745 poster BREAST CONSERVING THERAPY: EVALUATION OF THE TUMOR DIAMETER AND TREATED VOLUMES (original) (raw)
Related papers
Radiation Oncology, 2013
Purpose: To analyze dosimetric parameters of patients receiving adjuvant breast radiotherapy (RT) in the prone versus supine position. Methods and materials: Forty-one out of 55 patients with pendulous breasts and candidates for adjuvant RT were enrolled in the study after informed consent. They underwent computed tomography (CT)-simulation in both prone and supine position. Target and non target volumes were outlined on CT images. Prescribed dose was 50 Gy delivered by two tangential photon fields followed by 10 Gy electron boost. Target coverage and dose homogeneity to clinical target volume (CTV) and planning target volume (PTV) were assessed by V95, V105 and V107 and dose to lung, heart and left anterior descending coronary artery (LAD) by V5, V10, V20, and mean and maximum dose. Data were analyzed by Student's t-test.
Benha Medical Journal, 2021
Objective: To investigate the toxicity of prone position in whole breast radiotherapy after breast conserving surgery (BCS) in breast cancer patients with large pendulous breasts. Patient and methods: Thirty patients (stage I-II) with large pendulous breast were simulated in both supine and prone positions. Target volumes and organs at risk were contoured on CT images. For each patient, the two planes were calculated and dose volume histograms were compared. The prescribed dose was 40 Gy in 15 fractions over 3 weeks to whole breast with 6-10 MV photon followed by 10 Gy in 5 fractions over one week boost to the tumor bed. The selection of treatment position was based on best target coverage and optimal sparing of organs at risk. Results: Among 30 patients, 13 patients (43.3%) were treated in the prone position, while the remaining 17 patients (56.7%) were treated in supine position. Higher grades of acute dermatitis were significantly reported in supine position (p=0.01).Grades 1 and 2 chronic radiation dermatitis were more in supine position, but no statistically significant difference (p=0.41). Grade I radiation pneumonitis was developed in 2 patients (14.3%) in supine group which was not significantly different (p=0.49). No cardiac symptoms were noted among both groups. Grade I lymphedema was noted in (11.8%) in supine group versus (23.1%) in prone group (p=0.6). Conclusion: Prone position is a suitable alternative to supine position in large pendulous breast with accepted toxicity profile.
Long-term Clinical Outcomes of Whole-Breast Irradiation Delivered in the Prone Position
International Journal of Radiation Oncology*Biology*Physics, 2007
Purpose: The aim of this study was to evaluate retrospectively the effectiveness and toxicity of post-lumpectomy whole-breast radiation therapy delivered with prone positioning. Methods and Materials: Between September 1992 and August 2004, 245 women with 248 early-stage invasive or in situ breast cancers were treated using a prone breast board. Photon fields treated the whole breast to 46 to 50.4 Gy with standard fractionation. The target volume was clinically palpable breast tissue; no attempt was made to irradiate chest wall lymphatics. Tumor bed boosts were delivered in 85% of cases. Adjuvant chemotherapy and hormonal therapy were administered to 42% and 62% of patients, respectively. Results: After a median follow-up of 4.9 years, the 5 year actuarial true local and elsewhere ipsilateral breast tumor recurrence rates were 4.8% and 1.3%, respectively. The 5-year actuarial rates of regional nodal recurrence and distant metastases were 1.6% and 7.4%. Actuarial disease-free, disease-specific, and overall survival rates at 5 years were 89.4%, 97.3%, and 93%, respectively. Treatment breaks were required by 2.4% of patients. Grade 3 acute dermatitis and edema were each limited to 2% of patients. Only 4.9% of patients complained of acute chest wall discomfort. Chronic Grade 2 to 3 skin and subcutaneous tissue toxicities were reported in 4.4% and 13.7% of patients, respectively. Conclusions: Prone position breast radiation results in similar long-term disease control with a favorable toxicity profile compared with standard supine tangents. The anatomic advantages of prone positioning may contribute to improving the therapeutic ratio of post-lumpectomy radiation by improving dose homogeneity and minimizing incidental cardiac and lung dose.
The role of a prone setup in breast radiation therapy
Frontiers in oncology, 2011
Most patients undergoing breast conservation therapy receive radiotherapy in the supine position. Historically, prone breast irradiation has been advocated for women with large pendulous breasts in order to decrease acute and late toxicities. With the advent of CT planning, the prone technique has become both feasible and reproducible. It was shown to be advantageous not only for women with larger breasts but in most patients since it consistently reduces, if not eliminates, the inclusion of heart and lung within the field. The prone setup has been accepted as the best localizing position for both MRI and stereotactic biopsy, but its adoption has been delayed in radiotherapy. New technological advances including image-modulated radiation therapy and image-guided radiation therapy have made possible the exploration of accelerated fractionation schemes with a concomitant boost to the tumor bed in the prone position, along with better imaging and verification of reproducibility of pati...
