Can intensity-modulated radiation therapy spare the central flapped area while encompassing the target volume in radiotherapy after immediate breast reconstruction?

Jung Ae Lee, Won Sup Yoon, Se Young Chung, Dae-Sik Yang, Suk Lee, Young Je Park, Chul Yong Kim, Gil Soo Son, Eul Sik Yoon

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1 Citation (Scopus)

Abstract

Introduction Radiotherapy increases the morbidity of immediate breast reconstruction. To spare the flapped area without an adverse dose distribution of the target volume and organ at risks, various radiation techniques were assessed. Methods Twelve breasts undergoing skin-sparing mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction were evaluated. After a delineation of whole breast, the doughnut-like breast target volume (BTV) including the chest wall and skin and the subtracted central flapped volume (FV) were defined. The opposed wedge tangential radiotherapy (3-dimensional conformal radiotherapy (3-D CRT)), field-in-field radiotherapy (FiF), inverse intensity-modulated radiotherapy (iIMRT), volumetric modulated arc radiotherapy (VMRT) and the mixture of FiF and iIMRT (HYBRID) were tried. Total 50 Gy was prescribed to the BTV. The paired student t-tests were performed. Results The V47.5Gy of the BTV was improved in iIMRT and VMRT compared with 3-D CRT and FiF. The mean FV doses in iIMRT and VMRT were 76.7 ± 3.9% and 85.5 ± 4.0%, respectively. However the mean ipsilateral lung doses were aggravated by iIMRT and VMRT. In terms of HYBRID, the V47.5Gy for the BTV was 97.5 ± 0.7%. The mean FV dose was 89.4 ± 2.1%. While the mean FV dose in HYBRID was 13.7 ± 2.1% (P < 0.001) lower than FiF, it was 12.8 ± 1.9% (P < 0.001) higher than iIMRT. The mean ipsilateral lung dose in HYBRID was 2.8 ± 1.9% (P < 0.001) worse than FiF, and 2.6 ± 1.8% (P < 0.001) better than iIMRT. Conclusions The HYBRID could minimise the adverse dose distribution of lung and reduce 10% of the mean dose to the flapped area. For patients with adverse factors for the failure of breast reconstruction, the HYBRID could be considered.

Original languageEnglish
Pages (from-to)595-602
Number of pages8
JournalJournal of Medical Imaging and Radiation Oncology
Volume57
Issue number5
DOIs
Publication statusPublished - 2013 Oct 1

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Mammaplasty
Intensity-Modulated Radiotherapy
Radiotherapy
Breast
Conformal Radiotherapy
Lung
Organs at Risk
Rectus Abdominis
Skin
Myocutaneous Flap
Mastectomy
Thoracic Wall
Radiation
Students
Morbidity

Keywords

  • breast cancer
  • breast reconstruction
  • intensity-modulated radiation therapy
  • organ at risk
  • target volume

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

Cite this

@article{0a863e2571674477bb6997e3d9984c8d,
title = "Can intensity-modulated radiation therapy spare the central flapped area while encompassing the target volume in radiotherapy after immediate breast reconstruction?",
abstract = "Introduction Radiotherapy increases the morbidity of immediate breast reconstruction. To spare the flapped area without an adverse dose distribution of the target volume and organ at risks, various radiation techniques were assessed. Methods Twelve breasts undergoing skin-sparing mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction were evaluated. After a delineation of whole breast, the doughnut-like breast target volume (BTV) including the chest wall and skin and the subtracted central flapped volume (FV) were defined. The opposed wedge tangential radiotherapy (3-dimensional conformal radiotherapy (3-D CRT)), field-in-field radiotherapy (FiF), inverse intensity-modulated radiotherapy (iIMRT), volumetric modulated arc radiotherapy (VMRT) and the mixture of FiF and iIMRT (HYBRID) were tried. Total 50 Gy was prescribed to the BTV. The paired student t-tests were performed. Results The V47.5Gy of the BTV was improved in iIMRT and VMRT compared with 3-D CRT and FiF. The mean FV doses in iIMRT and VMRT were 76.7 ± 3.9{\%} and 85.5 ± 4.0{\%}, respectively. However the mean ipsilateral lung doses were aggravated by iIMRT and VMRT. In terms of HYBRID, the V47.5Gy for the BTV was 97.5 ± 0.7{\%}. The mean FV dose was 89.4 ± 2.1{\%}. While the mean FV dose in HYBRID was 13.7 ± 2.1{\%} (P < 0.001) lower than FiF, it was 12.8 ± 1.9{\%} (P < 0.001) higher than iIMRT. The mean ipsilateral lung dose in HYBRID was 2.8 ± 1.9{\%} (P < 0.001) worse than FiF, and 2.6 ± 1.8{\%} (P < 0.001) better than iIMRT. Conclusions The HYBRID could minimise the adverse dose distribution of lung and reduce 10{\%} of the mean dose to the flapped area. For patients with adverse factors for the failure of breast reconstruction, the HYBRID could be considered.",
keywords = "breast cancer, breast reconstruction, intensity-modulated radiation therapy, organ at risk, target volume",
author = "Lee, {Jung Ae} and Yoon, {Won Sup} and Chung, {Se Young} and Dae-Sik Yang and Suk Lee and Park, {Young Je} and Kim, {Chul Yong} and Son, {Gil Soo} and Yoon, {Eul Sik}",
year = "2013",
month = "10",
day = "1",
doi = "10.1111/1754-9485.12078",
language = "English",
volume = "57",
pages = "595--602",
journal = "Journal of Medical Imaging and Radiation Oncology",
issn = "1754-9477",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Can intensity-modulated radiation therapy spare the central flapped area while encompassing the target volume in radiotherapy after immediate breast reconstruction?

