Törekvés a sugárterápia individualizálására emlörákban

Egyéni rizikóbecslés és egyénileg alkalmazott technikák

Translated title of the contribution: Approaches to individual radiotherapy in breast cancer: Individual risk estimation and individualized techniques

Z. Kahán, Zoltán Varga, Melinda Csenki, Júlia Szabó, Elemér Szil, Gábor Fekete, K. Hideghéty, K. Boda, L. Thurzó

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Radiotherapy comprises an integral part of the curative therapy of breast cancer by improving the locoregional control and survival when given on an individualized basis. Conformal radiotherapy and three-dimensional radiation treatment planning enhance the safety of radiotherapy by adjusting the irradiated volume to the shape of the target volume, and providing control of the radiation dose to the organs at risk (OARs). Patients and methods: The methods introduced at the authors' institute in 2002 are demonstrated. The breast/chest wall and lymph node areas were irradiated provided that there was a minimum risk of local or locoregional relapse of 10%. CT-based 3D radiotherapy treatment planning and individual patient-positioning were applied, with thermoplastic mask-fixation in the second part of the study. The dose constraints of the OARs were given in accordance with the literature recommendations. In the first group of patients, individually shaped blocks, in the second group, multileaf collimator, and in the third group, with the aim of a more homogenous dose-distribution in the target volume, intensity-modulated beams were applied. Results: During the study, 737 breast cancer patients received conformal radiotherapy based on individual risk estimation. In 372 cases only local, while in 365 cases locoregional radiotherapy was delivered. The dose-homogeneity in the target volume was significantly improved in the second period of the study, when segments were superposed on the radiotherapy fields. The proportions of the target volumes irradiated with ± 10% of the planned dose in the breast/chest wall, axillary and supraclavicular lymph nodes and internal mammary lymph nodes varied between 90.5-94.2%, 84.1-93.8% and 86.7-91.6%, respectively, depending on the radiation technique used. The parameters indicating the dose to the ipsilateral lung or to the heart were significantly higher when locoregional radiotherapy was applied compared to that in case of local radiotherapy. Radiation dose to the ipsilateral lung and the heart was significantly reduced in the second part of the study when locoregional, but not when local radiotherapy was delivered. The introduction of individual immobilization by means of thermoplastic mask-fixation resulted in a relevant decrease in the uncertainty due to breathing motion and daily positioning errors, and also in a significant reduction of the dose to the contralateral breast. Conclusions: Adjuvant radiotherapy should be based on individual risk-benefit features. The need of the introduction of special techniques may be decided after the dose-volume analysis of the conformal radiotherapy plan based on 3D radiation treatment planning.

Original languageHungarian
Pages (from-to)833-841
Number of pages9
JournalOrvosi Hetilap
Volume148
Issue number18
DOIs
Publication statusPublished - May 6 2007

Fingerprint

Radiotherapy
Breast Neoplasms
Conformal Radiotherapy
Radiation
Breast
Organs at Risk
Lymph Nodes
Thoracic Wall
Masks
Patient Positioning
Lung
Adjuvant Radiotherapy
Therapeutics
Immobilization
Uncertainty
Respiration
Safety
Recurrence
Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Törekvés a sugárterápia individualizálására emlörákban : Egyéni rizikóbecslés és egyénileg alkalmazott technikák. / Kahán, Z.; Varga, Zoltán; Csenki, Melinda; Szabó, Júlia; Szil, Elemér; Fekete, Gábor; Hideghéty, K.; Boda, K.; Thurzó, L.

In: Orvosi Hetilap, Vol. 148, No. 18, 06.05.2007, p. 833-841.