American Journal of Clinical Oncology, 2011
Purpose: Supine tangential radiotherapy for the intact breast is a standard component of breast conservation management; a supraclavicular (SCV) field can be added for patients at high risk for nodal failure. Treatment in the prone position has demonstrated improvements in lung sparing, but has been limited to early-stage patients in whom radiation to only the breast was indicated. We sought to investigate the dosimetric feasibility of treating women in the prone position, using a 3-field monoisocentric technique. Methods: A total of 10 patients previously simulated supine and prone were selected for replanning. The heart, ipsilateral breast, contralateral breast, and axillary/SCV lymph node regions were contoured in accordance with Radiation Therapy Oncology Group guidelines. The 3-field monoisocentric plans were created for both the supine and prone scans. Target coverage, homogeneity, and organ at risk sparing were examined. Results: Both plans achieved acceptable coverage of the breast. The mean percentage of the breast receiving at least 95% of the prescription dose (V95%) were similar in the prone and supine positions, 89.3% versus 90.7% (P ϭ 0.29). Mean V95% of the level 3 axilla and SCV were 93.8% versus 97.0% prone versus supine (P ϭ 0.16). The percentage of ipsilateral lung receiving Ͼ20 Gy was substantially reduced from 21.2% supine to 9.3% prone (P ϭ 0.001). Conclusion: Three-field radiotherapy in the prone position appears to be dosimetrically equivalent to supine treatment with respect to target coverage, but the prone position decreases lung dose.
Prone versus supine free-breathing for right-sided whole breast radiotherapy
Scientific Reports, 2022
Prone setup has been advocated to improve organ sparing in whole breast radiotherapy without impairing breast coverage. We evaluate the dosimetric advantage of prone setup for the right breast and look for predictors of the gain. Right breast cancer patients treated in 2010–2013 who had a dual supine and prone planning were retrospectively identified. A penalty score was computed from the mean absolute dose deviation to heart, lungs, breasts, and tumor bed for each patient's supine and prone plan. Dosimetric advantage of prone was assessed by the reduction of penalty score from supine to prone. The effect of patients' characteristics on the reduction of penalty was analyzed using robust linear regression. A total of 146 patients with right breast dual plans were identified. Prone compared to supine reduced the penalty score in 119 patients (81.5%). Lung doses were reduced by 70.8%, from 4.8 Gy supine to 1.4 Gy prone. Among patient's characteristics, the only significant ...
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2018
The benefit of reduced radiation heart exposure in the prone vs. supine position individually differs. In this prospective cohort study, the goal was to develop a simple method for the operation of a validated model for the prediction of preferable treatment position during left breast radiotherapy. In 100 cases, a single CT slice was utilized for the collection of the needed patient-specific data (in addition to body mass index, the distance of the LAD from the chest wall and the area of the heart included in the radiation fields at the middle of the heart in the supine position). Outcome was analyzed in relation to the full CT series acquired in both positions and dosimetric data. Great consistency was found between the tested and original method regarding sensitivity and specificity. The prioritization of LAD dose, and the use of heart dose and position-specific dose constraints as safety measures ensure sensitivity and specificity values of 82.8% and 87.3%, respectively. In an a...
Practical Radiation Oncology
Purpose: To evaluate the impact of MRI vs CT derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiotherapy. Methods and Materials: Four WB radiotherapy plans were generated for 28 patients, where PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6MV tangential IMRT technique was used, with plans designated as ideal, acceptable or non-compliant. Dose metrics for PTVs and OARs were compared to analyse any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone). Results: With respect to imaging modality 2/11 WB_PTV dose metrics (V90% and V110%) displayed statistically significant differences, however these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan vs a non-compliant plan were higher for the supine position compared to the prone position (p=0.026). The minimum distance between the seroma cavity (SC)_PTV and the chest-wall was increased with prone positioning, (p<0.001, supine and prone values 1.1 mm and 8.7 mm respectively). Heart volume was greater in the supine position (p=0.005). Heart doses were lower in the supine position than prone (p<0.01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone respectively). Mean lung doses met ideal dose constraints in both positions, however best spared in the prone position. The contra-lateral breast D1cc showed significantly lower doses in the supine position, (p<0.001, 4.64 Gy vs 9.51 Gy). Conclusions: Planning with PTVs generated from MRI data showed no clinically significant differences to planning with PTVs generated from CT with respect to PTV and OAR doses. Prone positioning within this study reduced mean lung dose and whole heart volumes but increased mean heart and contra-lateral breast doses, compared to supine.