title: Dosimetric Improvements with a Novel Breast Stereotactic Radiotherapy Device for Delivery of Preoperative Partial-Breast Irradiation.
abstract: Partial-breast irradiation (PBI) with external-beam radiotherapy has produced higher than expected rates of fair-to-poor cosmesis. Worsened outcomes have been correlated with larger volumes of breast tissue exposed to radiation. A novel breast-specific stereotactic radiotherapy (BSRT) device (BSRTD) has been developed at our institution and has shown promise in delivering highly conformal dose distributions. We compared normal tissue sparing with this device with that achieved with intensity-modulated radiation therapy (IMRT)-PBI.
  
  
  
  Fifteen women previously treated with breast conservation therapy were enrolled on an institutional review board-approved protocol. Each of them underwent CT simulation in the prone position using the BSRTD-specific immobilization system. Simulated postoperative and preoperative treatment volumes were generated based on surgical bed/clip position. Blinded planners generated IMRT-PBI plans and BSRT plans for each set of volumes. These plans were compared based on clinically validated markers for cosmetic outcome and toxicity using a Wilcoxon rank-sum test.
  
  
  
  The BSRT plans consistently reduced the volumes receiving each of several dose levels (Vx) to breast tissue, the chest wall, the lung, the heart, and the skin in both preoperative and postoperative settings (p < 0.05). Preoperative BSRT yielded particularly dramatic improvements.
  
  
  
  The novel BSRTD has demonstrated significant dosimetric benefits over IMRT-PBI. Further investigation is currently proceeding through initial clinical trials.
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Snider
authors.forename: Yildirim
authors.initials: Y
authors.lastname: Mutaf
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nichols
authors.forename: Andrea
authors.initials: A
authors.lastname: Hall
authors.forename: Patrick
authors.initials: P
authors.lastname: Vadnais
authors.forename: William F
authors.initials: WF
authors.lastname: Regine
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Feigenberg
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000295:instrumentation / Q000379:methods; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*