Abstract
Purpose
This study evaluated dose distribution and homogeneity of field-in-field intensity-modulated radiation treatment (FIF-IMRT) compared with standard wedged tangential-beam 3D conformal radiotherapy (CRT) of the left breast in patients who have undergone lumpectomy. Our aim was to improve dose-distribution homogeneity in the breast and decrease the dose to organs at risk (OAR), i.e, heart and vessels, ipsilateral lung, and contralateral breast.
Materials and methods
FIF-IMRT and wedge plans of 3D-CRT were carried out for 18 patients with cancer of the left breast. Plans were compared according to cumulative dose-volume histogram (c-DVH) analysis in terms of planned treatment volume (PTV), homogeneity index (HI), and conformity index (CI), as well as dose and volume parameters of OARs.
Results
When the targeted volumes receiving 105 % and 110 % of the prescribed dose in the PTV were compared, significant decreases were found with the FIF-IMRT technique. With the 105 % dose to the OARs, monitor unit (MU) counts were significantly lower with the FIF-IMRT technique. V2 of pulmonary artery, left atrium, and aorta and V1 for the contralateral breast were statistically significantly lower with FIF-IMRT plans (p = 0.001). PTV showed a better HI and CI with FIF-IMRT.
Conclusions
FIF-IMRT enables better dose distribution in the PTV and reduces dose to OARs in breast cancer radiotherapy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Habermann EB, Abbott A, Parsons HM, Virnig BA, Al-Refaie WB, Tuttle TM. Are mastectomy rates really increasing in the United States? J Clin Oncol. 2010;28(21):3437–41.
Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. 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 randomised trials. Lancet. 2005;366(9503):2087–106.
Giordano SH, Kuo YF, Freeman JL, Buchholz TA, Hortobagyi GN, Goodwin JS. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst. 2005;97(6):419–24.
Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, Harris EE. Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol. 2007;25(21):3031–7.
Gao X, Fisher SG, Emami B. Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: a population-based study. Int J Radiat Oncol Biol Phys. 2003;56:1038–45.
Beckham WA, Popescu CC, Patenaude VV, Wai ES, Olivotto IA. Is multibeam IMRT better than standard treatment for patients with left-sided breast cancer? Int J Radiat Oncol Biol Phys. 2007;69(3):918–24.
Burmeister J, Alvarado N, Way S, McDermott P, Bossenberger T, Jaenisch H, et al. Assessment and minimization of contralateral breast dose for conventional and intensity modulated breast radiotherapy. Med Dosim. 2008;33(1):6–13.
Moody AM, Mayles WPM, Bılls JM. The influence of breast size on late radiation effects and association with radiotherapy doseinhomogenity. Radiother Oncol. 1994;33:106–12.
Neal AJ, Torr M, Helyer S, Yarnold JR. Correlation of breast heterogenity with breast size using 3D CT planing and dose volume histograms. Radiother Oncol. 1995;34:210–8.
Zablotska LB, Neugut AI. Lung carcinoma after radiation therapy in women treated with lumpectomy or mastectomy for primary breast carcinoma. Cancer. 2003;97(6):1404–11.
Prochazka M, Granath F, Ekbom A, Shields PG, Hall P. Lung cancer risks in women with previous breast cancer. Eur J Cancer. 2002;38(11):1520–5.
Galper S, Gelman R, Recht A, Silver B, Kohli A, Wong JS, et al. Second nonbreast malignancies after conservative surgery and radiation therapy for early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2002;52(2):406–14.
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.
Roychoudhuri R, Evans H, Robinson D, Moller H. Radiation-induced malignancies following radiotherapy for breast cancer. Br J Cancer. 2004;91(5):868–72.
Muren LP, Maurstad G, Hafslund R, Anker G, Dahl O. Cardiac and pulmonary doses and complication probabilities in standard and conformal tangential irradiation in conservative management of breast cancer. Radiother Oncol. 2002;62(2):173–83.
Herrick JS, Neil CJ, Rosser PF. A comprehensive clinical 3-dimensional dosimetric analysis of forward planned techniques for intact breast radiotherapy. Med Dosim. 2008;33:62–70.
Ercan Tülay, Igdem Sefik, Alco Gül, Zengin Funda. Dosimetric comparison of field in field intensity-modulated radiotherapy technique with conformal radiotherapy techniques in breast cancer. Jpn J Radiol. 2010;28:283–9.
Selveraj RN, Beriwal S, Pourarian RJ, Lalonde RJ. Clinical implementation of tangential field intensity modulated radiation therapy using sliding window technique and dosimetric comparison with 3D conformal therapy in breast cancer. Med Dosim. 2007;32:299–304.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Baycan, D., Karacetin, D., Balkanay, A.Y. et al. Field-in-field IMRT versus 3D-CRT of the breast. Cardiac vessels, ipsilateral lung, and contralateral breast absorbed doses in patients with left-sided lumpectomy: a dosimetric comparison. Jpn J Radiol 30, 819–823 (2012). https://doi.org/10.1007/s11604-012-0126-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-012-0126-z