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 2023 EHA Congress 2023 ASCO Annual Meeting
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 1/2013

Open Access 01-12-2013 | Research

Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities

Authors: Jinli Ma, Jiongyan Li, Jiang Xie, Jian Chen, Chuanying Zhu, Gang Cai, Zhen Zhang, Xiaomao Guo, Jiayi Chen

Published in: Radiation Oncology | Issue 1/2013

Login to get access

Abstract

Background

Conventional post-mastectomy radiation therapy is delivered with tangential fields for chest wall and separate fields for regional nodes. Although chest wall and regional nodes delineation has been discussed with RTOG contouring atlas, CT-based planning to treat chest wall and regional nodes as a whole target has not been widely accepted. We herein discuss the dosimetric characteristics of a linac IMRT technique for treating chest wall and regional nodes as a whole PTV after modified radical mastectomy, and observe acute toxicities following irradiation.

Methods

Patients indicated for PMRT were eligible. Chest wall and supra/infraclavicular region +/−internal mammary nodes were contoured as a whole PTV on planning CT. A simplified linac IMRT plan was designed using either integrated full beams or two segments of half beams split at caudal edge of clavicle head. DVHs were used to evaluate plans. The acute toxicities were followed up regularly.

Results

Totally, 85 patients were enrolled. Of these, 45 had left-sided lesions, and 35 received IMN irradiation. Planning designs yielded 55 integrated and 30 segmented plans, with median number of beams of 8 (6–12). The integrated and segmented plans had similar conformity (1.41±0.14 vs. 1.47±0.15, p=0.053) and homogeneity indexes (0.13±0.01 vs. 0.14±0.02, p=0.069). The percent volume of PTV receiving >110% prescription dose was <5%. As compared to segmented plans, integrated plans typically increased V5 of ipsilateral lung (p=0.005), and heart (p=0.001) in patients with left-sided lesions. Similarly, integrated plans had higher spinal cord Dmax (p=0.009), ipsilateral humeral head (p<0.001), and contralateral lung Dmean (p=0.019). During follow-up, 36 (42%) were identified to have ≥ grade 2 radiation dermatitis (RD). Of these, 35 developed moist desquamation. The median time to onset of moist desquamation was 6 (4–7) weeks from start of RT. The sites of moist desquamation were most frequently occurred in anterior axillary fold (32/35), and secondly chest wall (12/35). The difference in occurrence of ≥ grade 2 RD between integrated and segmented plans was statistically insignificant (X2=0.35, p=0.55). Only 2 were found to have grade 2 radiation pneumonitis.

