PMID- 19169915
OWN - NLM
STAT- MEDLINE
DCOM- 20090512
LR  - 20090417
IS  - 1651-226X (Electronic)
IS  - 0284-186X (Linking)
VI  - 48
IP  - 4
DP  - 2009
TI  - A planning comparison of dose patterns in organs at risk and predicted risk for 
      radiation induced malignancy in the contralateral breast following radiation 
      therapy of primary breast using conventional, IMRT and volumetric modulated arc 
      treatment techniques.
PG  - 495-503
LID - 10.1080/02841860802657227 [doi]
AB  - PURPOSE: To investigate the impact of using different radiation therapy 
      techniques on contra-lateral breast (CB) dose, and also dose to other involved 
      organs at risk such as heart and lungs following radiation therapy of breast and 
      regional lymph nodes. Furthermore, to predict the risk for induced malignancies 
      in CB using linear and non linear models. MATERIAL AND METHODS: Eight patients 
      with stage II-III breast cancer were included in this analysis. It was focused on 
      three treatment techniques; conventional radiotherapy technique forwardly planed, 
      IMRT and volumetric modulated arc (RapidArc) techniques, inversely planed. The CC 
      algorithm was employed to calculate the standard treatment plans whereas for the 
      IMRT and RapidArc treatment plans AAA algorithm was adopted. The dose results 
      based on mostly DVH analysis were compared. The excess relative risk (ERR) for 
      cancer induction in CB, employed both linear and non-linear models, was 
      estimated. RESULTS: A better homogeneity and conformation in PTV was observed in 
      the RapidArc plans. The highest minimum dose to PTV was observed in the 
      conventional plans while no difference was observed for minimum significant doses 
      D(98%) and D(99%) where D(X%) is the dose received by X% of the PTV volume. In 
      terms of organ sparing, the IMRT and RapidArc plans spare ipsilateral-lung 
      better, but a 40% lower mean dose in the contra-lateral lung in the conventional 
      plans is observed. The mean dose to the contra-lateral breast was lowest for the 
      RapidArc plans as well as the V(10Gy) and the maximum dose. The mean predicted 
      ERR for the eight patients were lower for the conventional and RA plans than for 
      the IMRT plans assuming a linear dose-risk relationship. The mean predicted ERR 
      when using a non linear model was lower for all the three techniques (with lowest 
      ERR for RapidArc plans). CONCLUSIONS: From a clinical perspective, it should be 
      concluded that all three solutions investigated in the study can offer high 
      quality treatment of patients. Further comparative analysis of the two algorithms 
      used in the present study, however, should be performed especially on the 
      peripheral organ dose. The impact of CB exposure to a low-dose radiation on 
      minimizing the risk of radiation induced malignancy in CB can be interpreted 
      differently when using linear or non linear models to predict ERR. In general, no 
      detriment was observed when using RapidArc compared to conventional treatments 
      while a potentially higher risk could be associated to IMRT treatments with fixed 
      gantry.
FAU - Johansen, Safora
AU  - Johansen S
AD  - Institute for Cancer Research, Norwegian Radium Hospital, Rikshospitalet 
      University Hospital, Oslo, Norway. safora.johansen@radiumhospitalet.no
FAU - Cozzi, Luca
AU  - Cozzi L
FAU - Olsen, Dag Rune
AU  - Olsen DR
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Sweden
TA  - Acta Oncol
JT  - Acta oncologica (Stockholm, Sweden)
JID - 8709065
SB  - IM
MH  - Breast Neoplasms/*etiology/*radiotherapy
MH  - Female
MH  - Humans
MH  - Neoplasms, Radiation-Induced/*etiology
MH  - Predictive Value of Tests
MH  - Radiotherapy/adverse effects/methods
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted
MH  - Risk Assessment
MH  - Risk Factors
EDAT- 2009/01/27 09:00
MHDA- 2009/05/13 09:00
CRDT- 2009/01/27 09:00
PHST- 2009/01/27 09:00 [entrez]
PHST- 2009/01/27 09:00 [pubmed]
PHST- 2009/05/13 09:00 [medline]
AID - 908139333 [pii]
AID - 10.1080/02841860802657227 [doi]
PST - ppublish
SO  - Acta Oncol. 2009;48(4):495-503. doi: 10.1080/02841860802657227.