IJMPCERO  Vol.2 No.4 , November 2013
Dosimetric Analysis of Prone Breast Treatment in Tomotherapy and Conventional Linear Accelerator
ABSTRACT

Purpose: To evaluate planning quality and dosimetric differences of clinically deliverable 3D conformal plans generated from Tomotherapy with TomoDirectTM (TD) and conventional field-in-field approach in prone breast treatment. Materials and methods: Total of twelve randomly selected early stage left breast patients who went through lumpectomy and were previously treated on traditional Linear Accelerator (LINAC) have been re-planned and tested on Tomotherapy TomoDirect module. Baseline prescription dose was chosen at 50.4 Gy (1.8 Gy × 28 fractions) to cover ≥95% of PTV for planning criteria with other critical structure dose constraints in the thoracic region. Planning outcomes such as D95 (95% of volume of PTV receiving the prescribed dose), D5 and D1, heart, both lungs as well as the contralateral breast were simultaneously evaluated. Conformity of the prescription isodose/volume to PTV was evaluated as conformity index (CI) and dose uniformity was also evaluated with homogeneity index (HI) in the same study series. All outcome parameters were analyzed and summarized to evaluate dosimetric impact of planning qualities between these two planning platforms. Results: The planning results indicate that CI, HI, D95, D5 and D1 of PTV, critical structures such as heart, ipsilateral and contralateral lungs as well as contralateral breast doses were comparable but with better overall statistical end points from TD plans. The D95, D5 and D1 of PTV for TD plans were superior in dosimetric analysis and more uniform than those plans generated from PinnacleTM field-in-field planning technique. Overall, TD plans have superior planning quality than the conventional method does, with straightforward and automated planning process once the beam delivery parameters were established. Conclusions: From the clinical treatment planning results, plans from TD in general achieved better uniform tumor coverage with fewer hot spots while sparing more critical structures were based upon isodose distribution and Dose Volume Histogram (DVH) analysis. Image guidance of TD delivery automates the setup within the treatment bore without tedious verification process compared to the process with LINAC. Though all plans are deliverable, TD planning possesses dosimetric advantages due to its modulated optimization pattern. However, TD did present a challenge during the simulation if a patient is oversized with long pendulant breast which is hard to fit into the Tomotherapy ring structure. From our analysis, TD plans reserve superior dosimetric outcome with CI, HI, D95, D5, and D1 of PTV, and better sparing contralateral lung and breast doses.


Cite this paper
C. Jack Yang, Z. Hu, Y. Chen and J. Qiu, "Dosimetric Analysis of Prone Breast Treatment in Tomotherapy and Conventional Linear Accelerator," International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Vol. 2 No. 4, 2013, pp. 161-168. doi: 10.4236/ijmpcero.2013.24021.
References
[1]   L. Beloqui and J. M. Usategui, M. Clarke, R. Collins, S. Darby, C. Davies, P. Elphinstone, E. Evans, J. Goodwin, R. Gray, C. Hicks, C. James, E. MacKinnon, P. McGale, T. McHugh, R. Peto, C. Taylor and Y. Wang, “Effects of Radiotherapy and of Differences in the Extent of Surgery for Early Breast Cancer on Local Recurrence and 15-Year Survival: An Overview of the Randomized Trials,” Lancet, Vol. 366, No. 9503, 2005, pp. 2087-2106.

[2]   S. Pierce, A. Recht, T. Lingos and Noname, “Long-Term Radiation Complications Following Conservative Surgery (CS) and Radiation Therapy (RT) in Patients with Early Stage Breast Cancer,” International Journal of Radiation Oncology*Biology*Physics, Vol. 23, No. 5, 1992, pp. 915-923.
http://dx.doi.org/10.1016/0360-3016(92)90895-O

[3]   L. Marks, X. Yu, R. Prosnitz, S. Zhou, P. Hardenbergy, M. Blazing, D. Hollis, P. Lind, A. Tisch, T. Wong and S. Borges-Neto, “The Incidence and Functional Consequences of RT-Associated Cardiac Perfusion Defects,” International Journal of Radiation Oncology*Biology* Physics, Vol. 63, No. 1, 2005, pp. 214-223.

