Dosimetric analysis of six whole-breast irradiation techniques in supine and prone positions.
Humans
Female
Breast Neoplasms
/ radiotherapy
Prone Position
Supine Position
Organs at Risk
/ radiation effects
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
/ methods
Radiometry
/ methods
Patient Positioning
/ methods
Lung
/ radiation effects
Middle Aged
Radiotherapy, Intensity-Modulated
/ methods
Heart
/ radiation effects
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
21 Jun 2024
21 Jun 2024
Historique:
received:
27
11
2023
accepted:
20
06
2024
medline:
22
6
2024
pubmed:
22
6
2024
entrez:
21
6
2024
Statut:
epublish
Résumé
In breast cancer radiation therapy, minimizing radiation-related risks and toxicity is vital for improving life expectancy. Tailoring radiotherapy techniques and treatment positions can reduce radiation doses to normal organs and mitigate treatment-related toxicity. This study entailed a dosimetric comparison of six different external beam whole-breast irradiation techniques in both supine and prone positions. We selected fourteen breast cancer patients, generating six treatment plans in both positions per patient. We assessed target coverage and organs at risk (OAR) doses to evaluate the impact of treatment techniques and positions. Excess absolute risk was calculated to estimate potential secondary cancer risk in the contralateral breast, ipsilateral lung, and contralateral lung. Additionally, we analyzed the distance between the target volume and OARs (heart and ipsilateral lung) while considering the treatment position. The results indicate that prone positioning lowers lung exposure in X-ray radiotherapy. However, particle beam therapies (PBTs) significantly reduce the dose to the heart and ipsilateral lung regardless of the patient's position. Notably, negligible differences were observed between arc-delivery and static-delivery PBTs in terms of target conformity and OAR sparing. This study provides critical dosimetric evidence to facilitate informed decision-making regarding treatment techniques and positions.
Identifiants
pubmed: 38907042
doi: 10.1038/s41598-024-65461-y
pii: 10.1038/s41598-024-65461-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
14347Subventions
Organisme : Yonsei University College of Medicine
ID : 6-2021-0234
Organisme : Korea Institute for Advancement of Technology
ID : P0026103
Organisme : Nuclear Safety and Security Commission
ID : RS-2022-KN071210
Organisme : Ministry of Education
ID : RS-2023-00249964
Informations de copyright
© 2024. The Author(s).
Références
Lei, S. et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun. 41, 1183–1194 (2021).
doi: 10.1002/cac2.12207
Soerjomataram, I. & Bray, F. Planning for tomorrow: Global cancer incidence and the role of prevention 2020–2070. Nat. Rev. Clin. Oncol. 18, 663–672 (2021).
pubmed: 34079102
doi: 10.1038/s41571-021-00514-z
Bray, F. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 68, 394–424 (2018).
pubmed: 30207593
doi: 10.3322/caac.21492
Fisher, B. et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N. Engl. J. Med. 347, 1233–1241 (2002).
pubmed: 12393820
doi: 10.1056/NEJMoa022152
Early Breast Cancer Trialists’ Collaborative Group et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 378, 1707–1716 (2011).
doi: 10.1016/S0140-6736(11)61629-2
Aznar, M. C., Duane, F. K., Darby, S. C., Wang, Z. & Taylor, C. W. Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010–2015. Radiother. Oncol. 126, 148–154 (2018).
pubmed: 29246585
pmcid: 5807032
doi: 10.1016/j.radonc.2017.11.022
Darby, S. C. et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N. Engl. J. Med. 368, 987–998 (2013).
pubmed: 23484825
doi: 10.1056/NEJMoa1209825
Darby, S. C., McGale, P., Taylor, C. W. & Peto, R. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: Prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol. 6, 557–565 (2005).
pubmed: 16054566
doi: 10.1016/S1470-2045(05)70251-5
Sato, H. et al. Incidence of organizing pneumonia after whole-breast radiotherapy for breast cancer, and risk factor analysis. J. Radiat. Res. 59, 298–302 (2018).
pubmed: 29415179
pmcid: 5967573
doi: 10.1093/jrr/rry001
Taylor, C. et al. Estimating the risks of breast cancer radiotherapy: Evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J. Clin. Oncol. 35, 1641–1649 (2017).
