PMID- 24689645
OWN - NLM
STAT- MEDLINE
DCOM- 20150105
LR  - 20140514
IS  - 1651-226X (Electronic)
IS  - 0284-186X (Linking)
VI  - 53
IP  - 6
DP  - 2014 Jun
TI  - Accelerated partial breast irradiation (APBI): are breath-hold and volumetric 
      radiation therapy techniques useful?
PG  - 788-94
LID - 10.3109/0284186X.2014.887226 [doi]
AB  - BACKGROUND: In a selective group of patients accelerated partial breast 
      irradiation (APBI) might be applied after conservative breast surgery to reduce 
      the amount of irradiated healthy tissue. The role of volumetric modulated arc 
      therapy (VMAT) and voluntary moderately deep inspiration breath-hold (vmDIBH) 
      techniques in further reducing irradiated healthy--especially heart--tissue is 
      investigated. MATERIAL AND METHODS: For 37 partial breast planning target volumes 
      (PTVs), three-dimensional conformal radiotherapy (3D-CRT) (3-5 coplanar or 
      non-coplanar 6 and/or 10 MV beams) and VMAT (two partial 6 MV arcs) plans were 
      made on CTs acquired in free-breathing (FB) and/or in vmDIBH. Dose-volume 
      parameters for the PTV, heart, lungs, and breasts were compared. RESULTS: Better 
      dose conformity was achieved with VMAT compared to 3D-CRT (conformity index 
      1.24+/-0.09 vs. 1.49+/-0.20). Non-PTV ipsilateral breast receiving >/=50% of the 
      prescribed dose was on average reduced by 28% in VMAT plans compared to 3D-CRT 
      plans. Mean heart dose (MHD) reduced from 2.0 (0.1-5.1) Gy in 3D-CRT(FB) to 0.6 
      (0.1-1.6) Gy in VMAT(vmDIBH). VMAT is beneficial for MHD reduction if MHD with 
      3D-CRT exceeds 0.5Gy. Cardiac dose reduction as a result of VMAT increases with 
      increasing initial MHD, and adding vmDIBH reduces the cardiac dose further. Mean 
      dose to the ipsilateral lung decreased from 3.7 (0.7-8.7) to 1.8 (0.5-4.0) Gy 
      with VMAT(vmDIBH) compared to 3D-CRT(FB). VMAT resulted in a slight increase in 
      the contralateral breast dose (DMean) always remaining <1.9 Gy). CONCLUSIONS: For 
      APBI patients, VMAT improves PTV dose conformity and delivers lower doses to the 
      ipsilateral breast and lung compared to 3D-CRT. This goes at the cost of a slight 
      but acceptable increase of the contralateral breast dose. VMAT reduces cardiac 
      dose if MHD exceeds 0.5 Gy for 3D-CRT. Adding vmDIBH results in a further 
      reduction of heart and ipsilateral lung dose.
FAU - Essers, Marion
AU  - Essers M
AD  - Radiation Oncology, Institute Verbeeten , Tilburg , The Netherlands.
FAU - Osman, Sarah O S
AU  - Osman SO
FAU - Hol, Sandra
AU  - Hol S
FAU - Donkers, Tanja
AU  - Donkers T
FAU - Poortmans, Philip M
AU  - Poortmans PM
LA  - eng
PT  - Journal Article
DEP - 20140401
PL  - Sweden
TA  - Acta Oncol
JT  - Acta oncologica (Stockholm, Sweden)
JID - 8709065
SB  - IM
MH  - Adult
MH  - Breast Neoplasms/*radiotherapy
MH  - Breath Holding
MH  - Female
MH  - Humans
MH  - Mastectomy, Segmental
MH  - *Organs at Risk
MH  - Radiotherapy Planning, Computer-Assisted/*methods
MH  - Radiotherapy, Adjuvant/methods
MH  - Radiotherapy, Conformal/*methods
MH  - Radiotherapy, Intensity-Modulated/*methods
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
EDAT- 2014/04/03 06:00
MHDA- 2015/01/06 06:00
CRDT- 2014/04/03 06:00
PHST- 2014/04/03 06:00 [entrez]
PHST- 2014/04/03 06:00 [pubmed]
PHST- 2015/01/06 06:00 [medline]
AID - 10.3109/0284186X.2014.887226 [doi]
PST - ppublish
SO  - Acta Oncol. 2014 Jun;53(6):788-94. doi: 10.3109/0284186X.2014.887226. Epub 2014 
      Apr 1.