Research output: Contribution to journalArticle

Kahán, Z. ; Varga, Zoltán ; Csenki, Melinda ; Szabó, Júlia ; Szil, Elemér ; Fekete, Gábor ; Hideghéty, K. ; Boda, K. ; Thurzó, L. / Törekvés a sugárterápia individualizálására emlörákban : Egyéni rizikóbecslés és egyénileg alkalmazott technikák. In: Orvosi Hetilap. 2007 ; Vol. 148, No. 18. pp. 833-841.
@article{d0a059db7fd24fcd88c37cfcc12b627c,
title = "T{\"o}rekv{\'e}s a sug{\'a}rter{\'a}pia individualiz{\'a}l{\'a}s{\'a}ra eml{\"o}r{\'a}kban: Egy{\'e}ni rizik{\'o}becsl{\'e}s {\'e}s egy{\'e}nileg alkalmazott technik{\'a}k",
abstract = "Introduction: Radiotherapy comprises an integral part of the curative therapy of breast cancer by improving the locoregional control and survival when given on an individualized basis. Conformal radiotherapy and three-dimensional radiation treatment planning enhance the safety of radiotherapy by adjusting the irradiated volume to the shape of the target volume, and providing control of the radiation dose to the organs at risk (OARs). Patients and methods: The methods introduced at the authors' institute in 2002 are demonstrated. The breast/chest wall and lymph node areas were irradiated provided that there was a minimum risk of local or locoregional relapse of 10{\%}. CT-based 3D radiotherapy treatment planning and individual patient-positioning were applied, with thermoplastic mask-fixation in the second part of the study. The dose constraints of the OARs were given in accordance with the literature recommendations. In the first group of patients, individually shaped blocks, in the second group, multileaf collimator, and in the third group, with the aim of a more homogenous dose-distribution in the target volume, intensity-modulated beams were applied. Results: During the study, 737 breast cancer patients received conformal radiotherapy based on individual risk estimation. In 372 cases only local, while in 365 cases locoregional radiotherapy was delivered. The dose-homogeneity in the target volume was significantly improved in the second period of the study, when segments were superposed on the radiotherapy fields. The proportions of the target volumes irradiated with ± 10{\%} of the planned dose in the breast/chest wall, axillary and supraclavicular lymph nodes and internal mammary lymph nodes varied between 90.5-94.2{\%}, 84.1-93.8{\%} and 86.7-91.6{\%}, respectively, depending on the radiation technique used. The parameters indicating the dose to the ipsilateral lung or to the heart were significantly higher when locoregional radiotherapy was applied compared to that in case of local radiotherapy. Radiation dose to the ipsilateral lung and the heart was significantly reduced in the second part of the study when locoregional, but not when local radiotherapy was delivered. The introduction of individual immobilization by means of thermoplastic mask-fixation resulted in a relevant decrease in the uncertainty due to breathing motion and daily positioning errors, and also in a significant reduction of the dose to the contralateral breast. Conclusions: Adjuvant radiotherapy should be based on individual risk-benefit features. The need of the introduction of special techniques may be decided after the dose-volume analysis of the conformal radiotherapy plan based on 3D radiation treatment planning.",
keywords = "Adjuvant radiotherapy, Breast cancer, Conformal radiotherapy, Organs at risk, Regional lymph nodes",
author = "Z. Kah{\'a}n and Zolt{\'a}n Varga and Melinda Csenki and J{\'u}lia Szab{\'o} and Elem{\'e}r Szil and G{\'a}bor Fekete and K. Hidegh{\'e}ty and K. Boda and L. Thurz{\'o}",
year = "2007",
month = "5",
day = "6",
doi = "10.1556/OH.2007.27877",
language = "Hungarian",
volume = "148",
pages = "833--841",
journal = "Orvosi Hetilap",
issn = "0030-6002",
publisher = "Akademiai Kiado",
number = "18",

}

TY - JOUR

T1 - Törekvés a sugárterápia individualizálására emlörákban

T2 - Egyéni rizikóbecslés és egyénileg alkalmazott technikák

AU - Kahán, Z.

AU - Varga, Zoltán

AU - Csenki, Melinda

AU - Szabó, Júlia

AU - Szil, Elemér

AU - Fekete, Gábor

AU - Hideghéty, K.

AU - Boda, K.

AU - Thurzó, L.

