Three dimensional conformal radiotherapy for synchronous bilateral breast irradiation using a mono iso-center technique

• Autorzy: Mani K. R. , Basu S. , Bhuiyan M. A. , Ahmed M. A. , Sumon M. A. , Haque K. A. , Sengupta A. K. , Un Nabi M. R. , Das K. J. M.

Identyfikatory

DOI

10.1515/pjmpe-2017-0004

• Języki publikacji: EN

Abstrakty

EN

Objective: The purpose of this study is to demonstrate the synchronous bilateral breast irradiation radiotherapy technique using a single isocenter. Materials and Methods: Six patients of synchronous bilateral breast were treated with single isocenter technique from February 2011 to June 2016. All the patients underwent a CT-simulation using appropriate positioning device. Target volumes and critical structures like heart, lung, esophagus, thyroid, etc., were delineated slice by slice in the CT data. An isocenter was placed above the sternum on the skin and both medial tangential and lateral tangential of the breast / chest wall were created using asymmetrical jaws to avoid the beam divergence through the lung and heart. The field weighting were adjusted manually to obtain a homogenous dose distribution. The planning objectives were to deliver uniform doses around the target and keep the doses to the organ at risk within the permissible limit. The beam energy of 6 MV or combination of 6 MV and 15 MV photons were used in the tangential fields according to the tangential separation. Boluses were used for all the mastectomy patients to increase the doses on the chest wall. In addition to that enhanced dynamic wedge and field in field technique were also used to obtain a homogenous distribution around the target volume and reduce the hot spots. The isocenter was just kept on the skin, such that the beam junctions will be overlapped only on the air just above the sternum. Acute toxicity during the treatment and late toxicity were recorded during the patient’s follow-up. Results: During the radiotherapy treatment follow-up there were no acute skin reactions in the field junctions, but one patient had grade 1 esophagitis and two patients had grade 2 skin reactions in the chest wall. With a median follow-up of 38.5 months (range: 8 - 49 months), no patients had a local recurrence, but one patients with triple negative disease had a distant metastases in brain and died after 28 months. Conclusions: We were able to successfully treat the synchronous bilateral breast using single isocenter radiotherapy while keeping the lung and heart doses within the acceptable dose limits. During the treatment follow-up there were no symptoms of acute skin reactions in the field junction.

Słowa kluczowe

EN

bilateral breast; synchronous bilateral breast; mono isocente

• Wydawca: Polskie Towarzystwo Fizyki Medycznej ; De Gruyter
• Czasopismo: Polish Journal of Medical Physics and Engineering
• Rocznik: 2017
• Tom: Vol. 23, Iss. 2
• Strony: 15--19
• Opis fizyczny: Bibliogr. 8 poz., rys., tab.

Twórcy

autor

Mani K. R.

• Research and Development Centre, Bharathiar University, Coimbatore-641046, Tamilnadu, India
• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Basu S.

• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Bhuiyan M. A.

• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Ahmed M. A.

• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Sumon M. A.

• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Haque K. A.

• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Sengupta A. K.

• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Un Nabi M. R.

• Department of Radiation Oncology, United Hospital, Gulshan-2, Dhaka-1212, Bangladesh

autor

Das K. J. M.

• Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rai Bareilly Road, Lucknow- 226014, Uttar Pradesh India

Bibliografia

• [1] Padmanabhan N, Subramanyan A, Radhakrishna S. Synchronous Bilateral Breast Cancers. J Clin Diagn Res. 2015;9(9):XC05-XC08.
• [2] Ekici K et al. Is helical tomotherapy - based intensity-modulated radiotherapy feasible and effective in bilateral synchronous breast cancer? A two-center experience. JBUON. 2016;21(1):46-52.
• [3] Nicolini G, Clivio A, Fogliata A, et al. Simultaneous integrated boost radiotherapy for bilateral breast: a treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapy. Radiat Oncol. 2009;4:27.
• [4] Wang, Y. Park JL. Radiation Therapy of Synchronous Bilateral Breast Carcinoma (SBBC) Using Volumetric Modulated Arc Therapy (VMAT). Int J Radiat Oncol Biol Phys. 2015;93(3):E554-E555.
• [5] ICRU. Prescribing, Recording, and Reporting Intensity-Modulated Photon-Beam Therapy (IMRT). Bethesda, MD: International Commission on Radiation Units and Measurements, ICRU Report 83; 2010;
• [6] Gokula K, Earnest A, Wong LC. Meta-analysis of incidence of early lung toxicity in 3-dimensional conformal irradiation of breast carcinomas. Radiat Oncol. 2013;8:268.
• [7] Lind PA, Wennverg B, Gagliardi G, et al. Pulmonary complications following different radiotherapy techniques for breast cancer, and the association to irradiated lung volume and dose. Breast Cancer Res Treat. 2001;68(3):199-210.
• [8] Darby SC, Ewertz M, Mcgale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368(11):987-998.