Three-Dimensional Conformal External Beam Radiotherapy (3D-CRT) for Accelerated Partial Breast Irradiation (APBI)

Department of Radiation Oncology, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298-0058, USA.
American journal of clinical oncology (Impact Factor: 3.06). 11/2006; 29(5):474-8. DOI: 10.1097/01.coc.0000225409.99284.f2
Source: PubMed


This study is an evaluation of the biologic equivalence of the dose prescriptions for brachytherapy and 3-dimensional conformal external beam radiotherapy (3D-CRT) accelerated partial breast irradiation (APBI), using actual patient dose matrix data, and is based on the concept of equivalent uniform biologically effective dose (EUBED). This formalism allows a nonuniform dose distribution to be reduced to an equivalent uniform dose, while also accounting for fraction size.
Five computed tomography scans were selected from a group of patients treated with multicatheter interstitial APBI. Dose matrices for the brachytherapy plans were computed and analyzed with in-house software. For each patient, the EUBED for the brachytherapy dose matrix was generated based on calculations performed at the voxel-level. These EUBED values were then used to calculate the biologically equivalent fraction size for 3D-CRT (eud).
The mean equivalent fraction size (eudmean) and maximum equivalent fraction size (eudmax) were calculated for each patient using 100 different values of the alpha/beta ratio. The eudmean ranged from 3.67 to 3.69 Gy, while the eudmax ranged from 3.79 to 3.82 Gy. For all values of the alpha/beta ratio, the maximum fraction size calculated to deliver a biologically equivalent dose with 3D-CRT was 3.82 Gy, with an equivalent total prescription dose of 38.2 Gy.
Utilizing a wide range of established radiobiological parameters, this study suggests that the maximum fraction size needed to deliver a biologically equivalent dose using 3D-CRT is 3.82 Gy, supporting the continued use of 3.85Gy BID in the current national cooperative trial.

12 Reads
  • Source
    • "Livi et al.[102] in randomized Phase III trial have used a dose of 30 Gy in five fractions (6 Gy/fraction) and argued that it was equivalent to 54 Gy in a standard fractionation of 2 Gy fractionation. However, Cuttino et al. [103] utilizing a wide range of established radiobiological parameters, determined that the maximum fraction size needed to deliver a biologically equivalent dose using 3D-CRT is 3.82 Gy, supporting the continued use of 3.85Gy BID in the current national cooperative trial. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Breast conservation therapy (BCT) is the procedure of choice for the management of the early stage breast cancer. However, its utilization has not been maximized because of logistics issues associated with the protracted treatment involved with the radiation treatment. Accelerated Partial Breast Irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1-2 cm margin, rather than the whole breast. Hence because of the small volume of irradiation a higher dose can be delivered in a shorter period of time. There has been growing interest for APBI and various approaches have been developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy and intra-operative radiation therapy (IORT). Balloon-based brachytherapy approaches include Mammosite, Axxent electronic brachytherapy and Contura, Hybrid brachytherapy devices include SAVI and ClearPath. This paper reviews the different techniques, identifying the weaknesses and strength of each approach and proposes a direction for future research and development. It is evident that APBI will play a role in the management of a selected group of early breast cancer. However, the relative role of the different techniques is yet to be clearly identified.
    Radiation Oncology 10/2010; 5(1):90. DOI:10.1186/1748-717X-5-90 · 2.55 Impact Factor
  • Source
    • "Several groups have shown that accelerated partial breast irradiation (APBI) for selected patients have comparable outcome to the standard whole breast irradiation after breast conservative surgery [1-3]. The three-dimensional conformal radiotherapy (3DCRT) has shown the advantages of noninvasive and easy implementation in a modern radiotherapy department [4,5]. According to the RTOG 0319 report [6], APBI has achieved similar early outcomes as whole-breast irradiation (WBI). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The cone beam CT (CBCT) guided radiation can reduce the systematic and random setup errors as compared to the skin-mark setup. However, the residual and intrafractional (RAIF) errors are still unknown. The purpose of this paper is to investigate the magnitude of RAIF errors and correction action levels needed in cone beam computed tomography (CBCT) guided accelerated partial breast irradiation (APBI). Ten patients were enrolled in the prospective study of CBCT guided APBI. The postoperative tumor bed was irradiated with 38.5 Gy in 10 fractions over 5 days. Two cone-beam CT data sets were obtained with one before and one after the treatment delivery. The CBCT images were registered online to the planning CT images using the automatic algorithm followed by a fine manual adjustment. An action level of 3 mm, meaning that corrections were performed for translations exceeding 3 mm, was implemented in clinical treatments. Based on the acquired data, different correction action levels were simulated, and random RAIF errors, systematic RAIF errors and related margins before and after the treatments were determined for varying correction action levels. A total of 75 pairs of CBCT data sets were analyzed. The systematic and random setup errors based on skin-mark setup prior to treatment delivery were 2.1 mm and 1.8 mm in the lateral (LR), 3.1 mm and 2.3 mm in the superior-inferior (SI), and 2.3 mm and 2.0 mm in the anterior-posterior (AP) directions. With the 3 mm correction action level, the systematic and random RAIF errors were 2.5 mm and 2.3 mm in the LR direction, 2.3 mm and 2.3 mm in the SI direction, and 2.3 mm and 2.2 mm in the AP direction after treatments delivery. Accordingly, the margins for correction action levels of 3 mm, 4 mm, 5 mm, 6 mm and no correction were 7.9 mm, 8.0 mm, 8.0 mm, 7.9 mm and 8.0 mm in the LR direction; 6.4 mm, 7.1 mm, 7.9 mm, 9.2 mm and 10.5 mm in the SI direction; 7.6 mm, 7.9 mm, 9.4 mm, 10.1 mm and 12.7 mm in the AP direction, respectively. Residual and intrafractional errors can significantly affect the accuracy of image-guided APBI with nonplanar 3DCRT techniques. If a 10-mm CTV-PTV margin is applied, a correction action level of 5 mm or less is necessary so as to maintain the RAIF errors within 10 mm for more than 95% of fractions. Pre-treatment CBCT guidance is not a guarantee for safe delivery of the treatment despite its known benefits of reducing the initial setup errors. A patient position verification and correction during the treatment may be a method for the safe delivery.
    Radiation Oncology 10/2010; 5(1):96. DOI:10.1186/1748-717X-5-96 · 2.55 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Plasma, generated by vacuum-arc discharge with titanium cathode at Ar and N<sub>2</sub> presence, has been investigated using a quadruple RF mass spectrometer and multigrid electrostatic probe. Metal and gas ions radial flows intensities and their energies depending on discharge current and gas pressure has been investigated. It is defined that gas ions created by interaction between primary erosion metal plasma flow and gas target motion mainly in the radial direction as a result of particles dispersion on the large angles, which is characteristic to recharging processes
    Discharges and Electrical Insulation in Vacuum, 1996. Proceedings. ISDEIV., XVIIth International Symposium on; 08/1996
Show more