Skip to main content

Advertisement

SpringerLink
Log in

Whole breast external beam radiotherapy in elderly patients affected by left-sided early breast cancer: a dosimetric comparison between two simple free-breathing techniques

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Elderly breast cancer patients are frequently affected by significant comorbidities that make sophisticated radiotherapy treatments particularly challenging.

Aims

We dosimetrically analyzed two different simple free-breathing external beam radiotherapy (EBRT) techniques for the hypofractionated treatment of the left breast in elderly patients with a low compliance, to compare target coverage, and heart and left anterior descending coronary artery (LADCA) sparing.

Methods

We developed radiation plans for 24 elderly patients using 3D conformal (3DCRT) field-in-field tangential technique and intensity-modulated (IMRT) tangential beam technique. Dose-Volume-Histograms (DVHs) were used to provide a quantitative comparison between plans.

Results

The median breast volume was 645 cm3. IMRT and 3DCRT plans comparison demonstrated no significant differences in terms of organ sparing for the heart. Regarding LADCA, mean dose (10.3 ± 9.5 Gy vs 11.9 ± 9.6 Gy, p = 0.0003), maximum dose (26.1 ± 16.1 Gy vs 29.1 ± 16.1 Gy, p = 0.004) and V17 Gy (21.5% ± 26.9% vs 25.0% ± 27.2%, p = 0.002) significantly decreased using IMRT compared with 3DCRT. IMRT plans showed a better target coverage compared with 3DCRT (0.91 ± 0.05 vs 0.93 ± 0.04, p = 0.05).

Discussion

Comparing the two different EBRT techniques, we demonstrated few, although substantial, dosimetric differences in terms of doses to the organs at risk characterized by a statistically significant dose reduction of LADCA in the IMRT plans.

Conclusions

Elderly patients with a low compliance to treatment might benefit from 3DCRT with field-in-field tangential arrangement or from a simple IMRT approach. IMRT should be preferred.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Vallis KA, Tannock IF (2004) Postoperative radiotherapy for breast cancer: growing evidence for an impact on survival. J Natl Cancer Inst 96:88–89

    Article  Google Scholar 

  2. Gagliardi G, Lax I, Rutqvist LE (1992) Radiation therapy of stage I breast cancer: analysis of treatment technique accuracy using three-dimensional treatment planning tools. Radiother Oncol 24:94–101

    Article  CAS  Google Scholar 

  3. Haviland JS, Owen JR, Dewar JA et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094

    Article  Google Scholar 

  4. DeSantis C, Ma J, Bryan L, Jemal A (2014) Breast cancer statistics, 2013. CA Cancer J Clin 64:52–62

    Article  Google Scholar 

  5. Darby SC, Ewertz M, McGale P (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998

    Article  CAS  Google Scholar 

  6. Nilsson G, Holmberg L, Garmo H et al (2012) Distribution of coronary artery stenosis after radiation for breast cancer. J Clin Oncol 30:380–386

    Article  Google Scholar 

  7. Lohr F, El-Haddad M, Dobler B et al (2009) Potential effect of robust and simple IMRT approach for left-sided breast cancer on cardiac mortality. Int J Radiat Oncol Biol Phys 74:73–80

    Article  Google Scholar 

  8. Cozzi L, Lohr F, Fogliata A et al (2017) Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer. Radiat Oncol. 12:200

    Article  Google Scholar 

  9. Bartlett FR, Colgan RM, Donovan EM et al (2014) Voluntary breath-hold technique for reducing heart dose in left breast radiotherapy. J Vis Exp. 89:e51578

    Google Scholar 

  10. Bartlett FR, Colgan RM, Donovan EM et al (2015) The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery. Radiother Oncol 114:66–72

    Article  Google Scholar 

  11. Rahimy E, Hong JC, Gross CP et al (2017) Increased number of beam angles is associated with higher cardiac dose in adjuvant fixed gantry intensity modulated radiation therapy of left-sided breast cancer. Int J Radiat Oncol Biol Phys 99:1137–1145

    Article  Google Scholar 

  12. RTOG Breast Cancer Contouring Atlas (2018). https://www.rtog.org/LinkClick.aspx?fileticket=vzJFhPaBipE%3d&tabid=236

  13. Feng M, Moran JM, Koelling T et al (2011) Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer. Int J Radiat Oncol Biol Phys 79:10–18

    Article  Google Scholar 

  14. Mayo CS, Urie MM, Fitzgerald TJ (2005) Hybrid Imrt plans-concurrently treating conventional and imrt beams for improved breast irradiation and reduced planning time. Int J Radiat Oncol Biol Phys 61:922–932

    Article  Google Scholar 

  15. Berg M, Lorenzen EL, Jensen I et al (2018) The potential benefits from respiratory gating for breast cancer patients regarding target coverage and dose to organs at risk when applying strict dose limits to the heart: results from the DBCG HYPO trial. Acta Oncol 57:113–119

