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Ben J Mijnheer - One of the best experts on this subject based on the ideXlab platform.
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reduction of cardiac and Lung Complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation
Radiotherapy and Oncology, 2002Co-Authors: Coen W Hurkmans, E Damen, Lambert Zijp, Ben J MijnheerAbstract:Purpose: The main purpose of this work is to reduce the cardiac and Lung dose by applying conformal tangential beam irradiation of the intact left breast with and without intensity modulation, instead of rectangular tangential treatment fields. The extension of the applicability of the maximum heart distance (MHD) to conformal tangential fields as a simple patient selection criterion, identifying patients for which rectangular and conformal tangential fields without intensity modulation will result in unacceptable normal tissue Complication probability (NTCP) values for late cardiac mortality (e.g. .2%), was also investigated. Materials and methods: Three-dimensional treatment planning was performed for 17 left-sided breast cancer patients. Three different tangential beam techniques were compared: (1) optimized wedges without blocks, (2) optimized wedges with conformal blocks and (3) intensity modulation. Plans were evaluated using dose‐volume histograms (DVHs) for the planning target volume (PTV), the heart and the Lungs. NTCPs for radiation pneumonitis and late cardiac mortality were calculated using the DVH data. The MHD was measured for all rectangular (MHDrectangular) and conformal (MHDconformal) treatment plans. Results: For all patients, on average, part of the PTV receiving a dose between 95 and 107% of the prescribed dose of 50 Gy in 25 fractions of 2 Gy was 90.8% (standard deviation (SD): 5.0%), 92.8% (SD: 3.5%) and 92.8% (SD: 3.6%) for the intensity modulation radiation therapy (IMRT), conformal and rectangular field treatment techniques, respectively. The NTCP for radiation pneumonitis was 0.3% (SD: 0.1%), 0.4% (SD: 0.4%) and 0.5% (SD: 0.6%) for the IMRT, conformal and rectangular field techniques, respectively. The NTCP for late cardiac mortality was 5.9% (SD: 2.2%) for the rectangular field technique. This value was reduced to 4.0% (SD: 2.3%) with the conformal technique. A further reduction to 2.0% (SD: 1.1%) could be accomplished with the IMRT technique. The NTCP for late cardiac mortality could be described as a second order polynomial function of the MHD. This function could be described with a high accuracy and was independent of the technique for which the MHD was determined ðr 2 ¼ 0:88Þ. In order to achieve a NTCP value for late cardiac mortality below 1, 2 or 3%, the MHD should be equal to or smaller than 11, 17 or 23 mm, respectively. If such a maximum Complication probability cannot be accomplished, a treatment using the IMRT technique should be considered. Conclusions: The use of conformal tangential fields decreases the NTCP for late cardiac toxicity on average by 30% compared to using rectangular fields, while the tangential IMRT technique can further reduce this value by an additional 50%. The MHD can be used to estimate the NTCP for late cardiac mortality if rectangular or conformal tangential treatment fields are used. q 2002 Elsevier Science Ireland Ltd. All rights reserved.
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cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P<0.001) by 1.7% (Technique A) and 1.0% (Technique B) when locoregional breast irradiation was given, compared with irradiation of the left breast only. The NTCP values for the tangential field technique could be estimated using the Maximum Heart Distance. NTCP values for radiation pneumonitis were very low for all techniques; between 0.0 and 1.0%. Conclusions: Technique B results in a good coverage of the breast and locoregional lymph nodes, while Technique A sometimes results in an underdosage of part of the target volume. Both techniques result in a higher probability of heart Complications compared with tangential irradiation of the breast only. Irradiation toxicity for the Lung is low in all techniques. The Maximum Heart Distance is a simple and useful parameter to estimate the NTCP values for cardiac mortality for tangential breast irradiation.
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Cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P
Coen W Hurkmans - One of the best experts on this subject based on the ideXlab platform.
