 % of the breast PTV. Daily image-guided radiotherapy (IGRT) was performed. Setup deviations were described.

Results

Constraints were not accomplished for heart when using intensity modulated radiotherapy (IMRT) + SB or conformal radiotherapy with three photon fields and SB. Left lung constraint was not achieved by any of the techniques in comparison. IMRT + SIB and conformal photons and electrons + SB plan were closer to the objective. Integral doses were lower with IMRT for heart and ipsilateral lung; however, it were higher for contralateral breast and lung. Coverage and tumoral conformity indexes were similar for all techniques in comparison. Greater inhomogeneity was observed with the photons and electrons + SB. IMRT + SIB treatment was administered daily with grade I skin toxicity. The highest setup error was observed in Y direction.

Conclusion

Planning target volume coverage was similar with the four techniques. Homogeneity was superior with both IMRT plans. A good balance between dose constraints for organs at risk, PTV coverage, homogeneity, and NTCP was observed with IMRT + SIB. The documented daily setup error justifies the use of online IGRT.
Literature
1.
Hortobagyi GN, de la Garza Salazar J, Pritchard K, Amadori D, Haidinger R, Hudis CA, Khaled H, Liu MC, Martin M, Namer M, O’Shaughnessy JA, Shen ZZ, Albain KS; ABREAST Investigators (2005) The global breast cancer burden: variations in epidemiology and survival. Clin Breast Cancer 6(5):391–401
2.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM (2010) GLOBOCAN 2008, cancer incidence and mortality worldwide: IARC CancerBase No. 10.International Agency for Research on Cancer, Lyon
3.
Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y, Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366(9503):2087–2106
4.
Giordano SH, Kuo YF, Freeman JL et al (2005) Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 97(6):419–424PubMedCrossRef
5.
Roychoudhuri R, Robinson D, Putcha V et al (2007) Increased cardiovascular mortality more than fifteen years after radiotherapy for breast cancer: a population-based study. BMC Cancer 15(7):9CrossRef
6.
O’Donnell H, Cooke K, Walsh N, Plowman PN (2009) Early experience of tomotherapy-based intensity-modulated radiotherapy for breast cancer treatment. Clin Oncol (R Coll Radiol) 21(4):294–301 (Epub 2009 Feb 26)
7.
Cendales R, Schiappacasse L, Schnitman F, García G, Marsiglia H (2011) Helical tomotherapy in patients with breast cancer and complex treatment volumes. Clin Transl Oncol 13(4):268–274
8.
Jaroszewski D, Notrica D, McMahon L, Steidley DE, Deschamps C (2010) Current Management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med 23(2):230–239
9.
Radiation Therapy Oncology Group (RTOG) (2005) NSABP Protocol B-39, RTOG Protocol 0413: a randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with Stage 0, I, or II breast cancer.RTOG, Philadelphia (PA). http://​www.​rtog.​org/​members/​protocols/​0413/​0413.​pdf. Accessed on 20 April 2010
10.
Penninkhof J, Quint S, Boer H, Mens JW, Heijmen B, Dirkx M (2009) Surgical clips for position verification and correction of non-rigid breast tissue in simultaneously integrated boost (SIB) treatments. Radiother Oncol 90(1):110–115PubMedCrossRef
11.
Kantor G, Mahé MA, Giraud P et al (2006) Helical tomotherapy: general methodology for clinical and dosimetric evaluation (national French project). Cancer Radiother 10(6–7):488–491PubMedCrossRef
12.
Sanchez-Nieto B, Nahum AE (2000) BIOPLAN: software for the biological evaluation of radiotherapy treatment plans. Med Dosim 25(2):71–76
13.
Kutcher GJ, Burman C (1989) Calculation of complication probability factors for non-uniform normal tissue irradiation: the effective volume method. Int J Radiat Oncol Biol Phys 16(6):1623–1630PubMedCrossRef
14.
Källman P, Agren A, Brahme A (1992) Tumour and normal tissue responses to fractionated non-uniform dose delivery. Int J Radiat Biol 62(2):249–262PubMedCrossRef
