Evaluation Treatment Planning for Breast Cancer Based on Dose-Response Model
The delivery of radiation therapy to patients requires prior planning made by medical physicists to achieve radiotherapy goals. Radiotherapy has a plan to eradicate the growth of cancer cells by giving high doses and minimizing the radiation dose to normal tissue. Evaluation of planning is generally done based on dosimetric parameters, such as minimum dose, maximum dose, and means dose obtained from the DVHs data. Based on the same DVHs, data were evaluate dinterms of biological effects to determine the highest possible toxicity in normal tissue after the tumor had been treated with radiation using the NTCP model. The evaluation was conducted by selecting three DICOM-RT data of post-mastectomy right breast cancer patients who had been prescribed a dose of 50 Gy obtained from the Hospital MRCCC Siloam Semanggi database. All data were processed using open-source software DICOManTX to get the DVH and isodose information. Matlab-based CERR software was used to calculate the NTCP model. The results show that the three patients' DVH and isodose treatment planning result in a homogeneous dose distribution result because the PTV area obtains adose limit of ≥ 95%. Moreover, normalt issue still gets adose below the tolerance limit based on the standard from RTOG 1005 and ICRU 83. Analysis of NTCP shows a complication probability below 1% for each organ, suggesting that any organ which has been irradiated has a low likelihood of complications. Therefore, it can be concluded that the treatment planning which has been made in the three patients using the IMRT technique has achieved the objectives of radiotherapy, which is to minimize toxicity to healthy organs. |
Keywords: DVH, isodose, NTCP, radiotherapy.
American Cancer Society. 2021. Treatment of Breast Cancer Stages I-III. (n.d.). Retrieved January 21, 2021, from https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-breast-cancer-stages-i-iii.html
Chui, C.-S., Hong, L., Hunt, M., & McCormick, B. 2002. A simplified intensity modulated radiation therapy technique for the breast. Medical Physics, 29(4), 522–529.
Das, I. J., Andersen, A., Chen, Z. (Jay), Dimofte, A., Glatstein, E., Hoisak, J., Huang, L., Langer, M. P., Lee, C., Pacella, M., Popple, R. A., Rice, R., Smilowitz, J., Sponseller, P., & Zhu, T. 2017. State of dose prescription and compliance to international standard (ICRU-83) in intensity modulated radiation therapy among academic institutions. Practical Radiation Oncology, 7(2), e145–e155.
Deasy, J. O., Blanco, A. I., & Clark, V. H. 2003. CERR: A computational environment for radiotherapy research. Medical Physics, 30(5), 979–985.
Early Breast Cancer Trialists' Collaborative Group. 1995. Effects of Radiotherapy and Surgery in Early Breast Cancer — An Overview of the Randomized Trials. New England Journal of Medicine, 333(22), 1444–1456.
Freedman, G. M., Anderson, P. R., Li, J., Eisenberg, D. F., Hanlon, A. L., Wang, L., & Nicolaou, N. 2006. Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. American Journal of Clinical Oncology: Cancer Clinical Trials, 29(1), 66–70.
Harris, J. R. 2014. Fifty Years of Progress in Radiation Therapy for Breast Cancer. American Society of Clinical Oncology Educational Book, 34, 21–25.
Harsolia, A., Kestin, L., Grills, I., Wallace, M., Jolly, S., Jones, C., Lala, M., Martinez, A., Schell, S., & Vicini, F. A. 2007. Intensity-Modulated Radiotherapy Results in Significant Decrease in Clinical Toxicities Compared With Conventional Wedge-Based Breast Radiotherapy. International Journal of Radiation Oncology Biology Physics, 68(5), 1375–1380.
Kutcher, G. J., & Burman, C. 1989. Calculation of complication probability factors for non-uniform normal tissue irradiation: The effective volume method gerald. International Journal of Radiation Oncology, Biology, Physics, 16(6), 1623–1630.
