Three dimensional conformal simultaneously integrated boost technique for
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In this presentation, i have discussed a research paper published in International Journal of Radiation Oncology Biology Physics 2007; 68: 1018-1023
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Sib.si
Simultaneously integrated boost (SIB) allows different doses to be delivered simultaneously to the planning target volume (PTV) and gross tumor volume (GTV), reducing the number of fractions needed. SIB provides a greater biological effective dose while allowing individual dose optimization to both targets in a single plan, overcoming limitations of conventional fractionation. An institutional study compared SIB to conventional 3D conformal radiation therapy in 30 patients with brain, breast, or bladder cancer, finding SIB reduced maximum doses to targets and organs at risk while shortening treatment duration by about a week.
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2) TD significantly reduced the volume of ipsilateral lung receiving low doses of radiation compared to IMRT.
3) TD planning was significantly faster than IMRT, requiring approximately half the time with a mean savings of 17.8 minutes per patient.
4) Other organs at risk were comparable between the two techniques.
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This document discusses target volume definitions in radiotherapy planning according to ICRU reports. It defines key volumes including the gross tumor volume (GTV), clinical target volume (CTV), internal target volume (ITV), planning target volume (PTV), treated volume, and irradiated volume. The CTV accounts for subclinical spread around the GTV, while margins are added to the CTV to create the ITV and PTV to account for organ motion and set-up uncertainties respectively. Together these volumes aim to ensure the prescribed dose is delivered to the tumor while minimizing dose to surrounding healthy tissues.
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1. IMRT allows more conformal dose distributions compared to 3D-CRT but requires more knowledge of dose-volume effects on tumors and tissues.
2. The increased time needed to deliver fractionated IMRT doses may reduce its biological effectiveness due to tissue repair between fractions.
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Sib.si
Simultaneously integrated boost (SIB) allows different doses to be delivered simultaneously to the planning target volume (PTV) and gross tumor volume (GTV), reducing the number of fractions needed. SIB provides a greater biological effective dose while allowing individual dose optimization to both targets in a single plan, overcoming limitations of conventional fractionation. An institutional study compared SIB to conventional 3D conformal radiation therapy in 30 patients with brain, breast, or bladder cancer, finding SIB reduced maximum doses to targets and organs at risk while shortening treatment duration by about a week.
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This document discusses geometric errors in 3D conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT). It explains that IMRT is more sensitive to geometric errors due to its higher conformality. There are two main types of errors: mechanical errors related to equipment and set-up errors from inaccurate patient positioning. Set-up errors can be random or systematic. Systematic errors have the largest impact on treatment accuracy. Minimizing errors requires reducing both random errors through improved immobilization and systematic errors through careful documentation and quality assurance procedures. Accurate patient positioning is crucial for optimal treatment.
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Static beam tomotherapy (TD) can provide an effective method for whole breast radiation therapy (WBRT) that is comparable or superior to intensity-modulated radiation therapy (IMRT) in several ways:
1) TD plans achieved comparable target coverage and homogeneity as IMRT plans while reducing the median dose, maximum dose, and homogeneity index slightly but significantly.
2) TD significantly reduced the volume of ipsilateral lung receiving low doses of radiation compared to IMRT.
3) TD planning was significantly faster than IMRT, requiring approximately half the time with a mean savings of 17.8 minutes per patient.
4) Other organs at risk were comparable between the two techniques.
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This document discusses various methods used to evaluate radiotherapy treatment plans, including physical and biological parameters. Physically, plans are evaluated using isodose curves, dose distribution statistics, differential and cumulative dose-volume histograms (DVHs). Target coverage should be within 95-100% of the prescribed dose. Biologically, tumor control probability (TCP) and normal tissue complication probability (NTCP) models are used. The therapeutic ratio and index compare the dose required for tumor control versus normal tissue complications. NTCP models include Lyman-Kutcher-Burman and critical element/volume models. Plan evaluation ensures target doses are adequate while respecting organ tolerance doses.
