Optimized Dose Coverage of Regional Lymph Nodes in Breast Cancer

The Role of Intensity-Modulated Radiotherapy

Nesrin Dogan, Laurie Cuttino, Rick Lloyd, Edward A. Bump, Douglas W. Arthur

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Purpose: To determine whether the use of intensity-modulated radiotherapy (IMRT) would lead to improved dosimetry for the breast and regional nodes. Methods and Materials: Ten patients with left-sided breast cancer were selected. The clinical target volume included left breast and internal mammillary (IM), supraclavicular (SC), and axillary (AX) nodes. The critical structures included heart, right and left lungs, contralateral breast, esophagus, thyroid, and humeral head. Conventional and a series of IMRT plans were generated for comparison. Results: The average heart D3 was reduced from 31.4 ± 18.9 with three-dimensional conformal radiotherapy (3D-CRT) to 15 ± 7.2 Gy with 9-field (9-FLD IMRT). The average left lung D30 was also decreased from 27.9 ± 11.5 Gy (3D-CRT) to 12.6 ± 8.2 Gy (9-FLD IMRT). The average contralateral breast D2 was reduced from 4.4 ± 5.3 Gy (3D-CRT) to 1.8 ± 1.2 Gy (4-FLD IMRT). Esophagus D2 was increased from 9.3 ± 8.1 Gy (3D-CRT) to 29.4 ± 5.4 (9-FLD IMRT); thyroid D50 was increased from 0.9 ± 0.6 Gy (3D-CRT) to 11.9 ± 6.6 (9-FLD IMRT); humeral head D2 was increased from 36.1 ± 13.1 Gy (3D-CRT) to 39.9 ± 6.5 (9-FLD IMRT). Conclusions: The use of IMRT improves breast and regional node coverage while decreasing doses to the lungs, heart, and contralateral breast when compared with 3D-CRT. Doses to esophagus, thyroid, and humeral head, however, were increased with IMRT.

Original languageEnglish (US)
Pages (from-to)1238-1250
Number of pages13
JournalInternational Journal of Radiation Oncology Biology Physics
Volume68
Issue number4
DOIs
StatePublished - Jul 15 2007
Externally publishedYes

Fingerprint

Intensity-Modulated Radiotherapy
lymphatic system
breast
Conformal Radiotherapy
radiation therapy
Lymph Nodes
cancer
Breast Neoplasms
dosage
Breast
Humeral Head
Esophagus
Thyroid Gland
esophagus
Lung
lungs

Keywords

  • Breast IMRT
  • Intensity-modulated radiotherapy
  • Regional node coverage

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Optimized Dose Coverage of Regional Lymph Nodes in Breast Cancer : The Role of Intensity-Modulated Radiotherapy. / Dogan, Nesrin; Cuttino, Laurie; Lloyd, Rick; Bump, Edward A.; Arthur, Douglas W.

In: International Journal of Radiation Oncology Biology Physics, Vol. 68, No. 4, 15.07.2007, p. 1238-1250.

Research output: Contribution to journalArticle

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AB - Purpose: To determine whether the use of intensity-modulated radiotherapy (IMRT) would lead to improved dosimetry for the breast and regional nodes. Methods and Materials: Ten patients with left-sided breast cancer were selected. The clinical target volume included left breast and internal mammillary (IM), supraclavicular (SC), and axillary (AX) nodes. The critical structures included heart, right and left lungs, contralateral breast, esophagus, thyroid, and humeral head. Conventional and a series of IMRT plans were generated for comparison. Results: The average heart D3 was reduced from 31.4 ± 18.9 with three-dimensional conformal radiotherapy (3D-CRT) to 15 ± 7.2 Gy with 9-field (9-FLD IMRT). The average left lung D30 was also decreased from 27.9 ± 11.5 Gy (3D-CRT) to 12.6 ± 8.2 Gy (9-FLD IMRT). The average contralateral breast D2 was reduced from 4.4 ± 5.3 Gy (3D-CRT) to 1.8 ± 1.2 Gy (4-FLD IMRT). Esophagus D2 was increased from 9.3 ± 8.1 Gy (3D-CRT) to 29.4 ± 5.4 (9-FLD IMRT); thyroid D50 was increased from 0.9 ± 0.6 Gy (3D-CRT) to 11.9 ± 6.6 (9-FLD IMRT); humeral head D2 was increased from 36.1 ± 13.1 Gy (3D-CRT) to 39.9 ± 6.5 (9-FLD IMRT). Conclusions: The use of IMRT improves breast and regional node coverage while decreasing doses to the lungs, heart, and contralateral breast when compared with 3D-CRT. Doses to esophagus, thyroid, and humeral head, however, were increased with IMRT.

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