Hostname: page-component-5c6d5d7d68-7tdvq Total loading time: 0 Render date: 2024-08-07T14:24:37.537Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of dose volumetric parameters of oesophagus in the radiation treatment of carcinoma breast with and without oesophagus delineation

Published online by Cambridge University Press:  01 October 2021

Reshma Bhaskaran ,
Sajeev George Pulickal Open the ORCID record for Sajeev George Pulickal [Opens in a new window] ,
Harikrishnan Reghu ,
Aparna Perumangat  and
Girish Babu Moolath
Reshma Bhaskaran
Affiliation:
Department of Radiotherapy and Oncology, Government T D Medical College, Alappuzha, Kerala, India
Sajeev George Pulickal*
Affiliation:
Department of Radiotherapy and Oncology, Government T D Medical College, Alappuzha, Kerala, India
Harikrishnan Reghu
Affiliation:
Department of Radiotherapy and Oncology, Government T D Medical College, Alappuzha, Kerala, India
Aparna Perumangat
Affiliation:
Department of Radiotherapy and Oncology, Government T D Medical College, Alappuzha, Kerala, India
Girish Babu Moolath
Affiliation:
Department of Radiotherapy and Oncology, Government T D Medical College, Alappuzha, Kerala, India Department of Statistics, Government Arts and Science College, Koduvally, Kerala, India
*
Author for correspondence: Dr Sajeev George Pulickal, Department of Radiotherapy and Oncolog, Government T D Medical College, Vandanam, Alappuzha 688005, Kerala, India. Tel: +91 944 759 8662. E-mail pulickan7@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

There are only limited studies available in literature that discuss methods to reduce the oesophageal dose and acute oesophagitis during breast cancer radiotherapy. The aim of this study is to compare dose volumetric parameters of oesophagus in radiation treatment of breast with and without oesophagus delineation.

Methods:

Treatment plans of 44 patients, who underwent chest wall and supraclavicular fossa irradiation, were selected for the study. Oesophagus was later delineated and treatment replanned using three-dimensional conformal radiotherapy (3DCRT) considering oesophagus as an organ at risk (OAR). The dose prescribed was 40 Gy/15 fractions to the planning target volume (PTV). Dose volumetric parameters of oesophagus such as maximum dose (Dmax), mean dose (Dmean), the percentage of oesophagus volume receiving ≥15Gy (V15), ≥25Gy(V25), ≥33Gy(V33) and ipsilateral lung volume parameters V4, V8 and V16 were compared with already executed plans in which oesophagus was not delineated.

Results:

Contouring the oesophagus as an OAR as a part of the radiotherapy treatment for Carcinoma Breast resulted in statistically significant reduction in dose to the oesophagus. No statistically significant change was found in the ipsilateral lung volume parameters. No compromise in plan quality was required as evident from the statistically non-significant differences in Homogeneity index and Conformity index.

Findings:

3DCRT planning with oesophagus delineation can be considered as a method to reduce oesophageal dose and the acute oesophageal toxicity during radiotherapy for carcinoma breast.