PY - 2007/5/6

Y1 - 2007/5/6

N2 - Introduction: Radiotherapy comprises an integral part of the curative therapy of breast cancer by improving the locoregional control and survival when given on an individualized basis. Conformal radiotherapy and three-dimensional radiation treatment planning enhance the safety of radiotherapy by adjusting the irradiated volume to the shape of the target volume, and providing control of the radiation dose to the organs at risk (OARs). Patients and methods: The methods introduced at the authors' institute in 2002 are demonstrated. The breast/chest wall and lymph node areas were irradiated provided that there was a minimum risk of local or locoregional relapse of 10%. CT-based 3D radiotherapy treatment planning and individual patient-positioning were applied, with thermoplastic mask-fixation in the second part of the study. The dose constraints of the OARs were given in accordance with the literature recommendations. In the first group of patients, individually shaped blocks, in the second group, multileaf collimator, and in the third group, with the aim of a more homogenous dose-distribution in the target volume, intensity-modulated beams were applied. Results: During the study, 737 breast cancer patients received conformal radiotherapy based on individual risk estimation. In 372 cases only local, while in 365 cases locoregional radiotherapy was delivered. The dose-homogeneity in the target volume was significantly improved in the second period of the study, when segments were superposed on the radiotherapy fields. The proportions of the target volumes irradiated with ± 10% of the planned dose in the breast/chest wall, axillary and supraclavicular lymph nodes and internal mammary lymph nodes varied between 90.5-94.2%, 84.1-93.8% and 86.7-91.6%, respectively, depending on the radiation technique used. The parameters indicating the dose to the ipsilateral lung or to the heart were significantly higher when locoregional radiotherapy was applied compared to that in case of local radiotherapy. Radiation dose to the ipsilateral lung and the heart was significantly reduced in the second part of the study when locoregional, but not when local radiotherapy was delivered. The introduction of individual immobilization by means of thermoplastic mask-fixation resulted in a relevant decrease in the uncertainty due to breathing motion and daily positioning errors, and also in a significant reduction of the dose to the contralateral breast. Conclusions: Adjuvant radiotherapy should be based on individual risk-benefit features. The need of the introduction of special techniques may be decided after the dose-volume analysis of the conformal radiotherapy plan based on 3D radiation treatment planning.

AB - Introduction: Radiotherapy comprises an integral part of the curative therapy of breast cancer by improving the locoregional control and survival when given on an individualized basis. Conformal radiotherapy and three-dimensional radiation treatment planning enhance the safety of radiotherapy by adjusting the irradiated volume to the shape of the target volume, and providing control of the radiation dose to the organs at risk (OARs). Patients and methods: The methods introduced at the authors' institute in 2002 are demonstrated. The breast/chest wall and lymph node areas were irradiated provided that there was a minimum risk of local or locoregional relapse of 10%. CT-based 3D radiotherapy treatment planning and individual patient-positioning were applied, with thermoplastic mask-fixation in the second part of the study. The dose constraints of the OARs were given in accordance with the literature recommendations. In the first group of patients, individually shaped blocks, in the second group, multileaf collimator, and in the third group, with the aim of a more homogenous dose-distribution in the target volume, intensity-modulated beams were applied. Results: During the study, 737 breast cancer patients received conformal radiotherapy based on individual risk estimation. In 372 cases only local, while in 365 cases locoregional radiotherapy was delivered. The dose-homogeneity in the target volume was significantly improved in the second period of the study, when segments were superposed on the radiotherapy fields. The proportions of the target volumes irradiated with ± 10% of the planned dose in the breast/chest wall, axillary and supraclavicular lymph nodes and internal mammary lymph nodes varied between 90.5-94.2%, 84.1-93.8% and 86.7-91.6%, respectively, depending on the radiation technique used. The parameters indicating the dose to the ipsilateral lung or to the heart were significantly higher when locoregional radiotherapy was applied compared to that in case of local radiotherapy. Radiation dose to the ipsilateral lung and the heart was significantly reduced in the second part of the study when locoregional, but not when local radiotherapy was delivered. The introduction of individual immobilization by means of thermoplastic mask-fixation resulted in a relevant decrease in the uncertainty due to breathing motion and daily positioning errors, and also in a significant reduction of the dose to the contralateral breast. Conclusions: Adjuvant radiotherapy should be based on individual risk-benefit features. The need of the introduction of special techniques may be decided after the dose-volume analysis of the conformal radiotherapy plan based on 3D radiation treatment planning.

KW - Adjuvant radiotherapy

KW - Breast cancer

KW - Conformal radiotherapy

KW - Organs at risk

KW - Regional lymph nodes

UR - http://www.scopus.com/inward/record.url?scp=34447293316&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447293316&partnerID=8YFLogxK

U2 - 10.1556/OH.2007.27877

DO - 10.1556/OH.2007.27877

M3 - Article

VL - 148

SP - 833

EP - 841

JO - Orvosi Hetilap

JF - Orvosi Hetilap

SN - 0030-6002

IS - 18

ER -