Document Type : Original Article

Authors

1 Assistant Professor, Department of Medical Physics, Kerman University of Medical Sciences, Kerman, Iran

2 Associate Professor, Department of Radiation Oncology& Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran

3 Instructor, Department of Medical Physics, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background: Breast cancer is becoming more frequently diagnosed at early stages with improved long term outcomes. Radiation-related heart disease and lung cancer can occur following radiotherapy for breast cancer. The aim of this study was to evaluate some dosimetric parameters of heart and lung during whole breast radiotherapy.
Methods:Twenty five consecutive patients with breast cancer who underwent radiotherapy were included in this study. Plans that employed the 3D conventional radiotherapy technique (Tangential Technique) were generated for each patient. Dose-volume histograms (DVHs) were calculated and dosimetric parameters such as, mean dose/volume receiving a dose 30 Gy (V30), mean dose/ volume receiving a dose 20 Gy (V20) for heart and lung were assessed, respectively.
Results:The average of mean dose of heart on left and right side irradiation was 9.68±5.10 Gy and 1.23±1.51 Gy, respectively. The average of mean dose of ipsilateral lung on left and right side irradiation was 14.49±4.07 Gy and 11.69±3.37 Gy, respectively. The percentage of heart volume that received at least 30 Gy was 16.32±9.56% for the left-sided treatment. The percentage of lung volume that received at least 20 Gy was 23.47±11.05% and 24.12±7.77% respectively on the left and right-sided breast irradiation.
Conclusion: Tangential beam conventional radiotherapy of the chest wall of postmastectomy breast cancer patients provides the potential to significantly keep the DVH parameters of heart and lung as low as the QUANTEC constrains.

