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This text is a concise handbook designed to assist the clinician in the implementation of Accelerated Partial Breast Irradiation (APBI). It includes a review of the principles that underlie APBI, a practical and detailed description of each technique for APBI, a review of current clinical results of APBI, and a review of the incidence and management of treatment related complications. The book encompasses a number of different techniques and approaches that include brachytherapy, intraoperative, and external beam techniques. There is currently no single source that describes these techniques and their clinical implementation.
Purpose: Breast cancer is one of the most common cancers among American women and is the second leading cause of cancer death among women in the U.S. While its incidence in Mississippi is among the lowest in the country, the state mortality rate is among the highest. Traditionally, regardless of the severity of the diagnosis, radical mastectomy followed by a combination of radiation therapy (RT) and chemotherapy was a woman's only option to treat early-stage breast cancer. The advent of breast conservation surgery (BCS) offers a less intrusive alternative and has become a popular and preferred treatment option for clinically qualified women with early stage breast cancer. Studies show lumpectomy followed by RT as equivalent to mastectomy for early stage breast cancer. Radiation Therapy is important to reduce the risk for local recurrence. BCS followed by RT is called breast conservation therapy (BCT). BCT has given rise to an accelerated or hypo-fractionated RT to the lumpectomy bed where the greatest recurrence risk exists. This treatment method, also called partial breast irradiation (PBI), allows for the breast to experience less radiation toxicity and reduces radiation treatment time. Accelerated partial breast irradiation (APBI) typically involves a radiation regimen of one week as compared to conventional whole breast irradiation requiring up to six weeks of daily radiation. Few APBI treatment techniques have gained popularity due to technical challenges and painful surgical procedures. One form that has gained favorability among physicians and patients utilizes high dose rate (HDR) brachytherapy. APBI with HDR is a two-step process involving a lumpectomy followed by surgical insertion of a balloon or strut type catheter that is used for radiation delivery. Delivery of radiation is through temporary placement of radioactive Iridium-192 within the lumpectomy site via the catheter. This outpatient procedure is typically a five-day course. A few studies have examined the impact of facility access to APBI utility. Additional studies in various states have investigated the impact of patient demographics on APBI utilization. Others have explored the association of surgeon training, physician density, and referral patterns on APBI utilization. There is currently a lack of research in APBI utilization in the state of Mississippi with respect to APBI facility access, patient demographics, and density of surgeons and radiation oncologists. Methods: Research included the analysis of Mississippi Cancer Registry (MCR) data to identify early stage breast cancer patients who received mastectomy, BCS, or BCT to include adjuvant radiation. The MCR data sought included records of early-stage breast cancer in women from 2004 to 2013, which is appropriate since APBI brachytherapy gained popularity in the last 10 years. Analysis of MCR data will correlate patient demographics to surgical and radiation treatment modality (mastectomy, BCS, or BCT). Radiation therapy facilities and the subset that offer the APBI treatment option within the state were identified through the Mississippi State Department of Health (MSDH). The Mississippi State Medical Association (MSMA) was used to identify general surgeons and radiation oncologists per county. RT facilities and physician density data was used with MCR data to classify patterns of APBI utilization within Mississippi counties. Chi-square analysis was used to investigate if radiation treatment modality selected differs by patients' race, county of diagnosis, and insurance status. Binary logistic regression was used to investigate factors associated with radiation treatment modality. Results: An analysis was performed on APBI eligible early-stage female breast cancer patients. The selection included women who received BCS and met all of the eligibility criteria for APBI treatment. Statistical analysis was performed based on demographic factors such as race, county of diagnosis, and insurance status. Additionally, statistical analysis was performed on proximity to physician density and radiation facilities within the county of diagnosis. Among APBI eligible patients, Chi-square analysis indicated a statistically significant difference for radiation treatment modality selected based on race, urban vs. rural county of diagnosis, insurance status, availability of a radiation oncologist, and availability of external beam radiation treatment facilities within the diagnosis county. Binary logistic regression analysis was performed for an outcome of no radiation versus any radiation received, as well as analysis of no radiation versus APBI brachytherapy. For both binary logistic regression analyses, there was a significant difference among treatment for patients in urban versus rural counties, race, and availability of external beam radiation facilities. For the outcome of no radiation versus brachytherapy, the availability of a surgeon or APBI brachytherapy facility within the diagnosis county showed a significant difference in treatment modality chosen. Multinomial regression analysis considered all radiation treatment modalities on controlling for all other covariates. This analysis demonstrated a statistically significant difference for any radiation