Arms Positioning Effect on Dose Distribution in Target and Organs at Risk in Breast Radiotherapy after Breast-Conserving Surgery
-
Abdullah Ali
,
Mohammad Ali Tajik-Mansoury
,
Mahdi Ghorbani
,
Mehdi Khosravi
,
Faranak Sadeghi Pour
,
Masoumeh Shafiee
,
Hussein Abdulkareem Dakhil
Abstract
Purpose: Breast cancer is the second most common cancer in women. This study aims to evaluate the effect of the patient’s arm positioning on dose distribution in Planning Target Volume (PTV) and Organs At Risk (OARs) in radiotherapy after Breast-Conserving Surgery (BCS).
Materials and Methods: Thirty patients were divided into two groups; each group included 15 patients, including those in the left arm-up position (group 1) and both arms-up positions (group 2). The patients were selected randomly, and both groups were planned based on 16-slice Computed Tomography (CT) with a 5 mm slice thickness. The patients had been treated with 6 MV photon beam energy at the prescribed dose of 50 Gy in 25 fractions, and planning was performed using the Monaco Treatment Planning System (TPS). The results of dose parameters for the PTV, such as minimum dose (Dmin), mean dose (Dmean), maximum dose (Dmax), Heterogeneity Index (HI), and Conformity Index (CI), were obtained. For OARs, dose parameters such as Dmin, Dmean, and Dmax were calculated. TCP for tumors and NTCP for OARs were also evaluated as radiobiological parameters.
Results: There was no statistically significant difference between the two groups in terms of dose parameters in PTV, but there was a difference for the OARs, such as thyroid.
Conclusion: The patient's arm position significantly affects the dose distribution for OARs such as the thyroid (p<0.05), and the position of both arms up (group 2) is relatively better than the left arm up (group 1) due to some clinical reasons.
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13- Z Varga, A Cserhati, F Rarosi, et al, “Individualized positioning for maximum heart protection during breast irradiation.” Acta Oncol, Vol. 53 (No. 1), pp. 58-64, (2014).
14- ML Groot Koerkamp, F van der Leij, T van 't Westeinde, et al, “Prone vs. supine accelerated partial breast irradiation on an MR-linac: A planning study.” Radiother Oncol, Vol. 165 (No. 1), pp. 193-199, (2021).
15- DA Shumway, KM Atkins, “Prone whole-breast radiotherapy-better than supine.” JAMA Oncol, Vol. 8 (No. 7), pp. 983-985, (2022).
16- N Temme, RM Hermann, T Hinsche, et al, “Radiotherapy of breast cancer in laterally tilted prone vs. supine position: What about the internal mammary chain?” J Pers Med, Vol. 12 (No. 4), pp. 653-655, (2022).
17- D Vesprini, M Davidson, S Bosnic, et al, “Effect of supine vs prone breast radiotherapy on acute toxic effects of the skin among women with large breast size: A randomized clinical trial.” JAMA Oncol, Vol. 8 (No. 7), pp. 994-1000, (2022).
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20- A Kazemzadeh, I Abedi, A Amouheidari, et al, “A radiobiological comparison of hypo-fractionation versus conventional fractionation for breast cancer 3D-conformal radiation therapy.” Rep Pract Oncol Radiother, Vol. 26 (No. 1), pp. 86-92, (2021).
21- KJ Ray, NR Sibson, AE Kiltie, “Treatment of breast and prostate cancer by hypofractionated radiotherapy: Potential risks and benefits.” Clin Oncol (R Coll Radiol), Vol. 27 (No. 7), pp. 420-426, (2015).
22- B Emami, J Lyman, A Brown, et al, “Tolerance of normal tissue to therapeutic irradiation.” Int J Radiat Oncol Biol Phys, Vol. 21 (No. 1), pp. 109-122, (1991).
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24- CH Chen, CC Hsieh, CS Chang, et al, “A retrospective analysis of dose distribution and toxicity in patients with left breast cancer treated with adjuvant intensity-modulated radiotherapy: Comparison with three-dimensional conformal radiotherapy.” Cancer Manag Res, Vol. 12 (No. 1), pp. 9173-9182, (2020).