15.
Aoyama H, Westerly DC, Mackie TR, Olivera GH, Bentzen SM, Patel RR, Jaradat H, Tome WA, Ritter MA, Mehta MP (2006) Integral radiation dose to normal structures with conformal external beam radiation. Int J Radiat Oncol Biol Phys 64(3):962–967PubMedCrossRef
16.
Yang R, Xu S, Jiang W, Xie C, Wang J (2009) Integral dose in three-dimensional conformal radiotherapy, intensity-modulated radiotherapy and helical tomotherapy. Clin Oncol (R Coll Radiol) 21(9):706–712CrossRef
17.
van Dijk H, Höppener PF, Siebenga J, Kragten HA (2011) Medical photography: a reliable and objective method for documenting the results of reconstructive surgery of pectus excavatum. J Vis Commun Med 34(1):14–21PubMedCrossRef
18.
Haller JA Jr, Kramer SS, Lietman SA (1987) Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg 22(10):904–906PubMedCrossRef
19.
Teh BS, Lu HH, Sobremonte S, Bellezza D, Chiu JK, Carpenter LS, Dennis WS, Woo SY, Butler EB (2001) The potential use of intensity modulated radiotherapy (IMRT) in women with pectus excavatum desiring breast-conserving therapy. Breast J 7(4):233–239
20.
O’Donnell H, Cooke K, Walsh N, Plowman PN (2009) Early experience of tomotherapy-based intensity-modulated radiotherapy for breast cancer treatment. Clin Oncol (R Coll Radiol) 21(4):294–301CrossRef
21.
McCormick B, Hunt M (2011) Intensity-modulated radiation therapy for breast: is it for everyone? Semin Radiat Oncol 21(1):51–54
22.
Hall EJ, Wuu CS (2003) Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 56(1):83–88PubMedCrossRef
23.
Barnett GC, Wilkinson JS, Moody AM, Wilson CB, Twyman N, Wishart GC, Burnet NG, Coles CE (2012) Randomized controlled trial of forward-planned intensity-modulated radiotherapy for early breast cancer: interim results at 2 years. Int J Radiat Oncol Biol Phys 82:715–723
24.
Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, Peckitt C, Reise S, Ross G, Sharp G, Symonds-Tayler R, Tait D, Yarnold J; Breast Technology Group (2007) Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 82(3):254–264
25.
Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, Vu TT, Truong P, Ackerman I, Paszat L (2008) A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 26(13):2085–2092PubMedCrossRef
26.
Murthy KK, Al-Rahbi Z, Sivakumar SS, Davis CA, Ravichandran R, El Ghamrawy K (2008) Verification of setup errors in external beam radiation therapy using electronic portal imaging. J Med Phys 33(2):49–53PubMedCrossRef
27.
Hurkmans CW, Remeijer P, Lebesque JV, Mijnheer BJ (2001) Set-up verification using portal imaging; review of current clinical practice. Radiother Oncol 58(2):105–120PubMedCrossRef
28.
Korreman S, Rasch C, McNair H, Verellen D, Oelfke U, Maingon P, Mijnheer B, Khoo V (2010) The European society of therapeutic radiology and oncology-European institute of radiotherapy (ESTRO-EIR) report on 3D CT-based in-room image guidance systems: a practical and technical review and guide. Radiother Oncol 94(2):129–144PubMedCrossRef
29.
Potters L, Gaspar LE, Kavanagh B, Galvin JM, Hartford AC, Hevezi JM, Kupelian PA, Mohiden N, Samuels MA, Timmerman R, Tripuraneni P, Vlachaki MT, Xing L (2010) American Society for Therapeutic Radiology and Oncology; American College of Radiology. American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guidelines for image-guided radiation therapy (IGRT). Int J Radiat Oncol Biol Phys 76(2):319–325PubMedCrossRef
Metadata
Title
Intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in a patient with left breast cancer and pectus excavatum
Authors
Ricardo Cendales
Jaider Vasquez
Juan Carlos Arbelaez
Ivan Bobadilla
Ricardo Espanol
Felipe Torres
Armando Gaitan
Publication date
01-10-2012
Publisher
Springer Milan
Published in
Clinical and Translational Oncology / Issue 10/2012
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-012-0862-7

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