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
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References
- Evidence based radiation oncology: breast cancer.Radiotherapy and Oncol. 2007; 84: 84-101
- 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
- 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
- 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
- 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
- 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
- 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
- Techniques of tumour bed boost irradiation in breast conserving therapy: current evidence and suggested guidelines.Acta Oncologica. 2007; 46: 879-892
- Design and production of 3D printed bolus for electron radiation therapy.J. appl. Clin. Med. Phys. 2014; 15: 194-211
- The Physics of Radiation Therapy.5th ed. Lippincott Williams & Wilkins, Philadelphia2014
- Clinical applications of 3-dimensional printing in radiation therapy.Medical dosimetry. 2017; 42: 150-155
- 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
- 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
- Evaluation of stereotactic radiosurgery conformity indices for 170 target volumes in patients with brain metastases.J. Appl. Clin. Med. Phys. 2011; 12: 245-253
- Planning and delivery of intensity modulated bolus electron conformal therapy.J. Appl. Clin. Med. Phys. 2021; 22: 8-21
- Dosimetric comparison of simultaneous integrated boost versus concomitant electron boost in radiotherapy treatment of breast cancer.J. Radiotherapy in Prac. 2017; 16: 334-341
- 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
- Introduction to passive electron intensity modulation.J. Appl. Clin. Med. Phys. 2017; 18: 10-19
- 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
- Risk of ischemic heart disease in women after radiotherapy for breast cancer.The New England J. Med. 2013; 368: 987-998
- 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
- Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy.Radiotherapy and Oncol. 2014; 112: 9-16
- The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors.Radiation Oncol. 2019; 14: 40
- 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
- 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
- Heart toxicity from breast cancer radiotherapy: current findings, assessment, and prevention.Strahlentherpie und Onkologie. 2019; 195: 1-12
- Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines.Clin. and Transl Radiation Oncol. 2019; 19: 39-45
- Exposure of the lungs in breast cancer radiotherapy: a systematic review of lung doses published 2010-2015.Radiotherapy and Oncol. 2018; 126: 148-154
- 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
- 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
Article info
Publication history
Published online: November 03, 2022
Accepted:
October 3,
2022
Received in revised form:
October 2,
2022
Received:
March 28,
2022
Identification
Copyright
© 2022 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
