Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) in Mono and Dual-isocentric Techniques of Breast Cancer Radiation Therapy

Main Article Content

Kaveh Shirani Tak Abi
Sediqeh Habibian
Marzieh Salimi
Ahmad Shakeri
Mohammad Mahdi Mojahed
Hussain Gharaati

Keywords

Tumor control probability, Normal tissue complication probability, External beam, Radiation therapy, Breast cancer

Abstract

Background: Nowadays, radiation therapy plays an important role in the treatment of breast cancer. The important point is the optimal control of the tumor along with the protection of organs at risk. This study aims to investigate and compare the radiobiological factors of the tumor and organs at risk in two different radiation therapy techniques of breast cancer.
Methods: Ten left-sided breast cancer patients with breast-conservative surgery were selected for this study. Three-dimensional treatment planning was performed using CT scan images of the patients using PCRT 3D software. Two different tangential external beam techniques were compared: first, dual-isocentric technique (DIT) with two isocentre, one on the breast tissue, and the other one on the supraclavicular lymph nodes and second, a mono-isocentric technique (MIT) with one isocentre at the intersection of the tangential and the supraclavicular field. The total prescribed dose was 5000 cGy per 25 fractions. Dose-volume histograms (DVHs), Tumor control probability (TCP), and normal tissue complication probability (NTCP) curves were used to compare the dosimetric and radiobiological parameters of the tissues in the prementioned techniques.
Results: The results showed that the maximum doses in planning target volume (PTV) with mean values of 109% and 110% in the SI and DIT were not significantly different in both techniques and that they were indeed at the optimum level based on the RTOG 1005 protocol. The dose homogeneity index in MMIT was more than that in DIT, while the conformity index and the mean TCP did not show a significant difference in the two techniques. Furthermore, minimum, mean, and maximum dose in the lung and the probability of pneumonitis decreased in MIT. On the other hand, the maximum dose, the dose of 33%, 66%, and 100% of the heart, and the probability of pericarditis in MIT were lower than the figure in DIT.
Conclusion: Due to the absence of hot spots at the intersection of tangential and supraclavicular fields and the reduction of mechanical movements of the coach and collimator in MIT, the superiority of this method was confirmed.

