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Hypofractioned Radiation Therapy in the Treatment of Partial Breast: 30 Gy in Five Consecutive Fractions

Journal of Cancer Therapy 2012年第6期3卷 1151-1158页

作者： Sara Terenzi Rosaria Barbarino Maria Daniela Falco Daniela di Cristino Luana Di Murro Dania Janniello Gianluca Ingrosso Alessandra Murgia grazia tortorelli Barbara Tolu Riccardo Santoni Department of Diagnostic Imaging Molecular Imaging Interventional Radiology and Radiotherapy Tor Vergata University General Hospital Viale Oxford Rome Italy.

Background and Purpose: Recent prospective studies have explored the partial breast irradiation (PBI) for patients with early-stage breast cancer using different technical approaches. The purpose of this study is to explore feasibility, tumor control and acute and late toxicity of a specific hypo-fractionated 3D-CRT when treating postmenopausal patients with early breast cancer with partial breast irradiation, using five fractions in five consecutive days. Materials and Methods: Ten patients, aged ≥ 70 underwent breast conservative surgery for invasive breast carcinoma with a complete microscopic resection;no lymphovascular invasion was found and negative axillary node status was assessed. Metal clips were positioned in the surgical bed at the time of surgery. All of the patients provided an informed consent for breast irradiation. Seven patients received Tamoxifen. Of the ten patients, five were treated for left breast disease, and five for right breast disease. The dose fractionation schedule was 3000 cGy delivered to the isocenter in 5 fractions (600 cGy/fr) using 6 MV photons. According to the linear quadratic model and an α/β ratio of 4 Gy this prescription is equivalent to 50 Gy in a standard 2-Gy fractionation schedule. Patients were treated in the supine position. A comercial breast board was used as immobilization device in order to keep the arms of the patient raised. The clinical target volume (CTV) was drawn with a uniform 1-cm three-dimensional margin around the surgical clips. The CTV was limited to 3 mm from the skin surface and 3 mm from the lung-chest wall interface. A three-dimensional margin was added to the CTV to obtain the planning target volume (PTV). The ipsilateral and controlateral breast, the ipsilateral and controlateral lung, heart and spinal cord were contoured as organs at risk (OAR). The treatment was developed using Precise Plan Treatment Planning System and four no-coplanar fields. The constraints used have been: uninvolved breast (

关键词： Breast Cancer Partial Breast Irradiation Hypofractioned

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Construction of a Simple Rectum Model Using Image Guidance in Prostate Patients Treated with 3D Conformal Radiotherapy

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Journal of Cancer Therapy 2014年第12期5卷 1039-1048页

作者： Marco D’Andrea Maria Daniela Falco Dahlia Fedele Elisabetta Ponti Barbara Tolu Daniela Di Cristino Rosaria Barbarino Luana Di Murro grazia tortorelli Andrea Duggento Paolo Bagalà Maria Guerrisi Riccardo Santoni Laboratory of Medical Physics and Expert Systems National Cancer Institute Regina Elena Rome Italy Department of Diagnostic Imaging Molecular Imaging Interventional Radiology and Radiotherapy Tor Vergata University General Hospital Rome Italy Department of Biomedicine and Prevention Medical Physics Section Tor Vergata University Rome Italy

Purpose: To evaluate the performance of a rectum model in predicting late rectal toxicity of prostate patients undergoing 3D conformal radiation therapy while following a dietary protocol combined with image guidance. Methods: A linear accelerator equipped with a Cone Beam Computed Tomography (CBCT) system was used to treat 20 patients who were following a dietary protocol. The set-up was verified by co-registering CBCT scans with the planning CT scan (pCT). A mean dose volume histogram () as the arithmetical mean of the rectum DVHs from each CBCT scan was obtained. A suitably defined 3D rectum model (Average Rectum, AR) was defined and its DVH (DVHAR) was calculated. DVHs were also evaluated for the first five CBCT scans using both methods (5 >?and DVHAR5). The Lyman-Kutcher-Burman NTCP model with QUANTEC parameters was used to compare the calculated DVHs. The QUANTEC dose values were used to describe the time behaviour of the relative volumes using the Gamma Distribution for the frequency of the relative rectum volumes at each QUANTEC dose value. Results: No statistically significant differences between NTCPAR5 and NTCPAR and between NTCP and NTCP were found. The best agreement with the observed toxicity rate (0%) was obtained form DVHAR. The Gamma Distributions of the rectum volumes at the QUANTEC dose levels were found to be highly variable among the patients. Conclusions: Both dietary protocol and image guidance were found effective in limiting late rectal toxicity. AR was a better predictor for late rectal toxicity and better described the rectum volume during the treatment course. Finally, from the Gamma distributions, and from our toxicity data, we can suggest V75 as the best predictor of late rectal toxicity.

关键词： Organ Motion Prostate Cancer Rectal Toxicity Radiotherapy

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