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Decrease of the lumpectomy cavity volume after whole-breast irradiation affects small field boost planning.

Majid M Mohiuddin1, Elizabeth M Nichols, Kimberley J Marter

  • 1Northwest Radiation Oncology & Division of Oncology, UT Medical School at Houston, Houston, TX, USA. majid.mohiuddin.md@gmail.com

Medical Dosimetry : Official Journal of the American Association of Medical Dosimetrists
|February 7, 2012
PubMed
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This summary is machine-generated.

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Small field boost (SFB) replanning during whole-breast irradiation (WBI) requires individual assessment. Replanning is recommended for photon plans if lumpectomy cavity volume decreases by ≥5 cm³ and ≥25%.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Breast Cancer Treatment

Background:

  • Small field boost (SFB) planning in whole-breast irradiation (WBI) aims to optimize radiation delivery.
  • Changes in lumpectomy cavity volume (LCV) during WBI may necessitate adjustments to SFB treatment plans.
  • Assessing the need for replanning and identifying predictive factors is crucial for effective breast-conserving therapy.

Purpose of the Study:

  • To evaluate the necessity of SFB replanning when LCV decreases during WBI.
  • To identify parameters that predict changes in SFB treatment plans.
  • To compare dosimetric outcomes between photon and electron SFB plans.

Main Methods:

  • Forty patients undergoing WBI were simulated twice (CT1 and CT2) to assess LCV changes.

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  • Three-field photon and single en face electron SFB plans were created and compared on both CT datasets.
  • Changes in normal breast tissue volume irradiated (BTV) and field dimensions were analyzed.

    • Main Results:

    • In patients with a ≥5 cm³ and ≥25% decrease in LCV, photon SFB plans showed significant differences in BTV and field dimensions.
    • Electron SFB plans required energy or field size changes in 20/35 patients, but no predictive factors were identified.
    • Electron plans consistently irradiated less BTV compared to photon plans.

    Conclusions:

    • SFB replanning should be individualized due to variable factors influencing dosimetric planning.
    • Replanning with 3-field photons is recommended for LCV decreases of ≥5 cm³ and ≥25%.
    • Electron SFB may offer benefits, but patient selection remains challenging; electron plans potentially improve cosmesis by reducing irradiated BTV.