Evaluation of Fractionation Schemes in Breast Cancer Radiotherapy and Dosimetric Study of the Main Organs at Risk

Maria Rodrigues; Pedro Teles; Rui Pirraco; Diana Oliveira; Paulo S. Costa

doi:10.15392/bjrs.v10i1.1746

Autores/as

Maria Rodrigues University of Lisbon
Pedro Teles 1- Departamento de Física e Astronomia da Faculdade de Ciências da Universidade do Porto 2 - Instituto Português de Oncologia do Porto Francisco Gentil, EPE (IPO-Porto)
Rui Pirraco Júlio Teixeira, S.A.
Diana Oliveira Júlio Teixeira, S.A.
Paulo S. Costa Júlio Teixeira, S.A.

DOI:

https://doi.org/10.15392/bjrs.v10i1.1746

Palabras clave:

External radiotherapy, breast cancer, fractionation, tolerance criteria, organs at risk, radiation protection

Resumen

The purpose of this work was to evaluate the impact of different breast cancer radiotherapy regimens on the acceptance of the tolerance criteria of the main organs at risk, the heart, and the ipsilateral lung.

In this context, the dosimetric treatment plans of 20 breast cancer patients treated at the Radiotherapy Service of Braga Hospital were analyzed. The treatment planning system was the XiO (Elekta) and the dosimetric treatment plans were performed using with 3D-CRT technique (three-dimensional conformal radiation therapy) and the pencil beam algorithm for photon dose calculation.

Two approaches to estimate the equivalence of different radiotherapy schedules have been proposed, the equivalent dose at 2Gy per fraction model and the biologically effective dose model. These models showed that the conventional radiotherapy course to 50Gy in 25 daily fractions is clinically equivalent to the hypofractionation course to 42,56Gy in 16 daily fractions.

Obtained results showed that the tolerance criteria for the organs at risk, the heart and the ipsilateral lung, referring to the hypofractionation course to 42,56Gy in 16 daily fractions, are more restrictive than the tolerance criteria of conventional regimen. This means that if the same setup and the same dose coverage in the planning target-volume are used, the tolerance criteria for the organs at risk of hypofractionation regiment are more difficult to attain.

These results can assist radiation oncologists in the evaluation of radiotherapy prescription doses for breast cancer, in compliance with the principles of radiation protection.

Descargas

Los datos de descarga aún no están disponibles.

Biografía del autor/a

Maria Rodrigues, University of Lisbon

Técnica Superiora em Júlio Teixeira, S.A.
Pedro Teles, 1- Departamento de Física e Astronomia da Faculdade de Ciências da Universidade do Porto 2 - Instituto Português de Oncologia do Porto Francisco Gentil, EPE (IPO-Porto)

Professor Auxiliar (Assistant Professor) no Departamento de Fìsica e Astronomia e Diretor do curso Mestrado em Física Médica do mesmo departamento.
Rui Pirraco, Júlio Teixeira, S.A.

Coordenador da Fìsica Médica em Júlio Teixeira, S.A.
Diana Oliveira, Júlio Teixeira, S.A.

Técnica Superiora em Júlio Teixeira, S.A.
Paulo S. Costa, Júlio Teixeira, S.A.

Coordenador Clínico da Radioncologia em Júlio Teixeira, S.A.

Referencias

CHEN, G.P.; LIU F.; et al. A Planning comparison of 7 irradiation Options Allowed in RTOG 1005 for Early-Stage Breast Cancer. Medical Dosimetry. v. 40, pp. 21-25, 2014.

APPELT A.L.; VOGELIUS I.R.; et al. Modern Hypofractionation Schedules for Tangential Whole Breast Irradiation Decrease the Fraction Size-corrected Dose to the Heart. Clinical Oncology. v. 25, pp 147-152, 2013.

JONES B.; DALE R.G.; et al. The Role of Biologically Effective Dose (BED) in Clinical Oncology. Clinical Oncology. v. 13, pp 71–81, 2001.

KOULOULIAS, V.E.; ZYGOGIANNI, A.G. Hypofractionated Radiotherapy for Breast Cancer: too fast or too much?. Translational Cancer Research. v. 5, pp 688-693, 2016.

WHELAN T.J.; PIGNOL J.P.; et al. Long-term Results of Hypofractionated Radiation Therapy for Breast Cancer. New England Journal of Medicine. v. 362, pp 513–520, 2010.

TAYLOR, C.; CORREA, C.; et al. Estimating the Risks of Breast Cancer Radiotherapy: Evidence from Modern Radiation Doses to the Lungs and Heart and from Previous Randomized Trials. Journal of Clinical Oncology. v. 35, pp 1641-1649, 2017.

SOUMAROVÁ, R.; RUSINOVÁ, L. Cardiotoxicity of Breast Cancer Radiotherapy – Overview of Current Results. Reports of Practical Oncology and Radiotherapy. v. 25, pp 182-186, 2019.

MOSAIQ brochure (visited 29/07/21) https://www.elekta.com/dam/jcr:d79cff58-91ce-4d4c-b27d-472dc38da371/MOSAIQ-RO-brochure.pdf

SHARON QI, X.; WHITE, J; et al. Is α/β for Breast Cancer Really Low?. Radiotherapy and Oncology. v. 100, pp 282–288, 2011.

VASSILIS, K.; IOANNIS, G.; et al. A Unique Hypofractionated Radiotherapy Schedule with 51.3Gy in 18 Fractions Three Times per Week for Early Breast Cancer: Outcomes Including Local Control, Acute and Late Skin Toxicity. Breast Cancer. v. 24, pp 263-270, 2017.

XiO brochure (visited 29/07/21) https://www.elekta.com/dam/jcr:b3948f4a-0ac8-4317-9b89-41178a44a670/XiO-Comprehensive-RTP-System-product-brochure.pdf

BEATOM, L.; BERGMAN, A.; et al. Cardiac Death after Breast Radiotherapy and the QUANTEC Cardiac Guidelines. Clinical and Translational Radiation Oncology. v. 19, pp 39–45, 2019.

ZEVERINO, M.; PETERSSON, K.; et al. A Treatment Planning Comparison of Contemporary Photon-based Radiation Techniques for Breast Cancer. Physics and Imaging in Radiation Oncology. v. 7, pp 32–38, 2018.

A Phase III Trial of Accelerated Whole Breast Irradiation with Hypofractionation Plus Concurrent Boost Versus Standard :Whole Breast Irradiation Plus Sequential Boost For Early-Stage Breast Cancer. Principal Investigator: VICINI, F. NRG Oncology, GRTOG 1005, 2014.