Target volume definition
This document discusses target volume definitions in radiotherapy planning according to ICRU reports. It defines key volumes including the gross tumor volume (GTV), clinical target volume (CTV), internal target volume (ITV), planning target volume (PTV), treated volume, and irradiated volume. The CTV accounts for subclinical spread around the GTV, while margins are added to the CTV to create the ITV and PTV to account for organ motion and set-up uncertainties respectively. Together these volumes aim to ensure the prescribed dose is delivered to the tumor while minimizing dose to surrounding healthy tissues.
Radiobiology of IMRT
1. IMRT allows more conformal dose distributions compared to 3D-CRT but requires more knowledge of dose-volume effects on tumors and tissues.
2. The increased time needed to deliver fractionated IMRT doses may reduce its biological effectiveness due to tissue repair between fractions.
3. Techniques like VMAT, tomotherapy, flattening filter-free beams, direct aperture optimization, and reducing the number of segments can help shorten fraction delivery times for IMRT.
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This document discusses radiation physics concepts related to 3D conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT). It describes how 3DCRT uses conformal beams shaped to the target volume to maximize tumor dose while minimizing normal tissue dose. IMRT uses inverse planning to optimize non-uniform beam intensities across multiple angles, allowing for tighter dose conformity. The document outlines the treatment planning and delivery processes for both techniques.
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This document discusses the evaluation of radiotherapy treatment planning through the use of various tools and indices. The goals of treatment planning are to ensure the prescription dose adequately covers and conforms to the target volume while minimizing doses to surrounding healthy tissues. Key evaluation tools discussed include isodose distributions, orthogonal planes, dose volume histograms, dose statistics, homogeneity indices, and conformity/coverage indices. These tools provide both qualitative and quantitative assessments of the dose distribution and how well it meets the goals of treatment planning.
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Treatment planning involves defining target volumes and organs at risk on imaging scans. Virtual simulation uses CT scans to delineate structures and localize the treatment isocenter. This allows improved volume definition compared to conventional simulation. Treatment planning optimization selects parameters like beam number, weighting, and modifiers to best conform the dose distribution to planning objectives while minimizing dose to organs at risk. Beam modifiers like wedges and compensators can be used to modify the dose distribution for target coverage and organ sparing.
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The document discusses the use of equivalent uniform dose (EUD) constraints in intensity-modulated radiation therapy (IMRT) planning. It describes how EUD provides a single parameter to represent the dose received by each organ. EUD constraints can be used in optimization to minimize the EUD to organs at risk while maximizing it to the target volume. Projection onto convex sets (POCS) methods are commonly used, where the dose distribution is iteratively projected onto constraint sets such as maximum dose, dose-volume, and EUD constraints until convergence. Examples show that EUD constraints can provide plans of similar or better quality than physical dose-based constraints alone.
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3-D conformal radiation therapy (3-D CRT) aims to conform the high radiation dose region to the target volume while reducing dose to surrounding normal tissues. The process involves immobilizing the patient, obtaining images like CT and MRI to define targets and organs at risk, delineating these structures, and planning radiation beams individually shaped to the target only. Key volumes defined include the gross tumor, clinical target, planning target, and organ at risk volumes.
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This document discusses the evaluation of radiotherapy treatment planning through the use of various tools and indices. The goals of treatment planning are to ensure the prescription dose adequately covers and conforms to the target volume while minimizing doses to surrounding healthy tissues. Key evaluation tools discussed include isodose distributions, orthogonal planes, dose volume histograms, dose statistics, homogeneity indices, and conformity/coverage indices. These tools provide both qualitative and quantitative assessments of the dose distribution and how well it meets the goals of treatment planning.
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This document discusses time, dose, and fractionation in radiation therapy. It begins by introducing the aims of delivering precisely measured radiation doses to tumors while minimizing damage to normal tissues. It then discusses tumor lethal dose, tissue tolerance factors, and how normal tissue tolerance limits the maximum dose that can be delivered. The document covers dose, time, and fractionation as treatment factors. It reviews several historical time-dose models including Strandquist lines, Cohen's model, Fowler's work, Ellis' NSD equation, and the linear quadratic model which is still commonly used today. It also notes limitations of some early empirical models.