    Article  Google Scholar 

  16. Feuvret L, Noel G, Mazeron JJ et al (2006) Conformity index: a review. Int J Radiat Oncol Biol Phys 64:333–342

    Article  Google Scholar 

  17. van’t Riet A, Mak AC, Moerland MA et al (1997) A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: Application to the prostate. Int J Radiat Oncol Biol Phys 37:731–736

    Article  Google Scholar 

  18. Jacob V, Bayer W, Astner ST et al (2010) A planning comparison of dynamic IMRT for different collimator leaf thicknesses with Helical Tomotherapy and RapidArc for prostate and head neck tumors. Strahlenther Onkol 186:502–510

    Article  Google Scholar 

  19. Pyakuryal A, Mynt WK, Gopalakrishnan M et al (2010) A computational tool for the efficient analysis of dose-volume histograms for radiation therapy treatment plans. J Appl Clin Med Phys 11:137–157

    Article  Google Scholar 

  20. Lancia A, Ingrosso G, Carosi A et al (2019) Oligometastatic cancer in elderly patients: the “blitzkrieg” radiotherapy approach. Aging Clin Exp Res 31:109–114

    Article  Google Scholar 

  21. Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trial. N Engl J Med 341:2061–2067

    Article  CAS  Google Scholar 

  22. Correa CR, Litt HI, Hwang WT et al (2007) Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol 25:3031–3037

    Article  Google Scholar 

  23. Wang W, Wainstein R, Freixa X et al (2011) Quantitative coronary angiography findings of patients who received previous breast radiotherapy. Radiother Oncol 100:184–188

    Article  Google Scholar 

  24. Wennstig AK, Garmo H, Isacsson U et al (2019) The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors. Radiat Oncol. 14:40

    Article  Google Scholar 

  25. Harris EE, Correa C, Hwang WT et al (2006) Late cardiac mortality and morbidity in early-stage breast cancer patients after breast-conservation treatment. J Clin Oncol 24:4100–4106

    Article  Google Scholar 

  26. Stewart FA, Hoving S, Russell NS (2010) Vascular damage as an underlying mechanism of cardiac and cerebral toxicity in irradiated cancer patients. Radiat Res 174:865–869

    Article  CAS  Google Scholar 

  27. Offersen B, Højris I, Overgaard M (2011) Radiation-induced heart morbidity after adjuvant radiotherapy of early breast cancer—is it still an issue? Radiother Oncol 100:157–159

    Article  Google Scholar 

  28. McGale P, Darby SC, Hall P et al (2011) Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol 100:167–175

    Article  Google Scholar 

  29. Kirby AM, Evans PM, Donovan EM et al (2010) Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother Oncol 96:178–184

    Article  Google Scholar 

  30. Cooper BT, Li X, Shin SM et al (2016) Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters. Adv Radiat Oncol. 1:373–381

    Article  Google Scholar 

  31. Mendez LC, Louie AV, Moreno C et al (2018) Evaluation of a new predictor of heart and left anterior descending artery dose in patients treated with adjuvant radiotherapy to the left breast. Radiat Oncol. 13:124

    Article  Google Scholar 

  32. Boda-Heggemann J, Knopf AC, Simeonova-Chergou A et al (2016) Deep inspiration breath hold-based radiation therapy: a clinical review. Int J Radiat Oncol Biol Phys 94:478–492

    Article  Google Scholar 

  33. Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 25:1824–1831

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Radiotherapy Unit, Department of Oncology and Hematology, Tor Vergata General Hospital, Rome, Italy

    Alessandra Carosi, Irene Turturici, Silvio Valeri, Rosaria Barbarino, Luana Di Murro, Marta Bottero, Elisabetta Ponti & Riccardo Santoni

  2. Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Piazza Lucio Severi 1, 06132, Perugia, Italy

    Gianluca Ingrosso, Simonetta Saldi & Cynthia Aristei

  3. Department of Radiation Oncology, Fondazione IRCCS San Matteo, Pavia, Italy

    Andrea Lancia

  4. Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy

    Alessio Bruni & Maria Andolina

  5. Department of Radiation Oncology, University of Pavia, Fondazione IRCCS San Matteo, Pavia, Italy

    Elisabetta Bonzano

Authors
  1. Alessandra Carosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gianluca Ingrosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Irene Turturici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Silvio Valeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rosaria Barbarino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luana Di Murro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marta Bottero
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea Lancia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Elisabetta Ponti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alessio Bruni
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Elisabetta Bonzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Simonetta Saldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Maria Andolina
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Cynthia Aristei
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Riccardo Santoni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gianluca Ingrosso.

Ethics declarations

Conflict of interest

On behalf of all Authors, the Corresponding Author states that the work is compliant with Ethical Standards and that there is no conflict of interest.

Ethical approval

It is an “in silico” study. In fact, it is a dosimetric analysis.

Statement of human and animal rights

All procedures performed including human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendements or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carosi, A., Ingrosso, G., Turturici, I. et al. Whole breast external beam radiotherapy in elderly patients affected by left-sided early breast cancer: a dosimetric comparison between two simple free-breathing techniques. Aging Clin Exp Res 32, 1335–1341 (2020). https://doi.org/10.1007/s40520-019-01312-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-019-01312-5

Keywords

Search

Navigation