• 한국의학물리학회지:의학물리
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• 제29권2호
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• pp.73-80
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• 2018

Accelerated partial breast irradiation (APBI) is a new treatment delivery technique that decreases overall treatment time by using higher fractional doses than conventional fractionation. Here, a quantitative analysis study of CyberKnife-based APBI was performed on 10 patients with left-sided breast cancer who had already finished conventional treatment at the Inha University Hospital. Dosimetric parameters for four kinds of treatment plans (3D-CRT, IMRT, VMAT, and CyberKnife) were analyzed and compared with constraints in the NSABP B39/RTOG 0413 protocol and a published CyberKnife-based APBI study. For the 10 patients recruited in this study, all the dosimetric parameters, including target coverage and doses to normal structures, met the NSABP B39/RTOG 0413 protocol. Compared with other treatment plans, a more conformal dose to the target and better dose sparing of critical structures were observed in CyberKnife plans. Accelerated partial breast irradiation via CyberKnife is a suitable treatment delivery technique for partial breast irradiation and offers improvements over external beam APBI techniques.

• Radiation Oncology Journal
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• 제32권4호
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• pp.262-265
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• 2014

Tamoxifen and radiotherapy are used in breast cancer treatment worldwide. Radiation recall dermatitis (RRD), induced by tamoxifen, has been rarely reported. Herein, we report a RRD case induced by tamoxifen. A 47-year-old woman had a right quadrantectomy and an axillary lymph node dissection due to breast cancer. The tumor was staged pT2N0; it was hormone receptor positive, and human epidermal growth factor receptor 2 negative. The patient received adjuvant chemotherapy followed by tamoxifen and radiotherapy. After 22 months of tamoxifen, the patient developed a localized heating sensation, tenderness, edema, and redness at the irradiated area of the right breast. The symptoms improved within 1 week without treatment. Three weeks later, however, the patient developed similar symptoms in the same area of the breast. She continued tamoxifen before and during dermatitis, and symptoms resolved within 1 week.

• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1197-1199
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• 2016

Background: This study aimed to facilitate decision-making in cases of breast cancer radiotherapy shifts by simulating millimetric shifts and analyzing their effects on dose distribution. Methods: The study included 30 patients with left side breast cancer who were treated with three dimensional conformal radiotherapy (3D-CRT) in the Radiation Oncology Department in Hatay Public Hospital, between January 2013 and April 2015. A treatment plan shifting at three axes with six different measures was simulated. Results: The biggest difference in values was (+3mm shift) 476cGy, with a 7.7 % change for heart and 25.6% for spinal cord. The shifts in values respectively for CTV min, mean, max were -4.8%, 2.5%, 4%. The differences for lymphatic min, mean, max were 21.3%, 20.3%, -12.2%. Conclusion: The most important thing is not the treatment plan quality, but its practicality. The treatment plan must be practical and its practice must be controlled rigidly.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7813-7818
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• 2015

Background: Radiotherapy plays an important role as adjuvant treatment in locally advanced breast cancer and in those patients who have undergone breast-conserving surgery. This study aimed to investigate the prognostic impact of adjuvant radiation on oncologic outcomes in elderly women with breast cancer. Materials and Methods: In this retrospective study, we reviewed and analyzed the characteristics, treatment outcome and survival of elderly women (aged ${\geq}60years$) with breast cancer who were treated and followed-up between 1993 and 2014. The median follow up for the surviving patients was 38 (range 3-207) months. Results: One hundred and seventy-eight patients with a median age of 74 (range 60-95) years were enrolled in the study. Of the total, 60 patients received postoperative adjuvant radiation (radiation group) and the remaining 118 did not (control group). Patients in the radiation group were significantly younger than those in the control group (P value=0.004). In addition, patients in radiation group had higher node stage (P value<0.001) and disease stage (P=0.003) and tended to have higher tumor grade (P=0.031) and received more frequent (P value<0.001) adjuvant and neoadjuvant chemotherapy compared to those in the control group. There was no statistically significant difference between two groups regarding the local control, disease-free survival and overall survival rates. Conclusions: In this study, we did not find a prognostic impact for adjuvant radiation on oncologic outcomes in elderly women with breast cancer.

