title: A planning comparison of dose patterns in organs at risk and predicted risk for radiation induced malignancy in the contralateral breast following radiation therapy of primary breast using conventional, IMRT and volumetric modulated arc treatment techniques.
abstract: OBJECTIVE
  To investigate the impact of using different radiation therapy techniques on contra-lateral breast (CB) dose, and also dose to other involved organs at risk such as heart and lungs following radiation therapy of breast and regional lymph nodes. Furthermore, to predict the risk for induced malignancies in CB using linear and non linear models.
  
  
  METHODS
  Eight patients with stage II-III breast cancer were included in this analysis. It was focused on three treatment techniques; conventional radiotherapy technique forwardly planed, IMRT and volumetric modulated arc (RapidArc) techniques, inversely planed. The CC algorithm was employed to calculate the standard treatment plans whereas for the IMRT and RapidArc treatment plans AAA algorithm was adopted. The dose results based on mostly DVH analysis were compared. The excess relative risk (ERR) for cancer induction in CB, employed both linear and non-linear models, was estimated.
  
  
  RESULTS
  A better homogeneity and conformation in PTV was observed in the RapidArc plans. The highest minimum dose to PTV was observed in the conventional plans while no difference was observed for minimum significant doses D(98%) and D(99%) where D(X%) is the dose received by X% of the PTV volume. In terms of organ sparing, the IMRT and RapidArc plans spare ipsilateral-lung better, but a 40% lower mean dose in the contra-lateral lung in the conventional plans is observed. The mean dose to the contra-lateral breast was lowest for the RapidArc plans as well as the V(10Gy) and the maximum dose. The mean predicted ERR for the eight patients were lower for the conventional and RA plans than for the IMRT plans assuming a linear dose-risk relationship. The mean predicted ERR when using a non linear model was lower for all the three techniques (with lowest ERR for RapidArc plans).
  
  
  CONCLUSIONS
  From a clinical perspective, it should be concluded that all three solutions investigated in the study can offer high quality treatment of patients. Further comparative analysis of the two algorithms used in the present study, however, should be performed especially on the peripheral organ dose. The impact of CB exposure to a low-dose radiation on minimizing the risk of radiation induced malignancy in CB can be interpreted differently when using linear or non linear models to predict ERR. In general, no detriment was observed when using RapidArc compared to conventional treatments while a potentially higher risk could be associated to IMRT treatments with fixed gantry.
authors.affiliation: Institute for Cancer Research, Norwegian Radium Hospital, Rikshospitalet University Hospital, Oslo, Norway. safora.johansen@radiumhospitalet.no
authors.forename: Safora
authors.initials: S
authors.lastname: Johansen
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.forename: Dag Rune
authors.initials: DR
authors.lastname: Olsen
mesh_terms: D001943:Breast Neoplasms / Q000209:etiology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000209:etiology*; D011237:Predictive Value of Tests; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018570:Risk Assessment; D012307:Risk Factors