Abstract
Locally advanced breast cancer patients with expander or implant reconstructions who
require comprehensive postmastectomy radiotherapy (PMRT) can pose unique treatment
planning challenges. Traditional 3D conformal radiation techniques often result in
large dose inhomogeneity throughout the treatment volumes, inadequate target coverage,
or excessive normal tissue doses. We have developed a volumetric modulated arc therapy
(VMAT) planning technique without entering through the ipsilateral arm that produced
adequate target volume coverage, excellent homogeneity throughout the target volume,
and acceptable doses to the normal structures. Twenty left-sided and 10 right-sided
patients with either ipsilateral or bilateral permanent implants or tissue expanders
who received comprehensive PMRT between October 2014 and February 2016 were included
in this study. Ten left-sided cases used deep inspiration breath hold (DIBH) technique,
and others used free breathing (FB). Planning target volume (PTV) included chestwall,
internal mammary nodes (IMNs), supraclavicular, and axillary lymph nodes. A VMAT plan
using 4 or 5 partial arcs with 6 MV photon beam avoiding entering through the ipsilateral
arm was generated for each patient. Prescription dose was 50 Gy in 25 fractions. PTV
coverage, maximum depth of IMNs, dose homogeneity and dose to the heart, lungs, thyroid,
contralateral intact breast or implant, liver, stomach, left anterior descending artery,
ipsilateral brachial plexus, esophagus, spinal cord, and total MU were evaluated.
PTV D95% (Gy) was 49.6 ± 0.9, 48.7 ± 0.9, and 49.5 ± 1.1; PTV D05% (Gy) was 55.7 ± 0.6,
55.1 ± 1.4, and 55.0 ± 0.7; maximum depth of IMNs (cm) was 4.3 ± 0.9, 4.6 ± 1.1, and
4.9 ± 2.3; ipsilateral lung, V20Gy (%) was 29.0 ± 2.1, 28.8 ± 2.5, and 27.5 ± 3.4;
heart mean dose (Gy) was 4.2 ± 0.4, 7.5 ± 1.1, and 6.6 ± 0.8 for right-sided FB, left-sided
FB, and left-sided DIBH cases, respectively. D95% of IMNs all received 100% prescription
dose. The maximum dose (Gy) to the left anterior descending artery was 33.8 ± 11.7
for left-sided FB and 31.4 ± 7.3 for left-sided DIBH. VMAT technique avoiding ipsilateral
arm can produce acceptable clinical plans for locally advanced breast cancer patients
with expander or implant reconstructions receiving comprehensive PMRT.
Keywords
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References
- Internal mammary node coverage: An investigation of presently accepted techniques.Int. J. Radiat. Oncol. Biol. Phys. 2000; 48: 139-462
- Postmastectomy radiotherapy of the chest wall: Dosimetric comparison of common techniques.Int. J. Radiat. Oncol. Biol. Phys. 2002; 52: 1220-1303
- Cardiac chamber and coronary artery dose associated with postmastectomy radiotherapy techniques to the chest wall and regional nodes.Int. J. Radiat. Oncol. Biol. Phys. 2004; 60: 1195-1203
- Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes.Int. J. Radiat. Oncol. Biol. Phys. 2005; 63: 1522-1530
- The impact of immediate breast reconstruction on the technical delivery of postmastectomy radiotherapy.Int. J. Radiat. Oncol. Biol. Phys. 2006; 66: 76-82
- Inverse-planned, dynamic, multi-beam, intensity-modulated radiation therapy (IMRT): A promising technique when target volume is the left breast and internal mammary lymph nodes.Med. Dosim. 2006; 31: 283-291
- Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer.Int. J. Radiat. Oncol. Biol. Phys. 2010; 78: 1594-1603
- Feasibility of postmastectomy treatment with helical tomotherapy.Int. J. Radiat. Oncol. Biol. Phys. 2010; 77: 836-842
- Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes.Int. J. Radiat. Oncol. Biol. Phys. 2010; 76: 287-295
- Planning strategies in volumetric modulated arc therapy for breast.Med. Phys. 2011; 38: 4025-4031
- Comparison of plan quality between arm avoidance(AA) vs. non arm avoidance VMAT planning techniques for breast cancer patients with bilateral implant reconstructions receiving postmastectomy radiation [Abstract].Med. Phys. 2015; 42: 3380
- Bilateral implant reconstruction does not affect the quality of postmastectomy radiation therapy.Med. Dosim. 2014; 39: 18-22
- Breast Contouring RADCOMP Consortium.(Available at:) (Accessed February 2016)
- 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 randomized trials.Lancet. 2005; 366: 2087-2106
- Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: A prospective study.Breast. 2005; 14: 201-208
- Risk of ischemic heart disease in women after radiotherapy for breast cancer.N. Engl. J. Med. 2013; 368: 987-998
- Single arc volumetric modulated arc therapy planning for left breast cancer and regional nodes.J. Radiat. Res. 2012; 53: 151-153
- Node-positive left-sided breast cancer: Dose VMAT improve treatment plan quality with respect to IMRT?.Strahlenther. Onkol. 2013; 189: 380-386
- Radiation Therapy Techniques and Treatment Planning for Breast Cancer, Practical Guides in Radiation Oncology.1st ed. Springer International Publishing, Switzerland2016: 111-114
Article info
Publication history
Published online: May 22, 2018
Accepted:
April 16,
2018
Received in revised form:
March 19,
2018
Received:
January 24,
2018
Footnotes
This research is funded by the MSK Cancer Center Support Grant/Core Grant (P30 CA008748).
Identification
Copyright
© 2018 American Association of Medical Dosimetrists. Published by Elsevier B.V. All rights reserved.