[4]   S. Das, A. Baydush, S. Zhou, M. Miften, X. Yu, O. Craciunescu, M. Oldham, K. Light, T. Wong, M. Blazing, S. Borges-Neto, M. Dewhirst and L. Marks, “Predicting Radiotherapy-Induced Cardiac Perfusion Defects,” Medical Physics, Vol. 32, No. 1, 2005, pp. 19-27.
http://dx.doi.org/10.1118/1.1823571

[5]   J. Gray, B. McCormick, L. Cox and J. Yahalom, “Primary Breast Irradiationin Large-Breasted or Heavy Women: Analysis of Cosmetic Outcome,” International Journal of Radiation Oncology*Biology*Physics, Vol. 21, No. 2, 1991, pp. 347-354.
http://dx.doi.org/10.1016/0360-3016(91)90781-X

[6]   D. Clarke, A. Martinez and R. Cox, “Analysis of Cosmetic Results and Complications in Patients with Stage I and II Breast Cancer Treated by Biopsy and Irradiation,” International Journal of Radiation Oncology*Biology*Physics, Vol. 9, No. 12, 1983, pp. 1807-1813.
http://dx.doi.org/10.1016/0360-3016(83)90348-6

[7]   A. Grann, B. McCormick, E. Chabner, S. Gollamudi, K. Schupak, B. Mychalczak, A. Heerdt, T. Merchant and M. Hunt, “Prone Breast Radiotherapy in Early-Stage Breast Cancer: A Preliminary Analysis,” International Journal of Radiation Oncology*Biology*Physics, Vol. 47, No. 2, 2000, pp. 319-325.
http://dx.doi.org/10.1016/S0360-3016(00)00448-X

[8]   K. Goodman, L. Hong, R. Wagman, M. Hunt and B. McCormick, “Dosimetric Analysis of a Simplified Intensity Modulation Technique for Prone Breast Radiotherapy,” International Journal of Radiation Oncology*Biology* Physics, Vol. 60, No. 1, 2004, pp. 95-102.
http://dx.doi.org/10.1016/j.ijrobp.2004.02.016

[9]   L. Kestin, M. Sharpe and R. Frazier, “Intensity Modulation to Improve Dose Uniformity with Tangential Breast Radiotherapy: Initial Clinical Experience,” International Journal of Radiation Oncology*Biology* Physics, Vol. 48, No. 5, 2000, pp. 1559-1568.
http://dx.doi.org/10.1016/S0360-3016(00)01396-1

[10]   Y. Lo, G. Yasuda and T. Fitzgerald, “Intensity Modualiton for Breast Treatment Using Static Multi-Leaf Collimators,” International Journal of Radiation Oncology*Biology*Physics, Vol. 46, No. 1, 2000, pp. 187-194.
http://dx.doi.org/10.1016/S0360-3016(99)00382-X

[11]   B. Smith, I. Pan, Y. Shih, G. Smith, J. Harris, R. Punglia, L. Pierce, R. Jagsi, J. Hayman, S. Giordano and T. Buchholz, “Adoption of Intensity-Modulated Radiation Therapy for Breast Cancer in the United States,” Journal of the National Cancer Institute, Vol. 103, No. 10, 2011, pp. 798-809. http://dx.doi.org/10.1093/jnci/djr100

[12]   V. Croog, A. Wu, B. McCormick and K. Beal, “Accelerated Whole Breast Irradiation with Intensity-Modulated Radiotherapy to the Prone Breast,” International Journal of Radiation Oncology*Biology*Physics, Vol. 73, No. 1, 2009, pp. 88-93.
http://dx.doi.org/10.1016/j.ijrobp.2008.04.036

[13]   L. Stegman, K. Beal, M. Hunt, M. Fornier and B. McCormick, “Long-Term Clinical Outcomes of Whole-Breast Irradiation Delivered in the Prone Position,” International Journal of Radiation Oncology*Biology*Physics, Vol. 68, No. 1, 2007, pp. 73-81.

