Optimal Target Delineation and Treatment Techniques in the Era of Conformal Photon and Proton Breast and Regional Nodal Irradiation.

Autor:	Kowalski ES; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Feigenberg SJ; Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania., Cohen J; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Fellows Z; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Vadnais P; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Rice S; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Mishra MV; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland., Molitoris JK; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland., Nichols EM; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland., Snider JW 3rd; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: jsnider@umm.edu.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2020 May - Jun; Vol. 10 (3), pp. 174-182. Date of Electronic Publication: 2019 Nov 28.
DOI:	10.1016/j.prro.2019.11.010
Abstrakt:	Purpose: Regional nodal irradiation improves disease-free and distant disease-free survival in patients with high-risk breast cancer (BC). Trials demonstrating this used 2- or 3-dimensional conformal radiation therapy (2-dimensional or 3-dimensional [3D] conformal radiotherapy [CRT]) fields based on bony anatomy. Modern volumetric-modulated arc therapy (VMAT) and pencil beam scanning proton therapy (PBSPT) may underdose regional nodes (RNs) not contoured but covered by 3D CRT. Multiple atlases guide modern treatment planning. This study addresses the risk of underdosing when relying on published atlases and treating with 3D CRT, VMAT, and PBSPT. Methods and Materials: Targets per the Radiation Therapy Oncology Group (RTOG), European Society for Radiotherapy and Oncology (ESTRO), and Radiotherapy Comparative Effectiveness Consortium (RADCOMP) atlases were contoured on a representative patient CT scan. 3D CRT plans based on anatomic borders and VMAT and PBSPT plans for each set of target volumes were generated. Positron emission tomography/computed tomography (PET/CT) scans were reviewed. CT-positive and 18 F-fluorodeoxyglucose ( 18 F-FDG)-avid RNs (n = 389) were mapped from 102 patients with locally advanced (n = 51; median 2; range, 1-8 nodes) and metastatic (n = 51; median 4; range, 1-19 nodes) BC: axillary (AX; n = 284), supraclavicular (SCV; n = 60), and internal mammary nodal (IMN; n = 45). 18 F-FDG-avid RNs falling within the 95% isodose line were considered adequately covered. Results: 3D CRT plans provided excellent RN coverage. Low AX nodes were covered (≥99%) in all plans. Underdosing of 18 F-FDG-avid RNs falling in the high AX (78%-92%), SCV (52%-75%), and IMN (84%-89%) volumes was observed following the RTOG and ESTRO atlases for VMAT and PBSPT plans. Use of the RADCOMP atlas provided coverage of these areas (89%-100%) with slightly increased heart and lung doses. Atlas guided VMAT/PBSPT plans provided cumulative nodal coverage as follows: ESTRO (89%/88%), RTOG (93%/91%), and RADCOMP (98%/96%). Conclusions: VMAT and PBSPT for regional nodal irradiation in patients with high-risk BC risks underdosage in the high AX, SCV, and IMN nodal regions unless comprehensive target delineation is performed. (Published by Elsevier Inc.)
Databáze:	MEDLINE
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