Analysis of Radiation Dose to the Shoulder by Treatment Technique and Correlation With Patient Reported Outcomes in Patients Receiving Regional Nodal Irradiation

Frontiers in Oncology

Karen Hock¹  Jose G. Bazan²  Sachin Jhawar²  Karla Kuhn²  Kylee Lindsey²  Dominic DiCostanzo²  Sasha Beyer²  Kayla Tedrick²  Erin Healy²  Julia R. White² 

[1] Department of Physical Therapy, The Ohio State University Comprehensive Cancer Center and Stefanie Spielman Comprehensive Breast Center – Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States;Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center and Stefanie Spielman Comprehensive Breast Center – Arthur G. James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States;

关键词: IMRT;    shoulder;    3DCRT;    quick DASH;    PMRT;    RNI;   

DOI  :  10.3389/fonc.2021.617926

来源: DOAJ

【 摘 要 】

Background/PurposeShoulder/arm morbidity is a late complication of breast cancer treatment with surgery and regional nodal irradiation (RNI). We set to analyze the impact of radiation technique [intensity modulated radiation therapy (IMRT) or 3D conformal radiation therapy (3DCRT)] on radiation dose to the shoulder with a hypothesis that IMRT use results in smaller volume of shoulder receiving radiation. We explored the relationship of treatment technique on long-term patient-reported outcomes using the quick disabilities of the arm, shoulder, and hand (q-DASH) questionnaire.Materials/MethodsWe identified patients treated with adjuvant RNI (50 Gy/25 fractions) from 2013 to 2018. We retrospectively contoured the shoulder organ-at-risk (OAR) from 2 cm above the ipsilateral supraclavicular (SCL) planning target volume (PTV) to the inferior SCL PTV slice and calculated the absolute volume of shoulder OAR receiving 5–50 Gy (V5–V50). We identified patients that completed a q-DASH questionnaire ≥6 months from the end of RNI.ResultsWe included 410 RNI patients: 54% stage III, 72% mastectomy, 35% treated with IMRT. IMRT resulted in significant reductions in the shoulder OAR volume receiving 20–50 Gy vs. 3DCRT. In total, 82 patients completed the q-DASH. The mean (SD) q-DASH=25.4 (19.1) and tended to be lower with IMRT vs. 3DCRT: 19.6 (16.4) vs. 27.8 (19.8), p=0.078.ConclusionWe found that IMRT reduces radiation dose to the shoulder and is associated with a trend toward reduced q-DASH scores ≥6 months post-RNI in a subset of our cohort. These results support prospective evaluation of IMRT as a technique to reduce shoulder morbidity in breast cancer patients receiving RNI.

【 授权许可】

Unknown