Bilateral regional nodal irradiation using volumetric modulated arc therapy: Dosimetric analysis and feasibility Journal Article
| Authors: | Bernstein, M. B.; Walker, K.; Gillespie, E.; Mueller, B.; Cuaron, J.; Xu, A.; McCormick, B.; Khan, A.; Cahlon, O.; Powell, S.; Braunstein, L. Z. |
| Article Title: | Bilateral regional nodal irradiation using volumetric modulated arc therapy: Dosimetric analysis and feasibility |
| Abstract: | Purpose: Dosimetric and technical challenges often limit radiation therapy (RT) target coverage for patients with breast cancer who require bilateral breast/chest wall and regional nodal irradiation (RNI). We evaluated the feasibility of using volumetric modulated arc therapy (VMAT) to administer bilateral comprehensive RNI including the internal mammary nodes. Methods and Materials: We analyzed all patients treated at our institution with bilateral RNI using VMAT between 2017 and 2020. Medical records were reviewed to ascertain clinicopathologic features, radiotherapeutic parameters, and treatment-related adverse events. Results: The cohort was comprised of 12 patients who underwent VMAT for bilateral RNI, with a median follow-up time of 14.5 months. Median volume of the lung receiving 5 Gy (V5) for the bilateral lungs was 96.1% (range, 84.5%-99.8%), and median volume of the lung receiving 20 Gy for each lung was 27.5% (range, 14.9%-38.1%). The cardiac mean dose was a median of 699 cGy (range, 527-1117 cGy). Five patients (41%) developed grade 1 cough/dyspnea, with one patient developing grade 3 dyspnea. Of note, 3 of these patients (60%) were current or former smokers. No patient received glucocorticoid therapy or required respiratory intervention, and none developed longer-term pulmonary complaints. A decline in ejection fraction occurred in one patient with a preexisting cardiac condition who also received anthracycline-based chemotherapy and trastuzumab. Only one patient experienced a locoregional recurrence with synchronous distant progression, and subsequently succumbed to the disease. No secondary cancers have been noted to date. Conclusions: VMAT appears to be a feasible and tolerable RT modality for patients with breast cancer who require bilateral comprehensive adjuvant RT with RNI to obtain excellent target coverage. No patients required medical intervention for pulmonary complaints despite a median bilateral V5 approaching 100%, providing further evidence that V5 is not predictive for complications. © 2021 American Society for Radiation Oncology |
| Keywords: | adult; clinical article; aged; middle aged; clinical feature; disease course; histopathology; cancer recurrence; doxorubicin; paclitaxel; cancer radiotherapy; radiation dose; follow up; lymph node metastasis; sentinel lymph node biopsy; breast cancer; mastectomy; heart disease; cohort analysis; cyclophosphamide; medical record review; prediction; coughing; dyspnea; lymphedema; feasibility study; dosimetry; partial mastectomy; anthracycline derivative; trastuzumab; radiation dermatitis; lymph node irradiation; axillary lymph node dissection; volumetric modulated arc therapy; lung volume; heart ejection fraction; human; article; current smoker; ex-smoker |
| Journal Title: | Practical Radiation Oncology |
| Volume: | 12 |
| Issue: | 3 |
| ISSN: | 1879-8519 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-05-01 |
| Start Page: | 189 |
| End Page: | 194 |
| Language: | English |
| DOI: | 10.1016/j.prro.2021.11.008 |
| PUBMED: | 35045364 |
| PROVIDER: | scopus |
| PMCID: | PMC9081150 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 June 2022 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work