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Three dimensional radiation treatment planning is superior to two dimensional planning for pelvic malignancies. 3D planning allows for a more accurate definition of the tumor and dose distribution, resulting in a more homogeneous dose to the target volume while better sparing nearby critical organs such as the bladder and rectum. Dose volume histograms based on 3D planning show improved target coverage and lower doses to organs at risk compared to 2D planning. Precise delineation of contours is important for effective 3D planning.
Medphysics Planning
Treatment planning involves defining target volumes and organs at risk on imaging scans. Virtual simulation uses CT scans to delineate structures and localize the treatment isocenter. This allows improved volume definition compared to conventional simulation. Treatment planning optimization selects parameters like beam number, weighting, and modifiers to best conform the dose distribution to planning objectives while minimizing dose to organs at risk. Beam modifiers like wedges and compensators can be used to modify the dose distribution for target coverage and organ sparing.
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The document discusses intensity-modulated radiation therapy (IMRT) for head and neck cancers. It describes how IMRT improves target coverage and sparing of organs-at-risk like the parotid glands compared to conventional radiation therapy. Studies show IMRT reduces the risk of xerostomia and improves quality of life outcomes for patients.
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1. The document discusses various aspects of intensity-modulated radiation therapy (IMRT) planning and delivery, including the use of inverse planning, optimization objectives and constraints, and different delivery methods like static field, dynamic field, tomotherapy, and VMAT.
2. It also discusses treatment volumes defined in ICRU 83 like gross tumor volume, clinical target volume, planning target volume, and organ-at-risk volumes. The document emphasizes using dose-volume histograms to specify dose rather than a single point.
3. Challenges with overlapping treatment volumes and the importance of evaluating the remaining volume at risk are also covered.
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1. Historical dose reporting systems like milligram-hours and Point A/B and introduces the concept of a reference volume receiving 60Gy.
2. Factors to report like treatment technique, time-dose patterns, and doses to organs at risk.
3. Volumes for reporting like the treated volume, high-dose volume, irradiated volume, and Point A volume.
4. Recommendations for specifying and reporting doses in a standardized way to allow comparison between different brachytherapy procedures
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Intensity modulated radiotherapy (IMRT) uses computer-optimized radiation beam intensities to conform the high dose region to the tumor target while reducing exposure to surrounding normal tissues. Key aspects of IMRT planning include tumor and organ contouring, beam arrangement optimization to meet dose constraints, and quality assurance of treatment delivery. IMRT offers advantages over conventional radiotherapy such as superior dose distribution, better normal tissue sparing, and potential for dose escalation through its ability to sculpt high dose regions closely to irregularly shaped tumor volumes.
Dose Constraints In Imrt
The document discusses the use of equivalent uniform dose (EUD) constraints in intensity-modulated radiation therapy (IMRT) planning. It describes how EUD provides a single parameter to represent the dose received by each organ. EUD constraints can be used in optimization to minimize the EUD to organs at risk while maximizing it to the target volume. Projection onto convex sets (POCS) methods are commonly used, where the dose distribution is iteratively projected onto constraint sets such as maximum dose, dose-volume, and EUD constraints until convergence. Examples show that EUD constraints can provide plans of similar or better quality than physical dose-based constraints alone.
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managment of neck nodes with occult primary
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Contouring guidelines Cervix IMRT
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Euthanasia presentation of Fatih Ayık and Salih Kırcık
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Radiotherapy in carcinoma cervix
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radiation therapy in ca breast
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
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Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
EBRT IN CARCINOMA CERVIX
1) Radiotherapy plays an important role in managing carcinoma of the cervix by delivering high doses through a combination of external beam radiotherapy and brachytherapy.
2) The disease has central and peripheral components - the central component confined to the cervix is best treated with brachytherapy, while the peripheral component involving surrounding tissues is treated with both external beam radiotherapy and brachytherapy.
3) External beam radiotherapy techniques include 3D conformal radiotherapy and IMRT to improve dose distribution and spare surrounding organs-at-risk.
