liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Clinical implications of the ISC technique for breast cancer radiotherapy and comparison with clinical recommendations
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0001-8425-8110
Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.ORCID iD: 0000-0001-7193-4458
Futurum - Academy for Health and Care, Jönköping.
Futurum - Academy for Health and Care, Jönköping.
Show others and affiliations
2014 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 34, no 7, 3563-3568 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The project studied the implications of using the irregular surface compensator (ISC) technique in comparison to three-dimensional conformal radiation therapy (3D-CRT) for breast cancer treatment. ISC is an electronic compensation algorithm that modulates the fluence across the radiation fields to compensate for irregularly shaped surfaces and deliver a homogeneous dose to a compensation plane. Methods: Ten breast cancer patients (five left- and five right-sided) were planned with both techniques. The planning was done for 50 Gy in 25 fractions with 2 Gy per fraction in all patients. Physical parameters such as doses to the clinical target volume (CTV-T) and the planned target volume (PTV), heterogeneity index and doses to lung and heart were determined and compared for the treatment plans. Results: The ISC technique led to significantly better coverage of the CTV-T and PTV in almost all patients with statistically significant better homogeneity of the dose distribution. The contralateral lung and the heart receive the same doses with both ISC and 3D-CRT plans. However, ISC showed a trend towards decreasing the volumes of the ipsilateral lung irradiated with high doses. Consequently this led to better compliance with the national recommendations for breast radiotherapy. Conclusion: The ISC technique leads to an improvement of the target coverage and the radiation burden of the ipsilateral lung thus allowing better compliance with the national recommendations and increasing the potential for improved quality of life for breast cancer patients. It should therefore be preferred over 3D-CRT for breast cases with difficult dose homogeneity to the PTV or CTV-T.

Place, publisher, year, edition, pages
International Institute of Anticancer Research, 2014. Vol. 34, no 7, 3563-3568 p.
Keyword [en]
breast radiotherapy, irregular surface compensator, fractionated radiotherapy, irradiation technique
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:liu:diva-106944ISI: 000338780300044PubMedID: 24982370OAI: oai:DiVA.org:liu-106944DiVA: diva2:720143
Available from: 2014-05-28 Created: 2014-05-28 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Radiation burden from modern radiation therapy techniques including proton therapy for breast cancer treatment - clinical implications
Open this publication in new window or tab >>Radiation burden from modern radiation therapy techniques including proton therapy for breast cancer treatment - clinical implications
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to study the clinical implications of modern radiotherapy techniques for breast cancer treatment. This was investigated in several individual studies.

Study I investigated the implications of using the analytical anisotropic algorithm (AAA) from the perspective of clinical recommendations for breast cancer radiotherapy. Pencil beam convolution plans of 40 breast cancer patients were recalculated with AAA. The latter plans had a significantly worse coverage of the planning target volume (PTV) with the 93% isodose, higher maximum dose in hotspots, higher volumes of the ipsilateral lung receiving doses below 25 Gy and smaller volumes with doses above 25 Gy. AAA also predicted lower doses to the heart.

Study II investigated the implications of using the irregular surface compensator (ISC), an electronic compensation algorithm, in comparison to three‐dimensional conformal radiotherapy (3D‐CRT) for breast cancer treatment. Ten breast cancer patients were planned with both techniques. The ISC technique led to better coverage of the clinical target volume of the tumour bed (CTV‐T) and PTV in almost all patients with significant improvement in homogeneity.

Study III investigated the feasibility of using scanning pencil beam proton therapy for regional and loco‐regional breast cancer with comparison of ISC photon planning. Ten patients were included in the study, all with dose heterogeneity in the target and/or hotspots in the normal tissues outside the PTV. The proton plans showed comparable or better CTV‐T and PTV coverage, with large reductions in the mean doses to the heart and the ipsilateral lung.

Study IV investigated the added value of enhanced inspiration gating (EIG) for proton therapy. Twenty patients were planned on CT datasets acquired during EIG and freebreathing (FB) using photon 3D‐CRT and scanning proton therapy. Proton spot scanning has a high potential to reduce the irradiation of organs‐at‐risk for most patients, beyond what could be achieved with EIG and photon therapy, especially in terms of mean doses to the heart and the left anterior descending artery.

Study V investigated the impact of physiological breathing motion during proton radiotherapy for breast cancer. Twelve thoracic patients were planned on CT datasets during breath‐hold at inhalation phase and breath‐hold at exhalation phase. Between inhalation and exhalation phase there were very small differences in dose delivered to the target and cardiovascular structures, with very small clinical implication.

The results of these studies showed the potential of various radiotherapy techniques to improve the quality of life for breast cancer patients by limiting the dose burden for normal tissues.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1505
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-127370 (URN)10.3384/diss.diva-127370 (DOI)978-91-7685-850-9 (ISBN)
Public defence
2016-06-01, Hugo Theorell, Campus US, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-04-27 Created: 2016-04-23 Last updated: 2016-05-13Bibliographically approved

Open Access in DiVA

fulltext(275 kB)283 downloads
File information
File name FULLTEXT01.pdfFile size 275 kBChecksum SHA-512
32e8eae444a548f9c1ae70f2865f1d3ac06f8d85134dc55258e6a1ccf6fbff297b6a000b5647202432e806a3c428e8eb35c7bc966202f2fd1ca419633b5dee9f
Type fulltextMimetype application/pdf

Other links

PubMedOpen Access PDF (192 kB)

Authority records BETA

Flejmer, Anna M.Josefsson, DanDasu, Alexandru

Search in DiVA

By author/editor
Flejmer, Anna M.Josefsson, DanDasu, Alexandru
By organisation
Division of Clinical SciencesFaculty of Health SciencesDivision of Radiological SciencesDepartment of Radiation Physics
In the same journal
Anticancer Research
Cancer and Oncology

Search outside of DiVA

GoogleGoogle Scholar
Total: 283 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

pubmed
urn-nbn

Altmetric score

pubmed
urn-nbn
Total: 603 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf