eprintid: 10074652
rev_number: 16
eprint_status: archive
userid: 608
dir: disk0/10/07/46/52
datestamp: 2019-05-23 11:29:27
lastmod: 2021-09-20 22:21:31
status_changed: 2019-05-23 11:29:27
type: article
metadata_visibility: show
creators_name: Ranger, A
creators_name: Dunlop, A
creators_name: Hutchinson, K
creators_name: Convery, H
creators_name: Maclennan, MK
creators_name: Chantler, H
creators_name: Twyman, N
creators_name: Rose, C
creators_name: McQuaid, D
creators_name: Amos, RA
creators_name: Griffin, C
creators_name: deSouza, NM
creators_name: Donovan, E
creators_name: Harris, E
creators_name: Coles, CE
creators_name: Kirby, A
title: A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain
ispublished: pub
divisions: UCL
divisions: B04
divisions: C05
divisions: F42
keywords: Heart-sparing radiotherapy; internal mammary chain radiotherapy; proton beam therapy for breast cancer
note: Copyright 2018 Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
abstract: Aims
Radiotherapy target volumes in early breast cancer treatment increasingly include the internal mammary chain (IMC). In order to maximise survival benefits of IMC radiotherapy, doses to the heart and lung should be minimised. This dosimetry study compared the ability of three-dimensional conformal radiotherapy, arc therapy and proton beam therapy (PBT) techniques with and without breath-hold to achieve target volume constraints while minimising dose to organs at risk (OARs).

Materials and methods
In 14 patients' datasets, seven IMC radiotherapy techniques were compared: wide tangent (WT) three-dimensional conformal radiotherapy, volumetric-modulated arc therapy (VMAT) and PBT, each in voluntary deep inspiratory breath-hold (vDIBH) and free breathing (FB), and tomotherapy in FB only. Target volume coverage and OAR doses were measured for each technique. These were compared using a one-way ANOVA with all pairwise comparisons tested using Bonferroni's multiple comparisons test, with adjusted P-values ≤ 0.05 indicating statistical significance.

Results
One hundred per cent of WT(vDIBH), 43% of WT(FB), 100% of VMAT(vDIBH), 86% of VMAT(FB), 100% of tomotherapy FB and 100% of PBT plans in vDIBH and FB passed all mandatory constraints. However, coverage of the IMC with 90% of the prescribed dose was significantly better than all other techniques using VMAT(vDIBH), PBT(vDIBH) and PBT(FB) (mean IMC coverage ± 1 standard deviation = 96.0% ± 4.3, 99.8% ± 0.3 and 99.0% ± 0.2, respectively). The mean heart dose was significantly reduced in vDIBH compared with FB for both the WT (P < 0.0001) and VMAT (P < 0.0001) techniques. There was no advantage in target volume coverage or OAR doses for PBT(vDIBH) compared with PBT(FB).

Conclusions
Simple WT radiotherapy delivered in vDIBH achieves satisfactory coverage of the IMC while meeting heart and lung dose constraints. However, where higher isodose coverage is required, VMAT(vDIBH) is the optimal photon technique. The lowest OAR doses are achieved by PBT, in which the use of vDIBH does not improve dose statistics.
date: 2018-06
date_type: published
publisher: ELSEVIER SCIENCE LONDON
official_url: https://doi.org/10.1016/j.clon.2018.01.017
oa_status: green
full_text_type: pub
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1562749
doi: 10.1016/j.clon.2018.01.017
lyricists_name: Amos, Richard
lyricists_id: RAMOS45
actors_name: Kalinowski, Damian
actors_id: DKALI47
actors_role: owner
full_text_status: public
publication: Clinical Oncology
volume: 30
number: 6
pagerange: 346-353
pages: 8
issn: 1433-2981
citation:        Ranger, A;    Dunlop, A;    Hutchinson, K;    Convery, H;    Maclennan, MK;    Chantler, H;    Twyman, N;                                     ... Kirby, A; + view all <#>        Ranger, A;  Dunlop, A;  Hutchinson, K;  Convery, H;  Maclennan, MK;  Chantler, H;  Twyman, N;  Rose, C;  McQuaid, D;  Amos, RA;  Griffin, C;  deSouza, NM;  Donovan, E;  Harris, E;  Coles, CE;  Kirby, A;   - view fewer <#>    (2018)    A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain.                   Clinical Oncology , 30  (6)   pp. 346-353.    10.1016/j.clon.2018.01.017 <https://doi.org/10.1016/j.clon.2018.01.017>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10074652/1/Amos_A%20Dosimetric%20Comparison%20of%20Breast%20Radiotherapy%20Techniques%20to%20Treat%20Locoregional%20Lymph%20Nodes%20Including%20the%20Internal%20Mammary%20Chain_VoR.pdf