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Second Cancer Risk after simultaneous integrated boost radiation therapy of right sided breast cancer with and without flattening filter

  • Background The aim of this study was to investigate if the flattening filter free mode (FFF) of a linear accelerator reduces the excess absolute risk (EAR) for second cancer as compared to the flat beam mode (FF) in simultaneous integrated boost (SIB) radiation therapy of right-sided breast cancer. Patients and methods Six plans were generated treating the whole breast to 50.4 Gy and a SIB volume to 63 Gy on CT data of 10 patients: intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and a tangential arc VMAT (tVMAT), each with flattening filter and without. The EAR was calculated for the contralateral breast and the lungs from dose-volume histograms (DVH) based on the linear-exponential, the plateau, and the full mechanistic dose-response model. Peripheral low-dose measurements were performed to compare the EAR in more distant regions as the thyroids and the uterus. Results FFF reduces the EAR significantly in the contralateral and peripheral organs for tVMAT and in the peripheral organs for VMAT. No reduction was found for IMRT. The lowest EAR for the contralateral breast and lung was achieved with tVMAT FFF, reducing the EAR by 25 % and 29 % as compared to tVMAT FF, and by 44 % to 58 % as compared to VMAT and IMRT in both irradiation modes. tVMAT FFF showed also the lowest peripheral dose corresponding to the lowest EAR in the thyroids and the uterus. Conclusion The use of FFF mode allows reducing the EAR significantly when tVMAT is used as the treatment technique. When second cancer risk is a major concern, tVMAT FFF is considered the preferred treatment option in SIB irradiation of right-sided breast cancer.

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Metadaten
Author:Barbara DoblerORCiD, Johannes Maier, Bernadette Knott, Manuel Maerz, Rainer LöschelGND, Oliver Kölbl
DOI:https://doi.org/10.1007/s00066-016-1025-5
Parent Title (English):Strahlentherapie und Onkologie
Title Additional (German):Sekundärmalignom-Risiko nach simultan integrierter Boost-Bestrahlung des rechtsseitigen Mamma-Karzinoms mit und ohne Ausgleichskörper
Publisher:Springer Nature
Place of publication:Heidelberg
Document Type:Article
Language:English
Year of first Publication:2016
Release Date:2022/04/06
Tag:3D-CRT; Breast Cancer; CONTRALATERAL BREAST; DOSES RELEVANT; HODGKIN COHORTS; IMRT; INDUCTION; JAPANESE A-BOMB; PREDICTED RISK; Peripheral Dose; Radiotherapy; Second Cancer Risk; VMAT; flattening filter free
Volume:192
Issue:10
First Page:687
Last Page:695
Institutes:Fakultät Informatik und Mathematik
Begutachtungsstatus:peer-reviewed
research focus:Lebenswissenschaften und Ethik
Licence (German):Keine Lizenz - Es gilt das deutsche Urheberrecht: § 53 UrhG