Accelerated Partial Breast Irradiation: What is Dosimetric Effect of Advanced Technology Approaches?

• Published in: International journal of radiation oncology, biology, physics Vol. 75; no. 1; pp. 294 - 301
• Main Authors: Moran, Jean M., Ph.D, Ben-David, Merav A., M.D, Marsh, Robin B., C.M.D, Balter, James M., Ph.D, Griffith, Kent A., M.P.H., M.S, Hayman, James A., M.D, Pierce, Lori J., M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2009
• Subjects: active breathing control; ARTERIES; breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Carcinoma in Situ - diagnostic imaging; Carcinoma in Situ - pathology; Carcinoma in Situ - radiotherapy; Carcinoma in Situ - surgery; Carcinoma, Ductal, Breast - diagnostic imaging; Carcinoma, Ductal, Breast - pathology; Carcinoma, Ductal, Breast - radiotherapy; Carcinoma, Ductal, Breast - surgery; COMPUTERIZED TOMOGRAPHY; Coronary Vessels - radiation effects; Female; HEART; Heart - radiation effects; Hematology, Oncology and Palliative Medicine; Humans; IRRADIATION; Lung - radiation effects; MAMMARY GLANDS; Mastectomy, Segmental; Movement; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSES; Radiation Injuries - prevention & control; Radiation planning; Radiography; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Conformal - methods; Radiotherapy, Intensity-Modulated - methods; RESPIRATION; Respiratory Mechanics; respiratory motion; Tumor Burden; breast cancer; Radiation planning; heart; respiratory motion; active breathing control
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.03.043

Purpose The present treatment planning study compared whole breast radiotherapy (WBRT) to accelerated partial breast irradiation (APBI) for different external beam techniques and geometries ( e.g., free breathing [FB] and deep inspiration breath hold [DIBH]). Methods and Materials After approval by our institutional review board, a treatment planning study was performed of 10 patients with left-sided Stage 0-I breast cancer enrolled in a Phase I-II study of APBI using intensity-modulated radiotherapy (IMRT). After lumpectomy, patients underwent planning computed tomography scans during FB and using an active breathing control device at DIBH. For the FB geometry, standard WBRT and three-dimensional conformal radiotherapy (3D-CRT) APBI plans were created. For the DIBH geometry with active breathing control, WBRT, 3D-CRT, and IMRT APBI plans were created. Results All APBI techniques had excellent planning target volume coverage. The maximal planning target volume dose was reduced from 116% of the prescription dose to 108% with the IMRT(DIBH) APBI plan. The maximal heart dose was >30 Gy for the WBRT techniques, 8.2 Gy for 3D-CRT(FB), and <5.0 Gy for 3D-CRT(DIBH) and IMRT(DIBH) techniques. The mean left anterior descending artery dose was significantly reduced from 11.4 Gy with WBRT(FB) to 4.2 with WBRT(DIBH) and <2.0 Gy with all APBI techniques. Conclusion Although planning target volume coverage was acceptable with all techniques, the plans using the DIBH geometry resulted in a marked reduction in the normal tissue dose compared with WBRT planned in the absence of cardiac blocking. Additional study is needed to determine whether these techniques result in clinical benefits.