Comparison of Radiotherapy Techniques in Breast Cancer with Inclusion of Internal Mammary Nodes through Thermoluminescent Dosimetry in a RANDO Phantom

Document Type : Original Paper

Authors

1 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran University of Medical Sciences, Mashhad, Iran

3 Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Department of Medical Physics, Reza Radiation Oncology Center, Mashhad, Iran

Abstract

Introduction: In various radiotherapy techniques for breast cancer, the inclusion of internal mammary nodes (IMNs) in the target volume is important for selecting the most appropriate technique. This study aimed to compare three radiotherapy techniques with the inclusion of IMNs regarding the dose homogeneity index (DHI) of regional lymph nodes and the chest wall, besides the dose received by the heart and the left lung.
Material and Methods: Three radiotherapy techniques were planned for CT imaging of the RANDO phantom, including the wide tangent (WT); oblique parasternal photon (OPP); and oblique parasternal electron (OPE) techniques. The doses reaching the contoured organs were compared between the three techniques, using the data gathered from the thermoluminescent dosimetry and treatment planning system.
Results: The OPE technique produced a lower absorbed dose for the left IMNs, compared to the other two techniques. In the OPP technique, the dose received by the left lung was higher than its tolerance, while the lung dose in the OPE technique was slightly lower than the WT technique. The absorbed dose by the heart was the lowest in the WT technique; also, the DHI value was better for this technique than the other two techniques.
Conclusion: The WT technique showed better results regarding the dose homogeneity distribution of IMNs and the chest wall, as well as protection of organs at risk.

Keywords

Main Subjects

References

  1. Tao Z, Shi A, Lu C, Song T, Zhang Z, Zhao J. Breast cancer: epidemiology and etiology. Cell Biochem Biophys. 2015 Jun 1; 72(2):333-8.
  2. Hortobagyi GN. Treatment of breast cancer. N Engl J Med. 1998 Oct 1; 339(14):974-84.
  3. Jagsi R. Postmastectomy radiation therapy: an overview for the practicing surgeon. ISRN surgery. 2013 Sep 11; 212979.
  4. Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989 Mar 30; 320(13):822-8.
  5. Caudrelier J-M, Morgan SC, Montgomery L, Lacelle M, Nyiri B, MacPherson M. Helical tomotherapy for locoregional irradiation including the internal mammary chain in left-sided breast cancer: dosimetric evaluation. Radiother Oncol. 2009 Jan 1; 90(1):99-105.
  6. Zhang Q, Yu XL, Hu WG, Chen JY, Wang JZ, Ye JS, et al. Dosimetric comparison for volumetric modulated arc therapy and intensitymodulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer. Radiol Oncol. 2015 Feb 11; 49(1):91-8.
  7. Beck RE, Kim L, Yue NJ, Haffty BG, Khan AJ, Goyal S. Treatment techniques to reduce cardiac irradiation for breast cancer patients treated with breast-conserving surgery and radiation therapy: a review. Front Oncol. 2014 Nov 14; 4:327.
  8. Niglas M, McCann C, Keller BM, Makhani N, Presutti J, Vesprini D, et al. A dosimetric study of cardiac dose sparing using the reverse semi-decubitus technique for left breast and internal mammary chain irradiation. Radiother Oncol. 2016 Jan 1; 118(1):187-93.
  9. Thorsen LB, Thomsen MS, Berg M, Jensen I, Josipovic M, Overgaard M, et al. CT-planned internal mammary node radiotherapy in the DBCG-IMN study: benefit versus potentially harmful effects. Acta Oncol. 2014 Aug 1; 53(8):1027-34.
  10. Marks LB, Hebert ME, Bentel G, Spencer DP, Sherouse GW, Prosnitz LR. To treat or not to treat the internal mammary nodes: a possible compromise. Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):903-9.
  11. Buchholz TA. Internal mammary lymph nodes: to treat or not to treat. Int J Radiat Oncol Biol Phys. 2000 Mar 1; 46(4):801-3.
  12. Fowble B, Hanlon A, Freedman G, Nicolaou N, Hoffman J, Sigurdson E, et al. Internal mammary node irradiation neither decreases distant metastases nor improves survival in stage I and II breast cancer. Int J Radiat Oncol Biol Phys. 2000 Jul 1; 47(4):883-94.
  13. Freedman GM, Fowble BL, Nicolaou N, Sigurdson ER, Torosian MH, Boraas MC, et al. Should internal mammary lymph nodes in breast cancer be a target for the radiation oncologist? Int J Radiat Oncol Biol Phys. 2000 Mar 1; 46(4):805-14.
  14. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015 Jul 23; 373(4):307-16.
  15. Poortmans PM, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015 Jul 23; 373(4):317-27.
  16. Dogan MH, Zincircioglu SB, Aydinol M. Research on different techniques in breast cancer radiotherapy. Contemporary Oncology. 2013 Jun 28; 17(3):291.
  17. Emami B. Tolerance of normal tissue to therapeutic radiation. Reports of radiotherapy and Oncology. 2013 Apr 10; 1(1).
  18. Petrova D, Smickovska S, Lazarevska E. Conformity index and homogeneity index of the postoperative whole breast radiotherapy. Open Access Maced J Med Sci. 2017 Oct 15; 5(6):736.
  19. Overgaard M, Juul Christensen J. Postoperative radiotherapy in DBCG during 30 years. Techniques, indications and clinical radiobiological experience. Acta Oncol. 2008 Jan 1; 47(4):639-53.
  20. Washington CM, Leaver DT. Principles and practice of radiation therapy. 4th ed. St. Louis Missouri : Mosby; 2015.
  21. Dogan MH, Zincircioglu SB, Zorlu F. Comparison of various radiation therapy techniques in breast cancer where target volume includes mammaria interna region. Med Dosim. 2009 Mar 1; 34(1):42-50.
  22. Sonnik D, Selvaraj RN, Faul C, Gerszten K, Heron DE, King GC. Treatment techniques for 3D conformal radiation to breast and chest wall including the internal mammary chain. Med Dosim. 2007 Mar 1; 32(1):7-12.

 

Iranian Journal of Medical Physics
Volume 18, Issue 4
July and August 2021
Pages 270-277

Files

History

  • Receive Date: 09 December 2019
  • Revise Date: 01 May 2020
  • Accept Date: 14 May 2020

Share

How to cite

Statistics