• Radiation Oncology Journal
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• 제34권1호
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• pp.1-9
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• 2016

Overexpression of human epidermal growth factor receptor 2 (HER2) is found in about 20% of breast cancer patients. With treatment using trastuzumab, an anti-HER2 monoclonal antibody, systemic control is improved. Nonetheless, the incidence of brain metastasis does not be improved, rather seems to be increased in HER2-positive breast cancer. The mainstay treatment for brain metastases is radiotherapy. According to the number of metastatic lesions and performance status of patients, radiosurgery or whole brain radiotherapy can be performed. The concurrent use of a radiosensitizer further improves intracranial control. Due to its large molecular weight, trastuzumab has a limited ability to cross the blood-brain barrier. However, small tyrosine kinase inhibitors such as lapatinib, has been noted to be a promising agent that can be used as a radiosensitizer to affect HER2-positive breast cancer. This review will outline general management of brain metastases and will focus on preclinical findings regarding the radiosensitizing effect of small molecule HER2 targeting agents.

• 대한방사선기술학회지:방사선기술과학
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• 제42권2호
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• pp.137-143
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• 2019

The aim of this study was analyzed the setup error of breast cancer patients in intensity modulated radiation therapy(IMRT) with deep inspiration breath holding(DIBH) and was analyzed the dose distribution due to setup error. A total of 45 breast cancer cases were performed a retrospective clinical analysis of setup error. In addition, the re-treatment planning was carried by shifting the setup error from the isocenter at the treatment. Based on this, the dose distribution of PTV and OARs was compared and analyzed. The 3D error for small breast group and medium breast group and large breast group were 3.1 mm and 3.7 mm and 4.1 mm, respectively. The difference between the groups was statistically significant(P=0.003). DVH results showed HI, CI for the PTV difference between standard treatment plan and re-treatment plan of 14.4%, 4%. The difference in $D_5$ and $V_{20}$ of the ipsilateral lung was 5.6%, 13% respectively. The difference in $D_5$ and $V_5$ of the heart of right breast cancer patients was 6.8%, 8% respectively. The difference in $D_5$, $V_{20}$ of the heart of left breast cancer patients was 7.2%, 23.5% respectively. In this study, there was a significant association between breast size and significant setup error in breast cancer patients with DIBH. In addition, it was found that the dose distribution of the PTV and OARs varied according to the setup error.

• 한국의학물리학회지:의학물리
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• 제28권4호
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• pp.218-225
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• 2017

Effects on skin caused by the dose from linear accelerator (LINAC) opposing portal irradiation and TomoDirect 3-D modeling treatment according to the radiation devices and treatment methods were measured, and a comparative analysis was performed. Two groups of 10 patients each were created and measurements were carried out using an optically stimulated luminescence dosimeter. These patients were already receiving radiation treatment in the hospital. Using the SPSS statistical program, the minimum and maximum average standard deviations of the measured skin dose data were obtained. Two types of treatment method were selected as independent variables; the measured points and total average were the dependent variables. An independent sample T-test was used, and it was checked whether there was a significance probability between the two groups. The average of the measured results for the LINAC opposing portal radiation was 117.7 cGy and PDD 65.39% for the inner breast, 144.7 cGy and PDD 80.39% for the outer breast, 143.2 cGy and PDD 79.56% for the upper breast, 151.4 cGy and PDD 84.11% for the lower breast, 149.6 cGy and PDD 83.11% for the axilla, and 141.32 cGy and PDD 78.51% for the total average. In contrast, for TomoDirect 3-D conformal radiotherapy, the corresponding measurement values were 137.6 cGy and PDD 76.44%, 152.3 cGy and PDD 84.61%, 148.6 cGy and PDD 82.56%, 159.7 cGy and PDD 88.72%, and 148.6 cGy PDD 82.56%, respectively, and the total average was 149.36 cGy and PDD 82.98%. To determine if the difference between the total averages was statistically significant, the independent sample T-test of the SPSS statistical program was used, which indicated that the P-value was P=0.024, which was 0.05 lower than the significance level. Thus, it can be understood that the null hypothesis can be dismissed, and that there was a difference in the averages. In conclusion, even though the treatment dose was similar, there could be a difference in the dose entering the body surface from the radiation treatment plan; however, depending on the properties of the treatment devices, there is a difference in the dose affecting the body surface. Thus, the absorbed dose entering the body surface can be high. During breast cancer radiotherapy, radiation dermatitis occurs in almost all patients. Most patients have a difficult time while undergoing treatment, and therefore, when choosing a radiotherapy treatment method, minimizing radiation dermatitis is an important consideration.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3257-3265
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• 2015