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reduction of cardiac and Lung Complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation
Radiotherapy and Oncology, 2002Co-Authors: Coen W Hurkmans, E Damen, Lambert Zijp, Ben J MijnheerAbstract:Purpose: The main purpose of this work is to reduce the cardiac and Lung dose by applying conformal tangential beam irradiation of the intact left breast with and without intensity modulation, instead of rectangular tangential treatment fields. The extension of the applicability of the maximum heart distance (MHD) to conformal tangential fields as a simple patient selection criterion, identifying patients for which rectangular and conformal tangential fields without intensity modulation will result in unacceptable normal tissue Complication probability (NTCP) values for late cardiac mortality (e.g. .2%), was also investigated. Materials and methods: Three-dimensional treatment planning was performed for 17 left-sided breast cancer patients. Three different tangential beam techniques were compared: (1) optimized wedges without blocks, (2) optimized wedges with conformal blocks and (3) intensity modulation. Plans were evaluated using dose‐volume histograms (DVHs) for the planning target volume (PTV), the heart and the Lungs. NTCPs for radiation pneumonitis and late cardiac mortality were calculated using the DVH data. The MHD was measured for all rectangular (MHDrectangular) and conformal (MHDconformal) treatment plans. Results: For all patients, on average, part of the PTV receiving a dose between 95 and 107% of the prescribed dose of 50 Gy in 25 fractions of 2 Gy was 90.8% (standard deviation (SD): 5.0%), 92.8% (SD: 3.5%) and 92.8% (SD: 3.6%) for the intensity modulation radiation therapy (IMRT), conformal and rectangular field treatment techniques, respectively. The NTCP for radiation pneumonitis was 0.3% (SD: 0.1%), 0.4% (SD: 0.4%) and 0.5% (SD: 0.6%) for the IMRT, conformal and rectangular field techniques, respectively. The NTCP for late cardiac mortality was 5.9% (SD: 2.2%) for the rectangular field technique. This value was reduced to 4.0% (SD: 2.3%) with the conformal technique. A further reduction to 2.0% (SD: 1.1%) could be accomplished with the IMRT technique. The NTCP for late cardiac mortality could be described as a second order polynomial function of the MHD. This function could be described with a high accuracy and was independent of the technique for which the MHD was determined ðr 2 ¼ 0:88Þ. In order to achieve a NTCP value for late cardiac mortality below 1, 2 or 3%, the MHD should be equal to or smaller than 11, 17 or 23 mm, respectively. If such a maximum Complication probability cannot be accomplished, a treatment using the IMRT technique should be considered. Conclusions: The use of conformal tangential fields decreases the NTCP for late cardiac toxicity on average by 30% compared to using rectangular fields, while the tangential IMRT technique can further reduce this value by an additional 50%. The MHD can be used to estimate the NTCP for late cardiac mortality if rectangular or conformal tangential treatment fields are used. q 2002 Elsevier Science Ireland Ltd. All rights reserved.
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cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P<0.001) by 1.7% (Technique A) and 1.0% (Technique B) when locoregional breast irradiation was given, compared with irradiation of the left breast only. The NTCP values for the tangential field technique could be estimated using the Maximum Heart Distance. NTCP values for radiation pneumonitis were very low for all techniques; between 0.0 and 1.0%. Conclusions: Technique B results in a good coverage of the breast and locoregional lymph nodes, while Technique A sometimes results in an underdosage of part of the target volume. Both techniques result in a higher probability of heart Complications compared with tangential irradiation of the breast only. Irradiation toxicity for the Lung is low in all techniques. The Maximum Heart Distance is a simple and useful parameter to estimate the NTCP values for cardiac mortality for tangential breast irradiation.
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Cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P
Joos V Lebesque - One of the best experts on this subject based on the ideXlab platform.
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cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P<0.001) by 1.7% (Technique A) and 1.0% (Technique B) when locoregional breast irradiation was given, compared with irradiation of the left breast only. The NTCP values for the tangential field technique could be estimated using the Maximum Heart Distance. NTCP values for radiation pneumonitis were very low for all techniques; between 0.0 and 1.0%. Conclusions: Technique B results in a good coverage of the breast and locoregional lymph nodes, while Technique A sometimes results in an underdosage of part of the target volume. Both techniques result in a higher probability of heart Complications compared with tangential irradiation of the breast only. Irradiation toxicity for the Lung is low in all techniques. The Maximum Heart Distance is a simple and useful parameter to estimate the NTCP values for cardiac mortality for tangential breast irradiation.
