Purpose: This work evaluates the use of target and organs at risk (OAR) dose-volume
goals in 3D conformal radiotherapy (3DCRT) planning for node positive breast
cancer (NPBC) patients undergoing regional nodal irradiation after
lumpectomy/mastectomy. Methods: Dosimetric data for 262 NPBC
patients receiving regional nodal and whole breast/chest wall (WB/CW) irradiation
from 2000-2009 were analyzed. In all cases, target & OAR volumes were
delineated on treatment CT scans for field generation and dose-volume
histograms (DVHs) were generated. Cases were analyzed to identify how
frequently they met treatment planning institutional dose-volume goals
(“institutional guidelines” & standardized in 2005) and how this would
affect OAR doses. Results: The incidence of cases from 2000-2009
meeting current institutional guidelines improved over the study period. Target
coverage improved from 2005-2009, when guidelines were followed as a part of the
plan approval. Those cases from 2000-2004 meeting acceptable target goals were
found to be significantly different from those cases from 2005-2009 (p < 0.01).
However, no significant difference between cases meeting OAR goals for plans
from 2000-2004 versus 2005-2009 was found. Conclusions: The
use of institutional guidelines in 3DCRT for WB/CW and regional nodal
irradiation for NPBC patients improved target coverage without a statistically
significant increase in heart and lung doses.
References
[1]
White, J., Moughan, J., Pierce, L.J., Morrow, M., Owen, J. and Wilson, J.F. (2004) Status of Postmastectomy Radiotherapy in the United States: A Patterns of Care Study. International Journal of Radiation Oncology * Biology * Physics, 60, 77-85. https://doi.org/10.1016/j.ijrobp.2004.02.035
[2]
Pignol, J., Olivotto, I., Rakovitch, E., Gardner, S., Sixel, K., Beckham, W., Vu, T.T.T., Truong, P., Ackerman, I. and Paszat, L. (2008) A Multicenter Randomized trial of Breast Intensity-Modulated Radiation Therapy to Reduce Acute Radiation Dermatitis. Journal of Clinical Oncology, 26, 2085-2092. https://doi.org/10.1200/JCO.2007.15.2488
[3]
Donovan, E., Bleakley, N., Denholm, E., Evans, P., Gothard, L., Hanson, J., Peckitt, C., Reise, S., Ross, G., Sharp, G., Symonds-Tayler, R., Tait, D. and Yarnold, J. (2007) Randomised Trial of Standard 2D Radiotherapy (RT) versus Intensity Modulated Radiotherapy (IMRT) in Patients Prescribed Breast Radiotherapy. Radiotherapy and Oncology, 82, 254-264. https://doi.org/10.1016/j.radonc.2006.12.008
[4]
Li, X.A., Tai, A., Arthur, D.W., Buchholz, T.A., Macdonald, S., Marks, L.B., Moran, J.M., Pierce, L.J., Rabinovitch, R., Taghian, A., Vicini, F., Woodward, W. and White, J.R. (2009) Variability of Target and Normal Structure Delineation for Breast Cancer Radiotherapy: An RTOG Multi-Institutional and Multiobserver Study. International Journal of Radiation Oncology * Biology * Physics, 73, 944-951. https://doi.org/10.1016/j.ijrobp.2008.10.034 https://doi.org/10.1158/1538-7445.sabcs15-ot2-02-02
[5]
Mamounas, E., Bandos, H., White, J., Julian, T., Khan, A., Shaitelman, S., Torres, M., Vicini, F., Ganz, P., McCloskey, S., Paik, S., Gupta, N., Li, X., DiCostanzo, D., Costantino, J., Curran, W. and Wolmark, N. (2016) Abstract OT2-02-02: NRG Oncology/NSABP B-51/RTOG 1304: A Phase III Clinical Trial to Determine If Chest Wall and Regional Nodal Radiotherapy (CWRNRT) Post Mastectomy (Mx) or the Addition of RNRT to Breast RT Post Breast-Conserving Surgery (BCS) Will Reduce Invasive Cancer Events in Patients (pts) with Positive Axillary (Ax) Nodes Who Are ypN0 after Neoadjuvant Chemotherapy (NC). Cancer Research, 76, OT2-02-02. http://cancerres.aacrjournals.org/content/76/4_Supplement/OT2-02-02
[6]
Sparks, I., Prior, P., Xiang, Q., Li, X.A., Yen, T.W. and White, J.R. (2011) Lymphedema and Arm Symptoms Following Three-Dimensional Conformal Radiation Therapy (3DCRT) for Node-Positive Breast Cancer (BC) Patients. Journal of Clinical Oncology, 29, 130. http://ascopubs.org/doi/abs/10.1200/jco.2011.29.27_suppl.130
[7]
Bradley, J., Prior, P., Sparks, I., Xiang, Q., Santana-Davila, R., Walker, A., Wilson, J., Li, X. and White, J. (2012) P3-13-05: Analysis of Heart Dose-Volume Parameters and Cardiac Events among Node Positive Breast Cancer (NPBC) Patients Treated with Three-Dimensional Conformal Radiation Therapy (3D-CRT). Cancer Research, 71, P3-13-05. http://cancerres.aacrjournals.org/content/71/24_Supplement/P3-13-05
[8]
Krasin, M., McCall, A., King, S., Olson, M. and Emami, B. (2000) Evaluation of a Standard Breast Tangent Technique: A Dose-Volume Analysis of Tangential Irradiation Using Three-Dimensional Tools. International Journal of Radiation Oncology * Biology * Physics, 47, 327-333. https://www.ncbi.nlm.nih.gov/pubmed/10802356 https://doi.org/10.1016/S0360-3016(00)00449-1
[9]
Goodman, R.L., Grann, A., Saracco, P. and Needham, M.F. (2001) The Relationship between Radiation Fields and Regional Lymph Nodes in Carcinoma of the Breast. International Journal of Radiation Oncology * Biology * Physics, 50, 99-105. https://www.ncbi.nlm.nih.gov/pubmed/11316551 https://doi.org/10.1016/S0360-3016(00)01581-9
[10]
Barnett, G.C., Wilkinson, J., Moody, A.M., Wilson, C.B., Sharma, R., Klager, S., Hoole, A.C.F., Twyman, N., Burnet, N.G. and Coles, C.E. (2009) A Randomised Controlled Trial of Forward-Planned Radiotherapy (IMRT) for Early Breast Cancer: Baseline Characteristics and Dosimetry Results. Radiotherapy and Oncology, 92, 34-41. https://doi.org/10.1016/j.radonc.2009.03.003
[11]
Barnett, G.C., Wilkinson, J.S., Moody, A.M., Wilson, C.B., Twyman, N., Wishart, G.C., Burnet, N.G. and Coles, C.E. (2012) Randomized Controlled Trial of Forward-Planned Intensity Modulated Radiotherapy for Early Breast Cancer: Interim Results at 2 Years. International Journal of Radiation Oncology * Biology * Physics, 82, 715-723. https://doi.org/10.1016/j.ijrobp.2010.10.068
[12]
Gagliardi, G., Constine, L.S., Moiseenko, V., Correa, C., Pierce, L.J., Allen, A.M. and Marks, L.B. (2010) Radiation Dose-Volume Effects in the Heart. International Journal of Radiation Oncology * Biology * Physics, 76, S77-S85. https://doi.org/10.1016/j.ijrobp.2009.04.093
