Long-term pulmonary outcomes of a feasibility study of inverse-planned, multibeam intensity modulated radiation therapy in node-positive breast cancer patients receiving regional nodal irradiation Journal Article


Authors: Ho, A. Y.; Ballangrud, A.; Li, G.; Gupta, G. P.; McCormick, B.; Gewanter, R.; Gelblum, D.; Zinovoy, M.; Mueller, B.; Mychalczak, B.; Dutta, P.; Borofsky, K.; Parhar, P.; Reyngold, M.; Braunstein, L. Z.; Chawla, M.; Krause, K.; Freeman, N.; Siu, C. T.; Cost, Z.; Arnold, B. B.; Zhang, Z.; Powell, S. N.
Article Title: Long-term pulmonary outcomes of a feasibility study of inverse-planned, multibeam intensity modulated radiation therapy in node-positive breast cancer patients receiving regional nodal irradiation
Abstract: Purpose: Multibeam intensity modulated radiation therapy (IMRT) enhances the therapeutic index by increasing the dosimetric coverage of the targeted tumor tissues while minimizing volumes of adjacent organs receiving high doses of RT. The tradeoff is that a greater volume of lung is exposed to low doses of RT, raising concern about the risk of radiation pneumonitis (RP). Methods and Materials: Between July 2010 and January 2013, patients with node-positive breast cancer received inverse-planned, multibeam IMRT to the breast or chest wall and regional nodes, including the internal mammary nodes (IMNs). The primary endpoint was feasibility, predefined by dosimetric treatment planning criteria. Secondary endpoints included the incidence of RP grade 3 or greater and changes in pulmonary function measured with the Common Terminology Criteria for Adverse Events version 3.0 scales, pulmonary function tests and community-acquired pneumonia questionnaires, obtained at baseline and 6 months after IMRT. Clinical follow-up was every 6 months for up to 5 years. Results: Median follow-up was 53.4 months (range, 0-82 months). Of 113 patients enrolled, 104 completed follow-up procedures. Coverage of the breast or chest wall and IMN was comprehensive (median 48.1 Gy and 48.9 Gy, respectively). The median volume of lung receiving a high dose (V20Gy) and a low dose (V5) was 29% and 100%, respectively. The overall rate of respiratory toxicities was 10.6% (11/104), including 1 grade 3 RP event (0.96%). No differences were found in pulmonary function test or community-acquired pneumonia scores after IMRT. The 5-year rates of locoregional recurrence-free, disease-free, and overall survival were 93.2%, 63.6%, and 80.3%, respectively. Conclusions: Multibeam IMRT in patients with breast cancer receiving regional nodal irradiation was dosimetrically feasible, based on early treatment planning criteria. Despite the large volume of lung receiving low-dose RT, the incidence of grade 3 RP was remarkably low, justifying inverse-planned IMRT as a treatment modality for patients with high-risk breast cancer in whom conventional RT techniques prove inadequate. © 2018 Elsevier Inc.
Keywords: intensity modulated radiation therapy; radiotherapy; dosimetry; irradiation; biological organs; diseases; surveys; internal mammary nodes; common terminology criteria; locoregional recurrence; inverse problems; methods and materials; regional nodal irradiation; pulmonary function test; community acquired pneumonias
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 103
Issue: 5
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2019-04-01
Start Page: 1100
End Page: 1108
Language: English
DOI: 10.1016/j.ijrobp.2018.11.045
PROVIDER: scopus
PUBMED: 30508620
DOI/URL:
Notes: Article -- Export Date: 1 April 2019 -- Source: Scopus
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MSK Authors
  1. Alice Yoosun Ho
    111 Ho
  2. Zhigang Zhang
    244 Zhang
  3. Simon Nicholas Powell
    168 Powell
  4. Preeti Kanwal Parhar
    14 Parhar
  5. Pinaki R Dutta
    15 Dutta
  6. Daphna Y Gelblum
    79 Gelblum
  7. Boris A Mueller
    43 Mueller
  8. Mohit Chawla
    21 Chawla
  9. Gaorav Gupta
    33 Gupta
  10. Marsha Laufer
    26 Laufer
  11. Guang Li
    54 Li
  12. Beryl McCormick
    251 McCormick
  13. Kate Krause
    15 Krause
  14. Brittany Berasi Arnold
    6 Arnold
  15. Chun Ting Siu
    16 Siu
  16. Zachary H Cost
    2 Cost