treatment modality when considering race, urban versus rural county of diagnosis, and availability of external beam radiation facilities within the county. For APBI brachytherapy, the availability of a surgeon and brachytherapy facilities within the county was shown to be statistically significant.Conclusion: This study examines the variation in radiation treatment among APBI eligible early stage breast cancer patients who received mastectomy versus BCS or BCT. The analysis showed that non-Hispanic white women are significantly more likely to receive external beam treatment or APBI brachytherapy treatment than non-Hispanic black women. Women in urban counties are significantly more likely to receive external beam or APBI brachytherapy than women in rural counties. When compared to uninsured women, those who have government insurance are more likely to receive external beam or APBI brachytherapy. Also, women with private pay insurance are more likely to receive APBI brachytherapy and significantly more likely to receive external beam treatment. While not statistically significant, not having a radiation oncologist available in the county of diagnosis decreased the likelihood of receiving either external beam RT or brachytherapy. Similarly not having a surgeon available within the diagnosis county decreased the likelihood of a patient receiving external beam treatment and significantly decreased the likelihood of brachytherapy. Not having a linear accelerator available within the county of diagnosis still increases the likelihood of receiving some type of radiation treatment, especially brachytherapy. Finally, having an HDR brachytherapy facility available within the county of diagnosis significantly increases the likelihood of receiving APBI brachytherapy treatment. Non-Hispanic white women with private or government insurance are more likely to receive external beam treatment or APBI brachytherapy treatment, indicating that race and insurance status have an impact on APBI utilization. Access to a radiation oncologist did not significantly have an impact on APBI utilization; however, not having a surgeon in the county significantly decreased the likelihood of APBI utilization. Patients were over five times more likely to receive APBI brachytherapy when there was no access to an external beam Linac facility within the county of diagnosis, indicating a significant impact on APBI utilization. Access to HDR brachytherapy facilities within the county of diagnosis did not significantly impact the utility of external beam radiation therapy, but did significantly decreased the likelihood of APBI utilization. Currently, there is a lack of APBI utilization data for the state of Mississippi, and this modality has not been analyzed with respect to race, location, insurance status, and access to radiation oncologists, surgeons, and treatment facilities in our state.
This text is a concise handbook designed to assist the clinician in the implementation of Accelerated Partial Breast Irradiation (APBI). It includes a review of the principles that underlie APBI, a practical and detailed description of each technique for APBI, a review of current clinical results of APBI, and a review of the incidence and management of treatment related complications. The book encompasses a number of different techniques and approaches that include brachytherapy, intraoperative, and external beam techniques. There is currently no single source that describes these techniques and their clinical implementation.
This book addresses the day-to-day treatment planning issues that radiation oncologists are likely to encounter during the treatment of breast cancer patients and provides numerous practical “tips” that will assist in navigation of the treatment planning process, from delineation of the tumor boundaries to discrimination of adjacent normal tissues and critical structures at risk of radiation injury. Differences in target delineation and treatment planning according to technique are emphasized, with coverage of conventional radiation therapy and advanced techniques including cardiac-sparing approaches, e.g., using active breathing control, intensity-modulated radiation therapy, proton beam therapy, and electron beam therapy post mastectomy. Individual chapters also focus on radiation setup and verification techniques and radiation treatment planning systems. The book, which is part of the Springer series Practical Guides in Radiation Oncology, is designed for hands-on use by radiation oncology residents/fellows in training and practicing radiation oncologists.
Perfect for radiation oncologists, medical physicists, and residents in both fields, Practical Radiation Oncology Physics provides a concise and practical summary of the current practice standards in therapeutic medical physics. A companion to the fourth edition of Clinical Radiation Oncology, by Drs. Leonard Gunderson and Joel Tepper, this indispensable guide helps you ensure a current, state-of-the art clinical practice. Covers key topics such as relative and in-vivo dosimetry, imaging and clinical imaging, stereotactic body radiation therapy, and brachytherapy. Describes technical aspects and patient-related aspects of current clinical practice. Offers key practice guideline recommendations from professional societies throughout — including AAPM, ASTRO, ABS, ACR, IAEA, and others. Includes therapeutic applications of x-rays, gamma rays, electron and charged particle beams, neutrons, and radiation from sealed radionuclide sources, plus the equipment associated with their production, use, measurement, and evaluation. Features a "For the Physician" box in each chapter, which summarizes the key points with the most impact on the quality and safety of patient care. Provides a user-friendly appendix with annotated compilations of all relevant recommendation documents. Medicine eBook is accessible on a variety of devices.
