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Normal tissue sparing potential of scanned proton beams with and without respiratory gating for the treatment of internal mammary nodes in breast cancer radiotherapy

Dasu, Alexandru; Flejmer, Anna M.; Edvardsson, Anneli LU and Witt Nyström, Petra (2018) In Physica Medica 52. p.81-85
Abstract

Proton therapy has shown potential for reducing doses to normal tissues in breast cancer radiotherapy. However data on the impact of protons when including internal mammary nodes (IMN) in the target for breast radiotherapy is comparatively scarce. This study aimed to evaluate normal tissue doses when including the IMN in regional RT with scanned proton beams, with and without respiratory gating. The study cohort was composed of ten left-sided breast patients CT-scanned during enhanced inspiration gating (EIG) and free-breathing (FB). Proton plans were designed for the target including or excluding the IMN. Targets and organs-at-risk were delineated according to RTOG guidelines. Comparison was performed between dosimetric parameters... (More)

Proton therapy has shown potential for reducing doses to normal tissues in breast cancer radiotherapy. However data on the impact of protons when including internal mammary nodes (IMN) in the target for breast radiotherapy is comparatively scarce. This study aimed to evaluate normal tissue doses when including the IMN in regional RT with scanned proton beams, with and without respiratory gating. The study cohort was composed of ten left-sided breast patients CT-scanned during enhanced inspiration gating (EIG) and free-breathing (FB). Proton plans were designed for the target including or excluding the IMN. Targets and organs-at-risk were delineated according to RTOG guidelines. Comparison was performed between dosimetric parameters characterizing target coverage and OAR radiation burden. Statistical significance of differences was tested using a paired, two-tailed Student's t-test. Inclusion of the IMN in the target volume led to a small increase of the cardiopulmonary burden. The largest differences were seen for the ipsilateral lung where the mean dose increased from 6.1 to 6.6 Gy (RBE) (P < 0.0001) in FB plans and from 6.9 to 7.4 Gy (RBE) (P = 0.003) in EIG plans. Target coverage parameters were very little affected by the inclusion of IMN into the treatment target. Radiotherapy with scanned proton beams has the potential of maintaining low cardiovascular burden when including the IMN into the target, irrespective of whether respiratory gating is used or not.

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author
organization
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Contribution to journal
publication status
published
subject
keywords
Breast radiotherapy, Enhanced inspiration gating, Internal mammary nodes, Respiratory gating, Scanning proton technique
in
Physica Medica
volume
52
pages
5 pages
publisher
ISTITUTI EDITORIALI E POLGRAFICI INTERNAZIONALI
external identifiers
  • scopus:85049332034
ISSN
1120-1797
DOI
10.1016/j.ejmp.2018.06.639
language
English
LU publication?
yes
id
2720bec2-4ffd-4d18-9940-643af0fbd835
date added to LUP
2018-07-12 14:51:44
date last changed
2018-07-12 14:51:44
@article{2720bec2-4ffd-4d18-9940-643af0fbd835,
  abstract     = {<p>Proton therapy has shown potential for reducing doses to normal tissues in breast cancer radiotherapy. However data on the impact of protons when including internal mammary nodes (IMN) in the target for breast radiotherapy is comparatively scarce. This study aimed to evaluate normal tissue doses when including the IMN in regional RT with scanned proton beams, with and without respiratory gating. The study cohort was composed of ten left-sided breast patients CT-scanned during enhanced inspiration gating (EIG) and free-breathing (FB). Proton plans were designed for the target including or excluding the IMN. Targets and organs-at-risk were delineated according to RTOG guidelines. Comparison was performed between dosimetric parameters characterizing target coverage and OAR radiation burden. Statistical significance of differences was tested using a paired, two-tailed Student's t-test. Inclusion of the IMN in the target volume led to a small increase of the cardiopulmonary burden. The largest differences were seen for the ipsilateral lung where the mean dose increased from 6.1 to 6.6 Gy (RBE) (P &lt; 0.0001) in FB plans and from 6.9 to 7.4 Gy (RBE) (P = 0.003) in EIG plans. Target coverage parameters were very little affected by the inclusion of IMN into the treatment target. Radiotherapy with scanned proton beams has the potential of maintaining low cardiovascular burden when including the IMN into the target, irrespective of whether respiratory gating is used or not.</p>},
  author       = {Dasu, Alexandru and Flejmer, Anna M. and Edvardsson, Anneli and Witt Nyström, Petra},
  issn         = {1120-1797},
  keyword      = {Breast radiotherapy,Enhanced inspiration gating,Internal mammary nodes,Respiratory gating,Scanning proton technique},
  language     = {eng},
  month        = {08},
  pages        = {81--85},
  publisher    = {ISTITUTI EDITORIALI E POLGRAFICI INTERNAZIONALI},
  series       = {Physica Medica},
  title        = {Normal tissue sparing potential of scanned proton beams with and without respiratory gating for the treatment of internal mammary nodes in breast cancer radiotherapy},
  url          = {http://dx.doi.org/10.1016/j.ejmp.2018.06.639},
  volume       = {52},
  year         = {2018},
}