[14]   M. Alonso-Basanta, J. Ko, M. Badcock, K. DeWyngaert and S. Formenti, “Coverage of Axillary Lymph Nodes in Supine vs. Prone Breast Radiotherapy,” International Journal of Radiation Oncology*Biology*Physics, Vol. 73, No. 3, 2009, pp. 745-751.
http://dx.doi.org/10.1016/j.ijrobp.2008.04.040

[15]   K. DeWyngaert, G. Jozsef, J. Mitchell, B. Rosenstein and S. Formenti, “Accelerated Intensity-Modulated Radiotherapy to Breast in Prone Position: Dosimetric Results,” International Journal of Radiation Oncology*Biology* Physics, Vol. 68, No. 4, 2007, pp. 1251-1259.
http://dx.doi.org/10.1016/j.ijrobp.2007.04.018

[16]   B. Wen, H. Hsu, G. Formenti-Ujlaki, S. Lymberis, C. Magnolfi, X. Zhao, J. Chang, K. DeWyngaert, G. Jozsef and S. Formenti, “Prone Accelerated Partial Breast Irradiation after Breast-Conserving Surgery: Compliance to the Dosimetry Requirement of RTOG-0413,” International Journal of Radiation Oncology*Biology* Physics, Vol. 84, No. 4, 2012, pp. 910-916.
http://dx.doi.org/10.1016/j.ijrobp.2012.01.055

[17]   C. Stella, J. Lymberis, K. DeWyngaert, A. Parhar, A. Chhabra, M. Fenton-Kerimian, J. Chang, T. Hochman, A. Guth, D. Roses, J. Goldberg and S. Formenti, “Prospective Assessemnt of Optimal Individual Position (Prone versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlation in 100 Patients,” International Journal of Radiation Oncology*Biology*Physics, Vol. 84, No. 4, 2012, pp. 902-909.
http://dx.doi.org/10.1016/j.ijrobp.2012.01.040

[18]   S. Formenti, M. Truong, J. Goldberg, V. Mukhi, B. Rosenstein, D. Roses, R. Shapiro, A. Guth and K. DeWyngaert, “Prone Accelerated Partial Breast Irradiation after Breast-Conserving Surgery: Preliminary Clinical Resutls and Dose-Volume Histogram Analysis,” International Journal of Radiation Oncology*Biology*Physics, Vol. 60, No. 2, 2004, pp. 493-504.
http://dx.doi.org/10.1016/j.ijrobp.2004.04.036

[19]   R. Patel, A. Becker, R. Das and T. Mackie, “A Dosimetric Comparison of Accelerated Partial Breast Irradiation Techniques: Multicatheter Interstitial Brachytherapy, Three-Dimensional Conformal Radiotherapy, and Supine versus Prone Helical Tomotherapy,” International Journal of Radiation Oncology*Biology*Physics, Vol. 68, No. 3, 2007, pp. 935-942.
http://dx.doi.org/10.1016/j.ijrobp.2007.03.005

[20]   A. Coon, A. Dickler, M. Kirk, Y. Liao, A. Shah, J. Strauss, S. Chen, J. Turian and K. Griem, “Tomotherapy and Multifield Intensity-Modulated Radiotherapy Planning Reduce Cardiac Doses in Left-Sided Breast Cancer Patients with Unfavorable Cardiac Anatomy,” International Journal of Radiation Oncology*Biology*Physics, Vol. 78, No. 1, 2010, pp. 104-110.
http://dx.doi.org/10.1016/j.ijrobp.2009.07.1705

[21]   Y. Rong, T. Fahner and J. Welsh, “Hypofractionated Breast and Chest Wall Irradiation Using Simultaneous In-Field Boost IMRT Delivered via Helical Tomotherapy,” Technology in Cancer Research and Treatment, Vol. 7, No. 6, 2008, pp. 433-439.

[22]   T. Reynders, K. Tournel, P. De Coninck, S. Heymann, V. Vinh-Hung, H. Van Parijs, M. Duchateau, N. Linthout, T. Gevaert, D. Verellen and G. Storme, “Dosimetric Assessment of Static and Helical Tomo Therapy in the Clinical Implementation of Breast Cancer Treatments,” Radiotherapy & Oncology, Vol. 93, No. 1, 2009, pp. 71-79.
http://dx.doi.org/10.1016/j.radonc.2009.07.005

[23]   L. Feuvret, G. Noel, J. Mazeron and P. Bey, “Conformity Index: A Review,” International Journal of Radiation Oncology*Biology*Physics, Vol. 64, No. 2, 2006, pp. 333-342. http://dx.doi.org/10.1016/j.ijrobp.2005.09.028

 
 
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