Contralateral breast dose after whole-breast irradiation: An analysis by treatment technique

Terence M. Williams, Jean M. Moran, Shu-Hui Hsu, Robin Marsh, Beth Yanke, Benedick A. Fraass, Lori J. Pierce

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose: To investigate the contralateral breast dose (CBD) across a continuum of breast-conservation therapy techniques. Methods and Materials: An anthropomorphic phantom was CT-simulated, and six treatment plans were generated: open tangents, tangents with an external wedge on the lateral beam, tangents with lateral and medial external wedges, a simple segment plan (three segments per tangent), a complex segmental intensity-modulated radiotherapy (IMRT) plan (five segments per tangent), and a beamlet IMRT plan (>100 segments). For all techniques, the breast on the phantom was irradiated to 5000 cGy. Contralateral breast dose was measured at a uniform depth at the center and each quadrant using thermoluminescent detectors. Results: Contralateral breast dose varied with position and was 50 ± 7.3 cGy in the inner half, 24 ± 4.1 cGy at the center, and 16 ± 2.2 cGy in the outer half for the open tangential plan. Compared with an average dose of 31 cGy across all points for the open field, the average doses were simple segment 32 cGy (range, 99-105% compared with open technique), complex segment 34 cGy (range, 103-117% compared with open technique), beamlet IMRT 34 cGy (range, 103-124% compared with open technique), lateral wedge only 46 cGy (range, 133-175% compared with open technique), and medial and lateral wedge 96 cGy (range, 282-370% compared with open technique). Conclusions: Single or dual wedge techniques resulted in the highest CBD increases compared with open tangents. To obtain the desired homogeneity to the treated breast while minimizing CBD, segmental and IMRT techniques should be encouraged over external physical compensators.

Original languageEnglish (US)
Pages (from-to)2079-2085
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number5
DOIs
StatePublished - Apr 1 2012
Externally publishedYes

Fingerprint

breast
Breast
tangents
Intensity-Modulated Radiotherapy
dosage
irradiation
wedges
radiation therapy
Therapeutics
Segmental Mastectomy
quadrants
compensators
homogeneity
conservation
therapy
continuums
detectors

Keywords

  • Breast cancer
  • Contralateral breast dose
  • IMRT
  • Second malignancies
  • Whole-breast irradiation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Contralateral breast dose after whole-breast irradiation : An analysis by treatment technique. / Williams, Terence M.; Moran, Jean M.; Hsu, Shu-Hui; Marsh, Robin; Yanke, Beth; Fraass, Benedick A.; Pierce, Lori J.

In: International Journal of Radiation Oncology Biology Physics, Vol. 82, No. 5, 01.04.2012, p. 2079-2085.

Research output: Contribution to journalArticle

Williams, Terence M. ; Moran, Jean M. ; Hsu, Shu-Hui ; Marsh, Robin ; Yanke, Beth ; Fraass, Benedick A. ; Pierce, Lori J. / Contralateral breast dose after whole-breast irradiation : An analysis by treatment technique. In: International Journal of Radiation Oncology Biology Physics. 2012 ; Vol. 82, No. 5. pp. 2079-2085.
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AU - Williams, Terence M.

AU - Moran, Jean M.

AU - Hsu, Shu-Hui

AU - Marsh, Robin

AU - Yanke, Beth

AU - Fraass, Benedick A.

AU - Pierce, Lori J.

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N2 - Purpose: To investigate the contralateral breast dose (CBD) across a continuum of breast-conservation therapy techniques. Methods and Materials: An anthropomorphic phantom was CT-simulated, and six treatment plans were generated: open tangents, tangents with an external wedge on the lateral beam, tangents with lateral and medial external wedges, a simple segment plan (three segments per tangent), a complex segmental intensity-modulated radiotherapy (IMRT) plan (five segments per tangent), and a beamlet IMRT plan (>100 segments). For all techniques, the breast on the phantom was irradiated to 5000 cGy. Contralateral breast dose was measured at a uniform depth at the center and each quadrant using thermoluminescent detectors. Results: Contralateral breast dose varied with position and was 50 ± 7.3 cGy in the inner half, 24 ± 4.1 cGy at the center, and 16 ± 2.2 cGy in the outer half for the open tangential plan. Compared with an average dose of 31 cGy across all points for the open field, the average doses were simple segment 32 cGy (range, 99-105% compared with open technique), complex segment 34 cGy (range, 103-117% compared with open technique), beamlet IMRT 34 cGy (range, 103-124% compared with open technique), lateral wedge only 46 cGy (range, 133-175% compared with open technique), and medial and lateral wedge 96 cGy (range, 282-370% compared with open technique). Conclusions: Single or dual wedge techniques resulted in the highest CBD increases compared with open tangents. To obtain the desired homogeneity to the treated breast while minimizing CBD, segmental and IMRT techniques should be encouraged over external physical compensators.

AB - Purpose: To investigate the contralateral breast dose (CBD) across a continuum of breast-conservation therapy techniques. Methods and Materials: An anthropomorphic phantom was CT-simulated, and six treatment plans were generated: open tangents, tangents with an external wedge on the lateral beam, tangents with lateral and medial external wedges, a simple segment plan (three segments per tangent), a complex segmental intensity-modulated radiotherapy (IMRT) plan (five segments per tangent), and a beamlet IMRT plan (>100 segments). For all techniques, the breast on the phantom was irradiated to 5000 cGy. Contralateral breast dose was measured at a uniform depth at the center and each quadrant using thermoluminescent detectors. Results: Contralateral breast dose varied with position and was 50 ± 7.3 cGy in the inner half, 24 ± 4.1 cGy at the center, and 16 ± 2.2 cGy in the outer half for the open tangential plan. Compared with an average dose of 31 cGy across all points for the open field, the average doses were simple segment 32 cGy (range, 99-105% compared with open technique), complex segment 34 cGy (range, 103-117% compared with open technique), beamlet IMRT 34 cGy (range, 103-124% compared with open technique), lateral wedge only 46 cGy (range, 133-175% compared with open technique), and medial and lateral wedge 96 cGy (range, 282-370% compared with open technique). Conclusions: Single or dual wedge techniques resulted in the highest CBD increases compared with open tangents. To obtain the desired homogeneity to the treated breast while minimizing CBD, segmental and IMRT techniques should be encouraged over external physical compensators.

KW - Breast cancer

KW - Contralateral breast dose

KW - IMRT

KW - Second malignancies

KW - Whole-breast irradiation

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