Skip to main content

Four-dimensional computed tomography in accelerated partial breast irradiation planning: single series from a phase III trial

La radiologia medica volume 120, pages 1078–1082 (2015)Cite this article

Abstract

Purpose

The aim of our study was to evaluate the usefulness of the four-dimensional computed tomography (4DCT) in accelerated partial breast irradiation (aPBI) planning.

Materials and methods

At our Institute, we have been treating the index quadrant with external intensity-modulated radiation therapy in a phase III trial. For this study, we selected a sample of 10 patients with right- or left-sided breast cancer and surgical clips at the excision site. Contouring of the target was performed both using three-dimensional computed tomography (3DCT) and 4DCT imaging. On both 3DCT and 4DCT, we recorded the clinical target volume (CTV) and the planning target volume (PTV) and the coordinates of the PTV centroid. We calculated the treatment plans, according to our protocol, using the contours drawn on the 3DCT and 4DCT and evaluated target coverage and sparing of organs at risk (OAR).

Results

Median age of the patients was 63.5 years (range 52–75). The comparison between the 3DCT and 4DCT PTV volumes was not statistically significant (p = 0.79). Concerning centroid coordinates, the average absolute differences were 0.1 mm in the latero-lateral, 0.7 mm in the antero-posterior and 0.3 mm in the supero-inferior direction. No statistically significant differences were observed both in PTV coverage and OAR sparing; the 4D PTV contour is adequately covered when the plan based on the 3D contours is used. Target coverage was reduced on average by 1 % and no statistically significant difference was observed (p = 0.93).

Conclusions

In our experience, no significant differences between PTV volumes, PTV coverage, OAR sparing and centroid position are evidenced when comparing 3DCT and 4DCT plans. Conventional 3DCT-based planning is adequate for aPBI.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Hartford AC, Galvin JM, Beyer DC, American College of Radiology, American Society for Radiation Oncology et al (2012) American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) practice guideline for intensity-modulated radiation therapy (IMRT). Am J Clin Oncol 35:612–617

    Article  PubMed  Google Scholar 

  2. Marta GN, Silva V, de Andrade Carvalho H et al (2014) Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Radiother Oncol 110:9–15

    Article  PubMed  Google Scholar 

  3. Dayes I, Rumble RB, Bowen J, Members of the IMRT Indications Expert Panel et al (2012) Intensity-modulated radiotherapy in the treatment of breast cancer. Clin Oncol 24:488–498

    CAS  Article  Google Scholar 

  4. Franceschini D, Paiar F, Meattini I et al (2013) Simultaneous integrated boost-intensity-modulated radiotherapy in head and neck cancer. Laryngoscope 123:E97–103

    Article  PubMed  Google Scholar 

  5. Keall P (2004) 4-dimensional computed tomography imaging and treatment planning. Semin Radiat Oncol 14:81–90

    Article  PubMed  Google Scholar 

  6. Bedi C, Kron T, Willis D et al (2011) Comparison of radiotherapy treatment plans for left-sided breast cancer patients based on three- and four-dimensional computed tomography imaging. Clin Oncol 23:601–607

    CAS  Article  Google Scholar 

  7. Richter A, Sweeney R, Baier K et al (2009) Effect of breathing motion in radiotherapy of breast cancer: 4D dose calculation and motion tracking via EPID. Strahlenther Onkol 185:425–430

    Article  PubMed  Google Scholar 

  8. Livi L, Meattini I, Marrazzo L et al (2015) Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer 51:451–463

    Article  PubMed  Google Scholar 

  9. Chen GT, Kung JH, Rietzel E (2007) Four-dimensional imaging and treatment planning of moving targets. Front Radiat Ther Oncol 40:59–71

    Article  PubMed  Google Scholar 

  10. Tanaka H, Hayashi S, Ohtakara K, Hoshi H (2014) Impact of respiratory motion on breast tangential radiotherapy using the field-in-field technique compared to irradiation using physical wedges. Radiol Oncol 48:94–98

    PubMed Central  Article  PubMed  Google Scholar 

  11. Liao ZW, Guan XX, Li FY et al (2010) Accelerated partial breast irradiation: use of four-dimensional CT for target localization and assessment of intrafractional motion. Oncol Res 18:503–507

    Article  PubMed  Google Scholar 

  12. Vicini FA, Kestin LL, Goldstein NS (2004) Defining the clinical target volume for patients with early-stage breast cancer treated with lumpectomy and accelerated partial breast irradiation: a pathologic analysis. Int J Radiat Oncol Biol Phys 60:722–730

    Article  PubMed  Google Scholar 

  13. Faverly DR, Hendriks JH, Holland R (2001) Breast carcinomas of limited extent: frequency, radiologic–pathologic characteristics, and surgical margin requirements. Cancer 91:647–659

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgments

Preliminary data of this analysis were presented during ESTRO Congress 31 (Barcelona, Spain; 9-13 May, 2012) as selected poster (Meattini I, Marrazzo L, Livi L et al. 4-dimensional computed tomography in accelerated partial breast irradiation planning. Radiotherapy and Oncology. Volume 103, Supplement 1, Page S305, May 2012).

Conflict of interest

The authors declare no conflict of interest.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Author information

Affiliations

  1. Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy

    Icro Meattini, Fabiola Paiar, Gabriele Simontacchi & Lorenzo Livi

  2. Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Livia Marrazzo, Stefania Pallotta & Marta Bucciolini

  3. University of Florence, Florence, Italy

    Margherita Zani, Stefania Pallotta, Marta Bucciolini & Lorenzo Livi

Authors
  1. Icro Meattini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Livia Marrazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Margherita Zani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabiola Paiar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefania Pallotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gabriele Simontacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marta Bucciolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lorenzo Livi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Icro Meattini.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Meattini, I., Marrazzo, L., Zani, M. et al. Four-dimensional computed tomography in accelerated partial breast irradiation planning: single series from a phase III trial. Radiol med 120, 1078–1082 (2015). https://doi.org/10.1007/s11547-015-0541-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-015-0541-1

Keywords

  • Partial breast irradiation
  • Four-dimensional computed tomography
  • IMRT
  • Breathing motion
  • Breast cancer