A Dosimetric Comparison of Tomotherapy and 3D-Conformal Radiotherapy for Left-Sided Breast Cancer in patients with pendulous breast
-
Masomeh Karampour Najafabadi
,
Soheil Elmtalab
,
Arman Esmailzadeh
,
Mostafa Alizade-Harakiyan
,
Hamed Zamani
,
Ahmad Shanei
,
Nadia Najafizadeh
,
Ali Yousefi
Abstract
Purpose: This study compares helical Tomotherapy in the supine position with three-dimensional Conformal Radiotherapy (3D-CRT) delivered in both prone and supine positions in pendulous left-breast cancer patients, aiming to achieve optimal target coverage while minimizing dose to Organs At Risk (OARs).
Materials and Methods: Twenty non-metastatic patients with large pendulous left breasts received three separate treatment plans (3D-prone, 3D-supine, and Tomo-supine). Dose–Volume Histogram (DVH)-based indices, including Dmean, V5Gy, V10Gy, V20Gy, and V30Gy for the heart, ipsilateral lung, contralateral lung, and contralateral breast, as well as CI and HI for the PTV, were evaluated. Plans were generated using TIGRT (3D-CRT) and Accuray Precision® Tomotherapy TPS. Statistical analysis was performed using paired t-tests, and p < 0.05 was considered significant.
Results: Tomotherapy achieved superior target conformity and homogeneity (higher CI and lower HI) and slightly increased PTV Dmean compared to 3D-CRT. However, it increased low- and intermediate-dose exposure to the ipsilateral lung and contralateral organs while significantly reducing high-dose volumes. The prone 3D-CRT approach demonstrated the lowest ipsilateral lung mean dose among all techniques.
Conclusion: While tomotherapy provides excellent PTV coverage and dose uniformity, it increases low-dose exposure to OARs compared with 3D-CRT. Therefore, the choice of technique should be individualized based on clinical priorities, particularly in younger patients, where secondary cancer risk may be of concern.
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32. C. E. Kurtman, M. N. Andrieu, A. Hiçsönmez et al., "Three-dimensional conformal breast irradiation in the prone position." Brazilian Journal of Medical and Biological Research, 2003, 36, no. 10, pp. 1441-1446, (2003).
2. S. Winters, C. Martin, and D. Murphy et al., "Breast cancer epidemiology, prevention, and screening." Progress in Molecular Biology and Translational Science, vol. 151, pp. 1-32, (2017).
3. S. Łukasiewicz, M. Czeczelewski, and A. Forma et al., "Breast cancer—epidemiology, risk factors, classification, prognostic markers, and current treatment strategies." Cancers, vol. 13, no. 17, p. 4287, (2021).
4. Z. Tao, A. Shi, C. Lu et al., "Breast cancer: epidemiology and etiology." Cell Biochemistry and Biophysics, 72, no. 2, pp. 333-338, (2015).
5. J. Parsons and C. Francavilla, "‘Omics approaches to explore the breast cancer landscape." Frontiers in Cell and Developmental Biology, vol. 7, p. 395, (2020).
6. A. Padegimas, S. Clasen, and B. Ky, "Cardioprotective strategies to prevent breast cancer therapy-induced cardiotoxicity." Trends in Cardiovascular Medicine, vol. 30, no. 1, pp. 22-28, 2020.
7. K. P. Trayes and S. H. E. Cokenakes, "Breast cancer treatment." American Family Physician, vol. 104, no. 2, pp. 171-178, (2021).
8. J. Ben-Dror, M. Shalamov, and A. Sonnenblick, "The history of early breast cancer treatment." Genes, vol. 13, no. 6, p. 960, (2022).
9. C. Speers and L. J. Pierce, "Postoperative radiotherapy after breast-conserving surgery for early-stage breast cancer: a review." JAMA Oncology, 2016, vol. 2, no. 8, pp. 1075-1082, (2016).
10. A. Jemal, R. Siegel, J. Xu et al., "Cancer statistics, 2010." CA: A Cancer Journal for Clinicians, vol. 60, no. 5, pp. 277-300, (2010).
11. S. Darby, P. McGale, and C. Correa et al. (2011). "Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomized trials." The Lancet, vol. 378, no. 9804, pp. 1707-1716, (2011).
12. E. Senkus-Konefka and J. Jassem, "Complications of breast-cancer radiotherapy." Clinical Oncology, vol. 18, no. 3, pp. 229-235 (2006).
13. A. Fiorentino, F. Gregucci, R. Mazzola et al., "Intensity-modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elderly patients with breast cancer: comparison of acute and late toxicities." La Radiologia Medica, vol. 124, no. 4, pp. 309-314, (2019).
14. M. Alizade-Harakiyan, A. Jangjoo, and B. Motlagh et al., "Radiobiological modeling of acute esophagitis following radiotherapy of thorax and head-neck tumors: a comparison of Lyman Kutcher Burman with equivalent uniform dose-based models." Iranian Journal of Medical Physics, vol. 17, no. 4, pp. 225-234, (2020).