Carcinoma of unknown primary
Target Audience: Oncology fellows and Oncologists
Carcinoma of unknown primary is a challenging scenario often encountered in Oncology practice. This slide presentation discusses favorable and unfavorable presentations of CUP and it's management
Cutaneous Toxicities Of Cancer Therapy
This document summarizes various cutaneous (skin) toxicities that can result from cancer therapies such as chemotherapy, radiation therapy, and targeted therapies. It discusses side effects including alopecia (hair loss), hyperpigmentation, hand-foot syndrome, radiation sensitivity and recall effects, hypersensitivity reactions, nail dystrophies, and extravasation injuries. Prevention and treatment strategies are provided for many of these side effects. The conclusion emphasizes the importance of recognizing both the physical and psychological impacts of cutaneous toxicities from cancer treatment.
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Radioactive Waste Management ABHIJEET 13011092 FINAL
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hypofractionationinbreastexperiment.pptx
This document discusses hypofractionated radiotherapy for breast cancer after breast-conserving surgery. It provides evidence that delivering 40.05 Gy to the whole breast and a simultaneous integrated boost of 48 Gy to the tumor bed cavity in 15 fractions is a feasible treatment approach with an acceptable toxicity profile. A study of 30 patients found most experienced only mild skin toxicity, with no cases of severe side effects. The treatment showed good target coverage and spared nearby organs at risk. While initial results are promising, longer follow-up is still needed to fully evaluate outcomes.
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Treatment of breast cancer
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Breast HDR interstitial brachytherapy
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FAST FORWARD.pptx
The FAST-Forward trial found that:
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2) The 26 Gy dose level resulted in similar patient-assessed and clinician-assessed normal tissue effects and photographic change in breast appearance as the standard 40 Gy in 15 fractions schedule.
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Seroma Volume Changes
The document summarizes a study evaluating changes in seroma volume in breast cancer patients undergoing radiation therapy and the dosimetric impact on sequential boost planning. 11 patients had CT scans before whole breast radiation (CT1) and before boost planning (CT2). On average, seroma volume decreased 57.1% between scans. Optimizing boost plans to CT2 volumes reduced the mean dose to normal breast tissue by 9.2% for sequential electron boosts and 16.2% for concurrent electron boosts compared to IMRT photon boosts. The results indicate acquiring a second CT scan prior to boost planning can improve dose distribution.
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This document discusses forward intensity-modulated radiation therapy (IMRT) using the field-in-field (FIF) technique for whole breast irradiation. It begins by introducing the goals of treatment planning to deliver a uniform dose to the target volume while minimizing dose to normal tissues. It then describes how the FIF technique uses multiple subfields in addition to the main tangential fields to improve dose homogeneity. Several studies have shown that improved homogeneity decreases skin toxicities. The document evaluates different methods for generating subfields and finds the alternate subfields method provides the best dose distribution. In summary, the FIF forward planning technique improves dose uniformity in the breast compared to conventional techniques.
Forward imrt in breast radiotherapy
This document discusses the forward intensity-modulated radiation therapy (IMRT) technique known as field-in-field (FIF) for whole breast radiotherapy. It begins by explaining how FIF uses multiple subfields in addition to the main tangential fields to improve dose homogeneity throughout the breast. Studies show improved homogeneity decreases skin toxicities. The document then evaluates three FIF techniques - single pair of subfields, multiple pairs of subfields, and alternate subfields. It finds the alternate subfields technique provides the best dose distribution and target coverage while being less time-consuming than other techniques. Finally, the document discusses how FIF with lung blocks further reduces lung dose compared to physical wedges.
Cancer of Right Breast with Single Liver Metastasis - Simultaneous Treatment ...