Keywords

acute radiation oesophagitisbreast cancer radiationoesophagus contouring as OAR
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e10
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Whelan, TJ, Olivotto, IA, Parulekar, WR et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med 2015; 373: 307–316.CrossRefGoogle ScholarPubMed
EBCTCG; McGale, P, Taylor, C et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014; 383: 2127–2351.Google ScholarPubMed
Turkolmez, S, Atasever, T, Akmansu, M. Effects of radiation therapy on oesophageal transit in patients with inner quadrant breast tumour. Nucl Med Commun 2005; 26 (8): 721–726.CrossRefGoogle ScholarPubMed
Werner-Wasik, M, Yorke, E, Deasy, J, Nam, J, Marks, LB. Radiation dose-volume effects in the esophagus. Int J Radiat Oncol Biol Phys 2010; 76(3 Suppl): S86–S93.CrossRefGoogle ScholarPubMed
Kim, TH, Cho, KH, Pyo, HR et al., Dose-volumetric parameters of acute esophageal toxicity in patients with lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2005; 62 (4): 995–1002.CrossRefGoogle ScholarPubMed
Ahn, SJ, Kahn, D, Zhou, S et al., Dosimetric and clinical predictors for radiation-induced esophageal injury. Int J Radiat Oncol Biol Phys 2005; 61: 335–347.CrossRefGoogle ScholarPubMed
Caglar, HB, Othus, M, Allen, AM. Esophagus in-field: a new predictor for esophagitis. Radiother Oncol 2010; 97: 48–53.CrossRefGoogle ScholarPubMed
Takeda, K, Nemotto, K, Saito, H et al., Dosimetric correlations of acute esophagitis in lung cancer patients treated with radiotherapy. Int J Radiat Oncol Biol Phys 2005; 62: 626–629.CrossRefGoogle ScholarPubMed
Emami, B, Lyman, J, Brown, A et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21: 109–122.CrossRefGoogle ScholarPubMed
Woodford, K, Panettieri, V, Ruben, JD, Senthi, S, Limiting the risk of cardiac toxicity with esophageal-sparing intensity modulated radiotherapy for locally advanced lung cancers. J Thoracic Disease 2016; 8 (5): 942–949.CrossRefGoogle ScholarPubMed
Granton, PV, Palma, DA, Louie, AV, Intentional avoidance of the esophagus using intensity modulated radiation therapy to reduce dysphagia after palliative thoracic radiation. Radiat Oncol. 2017; 12: 27.CrossRefGoogle ScholarPubMed
Ma, L, Qiu, B, Li, QW et al. An esophagus-sparing technique to limit radiation esophagitis in locally advanced non-small cell lung cancer treated by simultaneous integrated boost intensity modulated radiotherapy and concurrent chemotherapy. Radiat Oncol 2018; 13: 130.CrossRefGoogle ScholarPubMed
Al-Halabi, H, Paetzold, P, Sharp, GC et al. Contralateral esophagus-sparing technique to limit severe esophagitis associated with concurrent high-dose radiation and chemotherapy in patients with thoracic malignancies. Int J Radiation Oncol Biol Phys 2015; 92: 803–810.CrossRefGoogle Scholar
West, K, Schneider, M, Wright, C et al. Radiation-induced esophagitis in breast cancer: Factors influencing onset and severity for patients receiving supraclavicular nodal irradiation. J Med Imag Radiat Oncol 2020; 64: 113–119.CrossRefGoogle ScholarPubMed
Yaney, A, Ayan, AS, Pan, X et al. Dosimetric parameters associated with radiation-induced esophagitis in breast cancer patients undergoing regional nodal irradiation. Radiother Oncol 2021; 155: 167–173.CrossRefGoogle ScholarPubMed
White, JT, Arthur, D, Buchholz, T et al. Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions, Available from URL: http://www.rtog.org/LinkClick.Google Scholar
The START Trialists’ Group, Bentzen, S M, Agrawal, R K et al., The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 2008; 9: 331–341.Google ScholarPubMed
RTOG 1005, A phase III trial of accelerated whole breast irradiation with hypofractionation plus concurrent boost versus standard whole breast irradiation plus sequential boost for early-stage breast cancer.Google Scholar
Kataria, T, Sharma, K, Subramani, V, Karrthick, KP, Bisht, SS. Homogeneity index: an objective tool for assessment of conformal radiation treatments. J Med Phys 2012; 37: 207–213. CrossRefGoogle ScholarPubMed
Feuvret, L, Noël, G, Mazeron, J-J, Bey, P. Conformity index: a review. Int J Radiat Oncol Biol Phys 2006; 64 (2): 333–342.CrossRefGoogle ScholarPubMed
Grays Anatomy: The Anatomical Basis of Clinical Practice: Susan Standring (Ed), 42nd Edition, Elsevier, 2020. page 473Google Scholar