15. Q. Zhang, Y. Zeng, Y. Peng et al., "Critical evaluation of secondary cancer risk after breast radiation therapy with hybrid radiotherapy techniques." Breast Cancer: Targets and Therapy, 15, pp. 25-38, 2023.
16. S. Y. Chung, J. S. Chang, K. H. Shin et al., "Impact of radiation dose on complications among women with breast cancer who underwent breast reconstruction and post-mastectomy radiotherapy: a multi-institutional validation study." The Breast, vol. 56, no. 1, pp. 7-13, (2021).
17. C. W. Taylor, Z. Wang, and E. Macaulay et al., "Exposure of the heart in breast cancer radiation therapy: a systematic review of heart doses published from 2003 to 2013." International Journal of Radiation Oncology, Biology, Physics, vol. 93, no. 4, pp. 845-853, (2015).
18. E. Chung, J. R. Corbett, J. M. Moran et al., "Is there a dose–response relationship between heart disease and low-dose radiation therapy?" International Journal of Radiation Oncology, Biology, Physics, vol. 85, no. 4, pp. 959-964, (2013).
19. M. J. Adams, S. E. Lipshultz, and C. Schwartz et al., "Radiation-associated cardiovascular disease: manifestations and management." Seminars in Radiation Oncology, vol. 13, no. 3, pp. 346-356, 2003.
20. C. R. Correa, H. I. Litt, W-T. Hwang et al., "Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer." Journal of Clinical Oncology, vol. 25, no. 21, pp. 3031-3037, (2007).
21. V. A. B. van den Bogaard, P. van Luijk, Y. M. Hummel et al., "Cardiac function after radiation therapy for breast cancer." International Journal of Radiation Oncology, Biology, Physics, vol. 104, no. 2, pp. 392-400, (2019).
22. E. K. Chan, R. Woods, S. Virani et al. (2015), "Long-term mortality from cardiac causes after adjuvant hypofractionated vs. conventional radiotherapy for localized left-sided breast cancer." Radiotherapy and Oncology, vol. 114, no. 1, pp. 73-78, (2015).
23. X. Xie, S. Ouyang, H. Wang et al., "Dosimetric comparison of left-sided whole breast irradiation with 3D-CRT, IP-IMRT, and hybrid IMRT." Oncology Reports, 31, no. 5, pp. 2195-2205, (2014).
24. N. Y. Lee, N. Riaz, and J. J. Lu, "Target volume delineation for conformal and intensity-modulated radiation therapy." Springer, pp. 207-234, (2015).
25. S. M. Bentzen, L. S. Constine, J. O. Deasy et al., "Quantitative analyses of normal tissue effects in the clinic (QUANTEC): an introduction to the scientific issues." International Journal of Radiation Oncology, Biology, Physics, vol. 76, no. 3, pp. S3-S9, (2010).
26. D. Petrova, S. Smickovska,, and E. Lazarevska, "Conformity index and homogeneity index of the postoperative whole breast radiotherapy." Open Access Macedonian Journal of Medical Sciences, vol. 5, no. 6, pp. 736-739, (2017).
27. N. Monadi, D. Shahbazi-Gahrouei, S. Monadi et al., "Dosimetric characteristics of tomotherapy and three-dimensional conformal radiotherapy for head and neck cancer." International Journal of Radiation Research, vol. 21, no. 3, pp. 427-434, 2023.
28. P. M. Jhaveri, B. S. Teh, A. C. Paulino et al., "Helical tomotherapy significantly reduces the dose to normal tissues compared with 3D-CRT for locally advanced rectal cancer." Technology in Cancer Research & Treatment, vol. 8, no. 5, pp. 379-385, 2009.
29. N. Tomita, T. Kodaira, and H. Tachibana et al., "A comparison of radiation treatment plans using IMRT with helical tomotherapy and 3D conformal radiotherapy for nasal natural killer/T-cell lymphoma." The British Journal of Radiology, vol. 82, no. 981, pp. 756-763, (2009).
30. S. Zong-Wen, Y. Shuang-Yan, D. Feng-Lei et al., "Radiotherapy for adult medulloblastoma: evaluation of helical tomotherapy, volumetric intensity modulated arc therapy, and three-dimensional conformal radiotherapy and the results of helical tomotherapy therapy." BioMed Research International, 2018, p. 9153496, (2018).
31. S. J. Becker, C. Elliston, K. DeWyngaert et al., "Breast radiotherapy in the prone position primarily reduces the maximum out-of-field measured dose to the ipsilateral lung." Medical Physics, vol. 39, no. 5, pp. 2417-2423, (2012).
32. C. E. Kurtman, M. N. Andrieu, A. Hiçsönmez et al., "Three-dimensional conformal breast irradiation in the prone position." Brazilian Journal of Medical and Biological Research, 2003, 36, no. 10, pp. 1441-1446, (2003).
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How to Cite
1.
Najafabadi M, Elmtalab S, Esmailzadeh A, Alizade-Harakiyan M, Zamani H, Shanei A, Najafizadeh N, Yousefi A. A Dosimetric Comparison of Tomotherapy and 3D-Conformal Radiotherapy for Left-Sided Breast Cancer in patients with pendulous breast. Frontiers Biomed Technol. 2026;.
