Whole breast radiotherapy in prone and supine position: is there a place for multi-beam IMRT?

Radiation Oncology

Wilfried De Neve²  Liv Veldeman²  Werner De Gersem¹  Indira Madani²  Bruno Speleers¹  Thomas Mulliez² 

[1] Ghent University, De Pintelaan 185, Ghent 9000, Belgium;Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent 9000, Belgium

关键词: Multi-beam-IMRT;    Tangential field-IMRT;    Intensity-modulated radiotherapy;    Wedged tangential fields;    Supine position;    Prone position;    Whole-breast irradiation;   

Others  :  1153685
DOI  :  10.1186/1748-717X-8-151

 received in 2013-01-28, accepted in 2013-06-18,  发布年份 2013

【 摘 要 】

Background

Early stage breast cancer patients are long-term survivors and finding techniques that may lower acute and late radiotherapy-induced toxicity is crucial. We compared dosimetry of wedged tangential fields (W-TF), tangential field intensity-modulated radiotherapy (TF-IMRT) and multi-beam IMRT (MB-IMRT) in prone and supine positions for whole-breast irradiation (WBI).

Methods

MB-IMRT, TF-IMRT and W-TF treatment plans in prone and supine positions were generated for 18 unselected breast cancer patients. The median prescription dose to the optimized planning target volume (PTV_optim) was 50 Gy in 25 fractions. Dose-volume parameters and indices of conformity were calculated for the PTV_optim and organs-at-risk.

Results

Prone MB-IMRT achieved (p<0.01) the best dose homogeneity compared to WTF in the prone position and WTF and MB-IMRT in the supine position. Prone IMRT scored better for all dose indices. MB-IMRT lowered lung and heart dose (p<0.05) in supine position, however the lowest ipsilateral lung doses (p<0.001) were in prone position. In left-sided breast cancer patients population averages for heart sparing by radiation dose was better in prone position; though non-significant. For patients with a PTV_optim volume ≥600 cc heart dose was consistently lower in prone position; while for patients with smaller breasts heart dose metrics were comparable or worse compared to supine MB-IMRT. Doses to the contralateral breast were similar regardless of position or technique. Dosimetry of prone MB-IMRT and prone TF-IMRT differed slightly.

Conclusions

MB-IMRT is the treatment of choice in supine position. Prone IMRT is superior to any supine treatment for right-sided breast cancer patients and left-sided breast cancer patients with larger breasts by obtaining better conformity indices, target dose distribution and sparing of the organs-at-risk. The influence of treatment techniques in prone position is less pronounced; moreover dosimetric differences between TF-IMRT and MB-IMRT are rather small.

【 授权许可】

   
2013 Mulliez et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Henson KE, McGale P, Taylor C, Darby SC: Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer 2013, 108:179-182.
• [2]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 randomised trials. Lancet 2005, 366:2087-2106.
• [3]Early Breast Cancer Trialists' Collaborative G, Darby S, McGale P, et al.: Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011, 378:1707-1716.
• [4]Barnett GC, Wilkinson JS, Moody AM, et al.: Randomized controlled trial of forward-planned intensity modulated radiotherapy for early breast cancer: interim results at 2 years. Int J Radiat Oncol Biol Phys 2012, 82:715-723.
• [5]Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W: Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncology 2008, 9:367-375.
• [6]Borca VC, Franco P, Catuzzo P, et al.: Does TomoDirect 3DCRT represent a suitable option for post-operative whole breast irradiation? A hypothesis-generating pilot study. Radiat Oncol 2012, 7:211. BioMed Central Full Text
• [7]Coon AB, Dickler A, Kirk MC, et al.: Tomotherapy and Multifield Intensity-Modulated Radiotherapy Planning Reduce Cardiac Doses in Left-Sided Breast Cancer Patients with Unfavorable Cardiac Anatomy. Int J Radiat Oncol Biol Phys 2010, 72:104-110.
• [8]Beckham WA, Popescu CC, Patenaude VV, Wai ES, Olivotto IA: Is multibeam IMRT better than standard treatment for patients with left-sided breast cancer? Int J Radiat Oncol Biol Phys 2007, 69:918-924.
• [9]Fogliata A, Clivio A, Nicolini G, Vanetti E, Cozzi L: A treatment planning study using non-coplanar static fields and coplanar arcs for whole breast radiotherapy of patients with concave geometry. Radiother Oncol 2007, 85:346-354.
• [10]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. BioMed Central Full Text
• [11]Merchant TE, McCormick B: Prone position breast irradiation. Int J Radiat Oncol Biol Phys 1994, 30:197-203.
• [12]Gray JR, McCormick B, Cox L, Yahalom J: Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys 1991, 21:347-354.
• [13]Grann A, McCormick B, Chabner ES, et al.: Prone breast radiotherapy in early-stage breast cancer: a preliminary analysis. Int J Radiat Oncol Biol Phys 2000, 47:319-325.
• [14]Hardee ME, Raza S, Becker SJ, et al.: Prone hypofractionated whole-breast radiotherapy without a boost to the tumor bed: comparable toxicity of IMRT versus a 3D conformal technique. Int J Radiat Oncol Biol Phys 2012, 82:e415-423.
• [15]Goodman KA, Hong L, Wagman R, Hunt MA, McCormick B: Dosimetric analysis of a simplified intensity modulation technique for prone breast radiotherapy. Int J Radiat Oncol Biol Phys 2004, 60:95-102.
• [16]Veldeman L, Speleers B, Bakker M, et al.: Preliminary results on setup precision of prone-lateral patient positioning for whole breast irradiation. Int J Radiat Oncol Biol Phys 2010, 78:111-118.
• [17]Veldeman L, De Gersem W, Speleers B, et al.: Alternated Prone and Supine Whole-Breast Irradiation Using IMRT: Setup Precision, Respiratory Movement and Treatment Time. Int J Radiat Oncol Biol Phys 2012, 82:2055-2064.
• [18]Kirby AM, Evans PM, Donovan EM, Convery HM, Haviland JS, Yarnold JR: Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother Oncol 2010, 96:178-184.
• [19]Varga Z, Hideghety K, Mezo T, Nikolenyi A, Thurzo L, Kahan Z: Individual positioning: a comparative study of adjuvant breast radiotherapy in the prone versus supine position. Int J Radiat Oncol Biol Phys 2009, 75:94-100.
• [20]Lymberis SC, Dewyngaert JK, Parhar P, et al.: Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients. Int J Radiat Oncol Biol Phys 2012, 84:902-909.
• [21]Van Vaerenbergh K, De Gersem W, Vakaet L, et al.: Automatic generation of a plan optimization volume for tangential field breast cancer radiation therapy. Strahlenther Onkol 2005, 181:82-8.
• [22]De Neve W, Wu Y, Ezzel G: Practical IMRT planning. In Image-guided IMRT. Edited by Bortfeld T, Schmidt-Ulrich R, De Neve W, Wazer D. Berlin, Heidelberg: Springer; 2006:47-59.
• [23]Ahunbay EE, Chen GP, Thatcher S, et al.: Direct aperture optimization-based intensity-modulated radiotherapy for whole breast irradiation. Int J Radiat Oncol Biol Phys 2007, 67:1248-1258.
• [24]Harsolia A, Kestin L, Grills I, et al.: Intensity-modulated radiotherapy results in significant decrease in clinical toxicities compared with conventional wedge-based breast radiotherapy. Int J Radiat Oncol Biol Phys 2007, 68:1375-1380.