Dose to level I and II axillary lymph nodes and lung by tangential field radiation in patients undergoing postmastectomy radiation with tissue expander reconstruction

Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Methods and Materials Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent...

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Vydáno v:	Radiation oncology (London, England) Ročník 6; číslo 1; s. 179
Hlavní autoři:	Russo, James K, Armeson, Kent E, Rhome, Ryan, Spanos, Michele, Harper, Jennifer L
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London BioMed Central 28.12.2011 BioMed Central Ltd Springer Nature B.V BMC
Témata:	Adult Aged axillary dose Biomedical and Life Sciences Biomedicine Breast Neoplasms - radiotherapy Breast Neoplasms - surgery breast reconstruction Cancer Research Care and treatment Diagnosis Female Health aspects Humans Imaging Lung - radiation effects Lymph Nodes - radiation effects Lymphatic diseases Lymphatic Irradiation - methods Mammaplasty - instrumentation Mastectomy Middle Aged Oncology post-mastectomy radiation Radiation Dosage Radiology Radiotherapy tangent fields tissue expander Tissue Expansion Devices - adverse effects United States axillary dose tangent fields post-mastectomy radiation tissue expander breast reconstruction
ISSN:	1748-717X, 1748-717X
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Abstract	Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Methods and Materials Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. Results The mean coverage of the level I/II axillary volume by the 95% isodose line (V D95% ) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung V D50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary V D95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung V D50% correlated with angle of the expander from midline (p = 0.05). Conclusions In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated.
AbstractList	Abstract Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Methods and Materials Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. Results The mean coverage of the level I/II axillary volume by the 95% isodose line (VD95%) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung VD50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary VD95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung VD50% correlated with angle of the expander from midline (p = 0.05). Conclusions In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated. To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. The mean coverage of the level I/II axillary volume by the 95% isodose line (V(D95%)) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung V(D50%) was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary V(D95%) in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung V(D50%) correlated with angle of the expander from midline (p = 0.05). In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated. Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Methods and Materials Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. Results The mean coverage of the level I/II axillary volume by the 95% isodose line (V.sub.D95% ) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung V.sub.D50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary V.sub.D95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung V.sub.D50% correlated with angle of the expander from midline (p = 0.05). Conclusions In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated. To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. The mean coverage of the level I/II axillary volume by the 95% isodose line (V.sub.D95% ) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung V.sub.D50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary V.sub.D95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung V.sub.D50% correlated with angle of the expander from midline (p = 0.05). In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated. To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement.BACKGROUNDTo define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement.Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose.METHODS AND MATERIALSTwenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose.The mean coverage of the level I/II axillary volume by the 95% isodose line (V(D95%)) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung V(D50%) was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary V(D95%) in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung V(D50%) correlated with angle of the expander from midline (p = 0.05).RESULTSThe mean coverage of the level I/II axillary volume by the 95% isodose line (V(D95%)) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung V(D50%) was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary V(D95%) in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung V(D50%) correlated with angle of the expander from midline (p = 0.05).In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated.CONCLUSIONSIn patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated. Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander placement. Methods and Materials Twenty-three patients were identified who had undergone postmastectomy radiotherapy with tangent only fields. All patients had pre-radiation tissue expander placement and expansion. Thirteen patients had bilateral expander reconstruction. The level I/II axillary volumes were contoured using the RTOG contouring atlas. The patient-specific variables of expander volume, superior-to-inferior location of expander, distance between expanders, expander angle and axillary volume were analyzed to determine their relationship to the axillary volume and lung volume dose. Results The mean coverage of the level I/II axillary volume by the 95% isodose line (V D95% ) was 23.9% (range 0.3 - 65.4%). The mean Ipsilateral Lung V D50% was 8.8% (2.2-20.9). Ipsilateral and contralateral expander volume correlated to Axillary V D95% in patients with bilateral reconstruction (p = 0.01 and 0.006, respectively) but not those with ipsilateral only reconstruction (p = 0.60). Ipsilateral Lung V D50% correlated with angle of the expander from midline (p = 0.05). Conclusions In patients undergoing PMRT with tissue expanders, incidental doses delivered by tangents to the axilla, as defined by the RTOG contouring atlas, do not provide adequate coverage. The posterior-superior region of level I and II is the region most commonly underdosed. Axillary volume coverage increased with increasing expander volumes in patients with bilateral reconstruction. Lung dose increased with increasing expander angle from midline. This information should be considered both when placing expanders and when designing PMRT tangent only treatment plans by contouring and targeting the axilla volume when axillary treatment is indicated.
ArticleNumber	179
Audience	Academic
Author	Rhome, Ryan Harper, Jennifer L Armeson, Kent E Spanos, Michele Russo, James K
AuthorAffiliation	1 Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina: 169 Ashley Ave Room 168 MSC 318, Charleston, SC 29425, USA 2 Division of Biostatistics and Epidemiology, Hollings Cancer Center, Medical University of South Carolina: 86 Jonathan Lucas St., Charleston, SC 29425, USA
AuthorAffiliation_xml	– name: 1 Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina: 169 Ashley Ave Room 168 MSC 318, Charleston, SC 29425, USA – name: 2 Division of Biostatistics and Epidemiology, Hollings Cancer Center, Medical University of South Carolina: 86 Jonathan Lucas St., Charleston, SC 29425, USA
Author_xml	– sequence: 1 givenname: James K surname: Russo fullname: Russo, James K email: jakyru1981@gmail.com organization: Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina – sequence: 2 givenname: Kent E surname: Armeson fullname: Armeson, Kent E organization: Division of Biostatistics and Epidemiology, Hollings Cancer Center, Medical University of South Carolina – sequence: 3 givenname: Ryan surname: Rhome fullname: Rhome, Ryan organization: Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina – sequence: 4 givenname: Michele surname: Spanos fullname: Spanos, Michele organization: Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina – sequence: 5 givenname: Jennifer L surname: Harper fullname: Harper, Jennifer L organization: Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/22204504$$D View this record in MEDLINE/PubMed
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Copyright	Russo et al; licensee BioMed Central Ltd. 2011 2011 Russo et al; licensee BioMed Central Ltd. COPYRIGHT 2011 BioMed Central Ltd. 2011 Russo et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ©2011 Russo et al; licensee BioMed Central Ltd. 2011 Russo et al; licensee BioMed Central Ltd.
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Snippet	Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following... To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following tissue expander... Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT) following... Abstract Background: To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT)... Abstract Background To define the dosimetric coverage of level I/II axillary volumes and the lung volume irradiated in postmastectomy radiotherapy (PMRT)...
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SubjectTerms	Adult Aged axillary dose Biomedical and Life Sciences Biomedicine Breast Neoplasms - radiotherapy Breast Neoplasms - surgery breast reconstruction Cancer Research Care and treatment Diagnosis Female Health aspects Humans Imaging Lung - radiation effects Lymph Nodes - radiation effects Lymphatic diseases Lymphatic Irradiation - methods Mammaplasty - instrumentation Mastectomy Middle Aged Oncology post-mastectomy radiation Radiation Dosage Radiology Radiotherapy tangent fields tissue expander Tissue Expansion Devices - adverse effects
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Title	Dose to level I and II axillary lymph nodes and lung by tangential field radiation in patients undergoing postmastectomy radiation with tissue expander reconstruction
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