pubmed: 28319436
pmcid: 5548226
doi: 10.1200/JCO.2016.72.0722
Taylor, C. et al. Cardiac structure injury after radiotherapy for breast cancer: Cross-sectional study with individual patient data. J. Clin. Oncol. 36, 2288–2296 (2018).
pubmed: 29791285
pmcid: 6067799
doi: 10.1200/JCO.2017.77.6351
Wennstig, A. K. et al. The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors. Radiat. Oncol. 14, 40 (2019).
pubmed: 30845947
pmcid: 6407212
doi: 10.1186/s13014-019-1242-z
Piroth, M. D. et al. Heart toxicity from breast cancer radiotherapy: Current findings, assessment, and prevention. Strahlenther. Onkol. 195, 1–12 (2019).
pubmed: 30310926
doi: 10.1007/s00066-018-1378-z
Burt, L. M., Ying, J., Poppe, M. M., Suneja, G. & Gaffney, D. K. Risk of secondary malignancies after radiation therapy for breast cancer: Comprehensive results. Breast 35, 122–129 (2017).
pubmed: 28719811
doi: 10.1016/j.breast.2017.07.004
Gao, X., Fisher, S. G. & Emami, B. Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer: A population-based study. Int. J. Radiat. Oncol. Biol. Phys. 56, 1038–1045 (2003).
pubmed: 12829139
doi: 10.1016/S0360-3016(03)00203-7
de Gonzalez, A. B. et al. Second solid cancers after radiotherapy for breast cancer in SEER cancer registries. Br. J. Cancer 102, 220–226 (2010).
doi: 10.1038/sj.bjc.6605435
Roychoudhuri, R., Evans, H., Robinson, D. & Moller, H. Radiation-induced malignancies following radiotherapy for breast cancer. Br. J. Cancer 91, 868–872 (2004).
pubmed: 15292931
pmcid: 2409877
doi: 10.1038/sj.bjc.6602084
Ahmad, I. et al. Plan quality assessment of modern radiotherapy delivery techniques in left-sided breast cancer: An analysis stratified by target delineation guidelines. BJR Open 2, 20200007 (2020).
pubmed: 33330831
pmcid: 7736705
Chen, S. N., Ramachandran, P. & Deb, P. Dosimetric comparative study of 3DCRT, IMRT, VMAT, Ecomp, and hybrid techniques for breast radiation therapy. Radiat. Oncol. J. 38, 270–281 (2020).
pubmed: 33389982
pmcid: 7785843
doi: 10.3857/roj.2020.00619
Chang, K. H. et al. A retrospective dosimetric analysis of the new ESTRO-ACROP target volume delineation guidelines for postmastectomy volumetric modulated arc therapy after implant-based immediate breast reconstruction. Front. Oncol. 10, 578921 (2020).
pubmed: 33194701
pmcid: 7606939
doi: 10.3389/fonc.2020.578921
Malouff, T. D. et al. Carbon ion radiation therapy in breast cancer: A new frontier. Breast Cancer Res. Treat. 181, 291–296 (2020).
pubmed: 32318954
pmcid: 7734650
doi: 10.1007/s10549-020-05641-2
Mutter, R. W. et al. Proton therapy for breast cancer: A consensus statement from the particle therapy cooperative group breast cancer subcommittee. Int. J. Radiat. Oncol. Biol. Phys. 111, 337–359 (2021).
pubmed: 34048815
pmcid: 8416711
doi: 10.1016/j.ijrobp.2021.05.110
Ding, X. et al. Spot-scanning proton arc (SPArc) therapy: The first robust and delivery-efficient spot-scanning proton arc therapy. Int. J. Radiat. Oncol. Biol. Phys. 96, 1107–1116 (2016).
pubmed: 27869083
doi: 10.1016/j.ijrobp.2016.08.049
Chang, S. et al. Feasibility study: Spot-scanning proton arc therapy (SPArc) for left-sided whole breast radiotherapy. Radiat. Oncol. 15, 232 (2020).
pubmed: 33028378
pmcid: 7542109
doi: 10.1186/s13014-020-01676-3
Sun, T. et al. Heart and cardiac substructure dose sparing in synchronous bilateral breast radiotherapy: A dosimetric study of proton and photon radiation therapy. Front. Oncol. 9, 1456 (2019).