Surface Guided Radiation Therapy provides a comprehensive overview of optical surface image guidance systems for radiation therapy. It serves as an introductory teaching resource for students and trainees, and a valuable reference for medical physicists, physicians, radiation therapists, and administrators who wish to incorporate surface guided radiation therapy (SGRT) into their clinical practice. This is the first book dedicated to the principles and practice of SGRT, featuring: Chapters authored by an internationally represented list of physicists, radiation oncologists and therapists, edited by pioneers and experts in SGRT Covering the evolution of localization systems and their role in quality and safety, current SGRT systems, practical guides to commissioning and quality assurance, clinical applications by anatomic site, and emerging topics including skin mark-less setups. Several dedicated chapters on SGRT for intracranial radiosurgery and breast, covering technical aspects, risk assessment and outcomes. Jeremy Hoisak, PhD, DABR is an Assistant Professor in the Department of Radiation Medicine and Applied Sciences at the University of California, San Diego. Dr. Hoisak’s clinical expertise includes radiosurgery and respiratory motion management. Adam Paxton, PhD, DABR is an Assistant Professor in the Department of Radiation Oncology at the University of Utah. Dr. Paxton’s clinical expertise includes patient safety, motion management, radiosurgery, and proton therapy. Benjamin Waghorn, PhD, DABR is the Director of Clinical Physics at Vision RT. Dr. Waghorn’s research interests include intensity modulated radiation therapy, motion management, and surface image guidance systems. Todd Pawlicki, PhD, DABR, FAAPM, FASTRO, is Professor and Vice-Chair for Medical Physics in the Department of Radiation Medicine and Applied Sciences at the University of California, San Diego. Dr. Pawlicki has published extensively on quality and safety in radiation therapy. He has served on the Board of Directors for the American Society for Radiology Oncology (ASTRO) and the American Association of Physicists in Medicine (AAPM).
Thoroughly revised and updated, the 2nd Edition presents all of the latest advances in the field, including the most recent technologies and techniques. For each tumor site discussed, readers will find unparalleled coverage of multiple treatment plans, histology and biology of the tumor, its anatomic location and routes of spread, and utilization of specialized techniques. This convenient source also reviews all of the basic principles that underlie the selection and application of radiation as a treatment modality, including radiobiology, radiation physics, immobilization and simulation, high dose rate, intraoperative irradation, and more. Comprehensively reviews each topic, with a distinct clinical orientation throughout. Serves as a foundation for the basic principles that underlie the selection and application of radiation as a treatment modality, including radiobiology, radiation physics, immobilization and simulation, high dose rate, intraoperative irradation, and more. Guides readers through all stages of treatment application with step-by-step techniques for the assessment and implementation of radiotherapeutic options. Presents latest information on brachytherapy * 3-dimensional conformal treatment planning * sterotactic radiosurgery * and radiolabeled antibodies. Discusses the recent use of radiotherapy in the treatment of primary lymphoma, leukemia, multiple myeloma, and cancers of the prostate and central nervous system. Includes the latest AJCC staging system guidelines. Offers the latest advances in techniques, allowing you to deliver doses precisely to areas affected by malignancy and spare healthy tissue. Presents new chapters on the hottest topics including Three Dimensional Conformal Radiotherapy * Intensity Modulated Radiotherapy * Breathing Synchronized Radiotherapy * Plasma Cell Tumors: Multiple Myeloma and Solitary Plasmacytoma * Extracranial Stereotactic Radioablation * and [Imaging of the] Head and Neck * Thorax * Abdomen * and Pelvis.
Radiation Medicine Rounds is a trinary, hard cover, periodical designed to provide an up-to-date review of a dedicated radiation medicine topic of interest to clinicians and scientists who are involved in the care of patients receiving radiotherapy. It is intended to serve as both a reference and instructional tool for students, housestaff, fellows, practicing clinicians, medical physicists, cancer biologists, radiobiologists, and interdisciplinary colleagues throughout the oncology spectrum. This issue of Radiation Medicine Rounds discusses the more salient topics surrounding the role of radiation therapy in breast cancer. The specialty of radiation therapy has increased in complexity over the years, yet as technology improves, the goal of improving outcomes while decreasing toxicity remains critical. Breast Cancer provides the practitioner with a full current overview of the present best practices and recent research in management of this complex and challenging cancer.
Carbon-ion treatment for breast cancer was not effectively analyzed and compared with photon-based radiation treatment technique, yet. To quantitatively analyze the dosimetric effect of particle therapy on early-stage breast cancer, we compare three different kinds of radiation treatment planning by using RayStation treatment planning system including intensity modulated carbon-ion therapy (IMCT), intensity modulated proton therapy (IMPT), and conventional photon-based VMAT.For ten breast cancer patients referred for early stage T1N0M0 as APBI treatment, planning for IMCT, IMPT and VMAT was generated. All plan was generated based on the same CTV with different margins for PTV (2 mm for IMCT, IMPT, 3 mm for VMAT) to secure the reliability of treatment. IMCT, IMPT plan, consisting of three (non-)coplanar beam arrangement was applied with robust optimization for PTV (2 mm iso-tropical margin for patient setup uncertainty and 3.5% for range uncertainty) and VMAT with two arc beam arrangement was generated. 30 Gy in 5 fractions was applied for IMPT, VMAT whereas 30 gray equivalents (GyE; physical dose in Gy u00d7 RBE) in 5 fractions was applied for IMCT. CTV coverage and the organs at risk as well as conformity and homogeneity indexes for PTV was calculated from dose volume histograms.All treatment plan had fulfilled the prescription (D95% for CTV u2265u200999%). In planning comparison among the three different modalities, IMCT achieved better homogeneity compared to IMPT, VMAT and achieved better conformity compared to IMPT. Planning results from particle therapy has showed better OARs spare effect, especially for heart, contralateral breast and lung.