References

1. Shah C, Badiyan S, Berry S, Khan AJ, Goyal S, Schulte K, et al. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiotherapy and Oncology. 2014;112(1):9-16.
2. Sonnik D, Selvaraj RN, Faul C, Gerszten K, Heron DE, King GC. Treatment techniques for 3D conformal radiation to breast and chest wall including the internal mammary chain. Medical Dosimetry. 2007;32(1):7-12.
3. Mukesh MB, Harris E, Collette S, Coles CE, Bartelink H, Wilkinson J, et al. Normal tissue complication probability (NTCP) parameters for breast fibrosis: pooled results from two randomised trials. Radiotherapy and Oncology. 2013;108(2):293-8.
4. Taylor CW, Wang Z, Macaulay E, Jagsi R, Duane F, Darby SC. Exposure of the heart in breast cancer radiation therapy: a systematic review of heart doses published during 2003 to 2013. International Journal of Radiation Oncology* Biology* Physics. 2015;93(4):845-53.
5. Yadav BS, Sharma SC, Patel FD, Ghoshal S, Kapoor RK. Second primary in the contralateral breast after treatment of breast cancer. Radiotherapy and Oncology. 2008;86(2):171-6.
6. Lind PA, Marks LB, Hardenbergh PH, Clough R, Fan M, Hollis D, et al. Technical factors associated with radiation pneumonitis after local±regional radiation therapy for breast cancer. International Journal of Radiation Oncology Biology Physics. 2002;52(1):137-43.
7. Avanzo M, Stancanello J, Trovò M, Jena R, Roncadin M, Trovò MG, et al. Complication probability model for subcutaneous fibrosis based on published data of partial and whole breast irradiation. Physica Medica. 2012;28(4): 296-306.
8. Veldeman L, Schiettecatte K, De Sutter C, Monten C, Van Greveling A, Berkovic P, et al. The 2-year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted women. International Journal of Radiation Oncology Biology Physics. 2016;95(4):1210-7.
9. Polgár C, Major T, Fodor J, Németh G, Orosz Z, Sulyok Z, et al. High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: seven-year results of a comparative study. International Journal of Radiation Oncology Biology Physics. 2004;60(4):1173-81.
10. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. The lancet oncology. 2013;14(11):1086-94.
11. Rosenow UF, Valentine ES, Davis LW. A technique for treating local breast cancer using a single set-up point and asymmetric collimation. International Journal of Radiation Oncology* Biology Physics. 1990;19(1):183-8.
12. Conte G, Nascimben O, Turcato G, Polico R, Idi MB, Belleri LM, et al. Three-field isocentric technique for breast irradiation using individualized shielding blocks. International Journal of Radiation Oncology Biology Physics. 1988;14(6):1299-305.
13. Hurkmans CW, Borger JH, Bos LJ, van der Horst A, Pieters BR, Lebesque JV, et al. Cardiac and lung complication probabilities after breast cancer irradiation. Radiotherapy and oncology. 2000;55(2):145-51.
14. Hurkmans CW, Cho BJ, Damen E, Zijp L, Mijnheer BJ. Reduction of cardiac and lung complication probabilities after breast irradiation using conformal radiotherapy with or without intensity modulation. Radiotherapy and oncology. 2002;62(2):163-71.
15. Korreman SS, Pedersen AN, Josipović M, Aarup LR, Juhler-Nøttrup T, Specht L, et al. Cardiac and pulmonary complication probabilities for breast cancer patients after routine end-inspiration gated radiotherapy. Radiotherapy and oncology. 2006;80(2):257-62.
16. Rancati T, Wennberg B, Lind P, Svane G, Gagliardi G. Early clinical and radiological pulmonary complications following breast cancer radiation therapy: NTCP fit with four different models. Radiotherapy and oncology. 2007;82(3):308-16.
17. Chan TY, Tan PW, Tan CW, Tang JI. Assessing radiation exposure of the left anterior descending artery, heart and lung in patients with left breast cancer: A dosimetric comparison between multicatheter accelerated partial breast irradiation and whole breast external beam radiotherapy. Radiotherapy and Oncology. 2015;117(3):459-66.
18. Lee D, Dinniwell R, Lee G. A Retrospective Analysis of Lung Volume and Cardiac Dose in Left-Sided Whole Breast Radiotherapy. Journal of Medical Imaging and Radiation Sciences. 2016;47(3):S10-S4.
19.Wollschläger D, Karle H, Stockinger M, Bartkowiak D, Bührdel S, Merzenich H, et al. Radiation dose distribution in functional heart regions from tangential breast cancer radiotherapy. Radiotherapy and Oncology. 2016;119(1):65-70.
20. Brackstone M, Fletcher GG, Dayes IS, Madarnas Y, SenGupta SK, Verma S. Locoregional therapy of locally advanced breast cancer: a clinical practice guideline. Current Oncology. 2015;22(Suppl 1):S54.
21. Wood DE. National Comprehensive Cancer Network (NCCN) clinical practice guidelines for lung cancer screening. Thoracic surgery clinics. 2015;25(2):185-97.
22. Group EBCTC. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. The Lancet. 2005;366(9503):2087-106.
23. Kim J, Park W, Kim JH, Choi DH, Kim Y-J, Lee ES, et al. Clinical significance of lymph-node ratio in determining supraclavicular lymph-node radiation therapy in pN1 breast cancer patients who received breast-conserving treatment (KROG 14-18): A Multicenter Study. Cancers. 2019;11(5):680.
24. Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. New England Journal of Medicine. 2015;373(4):307-16.
25. Tai P, Joseph K, Sadikov E, Mahmood S, Lien F, Yu E. Nodal ratios in node-positive breast cancer—long-term study to clarify discrepancy of role of supraclavicular and axillary regional radiotherapy. International Journal of Radiation Oncology Biology Physics. 2007;68(3):662-6.