Conclusions

The linac IMRT technique applied in PMRT with chest wall and regional nodes as a whole PTV was dosimetrically feasible, and the treatment was proved to be well-tolerated by most patients.
Appendix
Available only for authorised users
Literature
1.
Yu KD, Di GH, Wu J, Lu JS, Shen KW, Shen ZZ, Shao ZM: Development and trends of surgical modalities for breast cancer in China: a review of 16-year data. Ann Surg Oncol 2007,14(9):2502-2509. 10.1245/s10434-007-9436-2CrossRefPubMed
2.
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer M, Gadeberg CC, Mouridsen HT, Jensen MB: Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 1997,337(14):949-955. 10.1056/NEJM199710023371401CrossRefPubMed
3.
Recht A, Gray R, Davidson NE, Fowble BL, Solin LJ, Cummings FJ, Falkson G, Falkson HC, Taylor SG, Tormey DC: Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol 1999,17(6):1689-1700.PubMed
4.
Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, Knowling MA, Coppin CM, Weir L, Gelmon K: Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst 2005,97(2):116-126. 10.1093/jnci/djh297CrossRefPubMed
5.
Rudat V, Alaradi AA, Mohamed A, Ai-Yahya K, Altuwaijri S: Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: a dosimetric comparison. Radiat Oncol 2011, 6: 26. 10.1186/1748-717X-6-26CrossRefPubMedPubMedCentral
6.
Fontanilla HP, Woodward WA, Lindberg ME, Kanke JE, Arora G, Durbin RR, Yu T-K, Zhang L, Sharp HJ, Strom EA: Current clinical coverage of Radiation Therapy Oncology Group-defined target volumes for postmastectomy radiation therapy. Practical Radiation Oncology 2012,2(3):201-209. 10.1016/j.prro.2011.10.001CrossRefPubMed
7.
Dijkema IM, Hofman P, Raaijmakers CP, Lagendijk JJ, Battermann JJ, Hillen B: Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position. Radiother Oncol 2004,71(3):287-295. 10.1016/j.radonc.2004.02.017CrossRefPubMed
8.
Cho BC, Schwarz M, Mijnheer BJ, Bartelink H: Simplified intensity-modulated radiotherapy using pre-defined segments to reduce cardiac complications in left-sided breast cancer. Radiother Oncol 2004,70(3):231-241. 10.1016/j.radonc.2003.11.016CrossRefPubMed
9.
ICRU: Prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT): contents. J ICRU 2010,10(1):NP.
10.
Nicolini G, Clivio A, Fogliata A, Vanetti E, Cozzi L: Simultaneous integrated boost radiotherapy for bilateral breast: a treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapy. Radiat Oncol 2009, 4: 27. 10.1186/1748-717X-4-27CrossRefPubMedPubMedCentral
11.
Klein EE, Taylor M, Michaletz-Lorenz M, Zoeller D, Umfleet W: A mono isocentric technique for breast and regional nodal therapy using dual asymmetric jaws. Int J Radiat Oncol Biol Phys 1994,28(3):753-760. 10.1016/0360-3016(94)90204-6CrossRefPubMed
12.
Hernandez V, Arenas M, Pons F, Sempau J: Clinical applications of geometrical field matching in radiotherapy based on a new analytical solution. Med Dosim 2011,36(2):160-165. 10.1016/j.meddos.2010.02.008CrossRefPubMed
13.
Bentel GC, Marks LB, Hardenbergh PH, Prosnitz LR: Variability of the depth of supraclavicular and axillary lymph nodes in patients with breast cancer: is a posterior axillary boost field necessary? Int J Radiat Oncol Biol Phys 2000,47(3):755-758. 10.1016/S0360-3016(00)00485-5CrossRefPubMed
14.
Liengsawangwong R, Yu TK, Sun TL, Erasmus JJ, Perkins GH, Tereffe W, Oh JL, Woodward WA, Strom EA, Salephour M: Treatment optimization using computed tomography-delineated targets should be used for supraclavicular irradiation for breast cancer. Int J Radiat Oncol Biol Phys 2007,69(3):711-715. 10.1016/j.ijrobp.2007.05.075CrossRefPubMedPubMedCentral
15.
Krueger EA, Fraass BA, McShan DL, Marsh R, Pierce LJ: Potential gains for irradiation of chest wall and regional nodes with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2003,56(4):1023-1037. 10.1016/S0360-3016(03)00183-4CrossRefPubMed
16.
Jagsi R, Moran J, Marsh R, Masi K, Griffith KA, Pierce LJ: Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys 2010,78(5):1594-1603. 10.1016/j.ijrobp.2010.04.072CrossRefPubMedPubMedCentral
17.
Cavey ML, Bayouth JE, Endres EJ, Pena JM, Colman M, Hatch S: Dosimetric comparison of conventional and forward-planned intensity-modulated techniques for comprehensive locoregional irradiation of post-mastectomy left breast cancers. Med Dosim 2005,30(2):107-116. 10.1016/j.meddos.2005.02.002CrossRefPubMed
18.
Jones R, Yang W, Read P, Sheng K: Radiation therapy of post-mastectomy patients with positive nodes using fixed beam tomotherapy. Radiother Oncol 2011,100(2):247-252. 10.1016/j.radonc.2011.05.004CrossRefPubMed
19.
Koshy M, Zhang B, Naqvi S, Liu B, Mohiuddin MM: A novel technique for post-mastectomy breast irradiation utilising non-coplanar intensity-modulated radiation therapy. Br J Radiol 2010,83(994):874-881. 10.1259/bjr/59469015CrossRefPubMedPubMedCentral
20.
van der Laan HP, Korevaar EW, Dolsma WV, Maduro JH, Langendijk JA: Minimising contralateral breast dose in post-mastectomy intensity-modulated radiotherapy by incorporating conformal electron irradiation. Radiother Oncol 2010,94(2):235-240. 10.1016/j.radonc.2009.12.015CrossRefPubMed
21.
Bostrom A, Lindman H, Swartling C, Berne B, Bergh J: Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: results from a double-blind, randomized study. Radiother Oncol 2001,59(3):257-265. 10.1016/S0167-8140(01)00327-9CrossRefPubMed
22.
Fisher J, Scott C, Stevens R, Marconi B, Champion L, Freedman GM, Asrari F, Pilepich MV, Gagnon JD, Wong G: Randomized phase III study comparing Best Supportive Care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97–13. Int J Radiat Oncol Biol Phys 2000,48(5):1307-1310. 10.1016/S0360-3016(00)00782-3CrossRefPubMed
23.
Matzinger O, Heimsoth I, Poortmans P, Collette L, Struikmans H, Van Den Bogaert W, Fourquet A, Bartelink H, Ataman F, Gulyban A: Toxicity at three years with and without irradiation of the internal mammary and medial supraclavicular lymph node chain in stage I to III breast cancer (EORTC trial 22922/10925). Acta Oncol 2010,49(1):24-34. 10.3109/02841860903352959CrossRefPubMed
24.
Wennberg B, Gagliardi G, Sundbom L, Svane G, Lind P: Early response of lung in breast cancer irradiation: radiologic density changes measured by CT and symptomatic radiation pneumonitis. Int J Radiat Oncol Biol Phys 2002,52(5):1196-1206. 10.1016/S0360-3016(01)02770-5CrossRefPubMed
25.
Kahan Z, Csenki M, Varga Z, Szil E, Cserhati A, Balogh A, Gyulai Z, Mandi Y, Boda K, Thurzo L: The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys 2007,68(3):673-681. 10.1016/j.ijrobp.2006.12.016CrossRefPubMed
26.
Zellars R: Post-mastectomy radiotherapy. Clin Adv Hematol Oncol 2009,7(8):533-543.PubMed
Metadata
Title
Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities
Authors
Jinli Ma
Jiongyan Li
Jiang Xie
Jian Chen
Chuanying Zhu
Gang Cai
Zhen Zhang
Xiaomao Guo
Jiayi Chen
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2013
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-8-81

Other articles of this Issue 1/2013

Radiation Oncology 1/2013 Go to the issue

Methodology

The advantage of 3D conformal treatment of lumbar spine metastases in comparison to traditional PA or AP-PA techniques: restoring an intermediate niche of therapeutic sophistication

Research

Impact of treatment planning target volumen (PTV) size on radiation induced diarrhoea following selenium supplementation in gynecologic radiation oncology - a subgroup analysis of a multicenter, phase III trial

Research

Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for stage I-II natural killer/T-cell lymphoma nasal type: dosimetric and clinical results

Research

Neural stem cell sparing by linac based intensity modulated stereotactic radiotherapy in intracranial tumors

Research

A study of 131iodine-labeling of histamine-indomethacin: its in vivo therapeutic effect and anti-tumor mechanisms in Lewis-bearing lung cancer

Research

Clinical implications in the use of the PBC algorithm versus the AAA by comparison of different NTCP models/parameters