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Cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P
Bradley R Pieters - One of the best experts on this subject based on the ideXlab platform.
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cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P<0.001) by 1.7% (Technique A) and 1.0% (Technique B) when locoregional breast irradiation was given, compared with irradiation of the left breast only. The NTCP values for the tangential field technique could be estimated using the Maximum Heart Distance. NTCP values for radiation pneumonitis were very low for all techniques; between 0.0 and 1.0%. Conclusions: Technique B results in a good coverage of the breast and locoregional lymph nodes, while Technique A sometimes results in an underdosage of part of the target volume. Both techniques result in a higher probability of heart Complications compared with tangential irradiation of the breast only. Irradiation toxicity for the Lung is low in all techniques. The Maximum Heart Distance is a simple and useful parameter to estimate the NTCP values for cardiac mortality for tangential breast irradiation.
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Cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P
Astrid Van Der Horst - One of the best experts on this subject based on the ideXlab platform.
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cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P<0.001) by 1.7% (Technique A) and 1.0% (Technique B) when locoregional breast irradiation was given, compared with irradiation of the left breast only. The NTCP values for the tangential field technique could be estimated using the Maximum Heart Distance. NTCP values for radiation pneumonitis were very low for all techniques; between 0.0 and 1.0%. Conclusions: Technique B results in a good coverage of the breast and locoregional lymph nodes, while Technique A sometimes results in an underdosage of part of the target volume. Both techniques result in a higher probability of heart Complications compared with tangential irradiation of the breast only. Irradiation toxicity for the Lung is low in all techniques. The Maximum Heart Distance is a simple and useful parameter to estimate the NTCP values for cardiac mortality for tangential breast irradiation.
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Cardiac and Lung Complication probabilities after breast cancer irradiation
Radiotherapy and Oncology, 2000Co-Authors: Coen W Hurkmans, Jacques Borger, Astrid Van Der Horst, Bradley R Pieters, Joos V Lebesque, Ben J MijnheerAbstract:Purpose: To assess for locoregional irradiation of breast cancer patients, the dependence of cardiac (cardiac mortality) and Lung (radiation pneumonitis) Complications on treatment technique and individual patient anatomy. Materials and methods: Three-dimensional treatment planning was performed for 30 patients with left-sided breast cancer and various breast sizes. Two locoregional techniques (Techniques A and B) and a tangential field technique, including only the breast in the target volume, were planned and evaluated for each patient. In both locoregional techniques tangential photon fields were used to irradiate the breast. The internal mammary (IM)–medial supraclavicular (MS) lymph nodes were treated with an anterior mixed electron/photon field (Technique A) or with an obliquely incident mixed electron/photon IM field and an anterior electron/photon MS field (Technique B). The optimal IM and MS electron field dimensions and energies were chosen on the basis of the IM–MS lymph node target volume as delineated on CT-slices. The position of the tangential fields was adapted to match the IM–MS fields. Dose-volume histograms (DVHs) and normal tissue Complication probabilities (NTCPs) for the heart and Lung were compared for the three techniques. In the beam's eye view of the medial tangential fields the maximum distance of the heart contour to the posterior field border was measured; this value was scored as the Maximum Heart Distance. Results: The lymph node target volume receiving more than 85% of the prescribed dose was on average 99% for both locoregional irradiation techniques. The breast PTV receiving more than 95% of the prescribed dose was generally smaller using Technique A (mean: 90%, range: 69–99%) than using Technique B (mean: 98%, range: 82–100%) or for the tangential field technique (mean: 98%, range: 91–100%). NTCP values for excess cardiac mortality due to acute myocardial ischemia varied considerably between patients, with minimum and maximum values of 0.1 and 7.5% (Technique A), 0.1 and 5.8% (Technique B) and 0.0 and 6.1% (tangential tech.). The NTCP values were on average significantly higher (P