AU - Lee, Jung Ae

AU - Yoon, Won Sup

AU - Chung, Se Young

AU - Yang, Dae-Sik

AU - Lee, Suk

AU - Park, Young Je

AU - Kim, Chul Yong

AU - Son, Gil Soo

AU - Yoon, Eul Sik

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Introduction Radiotherapy increases the morbidity of immediate breast reconstruction. To spare the flapped area without an adverse dose distribution of the target volume and organ at risks, various radiation techniques were assessed. Methods Twelve breasts undergoing skin-sparing mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction were evaluated. After a delineation of whole breast, the doughnut-like breast target volume (BTV) including the chest wall and skin and the subtracted central flapped volume (FV) were defined. The opposed wedge tangential radiotherapy (3-dimensional conformal radiotherapy (3-D CRT)), field-in-field radiotherapy (FiF), inverse intensity-modulated radiotherapy (iIMRT), volumetric modulated arc radiotherapy (VMRT) and the mixture of FiF and iIMRT (HYBRID) were tried. Total 50 Gy was prescribed to the BTV. The paired student t-tests were performed. Results The V47.5Gy of the BTV was improved in iIMRT and VMRT compared with 3-D CRT and FiF. The mean FV doses in iIMRT and VMRT were 76.7 ± 3.9% and 85.5 ± 4.0%, respectively. However the mean ipsilateral lung doses were aggravated by iIMRT and VMRT. In terms of HYBRID, the V47.5Gy for the BTV was 97.5 ± 0.7%. The mean FV dose was 89.4 ± 2.1%. While the mean FV dose in HYBRID was 13.7 ± 2.1% (P < 0.001) lower than FiF, it was 12.8 ± 1.9% (P < 0.001) higher than iIMRT. The mean ipsilateral lung dose in HYBRID was 2.8 ± 1.9% (P < 0.001) worse than FiF, and 2.6 ± 1.8% (P < 0.001) better than iIMRT. Conclusions The HYBRID could minimise the adverse dose distribution of lung and reduce 10% of the mean dose to the flapped area. For patients with adverse factors for the failure of breast reconstruction, the HYBRID could be considered.

AB - Introduction Radiotherapy increases the morbidity of immediate breast reconstruction. To spare the flapped area without an adverse dose distribution of the target volume and organ at risks, various radiation techniques were assessed. Methods Twelve breasts undergoing skin-sparing mastectomy and immediate transverse rectus abdominis myocutaneous flap reconstruction were evaluated. After a delineation of whole breast, the doughnut-like breast target volume (BTV) including the chest wall and skin and the subtracted central flapped volume (FV) were defined. The opposed wedge tangential radiotherapy (3-dimensional conformal radiotherapy (3-D CRT)), field-in-field radiotherapy (FiF), inverse intensity-modulated radiotherapy (iIMRT), volumetric modulated arc radiotherapy (VMRT) and the mixture of FiF and iIMRT (HYBRID) were tried. Total 50 Gy was prescribed to the BTV. The paired student t-tests were performed. Results The V47.5Gy of the BTV was improved in iIMRT and VMRT compared with 3-D CRT and FiF. The mean FV doses in iIMRT and VMRT were 76.7 ± 3.9% and 85.5 ± 4.0%, respectively. However the mean ipsilateral lung doses were aggravated by iIMRT and VMRT. In terms of HYBRID, the V47.5Gy for the BTV was 97.5 ± 0.7%. The mean FV dose was 89.4 ± 2.1%. While the mean FV dose in HYBRID was 13.7 ± 2.1% (P < 0.001) lower than FiF, it was 12.8 ± 1.9% (P < 0.001) higher than iIMRT. The mean ipsilateral lung dose in HYBRID was 2.8 ± 1.9% (P < 0.001) worse than FiF, and 2.6 ± 1.8% (P < 0.001) better than iIMRT. Conclusions The HYBRID could minimise the adverse dose distribution of lung and reduce 10% of the mean dose to the flapped area. For patients with adverse factors for the failure of breast reconstruction, the HYBRID could be considered.

KW - breast cancer

KW - breast reconstruction

KW - intensity-modulated radiation therapy

KW - organ at risk

KW - target volume

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JO - Journal of Medical Imaging and Radiation Oncology

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