Analysis of Radiation Dose to the Shoulder by Treatment Technique and Correlation With Patient Reported Outcomes in Patients Receiving Regional Nodal Irradiation
| Autor: | Karla Kuhn, Sachin R. Jhawar, Kylee Lindsey, Jose G. Bazan, Kayla Tedrick, E. Healy, Sasha Beyer, Dominic DiCostanzo, Karen Hock, Julia White |
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| Rok vydání: | 2021 |
| Předmět: |
musculoskeletal diseases
RNI Cancer Research shoulder Nodal irradiation medicine.medical_treatment lcsh:RC254-282 Prospective evaluation 03 medical and health sciences 0302 clinical medicine Breast cancer 3DCRT medicine In patient 030212 general & internal medicine IMRT Stage (cooking) Original Research quick DASH business.industry Radiation dose lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease Oncology 030220 oncology & carcinogenesis Cohort Nuclear medicine business human activities Mastectomy PMRT |
| Zdroj: | Frontiers in Oncology, Vol 11 (2021) Frontiers in Oncology |
| ISSN: | 2234-943X |
| Popis: | Background/PurposeShoulder/arm morbidity is a late complication of breast cancer treatment with surgery and regional nodal irradiation (RNI). We set to analyze the impact of radiation technique [intensity modulated radiation therapy (IMRT) or 3D conformal radiation therapy (3DCRT)] on radiation dose to the shoulder with a hypothesis that IMRT use results in smaller volume of shoulder receiving radiation. We explored the relationship of treatment technique on long-term patient-reported outcomes using the quick disabilities of the arm, shoulder, and hand (q-DASH) questionnaire.Materials/MethodsWe identified patients treated with adjuvant RNI (50 Gy/25 fractions) from 2013 to 2018. We retrospectively contoured the shoulder organ-at-risk (OAR) from 2 cm above the ipsilateral supraclavicular (SCL) planning target volume (PTV) to the inferior SCL PTV slice and calculated the absolute volume of shoulder OAR receiving 5–50 Gy (V5–V50). We identified patients that completed a q-DASH questionnaire ≥6 months from the end of RNI.ResultsWe included 410 RNI patients: 54% stage III, 72% mastectomy, 35% treated with IMRT. IMRT resulted in significant reductions in the shoulder OAR volume receiving 20–50 Gy vs. 3DCRT. In total, 82 patients completed the q-DASH. The mean (SD) q-DASH=25.4 (19.1) and tended to be lower with IMRT vs. 3DCRT: 19.6 (16.4) vs. 27.8 (19.8), p=0.078.ConclusionWe found that IMRT reduces radiation dose to the shoulder and is associated with a trend toward reduced q-DASH scores ≥6 months post-RNI in a subset of our cohort. These results support prospective evaluation of IMRT as a technique to reduce shoulder morbidity in breast cancer patients receiving RNI. |
| Databáze: | OpenAIRE |
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