Multisegmented tangential breast fields: A rational way to treat breast cancer

Ákos Gulybán, Péter Kovács, Zsolt Sebestyén, Róbert Farkas, Tibor Csere, Gábor Karácsonyi, Katalin Dérczy, Katalin Hideghéty, Olga Ésik

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27 Citations (Scopus)

Abstract

Purpose: Using three-dimensional conformal radiation therapy (3D-CRT) and multisegmented conformal radiation therapy (MS-CRT) for breast cancer treatment, the dose coverage of the planning target volume (PTV) and the radiation burden on the organs at risk (OARs) were evaluated. Material and Methods: 3D-CRT and MS-CRT were planned for 436 unilateral breasts (217 left). All patients were treated with MS-CRT between 2005 and 2007. For PTV delineation and beam orientation, supportive structures were applied. The mean PTV was 1,130 cm 3 (in ten patients > 2,200 cm3). Three-dimensional planning with weight-optimized medial and lateral open fields at a total dose of 50.4/1.8 Gy was followed by multisegmented planning with a reasonably high-dose-level dose cloud to define the medial subfield, and renewed optimization. This was repeated for the lateral subfield with a final optimization. For PTV coverage evaluation, the ICRU 50 was considered: the PTV portions receiving 95-107%, < 95% and > 107% of the prescribed dose (PTVD95- 107%, PTV<D95% and PTV>D107%), and the PTV maximal dose (PTVDmax). To compare the OAR radiation burdens, the mean doses to the ipsi-/contralateral lung, contralateral breast, and whole heart were documented. Results: The multisegmented plans furnished significantly (p < 0.0001) better target coverage (PTVD95-107% 82.8% vs. 90.9%, PTV<D95% 11.4% vs. 8.8%, PTV>D107% 5.9% vs. 0.3% and PTVDmax 56.6 vs. 54.3 Gy). The mean OAR doses remained almost unchanged: ipsilateral lung 10.5 versus 10.4 Gy, contralateral lung 0.4 versus 0.4 Gy, contralateral breast 0.8 versus 0.8 Gy, and whole heart (for left-sided cancers) 4.8 versus 4.8 Gy. The subfields required a mean of 9.8 MU (monitor units), i.e., a mean total 7.6 MU increment. The planning took 10-20 min, and the delivery 5-10 min. Conclusion: MS-CRT is a good alternative to breast intensity-modulated radiation therapy (IMRT) and seems adequate for right-sided cancers, whereas left-sided cancers necessitate a longer follow-up of heart-related side effects before a final assessment.

Original languageEnglish
Pages (from-to)262-269
Number of pages8
JournalStrahlentherapie und Onkologie
Volume184
Issue number5
DOIs
Publication statusPublished - May 1 2008

Keywords

  • Breast cancer
  • Dose homogeneity
  • Dummy structure
  • IMRT
  • Plan optimization
  • Segmented beams

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

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    Gulybán, Á., Kovács, P., Sebestyén, Z., Farkas, R., Csere, T., Karácsonyi, G., Dérczy, K., Hideghéty, K., & Ésik, O. (2008). Multisegmented tangential breast fields: A rational way to treat breast cancer. Strahlentherapie und Onkologie, 184(5), 262-269. https://doi.org/10.1007/s00066-008-1770-1