Impact of Three Dimensional-Conformal Radiation Therapy (3D-CRT) Fractionation Technique on Radiobiological Effects and Risk of Secondary Cancers: A Case Study of Post-Mastectomy Breast Cancer

Document Type : Original Paper

Authors

1 Laboratory of Medical Physics and Biophysics, Department of Physics, Institut Teknologi Sepuluh Nopember, Kampus ITS – Sukolilo Surabaya, 60111, East Java, Indonesia.

2 Department of Radiation Oncology, MRCCC Siloam Hospitals, Jakarta, Indonesia

Abstract

Introduction: The study aimed to analyze and determine impact of the 3D-CRT fractionation on risk of secondary cancer. 
Material and Methods: This study used a patient-specific anthropomorphic phantom, and radiation was performed using the Three Dimensional-Conformal Radiation Therapy Field in Field (3D-CRT FinF) technique with conventional, hypofractionation, and hyperfractionation with a dose of 200 cGy, 260 cGy, and 160 cGy in 25, 16, and 30 fractions respectively. It focused on the contralateral breast, contralateral lung, and ipsilateral lung as Organs at Risk (OAR). In addition, the Dose Volume Histogram (DVH) value, normal tissue complication probability (NTCP), and risk of secondary cancer were evaluated.
Results: The results showed that the average dose value (Dmean) for ipsilateral lung with hypofractionation was smaller than conventional and hyperfractionation of 1519.8, 1826.7, and 1753.6 cGy, respectively. Furthermore, hypofractionation also reduced radiobiological effects by 50% in the ipsilateral lung with an NTCP value of 0.01% compared to conventional and hyperfractionation with a value of 0.02%. Hypofractionation reduces the risk of secondary cancer in the contralateral breast, contralateral lung, and ipsilateral lung by 16.38, 17, and 22.31% compared to conventional fractionation and 12.75, 13.54, and 21.34% compared to hyperfractionation, respectively. 
Conclusion: The dose profiles in OAR was smaller in treatment planning with hypofractionation. EBT3 film verification results showed that the ipsilateral lung received more doses than planned, with an insignificant difference (p>0.05). In radiobiology, the ipsilateral lung has the highest probability of complications in treatment planning with conventional fractionation and hyperfractionation.