26. Keinj R, Bastogne T, Vallois P. Multinomial model-based formulations of TCP and NTCP for radiotherapy treatment planning. Journal of theoretical biology. 2011;279(1):55-62.
27. Stocks T, Hillen T, Gong J, Burger M. A stochastic model for the normal tissue complication probability (NTCP) and applications. Mathematical medicine and biology: a journal of the IMA. 2016;34(4):469-92.
28. Hillen T, De VrIeS G, Gong J, Finlay C. From cell population models to tumor control probability: including cell cycle effects. Acta Oncologica. 2010;49(8):1315-23.
29.Petrova D, Smickovska S, Lazarevska E. Conformity Index and Homogeneity Index of the Postoperative Whole Breast Radiotherapy. Open access Macedonian journal of medical sciences. 2017;5(6):736.
30. Vanaken ML, Breneman JC, Elson HR, Foster AE, Lukes SJ, Little R. Incorporation of patient immobilization, tissue compensation and matchline junction technique for three-field breast treatment. Medical Dosimetry. 1988; 13(3):131-5.
31. Fan Ll, Luo Yk, Xu Jh, He L, Wang J, Du Xb. A dosimetry study precisely outlining the heart substructure of left breast cancer patients using intensity‐modulated radiation therapy. Journal of applied clinical medical physics. 2014;15(5): 265-74.
32.Banaei A, Hashemi B, Bakhshandeh M. Comparing the monoisocentric and dual isocentric techniques in chest wall radiotherapy of mastectomy patients. Journal of applied clinical medical physics. 2015;16(1):130-8.
33. Klein EE, Taylor M, Michaletz-Lorenz M, Zoeller D, Umfleet W. A mono isocentric technique for breast and regional nodal therapy using dual asymmetric jaws. International Journal of Radiation Oncology Biology Physics. 1994;28(3):753-60.
34. Kataria T, Sharma K, Subramani V, Karrthick K, Bisht SS. Homogeneity Index: An objective tool for assessment of conformal radiation treatments. Journal of medical physics/Association of Medical Physicists of India. 2012;37(4):207.
35. Salimi M, Abi KST, Nedaie HA, Hassani H, Gharaati H, Samei M, et al. Assessment and Comparison of Homogeneity and Conformity Indexes in Step-and-Shoot and Compensator-Based Intensity Modulated Radiation Therapy (IMRT) and Three-Dimensional Conformal Radiation Therapy (3D CRT) in Prostate Cancer. Journal of medical signals and sensors. 2017;7(2):102.
36. Moshiri Sedeh N. Dosimetric and radiobiological comparison of Forward Tangent Intensity Modulated Radiation Therapy (FT-IMRT) and Volumetric Modulated Arc Therapy (VMAT) for early stage whole breast cancer. 2015:7.
37. Adam D, Suditu MD, Popa R, Ciocaltei V. Volumetric‐modulated arc therapy vs. 3D‐conformal radiotherapy for breast cancer. Rom Rep Phys. 2015 Jan 1;67:978-86
38. Ritter T, Quint DJ, Senan S, Gaspar LE, Komaki RU, Hurkmans CW, et al. Consideration of dose limits for organs at risk of thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. International Journal of Radiation Oncology Biology Physics. 2011;81(5):1442-57.
39. Arsene-Henry A, Foy J-P, Robilliard M, Xu H-P, Bazire L, Peurien D, et al. The use of helical tomotherapy in the treatment of early stage breast cancer: indications, tolerance, efficacy—a single center experience. Oncotarget. 2018;9(34):23608.
40. Heymann S, Dipasquale G, Nguyen NP, San M, Gorobets O, Leduc N, et al. Two-level factorial pre-tomobreast pilot study of tomotherapy and conventional radiotherapy in breast cancer: post hoc utility of a mean absolute dose deviation penalty score. Technology in cancer research & treatment. 2020;19:1533033820947759.
41. Emami B, Lyman J, Brown A, Cola L, Goitein M, Munzenrider J, et al. Tolerance of normal tissue to therapeutic irradiation. International Journal of Radiat ion Oncology* Biology* Physics. 1991;21(1):109-22.
42. Ohashi T, Takea A, Shigematsu N, Fukada J, Sanuki N, Amemiya A, et al. Dose distribution analysis of axillary lymph nodes for three-dimensional conformal radiotherapy with a field-in-field technique for breast cancer. International Journal of Radiation Oncology Biology Physics. 2009;73(1):80-7.
43.Emami B. Tolerance of normal tissue to therapeutic radiation. Reports of radiotherapy and Oncology. 2013;1(1):35-48.
44. Astudillo V, Paredes G, Resendiz G, Posadas V, Mitsoura E, Rodriguez L, et al. Tcp and NTCP radiobiological models: conventional and hypo fractionated treatments in radiotherapy. 2015;47(7):13 .
45. Kara FG, Haydaroğlu A, Eren H, Kitapçıoğlu G. Comparison of different techniques in breast cancer radiotherapy planning. The journal of breast health. 2014;10(2):83.
46. Kagkiouzis J, Platoni K, Kantzou I, Dilvoi M, Patatoukas G, Kypraiou E, et al. Review of the three-field techniques in breast cancer radiotherapy. Journal of BU ON: official journal of the Balkan Union of Oncology. 2017;22(3):599-605.
47.Marshall MG. Three-field isocentric breast irradiation using asymmetric jaws and a tilt board. Radiotherapy and Oncology. 1993;28(3):228-32.
48. Romeo N. A new isocentric technique for exact geometric matching in the radiotherapy of the breast and ipsilateral supraclavicular fossa using dual asymmetric jaws. Physica Medica. 2012;28(4):281-7.
49. Wang X, Fargier-Bochaton O, Dipasquale G, Laouiti M, Kountouri M, Gorobets O, et al. Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis. Strahlentherapie und Onkologie. 2021;197(4):317-31.

Article Statistics :Views : 214 | Downloads : 133 : 14