Advertisement

Dosimetric benefits of 3D-printed modulated electron bolus following lumpectomy and whole-breast radiotherapy for left breast cancer

Published:November 03, 2022DOI:https://doi.org/10.1016/j.meddos.2022.10.001

      Abstract

      Radiotherapy with electrons is commonly applied to the tumor bed after whole-breast radiotherapy following breast conservation surgery for breast cancer patients. However, the radiation dose to adjacent organs-at-risk (OARs) and conformity of planning target volume (PTV) cannot be optimized. In this study, we examine the feasibility of using modulated electron bolus (MEB) to improve PTV conformity and reduce the dose to these OARs. Twenty-seven patients with left breast cancer were retrospectively selected in this study. For each patient, a tangential photon plan in RayStation treatment planning system with prescription of 26 Gy in 5 fractions was created as base plan. Two electron plans, one without bolus and one with MEB using Adaptiiv software based on the PTV were created. Various dosimetric parameters of OARs including left lung, heart, left anterior descending artery (LAD) and ribs and the conformity indices of PTV of these 2 electron plans together with the base plans were compared. Statistically significant decreases in the dosimetric parameters (V5Gy, V10Gy, V20Gy, and mean dose) of the ipsilateral left lung and the heart were observed with MEB. The median maximum dose to the LAD and the ribs decreased by 6.2% and 4.5% respectively. The median conformity index was improved by 14.3% with median increases of monitor units by 1.7%. Our results show that MEB is feasible resulting in reduction of doses to the predefined OARs and an improved conformity of PTV. By using 3D printing, MEB might be considered as an alternative to conventional electron boost.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Medical Dosimetry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Poortmans P.
        Evidence based radiation oncology: breast cancer.
        Radiotherapy and Oncol. 2007; 84: 84-101
        • Fisher B
        • Anderson S
        • Redmond CK
        • et al.
        Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer.
        New England J. Med. 1995; 333: 1456-1461
        • Clarke M
        • Collins R
        • Darby S
        • et al.
        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
        • Bartelink H
        • Horiot J-C
        • Poortmans P
        • et al.
        Impact of higher radiation dose on local control, survival in breast-conserving therapy of early breast cancer: 10 years results of the randomized boost versus no boost EORTC trial 22881-10882.
        J. Clin. Oncol. 2007; 25: 3259-3265
        • Romestaing P
        • Lehingue Y
        • Carrie C
        • et al.
        Role of a 10-Gy boost in the conservative treatment of early breast cancer: result of a randomized clinical trial in Lyon, France.
        J Clin Oncol. 1997; 15: 963-968
        • Polgar C
        • Fodor J
        • Orosz Z
        • et al.
        Electron and high dose rate brachytherapy boost in the conservative treatment of stage I-II breast cancer. First results of the randomized.
        Budapest Boost Trial. Strahelentherapie und Onkologie. 2002; 178: 615-623
        • Hau E
        • Browne LH
        • Khanna S
        • et al.
        Radiotherapy breast boost with reduced whole-breast dose is associated with improved cosmesis: the results of a comprehensive assessment for the St. George and Wollongong randomized breast boost trial.
        Int. J. Radiation Oncol., Biol. and Phys. 2012; 82: 682-689
        • Jalali R
        • Singh S
        • Budrukkar A.
        Techniques of tumour bed boost irradiation in breast conserving therapy: current evidence and suggested guidelines.
        Acta Oncologica. 2007; 46: 879-892
        • Su S
        • Moran K
        • Robar JL.
        Design and production of 3D printed bolus for electron radiation therapy.
        J. appl. Clin. Med. Phys. 2014; 15: 194-211
        • Khan FM
        • Gibbons JP
        The Physics of Radiation Therapy.
        5th ed. Lippincott Williams & Wilkins, Philadelphia2014
        • Zhao Y
        • Moran K
        • Yewondwossen M
        • et al.
        Clinical applications of 3-dimensional printing in radiation therapy.
        Medical dosimetry. 2017; 42: 150-155
        • Brunt AM
        • Haviland JS
        • Wheatley DA
        • et al.
        Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomized, phase 3 trial.
        Lancet. 2020; 395: 1613-1626
        • Toscas JI
        • Linero D
        • Rubio I
        • et al.
        Boosting the tumor bed from deep-seated tumors in early-stage breast cancer: A planning study between electron, photon and proton beams.
        Radiotherapy and Oncol. 2010; 96: 192-198
        • Stanley J
        • Breitman K
        • Dunscombe P
        • et al.
        Evaluation of stereotactic radiosurgery conformity indices for 170 target volumes in patients with brain metastases.
        J. Appl. Clin. Med. Phys. 2011; 12: 245-253
        • Hilliard EN
        • Carver RL
        • Chambers EL
        • et al.
        Planning and delivery of intensity modulated bolus electron conformal therapy.
        J. Appl. Clin. Med. Phys. 2021; 22: 8-21
        • Yuen CY
        • Au WL
        • Chan WL
        • et al.
        Dosimetric comparison of simultaneous integrated boost versus concomitant electron boost in radiotherapy treatment of breast cancer.
        J. Radiotherapy in Prac. 2017; 16: 334-341
        • Pham JT
        • Allen LJ
        • Gomez SL.
        Why do Asian-American women have lower rates of breast conserving surgery: results of a survey regarding physician perceptions.
        BMC Public Health. 2009; 9: 246
        • Hogstrom KR
        • Carver RL
        • Chambers EL
        • et al.
        Introduction to passive electron intensity modulation.
        J. Appl. Clin. Med. Phys. 2017; 18: 10-19
        • Sasaki DK
        • McGeachy P
        • Aviles JEA
        • et al.
        A modern mold room: Meshing 3D surface scanning, digital design, and 3D printing with bolus fabrication.
        J. Appl. Clin. Med. Phys. 2019; 20: 78-85
        • Darby SC
        • Ewertz M
        • McGale P
        • et al.
        Risk of ischemic heart disease in women after radiotherapy for breast cancer.
        The New England J. Med. 2013; 368: 987-998
        • Milo MLH
        • Thorsen LBJ
        • Johnsen SP
        • et al.
        Risk of coronary artery disease after adjuvant radiotherapy in 29662 early breast cancer patients: a population-based Danish Breast Cancer Group Study.
        Radiotherapy and Oncol. 2021; 157: 106-113
        • Shah C
        • Badiyan S
        • Berry S
        • et al.
        Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy.
        Radiotherapy and Oncol. 2014; 112: 9-16
        • Wennstig AK
        • Garmo H
        • Isacsson U
        • et al.
        The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors.
        Radiation Oncol. 2019; 14: 40
        • Jacob S
        • Camilleri J
        • Derreumaux S
        • et al.
        Is mean heart dose a relevant surrogate paramenter of left ventricle and coronary arteries exposure during breast cancer radiotherapy: a dosimetric evaluation based on individually-determined radiation dose (BACCARAT study).
        Radiation Oncol. 2019; 14: 29
        • Duma MN
        • Herr AC
        • Borm KJ
        • et al.
        Tangential field radiotherapy for breast cancer - the dose to the heart and heart subvolumes: what structures must be contoured in future clinical trials?.
        Front. Oncol. 2017; 7: 130
        • Piroth MC
        • Baumann R
        • Budach W
        • et al.
        Heart toxicity from breast cancer radiotherapy: current findings, assessment, and prevention.
        Strahlentherpie und Onkologie. 2019; 195: 1-12
        • Beaton L
        • Bergman A
        • Nichol A
        • et al.
        Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines.
        Clin. and Transl Radiation Oncol. 2019; 19: 39-45
        • Marianne C
        • Frances K
        • Sarah C
        • et al.
        Exposure of the lungs in breast cancer radiotherapy: a systematic review of lung doses published 2010-2015.
        Radiotherapy and Oncol. 2018; 126: 148-154
        • Pierce SM
        • Recht A
        • Lingos TI
        • et al.
        Long-term radiation complications following conservative surgery (CS) and radiation therapy (RT) in patients with early stage breast cancer.
        Int J Radiat Oncol Biol Phys. 1992; 23 (30): 915-923
        • Rajan SS
        • Sharma SC
        • Kumar N
        • et al.
        Clinical and cosmetic results of breast boost radiotherapy in early breast cancer: a randomized study between electron and photon.
        J. Cancer Res. and Therapeutics. 2014; 10: 889-895