J Breast Cancer.  2012 Sep;15(3):320-328. 10.4048/jbc.2012.15.3.320.

Correlation of Conventional and Conformal Plan Parameters for Predicting Radiation Pneumonitis in Patients Treated with Breast Cancer

• Onal C
• Oymak E
• Kotek A
• Efe E
• Arslan G

• KMID: 2286458
• DOI: http://doi.org/10.4048/jbc.2012.15.3.320

Abstract

PURPOSE
The purpose of this study is to evaluate the correlation between the conventional plan parameters and dosimetric parameters obtained from conformal radiotherapy (RT) planning, and between these parameters and radiation pneumontitis (RP) incidence.
METHODS
Clinical and dosimetric data of 122 patients that were treated with mastectomy and adjuvant 3D conformal RT (39% received 2-field RT [2-FRT], and in addition, 61% received 4-field RT [4-FRT]) were retrospectively analyzed. Central lung depth (CLD), maximum lung depth (MLD), and lung length were measured by the conventional plan. Lung dose-volume histograms (DVH) were created with conformal planning, and the lung volumes receiving 5 to 50 Gy (V5Gy to V50Gy) were calculated. Minimum (Dmin), maximum (Dmax), and mean doses (Dmean) for the ipsilateral lung and bilateral lungs were measured by DVH. Correlations between 3D dosimetric data and 2D radiographic parameters were analyzed.
RESULTS
The conventional plan parameters did not significantly differ between 2-FRT and 4-FRT. The conformal plan Dmin, Dmax, and Dmean values were higher in 4-FRT versus 2-FRT. CLD and MLD were correlated with DVH parameter V5Gy to V45Gy values for ipsilateral, as well as bilateral lungs for 2-FRT. MLD and ipsilateral Dmean via 2-FRT planning had the strongest positive correlation (r=0.76, p<0.01). Moderate correlations existed between CLD and ipsilateral and bilateral lung V5Gy-45Gy, and between MLD and bilateral lung V5Gy-45Gy values in 2-FRT. Only four patients developed symptomatic RP, 4 with 4-FRT and one with 2-FRT.
CONCLUSION
The conformal plan parameters were strongly correlated with dose-volume parameters for breast 2-FRT. With only 4 cases of Grade 3 RP observed, our study is limited in its ability to provide definitive guidance, however assuming that CLD is an indicator for RP, V20Gy could be used as a predictor for RP and for 2-FRT. A well-defined parameters are still required to predict RP in 4-FRT.

Keyword

Adjuvant radiotherapy; Breast neoplasms; Conformal radiotherapy; Radiation pneumonitis; Radiotherapy

MeSH Terms

Breast
Breast Neoplasms
Humans
Lung
Mastectomy
Radiation Pneumonitis
Radiotherapy, Adjuvant
Radiotherapy, Conformal
Retrospective Studies

Figure

• 

  Figure 1 Dose distribution in patients included in this study. The lung and target doses are demonstrated on (A) coronal and (B) sagittal sections with 2-field radiotherapy. The lung doses increased as a result of additional lymphatic fields, as demonstrated on (C) coronal and (D) sagittal sections with 4-field radiotherapy. LL=lung length; CLD=central lung depth; MLD=maximum lung depth.

• 

  Figure 2 (A) Dose volume analyses of ipsilateral lungs obtained from 2-field and 4-field treatment planning. The values from 2-field and 4-field planning are significantly different (p<0.05). (B) Dose volume analyses of both lungs obtained from 2-field and 4-field treatment planning. The values from 2-field and 4-field planning are significantly different (p<0.05).

• 

  Figure 3 (A) Correlation between maximum lung diameter and mean lung doses at treated chest wall for 2-field planning. (B) Correlation between maximum lung diameter and the percentage of ipsilateral lung volume that received at least 20 Gy (V20Gy) with 2-field planning.

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