Keywords

Main Subjects

References

  1. Zhang Q, Liu J, Ao N, Yu H, Peng Y, Ou L, Zhang S. Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques. Scientific reports. 2020 Jan 27;10(1):1220. https://doi.org/10.1038/s41598-020-58134-z.
  2. Puspitasari RA, Pertiwi WI, Sholihah PM, Fariqoh WH, Kavilani N, Astuti SD. Analisis Kualitas Berkas Radiasi LINAC Untuk Effektivitas Radioterapi. Jurnal Biosains Pascasarjana. 2020;22(1):11-9. https://doi.org/10.20473/JBP.V22I1.2020.11-19.
  3. Schomberg PJ, Shanahan TG, Ingle JN, Donohue JH, Kuske RR, Sternfeld WC, et al. Accelerated hyperfractionation radiation therapy after lumpectomy and axillary lymph node dissection in patients with stage I or II breast cancer: pilot study. Radiology. 1997 Feb;202(2):565-9. https://doi.org/10.1148/RADIOLOGY.202.2.9015091.
  4. Marta GN, Riera R, Pacheco RL, Martimbianco AL, Meattini I, Kaidar-Person O, et al. Moderately hypofractionated post-operative radiation therapy for breast cancer: Systematic review and meta-analysis of randomized clinical trials. The Breast. 2022 Apr 1;62:84-92. https://doi.org/10.1016/J.BREAST.2022.01.018.
  5. EPimenta EB, Nogueira LB, de Campos TP. Dose measurements in a thorax phantom at 3DCRT breast radiation therapy. reports of practical Oncology and radiotherapy. 2021;26(2):242-50. https://doi.org/10.5603/RPOR.a2021.0037.
  6. Hedin E, Bäck A, Chakarova R. Impact of lung density on the lung dose estimation for radiotherapy of breast cancer. Physics and Imaging in Radiation Oncology. 2017 Jul 1;3:5-10. https://doi.org/10.1016/j.phro.2017.07.001.
  7. Khabaz R. Phantom dosimetry and cancer risks estimation undergoing 6 MV photon beam by an Elekta SL-25 linac. Applied Radiation and Isotopes. 2020 Sep 1;163:109232. https://doi.org/10.1016/j.apradiso.2020.109232.
  8. Haciislamoglu E, Cinar Y, Gurcan F, Canyilmaz E, Gungor G, Yoney A. Secondary cancer risk after whole-breast radiation therapy: field-in-field versus intensity modulated radiation therapy versus volumetric modulated arc therapy. The British journal of radiology. 2019 Oct 1;92(1102):20190317. https://doi.org/10.1259/BJR.20190317/ASSET/IMAGES/LARGE/BJR.20190317.G003.JPEG.
  9. Lee B, Lee S, Sung J, Yoon M. Radiotherapy-induced secondary cancer risk for breast cancer: 3D conformal therapy versus IMRT versus VMAT. Journal of radiological protection. 2014 Apr 4;34(2):325. https://doi.org/10.1088/0952-4746/34/2/325.
  10. Han EY, Paudel N, Sung J, Yoon M, Chung WK, Kim DW. Estimation of the risk of secondary malignancy arising from whole-breast irradiation: comparison of five radiotherapy modalities, including TomoHDA. Oncotarget. 2016 Apr 4;7(16):22960.
  11. Sitathanee C, Tangboonduangjit P, Dhanachai M, Suntiwong S, Yongvithisatid P, Rutchantuk S, et al. Secondary cancer risk from modern external-beam radiotherapy of prostate cancer patients: Impact of fractionation and dose distribution. Journal of Radiation Research. 2021 Jul;62(4):707-17. https://doi.org/10.1093/JRR/RRAB038.
  12. Apriantoro NH, Wibowo BS, Irsal M, Kasih PC. Result Analysis Of Treatment Planning System Between 3-Dimensional Conformal Radiation Therapy Technique And Intensity Modulated Radiation Therapy Technique In Nasopharyngeal Cancer Cases. Sanitas. 2017 Oct 26;8(1):29-34.
  13. Layton C, Twadell S, McDonald KA, Genuit T, Richter S. Preoperative Accelerated Hyperfractionated Whole-Breast Radiation as Treatment for Secondary Angiosarcoma of the Breast After Prior Accelerated Hypofractionated Whole-Breast Radiation Therapy: A Case Report and Review of the Literature. Advances in Radiation Oncology. 2022 Jul 1;7(4):100846. https://doi.org/10.1016/j.adro.2021.100846.
  14. Endarko E, Hariyanto AP. 3D Fantom Antropomorfik Untuk Jaminan Kualitas Radioterapi Pada Kasus Kanker Payudara Pasca-Mastektomi. 2021 Indonesia Patent: P00202102195.
  15. Gay HA, Niemierko A. A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Physica Medica. 2007 Dec 1;23(3-4):115-25. https://doi.org/10.1016/J.EJMP.2007.07.001.
  16. Murray LJ, Thompson CM, Lilley J, Cosgrove V, Franks K, Sebag-Montefiore D, et al. Radiation-induced second primary cancer risks from modern external beam radiotherapy for early prostate cancer: impact of stereotactic ablative radiotherapy (SABR), volumetric modulated arc therapy (VMAT) and flattening filter free (FFF) radiotherapy. Physics in Medicine & Biology. 2015 Jan 15;60(3):1237. https://doi.org/10.1088/0031-9155/60/3/1237.
  17. Schneider U, Sumila M, Robotka J. Site-specific dose-response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy. Theoretical Biology and Medical Modelling. 2011 Dec;8:1-21. https://doi.org/10.1186/1742-4682-8-27.
  18. Schneider U, Zwahlen D, Ross D, Kaser-Hotz B. Estimation of radiation-induced cancer from three-dimensional dose distributions: Concept of organ equivalent dose. International Journal of Radiation Oncology* Biology* Physics. 2005 Apr 1;61(5):1510-5. https://doi.org/10.1016/j.ijrobp.2004.12.040.
  19. Taheri H, Akhavan A, Tavakoli M, Moghareabed R, Kianinia M. Dosimetric Comparison and TCP-NTCP Modeling for Lung, Heart, Left Anterior Descending, and Right Coronary Artery in Left-sided Breast Cancer Conventional and Hypofractionated Radiotherapy. International Journal of Cancer Management. 2021 Dec 31;14(12). https://doi.org/10.5812/IJCM.117987.
  20. Moran MS, Truong PT. Hypofractionated radiation treatment for breast cancer: The time is now. The Breast Journal. 2020 Jan;26(1):47-54. https://doi.org/10.1111/TBJ.13724.
  21. Emami B, Lyman J, Brown A, Cola L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. International Journal of Radiation Oncology* Biology* Physics. 1991 May 15;21(1):109-22. https://doi.org/10.1016/0360-3016(91)90171-Y.
  22. Rastogi K, Jain S, Bhatnagar AR, Bhaskar S, Gupta S, Sharma N. A comparative study of hypofractionated and conventional radiotherapy in postmastectomy breast cancer patients. Asia-Pacific Journal of Oncology Nursing. 2018 Jan 1;5(1):107-13. https://doi.org/10.4103/APJON.APJON_46_17.
  23. GAFCHROMIC ™ DOSIMETRY MEDIA, TYPE EBT-3. 2018. [Online]. Available: http://www.gafchromic.com/gafchromic-film/radiotherapy-films/EBT/index.asp
  24. Abi KS, Habibian S, Salimi M, Shakeri A, Mojahed MM, Gharaati H. Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) in Mono and Dual-isocentric Techniques of Breast Cancer Radiation Therapy. Archives of Breast Cancer. 2021 Jul 27:192-202. https://doi.org/10.32768/ABC.202183192-202.
  25. Ray KJ, Sibson NR, Kiltie AE. Treatment of breast and prostate cancer by hypofractionated radiotherapy: potential risks and benefits. Clinical oncology. 2015 Jul 1;27(7):420-6. https://doi.org/10.1016/J.CLON.2015.02.008.
  26. Donovan EM, James H, Bonora M, Yarnold JR, Evans PM. Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer. Medical physics. 2012 Oct;39(10):5814-24. https://doi.org/10.1118/1.4748332.
  27. Vogel M, Gade J, Timm B, Schürmann M, Auerbach H, Nüsken F, et al. Comparison of Breast Cancer Radiotherapy Techniques Regarding Secondary Cancer Risk and Normal Tissue Complication Probability–Modelling and Measurements Using a 3D-Printed Phantom. Frontiers in Oncology. 2022 Jul 27;12:892923.
  28. Gerald B. A brief review of independent, dependent and one sample t-test. International journal of applied mathematics and theoretical physics. 2018 Aug;9(2):50-4. https://doi.org/10.11648/j.ijamtp.20180402.13.

 

 

 

 

 

Iranian Journal of Medical Physics
Volume 21, Issue 3 - Serial Number 3
May and June 2024
Pages 160-167

Files

History

  • Receive Date: 05 March 2023
  • Revise Date: 17 May 2023
  • Accept Date: 23 May 2023

Share

How to cite

Statistics