Back
 ABCR  Vol.10 No.3 , July 2021
Optimizing Adjuvant Radiation Planning Outcomes in Patients with Synchronous Bilateral Breast Cancer
Abstract: Background: Breast cancer is the most common cancer diagnosed worldwide, synchronous bilateral breast cancer accounts for unique entity of the disease, particularly post-operative radiotherapy for Synchronous Bilateral Breast Cancer (SBBC) is challenging with lack of evidence about the best irradiation technique. In this study, we tried to explore the optimum radiotherapy technique regarding the dosimetric parameters. Methods: We recruited 15 SBBC patients in whom post-operative radiotherapy was indicated and we established three plans for each patient using 3DCRT, IMRT and VMAT, and then we compared the three plans as regard target volume coverage parameters and organs at risk (OAR) doses. Results: We found that PTV coverage parameter was superior with IMRT compared with 3DCRT and VMAT in terms of Dmean (p = 0.001), D95% (p = 0.001), Dmax (p = 0.0001), conformity index (p = 0.0001) and HI (p = 0.0001). Doses to OAR were not significantly different between the three techniques in cardiac dose and LAD maximum dose, but 3DCRT was superior in LAD mean dose (p = 0.03) and lung volume receiving 20 Gy (V20) and 10 Gy (V10) (p = 0.0001), but this difference was non-significant between 3DCRT and IMRT (p = 0.4 and 0.06 respectively), while VMAT led to the highest doses to LAD and lung. Conclusions: IMRT showed the best target coverage parameters in post-operative radiotherapy for SBBC compared with 3DCRT and VMAT. For OAR doses IMRT showed comparable results with 3DCRT, while VMAT delivered a significantly higher dose to OAR.
Cite this paper: Alhefny, M. , Attallah, H. , Abdallah, M. , Yassin, A. , El-Shahat, K. and Obaya, A. (2021) Optimizing Adjuvant Radiation Planning Outcomes in Patients with Synchronous Bilateral Breast Cancer. Advances in Breast Cancer Research, 10, 110-119. doi: 10.4236/abcr.2021.103009.
References

[1]   Cho, Y., Cho, Y.J., Chang, W.S., Kim, J.W., Choi, W.H. and Lee, I.J. (2019) Evaluation of Optimal Treatment Planning for Radiotherapy of Synchronous Bilateral Breast Cancer Including Regional Lymph Node Irradiation. Radiation Oncology, 14, 1-8.
https://doi.org/10.1186/s13014-019-1257-5

[2]   Jobsen, J.J., van der Palen, J., Ong, F., Riemersma, S. and Struikmans, H. (2015) Bilateral Breast Cancer, Synchronous and Metachronous; Differences and Outcome. Breast Cancer Research and Treatment, 153, 277-283.
https://link.springer.com/article/10.1007/s10549-015-3538-5
https://doi.org/10.1007/s10549-015-3538-5

[3]   Kheirelseid, E.A.H., Jumustafa, H., Miller, N., Curran, C., Sweeney, K., Malone, C., et al. (2011) Bilateral Breast Cancer: Analysis of Incidence, Outcome, Survival and Disease Characteristics. Breast Cancer Research and Treatment, 126, 131-140.
https://pubmed.ncbi.nlm.nih.gov/20665107/
https://doi.org/10.1007/s10549-010-1057-y

[4]   Kim, S.J., Lee, M.J. and Youn, S.M. (2018) Radiation Therapy of Synchronous Bilateral Breast Carcinoma (SBBC) Using Multiple Techniques. Medical Dosimetry, 43, 55-68.
https://pubmed.ncbi.nlm.nih.gov/28988893/
https://doi.org/10.1016/j.meddos.2017.08.003

[5]   Balaji Subramanian, S., Balaji, K., Thirunavukarasu, M. and Premkumar, S. (2016) Bilateral Breast Irradiation Using Hybrid Volumetric Modulated Arc Therapy (h-VMAT) Technique: A Planning Case Report. Cureus, 8, e914.
https://doi.org/10.7759/cureus.914

[6]   White, J., Tai, A., Arthur, D., Buchholz, T., Macdonald, S., Marks, L., et al. (2009) Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions Collaborators. Breast Cancer Atlas for Radiation Therapy Planning, 73, 944-951.
https://www.rtog.org

[7]   Bentzen, S.M., Constine, L.S., Deasy, J.O., Eisbruch, A., Jackson, A., Marks, L.B., et al. (2010) Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An Introduction to the Scientific Issues. International Journal of Radiation Oncology, Biology, Physics, 76, S3.
https://doi.org/10.1016/j.ijrobp.2009.09.040

[8]   Radiation Oncology/Toxicity/RTOG-Wikibooks, Open Books for an Open World [Internet].
https://en.wikibooks.org/wiki/Radiation_Oncology/Toxicity/RTOG

[9]   Fiorentino, A., Mazzola, R., Naccarato, S., Giaj-Levra, N., Fersino, S., Sicignano, G., et al. (2017) Synchronous Bilateral Breast Cancer Irradiation: Clinical and Dosimetrical Issues Using Volumetric Modulated Arc Therapy and Simultaneous Integrated Boost. Radiologia Medica, 122, 464-471.
https://doi.org/10.1007/s11547-017-0741-y

[10]   Nicolini, G., Clivio, A., Fogliata, A., Vanetti, E. and Cozzi, L. (2009) Simultaneous Integrated Boost Radiotherapy for Bilateral Breast: A Treatment Planning and Dosimetric Comparison for Volumetric Modulated Arc and Fixed Field Intensity Modulated Therapy. Radiation Oncology, 4, 1-12.
https://doi.org/10.1186/1748-717X-4-27

 
 
Top