Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2012

Open Access 01-12-2012 | Research

Does TomoDirect 3DCRT represent a suitable option for post-operative whole breast irradiation? A hypothesis-generating pilot study

Authors: Valeria Casanova Borca, Pierfrancesco Franco, Paola Catuzzo, Fernanda Migliaccio, Flora Zenone, Stefania Aimonetto, Andrea Peruzzo, Massimo Pasquino, Giuliana Russo, Maria Rosa La Porta, Domenico Cante, Piera Sciacero, Giuseppe Girelli, Umberto Ricardi, Santi Tofani

Published in: Radiation Oncology | Issue 1/2012

Login to get access

Abstract

Background

This study investigates the use of TomoDirectTM 3DCRT for whole breast adjuvant radiotherapy (AWBRT) that represents a very attractive treatment opportunity, mainly for radiotherapy departments without conventional Linacs and only equipped with helical tomotherapy units.

Methods

Plans were created for 17 breast cancer patients using TomoDirect in 3DCRT and IMRT modality and field-in-field 3DCRT planning (FIF) and compared in terms of PTV coverage, overdosage, homogeneity, conformality and dose to OARs. The possibility to define patient-class solutions for TD-3DCRT employment was investigated, correlating OARs dose constraints to patient specific anatomic parameters.

Results

TD-3DCRT showed PTV coverage and homogeneity significantly higher than TD-IMRT and FIF. PTV conformality was significantly better for FIF, while no differences were found between TD-3DCRT and TD-IMRT. TD-3DCRT showed mean values of the OARs dosimetric endpoints significantly higher than TD-IMRT; with respect to FIF, TD-3DCRT showed values significantly higher for lung V20Gy, mean heart dose and V25Gy, while contralateral lung maximum dose and contralateral breast mean dose resulted significantly lower. The Central Lung Distance (CLD) and the maximal Heart Distance (HD) resulted as useful clinical tools to predict the opportunity to employ TD-3DCRT: positive correlations were found between CLD and both V20Gy and mean lung dose and between HD and both V25Gy and the mean heart dose. TD-3DCRT showed a significantly shorter mean beam-on time than TD-IMRT.