Keywords

  1. Nold R, Beamer RL, Helmer SD, McBoyle MF. Factors influencing a woman’s choice to undergo breast‑conserving surgery versus modified radical mastectomy. Am J Surg 2000; 180:413-8.
  2. Shahbazi-Gahrouei D, Changizi B, Jomehzadeh A, Larizadeh MH. The effect of contrast media on treatment planning and dose calculation in radiation therapy of pelvis cancers. J Med Isfahan School 2017; 34(408):1389-94.
  3. Bantema‑Joppe E, de Munck L, Visser O, Willemse PH, Langendijk JA, Siesling S, et al. Early‑stage young breast cancer patients: impact of local treatment on survival. Int J Radiat Oncol Biol Phys 2011; 81(4):553-9.
  4. Coles C, Harris EJ, Donovan EM, Bliss P, Evans PM, Fairfoul J, et al. Evaluation of implanted gold seeds for breast radiotherapy planning and on treatment verification: a feasibility study on behalf of the IMPORT trialists. Radiother Oncol 2011; 100(2):276-81.
  5. Kozak K, Doppke KP, Katz A, Taghian AG. Dosimetric comparison of two different three‑dimensional conformal external beam accelerated partial breast irradiation techniques. Int J Radiation Oncology Biol Phys 2006; 65(2):340-6.
  6. Jomehzadeh A, Shokrani P, Mohammadi M, Amouheidari A. A quality assurance program for an amorphous silicon electronic portal imaging device using in-house developed phantoms: a method development for dosimetry purposes. Int J Radiat Res 2014; 12(30):257-64.
  7. Seif F, Tahmasbi-Birgani MJ, Byatiani MR. An analytical empirical calculation of linear attenuation coefficient of megavoltage photon beam. J Biomed Phys Eng 2017; 7(3):225–32.
  8. Henson KE, McGale P, Taylor C, Darby SC. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer 2013; 108(1):179-82.
  9. Goldman UB, Anderson M, Wennberg B, Lind P. Radiation pneumonitis and pulmonary function with lung dose–volume constraints in breast cancer irradiation. J Radiother Pract 2014; 13(2):211-17.
  10. Rutqvist LE, Lax I, Fornander T, Johansson H. Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 1992; 22(5):887-96.
  11. Taylor CW, Nisbet A, McGale P, Darby SC. Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Radiat Oncol Biol Phys 2007; 69(5):1484-95.
  12. Grantzau T, Thomsen MS, Væth M, Overgaard J. Risk of second primary lung cancer in women after radiotherapy for breast cancer. Radiother Oncol 2014; 111(3):366-73.
  13. Rothwell RI, Kelly SA, Joslin CA. Radiation pneumonitis in patients treated for breast cancer. Radiother Oncol 1985; 4(1):9-14.
  14. Marks LB, Yu X, Vujaskovic Z, Small WJ, Folz R, Anscher MS. Radiation-induced lung injury. Semin Radiat Oncol 2003; 13(3):333-45.
  15. Taylor CW, Povall JM, McGale P, Nisbet A, Dodwell D, Smith JT, et al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys 2008; 72(2):501-7.
  16. Bouillon K, Haddy N, Delaloge S, Garbay JR, Garsi JP, Brindel P, et al. Long-term cardiovascular mortality after radiotherapy for breast cancer. J Am Coll Cardiol 2011; 57(4):445-52.
  17. Gagliardi G, Constine LS, Moiseenko V, Correa C, Pierce LJ, Allen AM. Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys 2010;76(3 Suppl):S77-85.
  18. Recht A, Ancukiewicz M, Alm El-Din MA, Lu XQ, Martin C, Berman SM, et al. Lung dose-volume parameters and the risk of pneumonitis for patients treated with accelerated partial-breast irradiation using three-dimensional conformal radiotherapy. J Clin Oncol 2009; 27(24):3887-93.
  19. Golestani A, Houshyari M, Mostaar A, Jabbari A. Evaluation of dose calculation algorithms of isogray treatment planning system using measurement in heterogeneous phantom. Rep Radiother Oncol 2015; 2(3):e5320.
  20. DeLuca PM. The international commission on radiation units and measurements. J ICRU 2007; 7(1):v-vi.
  21. Larizadeh MH, Neamati A, Moazed V, Bahremand F. Evaluation of regional nodes irradiation during breast cancer radiotherapy. Int J Radiat Res 2016; 14(3):257-61.
  22. Bentzen SM, Constine LS, Deasy JO, Eisbruch A, Jackson A,  Marks LB, et al. Quantitative analyses of normal tissue effects in the clinic (QUANTEC): an introduction to the scientific issues. Int J Radiat Oncol Biol Phys 2010; 76(3 Suppl):S3–S9.
  23. Mège A, Ziouèche A, Pourel N, Chauvet B. Toxicité cardiaque de la radiothérapie. Cancer Radiother 2011; 15(6-7):495-503.[In French]
  24. Prabhakar R, Ganesh T, Rath GK, Julka PK, Sridhar PS, Joshi RC, et al.  09.002. Impact of different CT slice thickness on clinical target volume for 3D conformal radiationtherapy. Med Dosim 2009; 34(1):36-41.
  25. Chung E, Corbett JR, Moran JM, Griffith KA, Marsh RB, Feng M, et al. Is there a dose-response relationship for heart disease with low-dose radiationtherapy? Int J Radiat Oncol Biol Phys 2013; 85(4):959–64.
  26. Taylor CW, Nisbet A, McGale P, Goldman U, Darby SC, Hall P, et al. Cardiac doses from Swedish breast cancer radiotherapy since the 1950s. Radiother Oncol 2009; 90(1):127-35.
  27. Gursel B, Meydan D, Ozbek N, Ofluoglu T. Dosimetric comparison of three different external beam whole breast irradiation techniques. Adv Ther 2011; 28(12):1114-25.
  28. Lingos TI, Recht A, Vicini F, Abner A, Silver B, Harris JR. Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1991; 21:355-60.
  29. Lee HK, Vaporciyan AA, Cox JD, Tucker SL, Putnam JB Jr, Ajani JA, et al. Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose‑volume histogram parameters. Int J Radiat Oncol Biol Phys 2003; 57(5):1317-22.
  30. Xie X, Ouyang S, Wang H, Yang W, Jin H, Hu B, et al. Dosimetric comparison of left-sided whole breast irradiation with 3D-CRT, IP-IMRT and hybrid IMRT. Oncology reports 2014; 31(5):2195-205.