25- S El-Mesidy, A El-Kashif, N El-Sherbini, et al, “Uncomplicated tumour control probability (UTCP) in post-operative radiotherapy of left breast cancer-three dimensional conformal versus intensity modulated radiation therapy (IMRT).” Kasr El-Aini J Clin Oncol Nucl Med, Vol. 8 (No. 1-2), pp. 41-49, (2012).
26- A Fiorentino, R Ruggieri, N Giaj-Levra, et al, “Three-dimensional conformal versus intensity modulated radiotherapy in breast cancer treatment: Is necessary a medical reversal.” Radiol Med, Vol. 122 (No. 2), pp. 146-153, (2017).
27- H Liu, X Chen, Z He, et al, “Evaluation of 3D-CRT, IMRT and VMAT radiotherapy plans for left breast cancer based on clinical dosimetric study.” Comput Med Imaging Graph, Vol. 54 (No. 1), pp. 1-5, (2016).
28- S Wei, N Tao, S Ouyang, et al, “Dosimetric comparisons of intensity-modulated radiation therapy and three-dimensional conformal radiation therapy for left-sided breast cancer after radical surgery.” Precis Radiat Oncol, Vol. 3 (No. 3), pp. 80-86, (2019).
2- T Mulliez, B Speleers, I Madani, et al, “Whole breast radiotherapy in prone and supine position: Is there a place for multi-beam IMRT.” Radiat Oncol, Vol. 8 (No. 1), pp. 1-7, (2013).
3- N Depauw, E Batin, A Johnson, et al, “Arms positioning in post-mastectomy proton radiation: Feasibility and development of a new arms down contouring atlas.” Phys Imaging Radiat Oncol, Vol. 14 (No. 1), pp. 6-11, (2020).
4- D Bernstein, A Taylor, S Nill, et al, “New target volume delineation and PTV strategies to further personalise radiotherapy.” Phys Med Biol, Vol. 66 (No. 5), pp. 1-11, (2021).
5- Z Brownlee, R Garg, M Listo, et al, “Late complications of radiation therapy for breast cancer: Evolution in techniques and risk over time.” Gland Surg, Vol. 7 (No. 4), pp. 371-378, (2018).
6- K Charaghvandi, T Van't Westeinde, S Yoo, et al, “Single dose partial breast irradiation using an mri linear accelerator in the supine and prone treatment position.” Clin Transl Radiat Oncol, Vol. 14 (No. 3), pp. 1-7, (2018).
7- M Csenki, D Ujhidy, A Cserhati, et al, “Radiation dose to the nodal regions during prone versus supine breast irradiation.” Ther Clin Risk Manag, Vol. 10 (No. 5), pp. 367-372, (2014).
8- P Deseyne, B Speleers, L Paelinck, et al, “Reproducibility of repeated breathhold and impact of breathhold failure in whole breast and regional nodal irradiation in prone crawl position.” Sci Rep, Vol. 12 (No. 1), pp. 1-11, (2022).
9- S Johansen, DR Olsen, T Danielsen, et al, “Contralateral breast doses following radiotherapy of the breast and regional lymph nodes: Measurements and treatment planning calculations.” Radiother Oncol, Vol. 82 (No. 3), pp. 332-336, (2007).
10- Z Kahan, F Rarosi, S Gaal, et al, “A simple clinical method for predicting the benefit of prone vs. supine positioning in reducing heart exposure during left breast radiotherapy.” Radiother Oncol, Vol. 126 (No. 3), pp. 487-492, (2018).
11- SC Lymberis, JK deWyngaert, P Parhar, et al, “Prospective assessment of optimal individual position (prone versus supine) for breast radiotherapy: Volumetric and dosimetric correlations in 100 patients.” Int J Radiat Oncol Biol Phys, Vol. 84 (No. 4), pp. 902-909, (2012).
12- MEJ Stouthandel, F Kayser, V Vakaet, et al, “Delineation guidelines for the lymphatic target volumes in 'prone crawl' radiotherapy treatment position for breast cancer patients.” Sci Rep, Vol. 11 (No. 1), pp. 1-8, (2021).
13- Z Varga, A Cserhati, F Rarosi, et al, “Individualized positioning for maximum heart protection during breast irradiation.” Acta Oncol, Vol. 53 (No. 1), pp. 58-64, (2014).
14- ML Groot Koerkamp, F van der Leij, T van 't Westeinde, et al, “Prone vs. supine accelerated partial breast irradiation on an MR-linac: A planning study.” Radiother Oncol, Vol. 165 (No. 1), pp. 193-199, (2021).