Lee, S., Cao, Y. J., & Kim, C. Y. 2015. Physical and Radiobiological Evaluation of Radiotherapy Treatment Plan. In Evolution of Ionizing Radiation Research. InTech. https://doi.org/10.5772/60846
Li, X. A., Alber, M., Deasy, J. O., Jackson, A., Wook, K.-, Jee, K., Marks, L. B., Martel, M. K., Mayo, C., Moiseenko, V., Nahum, A. E., Niemierko, A., Semenenko, V. A., & Yorke, E. D. 2012. The use and QA of biologically related models for treatment planning: Short report of the TG-166 of the therapy physics committee of the AAPM a).
Marks, L. B., Yorke, E. D., Jackson, A., Ten Haken, R. K., Constine, L. S., Eisbruch, A., Bentzen, S. M., Nam, J., & Deasy, J. O. 2010. Use of Normal Tissue Complication Probability Models in the Clinic. International Journal of Radiation Oncology Biology Physics, 76(3 SUPPL.), S10.
Nahum, A. E. (n.d.). CONVERTING DOSE DISTRIBUTIONS INTO TUMOUR CX)NTROL PROBABILITY.
Pyakuryal, A., Myint, W. K., Gopalakrishnan, M., Jang, S., Logemann, J. A., & Mittal, B. B. 2010. A computational tool for the efficient analysis of dose-volume histograms for radiation therapy treatment plans. Journal of Applied Clinical Medical Physics, 11(1), 137–157.
Ronckers, C. M., Erdmann, C. A., & Land, C. E. 2005. Radiation and breast cancer: A review of current evidence. In Breast Cancer Research (Vol. 7, Issue 1, pp. 21–32). BioMed Central. https://doi.org/10.1186/bcr970
Rudra, S., Al-Hallaq, H. A., Feng, C., Chmura, S. J., & Hasan, Y. 2014. Effect of RTOG breast/chest wall guidelines on dose‐volume histogram parameters *. Journal of Applied Clinical Medical Physics, 15(2), 127–137.
Seppenwoolde, Y., Lebesque, J. V., De Jaeger, K., Belderbos, J. S. A., Boersma, L. J., Schilstra, C., Henning, G. T., Hayman, J. A., Martel, M. K., & Ten Haken, R. K. 2003. Comparing different NTCP models that predict the incidence of radiation pneumonitis. International Journal of Radiation Oncology Biology Physics, 55(3), 724–735.
Siegel, R. L., Miller, K. D., & Jemal, A. 2019. Cancer statistics, 2019. CA: A Cancer Journal for Clinicians, 69(1), 7–34.
Supakalin, N., Pesee, M., Thamronganantasakul, K., Promsensa, K., Supaadirek, C., & Krusun, S. 2018. Comparision of different radiotherapy planning techniques for breast cancer after breast conserving surgery. Asian Pacific Journal of Cancer Prevention, 19(10), 2929–2934.
Tommasino, F., Nahum, A., & Cella, L. 2017. Increasing the power of tumour control and normal tissue complication probability modelling in radiotherapy: recent trends and current issues. Translational Cancer
Vicini, F. A., Sharpe, M., Kestin, L., Martinez, A., Mitchell, C. K., Wallace, M. F., Matter, R., & Wong, J. 2002. Optimizing breast cancer treatment efficacy with intensity-modulated radiotherapy. International Journal of Radiation Oncology Biology Physics, 54(5), 1336–1344.
Yan, Y., Mao, W., Ouyang, L., & Solberg, T. 2013. TH‐C‐137‐01: A Graphical Software Tool for TrueBeam Developer Mode. Medical Physics, 40(6), 532.
Zablotska, L. B., & Neugut, A. I. 2003. Lung carcinoma after radiation therapy in women treated with lumpectomy or mastectomy for primary breast carcinoma. Cancer, 97(6), 1404–1411.
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