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This document summarizes a prospective pilot study evaluating the dosimetric and clinical feasibility of the FAST-Forward trial hypofractionated radiation therapy protocol for early-stage breast cancer patients in India. 10 patients receiving postoperative radiation to the whole breast and tumor bed after breast-conserving surgery were included. Target volumes and organs-at-risk were contoured according to guidelines. The study found that the lung dose constraint could not be achieved in 7 of 10 patients, with excess dose variations of 0.4-4.5%. The heart dose constraint was met in right-sided cancers. One patient experienced grade 3 skin toxicity. The FAST-Forward protocol can generally be delivered effectively but poses challenges in meeting lung dose limits in some patients
Clinical aspects of uh breast radiotherapy
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This document summarizes the use of radiotherapy in early breast cancer treatment. It discusses how breast-conserving therapy with radiotherapy is as effective as mastectomy, and how radiotherapy reduces local recurrence when used as part of breast-conserving surgery for ductal carcinoma in situ. It also describes different radiotherapy techniques for early invasive breast cancer including whole breast irradiation, tumor bed boosts, and accelerated partial breast irradiation.
ADJUTANT RADIOTHERAPY IN BREAST CANCER
This document discusses the evidence for adjuvant radiotherapy in breast cancer treatment. It finds that radiotherapy after breast-conserving surgery or mastectomy significantly reduces the risk of local recurrence and improves overall survival. For patients undergoing breast-conserving surgery, radiotherapy reduces the 10-year cumulative incidence of recurrence in the ipsilateral breast from 39.2% to 14.3%. Post-mastectomy radiotherapy is recommended for patients with ≥4 positive lymph nodes or 1-3 positive lymph nodes with high-risk features, as it lowers the risk of locoregional recurrence and improves overall survival. The timing, techniques, target volumes, and indications for radiotherapy are also outlined based on clinical evidence and guidelines.
BLADDER PROTOCOL :- IS IT NECESSARY ?
This document summarizes a study investigating the usefulness of a full bladder preparation protocol to reduce radiation dose to organs at risk during external beam radiation therapy for pelvic cancers like prostate and cervix. The study involved contouring bladder volumes on CBCT images of 20 patients undergoing radiotherapy and found that maintaining a full bladder protocol resulted in bladder volumes matching the planning CT for 84% of prostate patients and 72% of cervix patients. Adhering to the full bladder protocol helps minimize radiation dose to nearby organs and improves treatment accuracy and outcomes.
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This document discusses lung stereotactic body radiotherapy (SBRT) for the treatment of early stage non-small cell lung cancer (NSCLC). It covers treatment indications for SBRT, methods used to account for tumor motion including 4DCT planning and respiratory gating, treatment planning guidelines, evidence from studies showing high rates of local control and survival, and results from RTOG trials of SBRT for lung cancer. In particular, it highlights that SBRT achieves local control rates of 85-95% and overall survival rates of 50-95% at 3-5 years for early stage NSCLC.
APBI-Dr Kiran
1) Accelerated partial breast irradiation (APBI) delivers radiation to only the portion of the breast surrounding the tumor site after breast-conserving surgery, shortening treatment time compared to whole breast irradiation (WBI).
2) Several phase III trials have found APBI to have local control rates comparable to WBI with reduced toxicity, though some trials found slightly higher recurrence rates with APBI.
3) Toxicity and cosmetic outcomes vary by technique, with brachytherapy generally showing better results than external beam techniques.
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This document discusses hepatobiliary tumors, including hepatocellular carcinoma and adenocarcinoma of the gallbladder. Key points include:
- Clinical features include abdominal pain and jaundice. Investigations include blood tests, imaging like CT/MRI, and biopsy.
- Management depends on stage and liver function, and may include surgical resection, liver transplant, ablation, TACE, radiation, chemotherapy, and targeted therapies like sorafenib.
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2nd year physics photoelectric effect
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Three dimensional conformal simultaneously integrated boost technique for
- 1. Three dimensional conformal simultaneously integrated boost technique for breast conserving radiotherapy Hans Paul van der Laan, Wil V. Dolsma, John H. Maduro, Erik W. Korevaar, Miranda Hollander, Johannes A. Langendijk International Journal of Radiation Oncology Biology Physics 2007; 68: 1018-1023 Presented by Sehrish Inam Trainee Medical Physicist
- 2. Abstract To compare the target coverage and normal tissue dose with the simultaneously integrated boost (SIB) and the sequential boost technique in breast cancer, and to evaluate the incidence of acute skin toxicity in patients treated with the SIB technique.