15- DA Shumway, KM Atkins, “Prone whole-breast radiotherapy-better than supine.” JAMA Oncol, Vol. 8 (No. 7), pp. 983-985, (2022).
16- N Temme, RM Hermann, T Hinsche, et al, “Radiotherapy of breast cancer in laterally tilted prone vs. supine position: What about the internal mammary chain?” J Pers Med, Vol. 12 (No. 4), pp. 653-655, (2022).
17- D Vesprini, M Davidson, S Bosnic, et al, “Effect of supine vs prone breast radiotherapy on acute toxic effects of the skin among women with large breast size: A randomized clinical trial.” JAMA Oncol, Vol. 8 (No. 7), pp. 994-1000, (2022).
18- L Feuvret, G Noël, JJ Mazeron, et al, “Conformity index: A review.” Int J Radiat Oncol Biol Phys, Vol. 64 (No. 2), pp. 333-342 (2006).
19- HA Gay, A Niemierko, “A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy.” Phys Med, Vol. 23 (No. 3-4), pp. 115-125, (2007).
20- A Kazemzadeh, I Abedi, A Amouheidari, et al, “A radiobiological comparison of hypo-fractionation versus conventional fractionation for breast cancer 3D-conformal radiation therapy.” Rep Pract Oncol Radiother, Vol. 26 (No. 1), pp. 86-92, (2021).
21- KJ Ray, NR Sibson, AE Kiltie, “Treatment of breast and prostate cancer by hypofractionated radiotherapy: Potential risks and benefits.” Clin Oncol (R Coll Radiol), Vol. 27 (No. 7), pp. 420-426, (2015).
22- B Emami, J Lyman, A Brown, et al, “Tolerance of normal tissue to therapeutic irradiation.” Int J Radiat Oncol Biol Phys, Vol. 21 (No. 1), pp. 109-122, (1991).
23- B Emami, “Tolerance of normal tissue to therapeutic radiation.” Rep Radiother Oncol , Vol. 1 (No. 1), pp. 123-127, (2013).
24- CH Chen, CC Hsieh, CS Chang, et al, “A retrospective analysis of dose distribution and toxicity in patients with left breast cancer treated with adjuvant intensity-modulated radiotherapy: Comparison with three-dimensional conformal radiotherapy.” Cancer Manag Res, Vol. 12 (No. 1), pp. 9173-9182, (2020).
25- S El-Mesidy, A El-Kashif, N El-Sherbini, et al, “Uncomplicated tumour control probability (UTCP) in post-operative radiotherapy of left breast cancer-three dimensional conformal versus intensity modulated radiation therapy (IMRT).” Kasr El-Aini J Clin Oncol Nucl Med, Vol. 8 (No. 1-2), pp. 41-49, (2012).
26- A Fiorentino, R Ruggieri, N Giaj-Levra, et al, “Three-dimensional conformal versus intensity modulated radiotherapy in breast cancer treatment: Is necessary a medical reversal.” Radiol Med, Vol. 122 (No. 2), pp. 146-153, (2017).
27- H Liu, X Chen, Z He, et al, “Evaluation of 3D-CRT, IMRT and VMAT radiotherapy plans for left breast cancer based on clinical dosimetric study.” Comput Med Imaging Graph, Vol. 54 (No. 1), pp. 1-5, (2016).
28- S Wei, N Tao, S Ouyang, et al, “Dosimetric comparisons of intensity-modulated radiation therapy and three-dimensional conformal radiation therapy for left-sided breast cancer after radical surgery.” Precis Radiat Oncol, Vol. 3 (No. 3), pp. 80-86, (2019).
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| Issue | Vol 12 No 4 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v12i4.19817 | |
| Keywords | ||
| Breast Cancer Radiotherapy Arms Positioning Dose Distribution Treatment Planning | ||
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How to Cite
1.
Ali A, Tajik-Mansoury MA, Ghorbani M, Khosravi M, Sadeghi Pour F, Shafiee M, Dakhil HA. Arms Positioning Effect on Dose Distribution in Target and Organs at Risk in Breast Radiotherapy after Breast-Conserving Surgery. Frontiers Biomed Technol. 2025;12(4):802-811.