pubmed: 31998635
doi: 10.3389/fonc.2019.01456
Stick, L. B. et al. Joint estimation of cardiac toxicity and recurrence risks after comprehensive nodal photon versus proton therapy for breast cancer. Int. J. Radiat. Oncol. Biol. Phys. 97, 754–761 (2017).
pubmed: 28244411
doi: 10.1016/j.ijrobp.2016.12.008
Ko, H. et al. Dosimetric comparison of radiation techniques for comprehensive regional nodal radiation therapy for left-sided breast cancer: A treatment planning study. Front. Oncol. 11, 645328 (2021).
pubmed: 33912459
pmcid: 8072050
doi: 10.3389/fonc.2021.645328
Cunningham, L., Penfold, S., Giles, E., Le, H. & Short, M. Impact of breast size on dosimetric indices in proton versus X-ray radiotherapy for breast cancer. J. Pers. Med. 11, 282 (2021).
pubmed: 33917818
pmcid: 8068250
doi: 10.3390/jpm11040282
Speleers, B. A. et al. Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain. Sci. Rep. 9, 4755 (2019).
pubmed: 30894606
pmcid: 6427000
doi: 10.1038/s41598-019-41283-1
Paganetti, H. et al. The risk for developing a secondary cancer after breast radiation therapy: Comparison of photon and proton techniques. Radiother. Oncol. 149, 212–218 (2020).
pubmed: 32464163
doi: 10.1016/j.radonc.2020.05.035
Zhang, Q. et al. Secondary cancer risk after radiation therapy for breast cancer with different radiotherapy techniques. Sci. Rep. 10, 1220 (2020).
pubmed: 31988348
pmcid: 6985127
doi: 10.1038/s41598-020-58134-z
Cartechini, G. et al. Proton pencil beam scanning reduces secondary cancer risk in breast cancer patients with internal mammary chain involvement compared to photon radiotherapy. Radiat. Oncol. 15, 228 (2020).
pubmed: 33008412
pmcid: 7532613
doi: 10.1186/s13014-020-01671-8
Unkelbach, J. et al. Robust radiotherapy planning. Phys. Med. Biol. 63, 2202 (2018).
doi: 10.1088/1361-6560/aae659
Cubillos-Mesias, M. et al. Quantification of plan robustness against different uncertainty sources for classical and anatomical robust optimized treatment plans in head and neck cancer proton therapy. Br. J. Radiol. 93, 20190573 (2020).
pubmed: 31778315
pmcid: 7066968
doi: 10.1259/bjr.20190573
Inaniwa, T. et al. Treatment planning for a scanned carbon beam with a modified microdosimetric kinetic model. Phys. Med. Biol. 55, 6721–6737 (2010).
pubmed: 21030747
doi: 10.1088/0031-9155/55/22/008
Inaniwa, T. & Kanematsu, N. Adaptation of stochastic microdosimetric kinetic model for charged-particle therapy treatment planning. Phys. Med. Biol. 63, 095011 (2018).
pubmed: 29726401
doi: 10.1088/1361-6560/aabede
Inaniwa, T. et al. Effects of dose-delivery time structure on biological effectiveness for therapeutic carbon-ion beams evaluated with microdosimetric kinetic model. Radiat. Res. 180, 44–59 (2013).
pubmed: 23768075
doi: 10.1667/RR3178.1
Feuvret, L., Noel, G., Mazeron, J. J. & Bey, P. Conformity index: A review. Int. J. Radiat. Oncol. Biol. Phys. 64, 333–342 (2006).
pubmed: 16414369
doi: 10.1016/j.ijrobp.2005.09.028
Wu, Q., Mohan, R., Morris, M., Lauve, A. & Schmidt-Ullrich, R. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: Dosimetric results. Int. J. Radiat. Oncol. Biol. Phys. 56, 573–585 (2003).
pubmed: 12738335
doi: 10.1016/S0360-3016(02)04617-5
Paddick, I. A simple scoring ratio to index the conformity of radiosurgical treatment plans: Technical note. J. Neurosurg. 93(Suppl 3), 219–222 (2000).
pubmed: 11143252
doi: 10.3171/jns.2000.93.supplement_3.0219
The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 37, 1–332 (2007).