- 3. Introduction • For early stage breast cancer RT, 50Gy is prescribed to whole PTV while16 Gy to lumpectomy. • Conventionally boost is delivered after RT of whole breast. • In SIB greater dose per fraction is delivered to the boost PTV and the no. of fractions is reduced. • Study to compare conventional 3D-CRT with sequential boost technique (SBT) vs 3D-CRT using SIB technique.
- 4. Materials & Methods • Patients and computed tomography o 30 patients with left sided breast cancer schedule to undergo RT after breast conserving surgery . o CT was conducted along with patients were positioned on a breast board with both arms abducted alongside the head. o Skin marks were placed to locate the boost volume isocenter
- 5. Materials & Methods • Target volume and organs at risk o The breast PTV was generated by adding a 3Dmargin of 5mm around CTV. o The boost PTV was generated by adding a 5mm margin accordingly. o Heart , both lungs and ipsilateral breast was contoured as OAR.
- 6. Materials & Methods • Sequential boost treatment planning o Two opposing tangential beams were constructed. o Wedge & MLC were used in forward planning. o Boost plan consists of 3 equally weighted photon beams. o The isocenter and dose normalization point were placed centrally in a slice representative of boost PTV. o 50Gy /25 fr with boost of 16Gy boost, cumulative dose of 66Gy.
- 7. Materials & Methods • SIB fractionation schedule o For SIB alternative fractionation schedule is necessary. o Using the linear-quadratic cell survival model, we calculated fraction sizes and total doses for the breast and boost PTVs that were biologically equivalent to the total dose delivered to the PTVs in 2-Gy fractions with the SBT. o For this purpose, an α/β ratio of 10 Gy for tumour response and an α/β ratio of 3 Gy for late-responding normal tissues were used.
- 8. Materials & Methods • SIB treatment planning o The SIB treatment plan was created by copying the sequentially planned breast and boost beams into an integrated treatment plan. o Same isocenter and dose normalization points were used. o Breast beams were set to contribute a daily dose of 1.81Gy to PTV & 0.49Gy to boost PTV. o Using wedge & MLC 95% isodose closely encompass the boost PTV in 3 dimensional uniformly. o A cumulative dose plan was calculated, taking into account 28 fractions of 2.3 Gy for the SIB plan.
- 9. Materials & Methods • Analyses of target coverage and normal tissue dose o Both PTV and boost covers 95% of their prescribed dose o Heart mean dose < 30Gy. o Volume of both lungs < 20Gy o Right breast receiving < 10Gy.
- 11. Results • PTV coverage and absolute volumes irradiated o At least 95% of the prescribed dose was delivered to 99% of the breast and boost PTVs for the SBT and SIB plans o When the SBT beams were constructed, MLC shielding was applied with a margin of 5–10 mm outside the boost PTV to obtain adequate coverage.
- 12. SIB fractionation schedule O With SIB technique PTV &boost PTV combined into an integrated treatment plan. O Alternative fractionation needed. O For schedule we calculate α/β=10Gy for tumor response & α/β=3Gy for late responding normal tissue.
- 13. Results • PTV coverage and absolute volumes irradiated • Heart mean dose > 30Gy. • Volume of both lungs > 20Gy • Right breast receiving > 10Gy • Acute toxicity o Grade 0 is 78% o Grade 1 is 60% o Grade 2 is 7.8% o Grade 3 is 31.1%
- 14. Disadvantage • Currently investigating the incidence of late toxicity because higher dose per fraction delivered to the boost could cause increase the risk of late fibrosis. • The lumpectomy cavity shrinks with the time elapsed since surgery . Therefore, the position and shape of the breast and boost PTVs should be monitored and verified during the RT session.
- 15. Conclusion The SIB technique is proposed for standard use in breast-conserving RT • reduce excess volumes of normal tissue irradiated • shorten the treatment course, • decrease the dose per fraction for the breast and increase the dose per fraction for the boost • low incidence of acute skin toxicity.