PMID- 30935400
OWN - NLM
STAT- MEDLINE
DCOM- 20190805
LR  - 20200225
IS  - 1748-717X (Electronic)
IS  - 1748-717X (Linking)
VI  - 14
IP  - 1
DP  - 2019 Apr 1
TI  - Evaluation of optimal treatment planning for radiotherapy of synchronous 
      bilateral breast cancer including regional lymph node irradiation.
PG  - 56
LID - 10.1186/s13014-019-1257-5 [doi]
LID - 56
AB  - BACKGROUND: We evaluated the optimal radiotherapy (RT) plan for synchronous 
      bilateral breast cancer (SBBC), especially treatment plans including the regional 
      lymph node (LN) area. METHODS: This study was conducted using 15 patients with 
      SBBC (5 with small breasts, 5 with large breasts, and 5 who underwent a left 
      total mastectomy). The clinical target volume (CTV) was defined as the volume 
      enveloping the bilateral whole breasts/chest wall and left regional LN area. We 
      established the following plans: 1) volumetric-modulated arc therapy (VMAT)-the 
      only plan using two pairs of partial arcs for the whole target volume, 2) VMAT 
      using one partial arc for the left CTV followed by a 3D tangential technique for 
      the right breast (primary hybrid plan), and 3) VMAT for the left CTV followed by 
      a tangential technique using an automatically calculated prescription dose for 
      the right breast, considering the background dose from the left breast VMAT plan 
      (modified hybrid plan). The Tukey test and one-way analysis of variance were used 
      to compare the target coverage and doses to organs at risk (OARs) of the three 
      techniques. RESULTS: For target coverage, the VMAT-only and modified hybrid plans 
      showed comparable target coverage in terms of D(mean) (50.33 Gy vs. 50.53 Gy, 
      p = 0.106). The primary hybrid plan showed the largest distribution of the 
      high-dose volume, with V(105%) of 25.69% and V(110%) of 6.37% for the planning 
      target volume (PTV) (p < 0.001). For OARs including the lungs, heart, and left 
      anterior descending artery, the percentages of volume at various doses (V(5Gy), 
      V(10Gy), V(20Gy), V(30Gy)) and D(mean) were significantly lower in both the 
      primary and modified hybrid plans compared to those of the VMAT-only plan. These 
      results were consistent in subgroup analyses of breast size and morphological 
      variation. CONCLUSIONS: The modified hybrid plan, using an automatically 
      calculated prescription dose for the right breast and taking into consideration 
      the background dose from the left breast VMAT plan, showed comparable target 
      coverage to that of the VMAT-only plan, and was superior for saving OARs. 
      However, considering that VMAT can be adjusted according to the physician's 
      intention, further evaluation is needed for developing a better plan.
FAU - Cho, Yeona
AU  - Cho Y
AD  - Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University 
      College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
FAU - Cho, Yoon Jin
AU  - Cho YJ
AD  - Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University 
      College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
FAU - Chang, Won Suk
AU  - Chang WS
AD  - Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University 
      College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
FAU - Kim, Jun Won
AU  - Kim JW
AD  - Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University 
      College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
FAU - Choi, Won Hoon
AU  - Choi WH
AD  - Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University 
      College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
FAU - Lee, Ik Jae
AU  - Lee IJ
AUID- ORCID: 0000-0001-7165-3373
AD  - Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University 
      College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea. 
      ikjae412@yuhs.ac.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20190401
PL  - England
TA  - Radiat Oncol
JT  - Radiation oncology (London, England)
JID - 101265111
MH  - Breast Neoplasms/*radiotherapy
MH  - Female
MH  - Humans
MH  - Lymph Nodes/*radiation effects
MH  - Organs at Risk/*radiation effects
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted/*methods
MH  - Radiotherapy, Intensity-Modulated/*methods
PMC - PMC6444509
OTO - NOTNLM
OT  - Breast Cancer
OT  - Organs at risk
OT  - Radiotherapy dosage
OT  - Volumetric-modulated arc therapy
COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study was approved by the 
      institutional review board of the Gangnam Severance Hospital (Protocol number: 
      3-2018-0196). Because we used the CT images of patients who already had finished 
      their treatment in our institution, patient informed consent was not required for 
      this study. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The 
      authors declare that they have no competing interests. PUBLISHER'S NOTE: Springer 
      Nature remains neutral with regard to jurisdictional claims in published maps and 
      institutional affiliations.
EDAT- 2019/04/03 06:00
MHDA- 2019/08/06 06:00
PMCR- 2019/04/01
CRDT- 2019/04/03 06:00
PHST- 2018/08/09 00:00 [received]
PHST- 2019/03/20 00:00 [accepted]
PHST- 2019/04/03 06:00 [entrez]
PHST- 2019/04/03 06:00 [pubmed]
PHST- 2019/08/06 06:00 [medline]
PHST- 2019/04/01 00:00 [pmc-release]
AID - 10.1186/s13014-019-1257-5 [pii]
AID - 1257 [pii]
AID - 10.1186/s13014-019-1257-5 [doi]
PST - epublish
SO  - Radiat Oncol. 2019 Apr 1;14(1):56. doi: 10.1186/s13014-019-1257-5.