Schneider, U., Sumila, M. & Robotka, J. Site-specific dose-response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy. Theor. Biol. Med. Model 8, 27 (2011).
pubmed: 21791103
pmcid: 3161945
doi: 10.1186/1742-4682-8-27
Schneider, U. & Kaser-Hotz, B. Radiation risk estimates after radiotherapy: Application of the organ equivalent dose concept to plateau dose-response relationships. Radiat. Environ. Biophys. 44, 235–239 (2005).
pubmed: 16273381
doi: 10.1007/s00411-005-0016-1
Mailhot Vega, R. B. et al. Establishing cost-effective allocation of proton therapy for breast irradiation. Int. J. Radiat. Oncol. Biol. Phys. 95, 11–18 (2016).
pubmed: 27084617
doi: 10.1016/j.ijrobp.2016.02.031
van den Bogaard, V. A. et al. Validation and modification of a prediction model for acute cardiac events in patients with breast cancer treated with radiotherapy based on three-dimensional dose distributions to cardiac substructures. J. Clin. Oncol. 35, 1171–1178 (2017).
pubmed: 28095159
pmcid: 5455600
doi: 10.1200/JCO.2016.69.8480
Luo, W. et al. Particle therapy for breast cancer: Benefits and challenges. Front. Oncol. 11, 662826 (2021).
pubmed: 34026640
pmcid: 8131859
doi: 10.3389/fonc.2021.662826
Karasawa, K. et al. A Phase I clinical trial of carbon ion radiotherapy for Stage I breast cancer: Clinical and pathological evaluation. J. Radiat. Res. 60, 342–347 (2019).
pubmed: 30805611
pmcid: 6530622
doi: 10.1093/jrr/rry113
Karasawa, K. et al. A clinical study of curative partial breast irradiation for stage I breast cancer using carbon ion radiotherapy. Radiat. Oncol. 15, 265 (2020).
pubmed: 33187529
pmcid: 7666457
doi: 10.1186/s13014-020-01713-1
Bogue, J., Wan, J., Lavey, R. S. & Parsai, E. I. Dosimetric comparison of VMAT with integrated skin flash to 3D field-in-field tangents for left breast irradiation. J. Appl. Clin. Med. Phys. 20, 24–29 (2019).
pubmed: 30653831
pmcid: 6371015
doi: 10.1002/acm2.12527
Liu, Y. C., Chang, H. M., Lin, H. H., Lu, C. C. & Lai, L. H. Dosimetric comparison of intensity-modulated radiotherapy, volumetric modulated arc therapy and hybrid three-dimensional conformal radiotherapy/intensity-modulated radiotherapy techniques for right breast cancer. J. Clin. Med. 9, 3884 (2020).
pubmed: 33260404
pmcid: 7760558
doi: 10.3390/jcm9123884
Viren, T. et al. Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiat. Oncol. 10, 79 (2015).
pubmed: 25888866
pmcid: 4404692
doi: 10.1186/s13014-015-0392-x
Mulliez, T. et al. Setup accuracy for prone and supine whole breast irradiation. Strahlenther. Onkol. 192, 254–259 (2016).
pubmed: 26864048
doi: 10.1007/s00066-016-0943-6
Mazal, A. et al. Biological and mechanical synergies to deal with proton therapy pitfalls: Minibeams, FLASH, arcs, and gantryless rooms. Front. Oncol. 10, 613669 (2020).
pubmed: 33585238
doi: 10.3389/fonc.2020.613669
Zhou, Y., Li, Y., Kubota, Y., Sakai, M. & Ohno, T. Robust angle selection in particle therapy. Front. Oncol. 11, 715025 (2021).
pubmed: 34621672
pmcid: 8490826
doi: 10.3389/fonc.2021.715025
Bertolet, A. & Carabe, A. Proton monoenergetic arc therapy (PMAT) to enhance LETd within the target. Phys. Med. Biol. 65, 165006 (2020).
pubmed: 32428896
doi: 10.1088/1361-6560/ab9455
Li, X. et al. Improve dosimetric outcome in stage III non-small-cell lung cancer treatment using spot-scanning proton arc (SPArc) therapy. Radiat. Oncol. 13, 35 (2018).
pubmed: 29486782
pmcid: 6389253
doi: 10.1186/s13014-018-0981-6
Toussaint, L. et al. Towards proton arc therapy: Physical and biologically equivalent doses with increasing number of beams in pediatric brain irradiation. Acta Oncol. 58, 1451–1456 (2019).