Conclusions

The present study showed that TD-3DCRT and TD-IMRT are two feasible and dosimetrically acceptable treatment approach for AWBRT, with an optimal PTV coverage and adequate OARs sparing. Some concerns might be raised in terms of dose to organs at risks if TD-3DCRT is applied to a general population. A correct patients clusterization according to simple quantitative anatomic measures, would help to correctly allocate patients to the appropriate treatment planning strategy in terms of target coverage, but also of normal tissue sparing.
Appendix
Available only for authorised users
Literature
1.
Veronesi U, Cascinelli N, Mariani I, et al.: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Eng J Med 2002, 347: 1227-1232. 10.1056/NEJMoa020989CrossRef
2.
Kestin LL, Sharpe MB, Frazier RC, et al.: Intensity modulation to improve dose uniformity with tangential breast radiotherapy: initial clinical experience. Int J Radiat Oncol Biol Phys 2000, 5: 1559-1568.CrossRef
3.
Coon AB, Dickler A, Kirk MC, et al.: TomoTherapy and multifield intensity-modulated radiotherapy planning reduce cardiac doses in left-sided breast cancer patients with unfavorable cardiac anatomy. Int J Radiat Oncol Biol Phys 2010, 78: 104-110. 10.1016/j.ijrobp.2009.07.1705CrossRefPubMed
4.
Franco P, Catuzzo P, Cante D, La Porta MR, Sciacero P, Girelli G, Casanova Borca V, Pasquino M, Numico G, Tofani S, Meloni T, Ricardi U, Ozzello F: TomoDirect: an efficient means to deliver radiation at static angles with tomotherapy. Tumori 2011,97(4):498-502.PubMed
5.
Reynders T, Tournel K, De Coninck P, et al.: Dosimetric assessment of static and helical TomoTherapy in the clinical implementation of breast cancer treatments. Radiother Oncol 2009, 93: 71-79. 10.1016/j.radonc.2009.07.005CrossRefPubMed
6.
Schubert LK, Gondi V, Sengbusch E, et al.: Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother Oncol 2011, 100: 241-246. 10.1016/j.radonc.2011.01.004CrossRefPubMed
7.
Mackie TR, Olivera GH, Kapatoes JM, Ruchala KJ, Balog JP, Tome WA, Hui S, Kissick M, Wu C, Jeraj R, Rockwerdt PJ, Harari P, Ritter M, Forrest L, Welsh JS, Metha MP: Helical tomotherapy. In Intensity-modulates radiation therapy. The State of the Art, AAPM summer school proceedings. Edited by: Palta J, Mackie TR. Madison: Medical Physics; 2003:247-284.
8.
Ahnesjo A: Collapsed cone convolution of radiant energy for photon dose calculation in heterogeneous media. Med Phys 1989, 16: 577-592. 10.1118/1.596360CrossRefPubMed
9.
van’t Riet A, Mak AC, Moerland MA, et al.: A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: Application to the prostate. Int J Radiat Oncol Biol Phys 1997, 37: 731-736. 10.1016/S0360-3016(96)00601-3CrossRefPubMed
10.
Oliver M, Chen J, Wong E, et al.: A treatment planning study comparing whole breast radiation therapy against conformal, IMRT and tomotherapy for accelerated partial breast irradiation. Radiother Oncol 2007, 82: 317-323. 10.1016/j.radonc.2006.11.021CrossRefPubMed
11.
Kong F-M, Klein EE, Bradley JD, et al.: The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast radiation. Int J Radiat Oncol Biol Phys 2002, 54: 963-971. 10.1016/S0360-3016(02)03741-0CrossRefPubMed
12.
Marks LB, Bentzen SM, Deasy J, et al.: Radiation dose–volume effects in the lung. Int J Radiat Oncol Biol Phys 2010, 76: S70-S76. 10.1016/j.ijrobp.2009.06.091PubMedCentralCrossRefPubMed
13.
Seppenwolde Y, Lebesque JV, de Jaeger K, et al.: Comparing different NCTP models that predict the incidence of radiation pneomonitis. Int J Radiat Oncol Biol Phys 2003, 55: 724-735. 10.1016/S0360-3016(02)03986-XCrossRef
14.
Tsujino K, Hirota S, Endo M, et al.: Predictive value of dose-volume histogram parameters for predicting radiation pneumonitis after concurrent chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys 2003, 55: 110-115. 10.1016/S0360-3016(02)03807-5CrossRefPubMed
15.
Kwa SL, Lebesque JV, Theuws JC, et al.: Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 1998, 42: 1-9.CrossRefPubMed
16.
Hernando ML, Marks LB, Bentel GC, et al.: Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys 2001, 51: 650-659. 10.1016/S0360-3016(01)01685-6CrossRefPubMed
17.
Das IJ, Cheng EC, Freedman G, Fowble B: Lung and heart dose-volume analyses with CT simulator in radiation treatment of breast cancer. Int J Radiat Oncol Biol Phys 1998, 42: 11-19.CrossRefPubMed
18.
Lichter AS, Fraass BA, Yanke B: Treatment techniques in the conservative management of breast cancer. Semin Radiat Oncol 1992, 2: 94-106. 10.1016/1053-4296(92)90013-BCrossRefPubMed
19.
Gagliardi G, Lax I, Ottolenghi A, Rutqvist LE: Long term cardiac mortality after radiotherapy of breast cancer – application of the relative seriality model. Brit J Radiol 1996, 69: 839-846. 10.1259/0007-1285-69-825-839CrossRefPubMed
20.
Carr ZA, Land CE, Kleinerman RA, et al.: Coronary heart disease after radiotherapy for peptic ulcer disease. Int J Radiat Oncol Biol Phys 2005, 61: 842-850. 10.1016/j.ijrobp.2004.07.708CrossRefPubMed
21.
Preston DL, Shimizu Y, Pierce DA, Suyama A, Mabuchi K: Studies of mortality of atomic bomb survivors. Report 13: solid cancer and noncancer disease mortality: 1950–1997. Radiat Res 2003, 160: 381-407. 10.1667/RR3049CrossRefPubMed
22.
Hurkmans CW, Borger JH, Bos LJ, et al.: Reduction of cardiac and lung complication probabilities after breast cancer irradiation. Radiother Oncol 2002, 62: 163-171. 10.1016/S0167-8140(01)00473-XCrossRefPubMed
23.
Pignol JP, Olivotto I, Racovitch E, et al.: A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008, 26: 2085-2092. 10.1200/JCO.2007.15.2488CrossRefPubMed
24.
Boice JD jr, Harvey EB, Blettner M, Stovall M, Flannery JT: Cancer in the contralateral breast after radiotherapy for breast cancer. New Engl J Med 1992, 326: 1243-1251.CrossRef
Metadata
Title
Does TomoDirect 3DCRT represent a suitable option for post-operative whole breast irradiation? A hypothesis-generating pilot study
Authors
Valeria Casanova Borca
Pierfrancesco Franco
Paola Catuzzo
Fernanda Migliaccio
Flora Zenone
Stefania Aimonetto
Andrea Peruzzo
Massimo Pasquino
Giuliana Russo
Maria Rosa La Porta
Domenico Cante
Piera Sciacero
Giuseppe Girelli
Umberto Ricardi
Santi Tofani
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-7-211

Other articles of this Issue 1/2012

Radiation Oncology 1/2012 Go to the issue

Research

A simple quality assurance test tool for the visual verification of light and radiation field congruent using electronic portal images device and computed radiography

Research

Influence of secondary neutrons induced by proton radiotherapy for cancer patients with implantable cardioverter defibrillators

Research

Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer

Research

Physician self-reported treatment of brain metastases according to patients’ clinical and demographic factors and physician practice setting

Research

The combination of olaparib and camptothecin for effective radiosensitization

Short report

Investigation of the change in marker geometry during respiration motion: a preliminary study for dynamic-multi-leaf real-time tumor tracking