PMID- 21055911
OWN - NLM
STAT- MEDLINE
DCOM- 20110609
LR  - 20110204
IS  - 1433-2981 (Electronic)
IS  - 0936-6555 (Linking)
VI  - 23
IP  - 2
DP  - 2011 Mar
TI  - Managing supraclavicular disease from breast cancer with brachial plexus-sparing 
      techniques using helical tomotherapy.
PG  - 101-7
LID - 10.1016/j.clon.2010.09.009 [doi]
AB  - AIMS: Managing supraclavicular fossa (SCF) disease in patients with breast cancer 
      can be challenging, with brachial plexopathy recognised as a complication of 
      high-dose radiotherapy to the SCF. Local control of SCF disease is an important 
      end point. Intensity-modulated radiotherapy (IMRT) techniques provide a steep 
      dose gradient and improve the therapeutic index, making it possible to escalate 
      dose to planning target volumes (PTVs), while reducing the dose to organs at risk 
      (OAR). We explored image-guided IMRT techniques using helical tomotherapy to dose 
      escalate SCF lymph nodes with a view to restrict the dose to the brachial plexus. 
      MATERIALS AND METHODS: Three cases with SCF nodal disease in varying clinical 
      stages of breast cancer were planned and treated using helical tomotherapy-IMRT 
      to assess the feasibility and safety of radiotherapy dose escalation to improve 
      the chances of local control in SCF while restricting the dose to the brachial 
      plexus. Consultant clinical oncologists were asked to define the PTVs and OARs as 
      per agreed inhouse policy. The brachial plexus was outlined as a separate OAR in 
      all three cases. In case 1 the left breast and SCF were treated with adjuvant 
      radiotherapy (40 Gy in 15 fractions) with a sequential boost (10 Gy in five 
      fractions) to the SCF PTV. In case 2, local recurrence was salvaged using a 
      simultaneous integrated boost to the gross tumour plus a 3 mm margin to 63 Gy and 
      54 Gy to the entire SCF. Case 3 was to control nodal disease with re-irradiation 
      of the SCF to a median dose of 44 Gy, while maintaining a low dose to the 
      brachial plexus. Inverse planning constraints (helical tomotherapy) were applied 
      to the PTV and OARs with the brachial plexus allowed a maximum biologically 
      effective dose (BED) of 120 Gy. RESULTS: It was possible to treat the SCF to a 
      higher dose using helical tomotherapy-IMRT. The treatment was successful in 
      controlling disease in the SCF. No patients reported symptoms suggestive of 
      brachial plexopathy. CONCLUSION: Sequential or simultaneous integrated boost to 
      the SCF was safe and feasible. This is the first publication of dose escalation 
      to the SCF when treating breast cancer with brachial plexus-sparing IMRT 
      techniques. The feasibility of such techniques warrants a multicentre phase II 
      study of dose escalation with IMRT to improve local control in isolated SCF 
      disease.
CI  - Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. 
      All rights reserved.
FAU - Chatterjee, S
AU  - Chatterjee S
AD  - Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK. 
      chatterjee72@hotmail.com
FAU - Lee, D
AU  - Lee D
FAU - Kent, N
AU  - Kent N
FAU - Wintle, T
AU  - Wintle T
FAU - Mott, J H
AU  - Mott JH
FAU - Kelly, C G
AU  - Kelly CG
FAU - Branson, A N
AU  - Branson AN
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20101105
PL  - England
TA  - Clin Oncol (R Coll Radiol)
JT  - Clinical oncology (Royal College of Radiologists (Great Britain))
JID - 9002902
SB  - IM
MH  - Adult
MH  - Brachial Plexus/radiation effects
MH  - Breast Neoplasms/pathology/*prevention & control/*radiotherapy
MH  - Clavicle
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/*prevention & control
MH  - Organs at Risk
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Adjuvant
MH  - Radiotherapy, Intensity-Modulated/adverse effects/*methods
MH  - Salvage Therapy/methods
MH  - Treatment Outcome
EDAT- 2010/11/09 06:00
MHDA- 2011/06/10 06:00
CRDT- 2010/11/09 06:00
PHST- 2010/05/04 00:00 [received]
PHST- 2010/08/09 00:00 [revised]
PHST- 2010/09/22 00:00 [accepted]
PHST- 2010/11/09 06:00 [entrez]
PHST- 2010/11/09 06:00 [pubmed]
PHST- 2011/06/10 06:00 [medline]
AID - S0936-6555(10)00392-4 [pii]
AID - 10.1016/j.clon.2010.09.009 [doi]
PST - ppublish
SO  - Clin Oncol (R Coll Radiol). 2011 Mar;23(2):101-7. doi: 
      10.1016/j.clon.2010.09.009. Epub 2010 Nov 5.