pubmed: 31303090
doi: 10.1080/0284186X.2019.1639823
Lai, J. et al. Prone position versus supine position in postoperative radiotherapy for breast cancer: A meta-analysis. Medicine 100, e26000 (2021).
pubmed: 34011096
pmcid: 8136988
doi: 10.1097/MD.0000000000026000
Kahan, Z. et al. A simple clinical method for predicting the benefit of prone vs supine positioning in reducing heart exposure during left breast radiotherapy. Radiother. Oncol. 126, 487–492 (2018).
pubmed: 29373194
doi: 10.1016/j.radonc.2017.12.021
Duma, M. N., Munch, S., Oechsner, M. & Combs, S. E. Heart-sparing radiotherapy in patients with breast cancer: What are the techniques used in the clinical routine?: A pattern of practice survey in the German-speaking countries. Med. Dosim. 42, 197–202 (2017).
pubmed: 28502653
doi: 10.1016/j.meddos.2017.03.002
Yu, T. et al. External-beam partial breast irradiation in a supine versus prone position after breast-conserving surgery for Chinese breast cancer patients. Sci. Rep. 8, 15354 (2018).
pubmed: 30337718
pmcid: 6193958
doi: 10.1038/s41598-018-33741-z
Kirby, A. M. et al. Prone versus supine positioning for whole and partial-breast radiotherapy: A comparison of non-target tissue dosimetry. Radiother. Oncol. 96, 178–184 (2010).
pubmed: 20561695
doi: 10.1016/j.radonc.2010.05.014
Bartlett, F. R. et al. The UK heart spare study (stage IB): Randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery. Radiother. Oncol. 114, 66–72 (2015).
pubmed: 25739317
doi: 10.1016/j.radonc.2014.11.018
Vakaet, V. et al. 5-year outcomes of a randomized trial comparing prone and supine whole breast irradiation in large-breasted women. Int. J. Radiat. Oncol. Biol. Phys. 110, 766–771 (2021).
pubmed: 33508375
doi: 10.1016/j.ijrobp.2021.01.026
Deseyne, P. et al. Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer. Radiat. Oncol. 12, 89 (2017).
pubmed: 28549483
pmcid: 5446717
doi: 10.1186/s13014-017-0828-6
Budhi Singh Yadav, D. D., Thakur, N., Ghoshal, S., Sharma, R. & Singh, A. O. Dosimetric comparison of supine versus prone radiotherapy techniques in patients with breast cancer. J. Radiat. Oncol. 9, 6 (2020).
Chung, Y., Yu, J. I., Park, W. & Choi, D. H. Korean first prospective phase II study, feasibility of prone position in postoperative whole breast radiotherapy: A dosimetric comparison. Cancer Res. Treat. 51, 1370–1379 (2019).
pubmed: 30776884
pmcid: 6790854
doi: 10.4143/crt.2018.423
Eley, J. G. et al. Comparative risk predictions of second cancers after carbon-ion therapy versus proton therapy. Int. J. Radiat. Oncol. Biol. Phys. 95, 279–286 (2016).
pubmed: 27084647
pmcid: 4844193
doi: 10.1016/j.ijrobp.2016.02.032
Ytre-Hauge, K. S. et al. Inter-patient variations in relative biological effectiveness for cranio-spinal irradiation with protons. Sci. Rep. 10, 6212 (2020).
pubmed: 32277106
pmcid: 7148381
doi: 10.1038/s41598-020-63164-8
Sethi, R. A., No, H. S., Jozsef, G., Ko, J. P. & Formenti, S. C. Comparison of three-dimensional versus intensity-modulated radiotherapy techniques to treat breast and axillary level III and supraclavicular nodes in a prone versus supine position. Radiat. Oncol. 102, 74–81 (2012).
doi: 10.1016/j.radonc.2011.09.008
Jimenez, R. B. et al. Phase II study of proton beam radiation therapy for patients with breast cancer requiring regional nodal irradiation. J. Clin. Oncol. 37, 2778 (2019).
pubmed: 31449469
pmcid: 7351324
doi: 10.1200/JCO.18.02366
Remouchamps, V. M. et al. Initial clinical experience with moderate deep-inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 56, 704–715 (2003).
pubmed: 12788176
doi: 10.1016/S0360-3016(03)00010-5