Background: Radiotherapy is an important treatment of choice for breast cancer patients after breast-conserving surgery, and we compare the feasibility of using dual arc volumetric modulated arc therapy (VMAT2), single arc volumetric modulated arc therapy (VMAT1) and Multi-beam Intensity Modulated Radiotherapy (M-IMRT) on patients after breast-conserving surgery. Materials and Methods: Thirty patients with breast cancer (half right-sided and half left-sided) treated by conservative lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned with three different radiotherapy techniques: 1) VMAT1; 2) VMAT2; 3) M-IMRT. The distributions for the planning target volume (PTV) and organs at risk (OARs) were compared. Dosimetries for all the techniques were compared. Results: All three techniques satisfied the dose constraint well. VMAT2 showed no obvious difference in the homogeneity index (HI) and conformity index (CI) of the PTV with respect to M-IMRT and VMAT1. VMAT2 clearly improved the treatment efficiency and can also decrease the mean dose and V5Gy of the contralateral lung. The mean dose and maximum dose of the spinal cord and contralateral breast were lower for VMAT2 than the other two techniques. The very low dose distribution (V1Gy) of the contralateral breast also showed great reduction in VMAT2 compared with the other two techniques. For the ipsilateral lung of right-sided breast cancer, the mean dose was decreased significantly in VMAT2 compared with VMAT1 and M-IMRT. The V20Gy and V30Gy of the ipsilateral lung of the left-sided breast cancer for VMAT2 showed obvious reduction compared with the other two techniques. The heart statistics of VMAT2 also decreased considerably compared to VMAT1 and M-IMRT. Conclusions: Compared to the other two techniques, the dual arc volumetric modulated arc therapy technique reduced radiation dose exposure to the organs at risk and maintained a reasonable target dose distribution.

• 혜화의학회지
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• 제5권2호
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• pp.473-484
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• 1997

This study was performed to survey the specific information about the time of onset, frequency, duration, and severity of the side effect of radiation therapy following breast cancer surgery, and identify the difference of these data according to the type of breast cancer surgery : modified radical mastectomy(MRM) vs. breast consevative operation(BCO). 38 breast cancer patients were interviewed with side effect profile about radiation therapy. Interview was done weekley from the start of radiation therapy through 6 weeks and 3 month follow-up interview was done at 3 month after completion of the treatment. The results are as follow : 1. Total score of side effect experienced by the breast cancer patients was rapidly increased at 2-3 week after intiating treatement and continousely raised maintaing high score until completion of the treatement. Some problems like cough, dyspnea and pain were more experienced after treatment. 2. Patients with modified radical mastectomy showed more total score of side effects than patients with breast conservative operation. And both patients with MRM and BCO experienced similar pattern of side effect to radiation therapy. Through these data we concluded that side effect to radiation therapy was not ended at completion of treatement. Patents will continously experiend various problems and suffer from not only acute side effects like skin problem, sore throat and swollowing difficulty but also late effect of the radiation therapy. Clinically these data can be used for oncologic nurse to provide informational interventions to prepare breast cancer patients for the radiation therapy.

• Radiation Oncology Journal
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• 제35권1호
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• pp.32-38
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• 2017

Purpose: Several accelerated partial breast radiation (APBR) techniques have been investigated in patients with early-stage breast cancer (BC); however, the optimal treatment delivery techniques remain unclear. We evaluated the feasibility and toxicity of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I BC, using a novel fractionation schedule. Materials and Methods: Forty-two patients aged ${\geq}65$ years, with stage I BC who underwent breast conserving surgery were enrolled in a phase I/II study evaluating APBR using IMRT. Forty eligible patients received 40 Gy in 4 Gy daily fractions. Patients were assessed for treatment related toxicities, and cosmesis, before APBR, during, and after completion of the treatment. Results: The median age was 73 years, median tumor size 0.8 cm and the median follow-up was 54 months. The 5-year locoregional control was 97.5% and overall survival 90%. Erythema and skin pigmentation was the most common acute adverse event, reported by 27 patients (69%). Twenty-six patients (65%) reported mild pain, rated 1-4/10. This improved at last follow-up to only 2 (15%). Overall the patient and physician reported worst late toxicities were lower than the baseline and at last follow-up, patients and physicians rated cosmesis as excellent/good in 93% and 86 %, respectively. Conclusion: In this prospective trial, we observed an excellent rate of tumor control with daily APBR. The acceptable toxicity profile and cosmetic results of this study support the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.