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Cancers
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Radiation Therapy for Breast Cancers
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Radiation Therapy for Breast Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 8102

Special Issue Editor

Prof. Dr. Stephanie Elisabeth Combs

E-Mail Website
Guest Editor
Department of Radiation Oncology, Technical University of Munich (TUM), Munich, GermanyNeuherberg, Germany
Interests: high-precision radiotherapy; neurooncology; GI-oncology; particle therapy

Special Issue Information

Dear Colleagues,

Radiation therapy is the most effective adjuvant treatment for local control of early-stage breast cancer and an indispensable component of multimodal therapy approaches for recurrent and metastatic breast cancer. As a result, the utility rate of radiation therapy for breast cancer patients (approx. 87%) is among the highest in oncology.

In recent years, advances in treatment techniques and imaging systems have constantly improved the precision of radiotherapy, which further improved the already existing potential for breast cancer treatment. This Special Issue will focus on how technical achievements such as respiratory gating, intraoperative radiotherapy, image-guided radiotherapy (IGRT), high-precision stereotactic treatments and radiosurgery, and partial breast irradiation can be optimally used to increase the effectiveness and reduce the toxicity of adjuvant radiation therapy in early breast cancer. In addition, we aim to investigate the potential of re-irradiation, stereotactic ablative therapy, and palliative radiotherapy for recurrent and metastatic breast cancer. Insights into complementary and alternative medicine complement this Special Issue, enabling a comprehensive overview and outlook on optimized radiotherapy approaches in breast cancer.

Prof. Dr. Stephanie Elisabeth Combs
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • breast cancer radiotherapy
  • IGRT
  • ABPI
  • SBRT
  • CAM
  • personalized therapy

Published Papers (4 papers)

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Research

17 pages, 4451 KiB  
Article
Impact of Denoising on Deep-Learning-Based Automatic Segmentation Framework for Breast Cancer Radiotherapy Planning
by Jung Ho Im, Ik Jae Lee, Yeonho Choi, Jiwon Sung, Jin Sook Ha and Ho Lee
Cancers 2022, 14(15), 3581; https://doi.org/10.3390/cancers14153581 - 22 Jul 2022
Cited by 3 | Viewed by 1690
Abstract
Objective: This study aimed to investigate the segmentation accuracy of organs at risk (OARs) when denoised computed tomography (CT) images are used as input data for a deep-learning-based auto-segmentation framework. Methods: We used non-contrast enhanced planning CT scans from 40 patients with breast [...] Read more.
Objective: This study aimed to investigate the segmentation accuracy of organs at risk (OARs) when denoised computed tomography (CT) images are used as input data for a deep-learning-based auto-segmentation framework. Methods: We used non-contrast enhanced planning CT scans from 40 patients with breast cancer. The heart, lungs, esophagus, spinal cord, and liver were manually delineated by two experienced radiation oncologists in a double-blind manner. The denoised CT images were used as input data for the AccuContourTM segmentation software to increase the signal difference between structures of interest and unwanted noise in non-contrast CT. The accuracy of the segmentation was assessed using the Dice similarity coefficient (DSC), and the results were compared with those of conventional deep-learning-based auto-segmentation without denoising. Results: The average DSC outcomes were higher than 0.80 for all OARs except for the esophagus. AccuContourTM-based and denoising-based auto-segmentation demonstrated comparable performance for the lungs and spinal cord but showed limited performance for the esophagus. Denoising-based auto-segmentation for the liver was minimal but had statistically significantly better DSC than AccuContourTM-based auto-segmentation (p < 0.05). Conclusions: Denoising-based auto-segmentation demonstrated satisfactory performance in automatic liver segmentation from non-contrast enhanced CT scans. Further external validation studies with larger cohorts are needed to verify the usefulness of denoising-based auto-segmentation. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancers)
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9 pages, 871 KiB  
Article
A Comprehensive Prospective Comparison of Acute Skin Toxicity after Hypofractionated and Normofractionated Radiation Therapy in Breast Cancer
by Kai J. Borm, Johanne Kleine Vennekate, Jan Vagedes, Mohammad O. A. Islam, Marciana N. Duma, Maximilian Loos, Stephanie E. Combs, Kilian Schiller, Sophie Klusen, Stefan Paepke, Marion B. Kiechle and Daniela Paepke
Cancers 2021, 13(22), 5826; https://doi.org/10.3390/cancers13225826 - 20 Nov 2021
Cited by 5 | Viewed by 1612
Abstract
The current study aims to determine whether hypofractionated radiotherapy (HF) leads to lower rates of acute radiodermatitis compared to conventional normofractionated radiotherapy (CF). A total of 166 patients with invasive breast cancer or DCIS were included in a prospective cohort study. Evaluation of [...] Read more.
The current study aims to determine whether hypofractionated radiotherapy (HF) leads to lower rates of acute radiodermatitis compared to conventional normofractionated radiotherapy (CF). A total of 166 patients with invasive breast cancer or DCIS were included in a prospective cohort study. Evaluation of acute radiodermatitis was obtained before radiotherapy, at the end of the treatment (T1), and 6 weeks after the treatment (T2) using CTCAE (v5.0) scores, the Skindex-16 questionnaire, and ultrasound measurement of the skin. CTCAE and Skindex-16 scores in the CF-group were significantly higher compared to the HF group indicating more pronounced side effects at the end of the treatment (CTCAE: CF-RT 1.0 (IQR: 0.0) vs. HF-RT 0.0 (0.25); p = 0.03; Skindex-16: CF: 20.8 (IQR: 25.8); HF: 8.3 (27.1); p = 0.04). At 6 weeks after the treatment, no significant differences between the two fractionation schemes were observed. Ultrasound based assessment showed that the skin thickness in the treated breast was higher compared to the healthy breast at all time-points. However, no significant difference between HF and CF was seen either at T1 or T2. The current study complements and confirms pre-existing evidence that HF leads to a lower degree of acute radiodermatitis and better patient reported outcome compared to CF at the end of treatment. This should be considered whenever fractionation of adjuvant breast cancer treatment is being discussed. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancers)
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9 pages, 1963 KiB  
Article
Excluding Lung Tissue from the PTV during Internal Mammary Irradiation. A Safe Technique for OAR-Sparing?
by Kai J. Borm, Christopher Hofmann, Mathias Düsberg, Markus Oechsner, Hendrik Dapper, Michal Devecka and Stephanie E. Combs
Cancers 2021, 13(8), 1951; https://doi.org/10.3390/cancers13081951 - 18 Apr 2021
Viewed by 1719
Abstract
The current study aims to determine whether exclusion of lung tissue from planning treatment volume (PTV) is a valid organ at risk (OAR)-sparing technique during internal mammary irradiation (IMNI). Twenty patients with left-sided breast cancer undergoing adjuvant radiotherapy including IMNI after mastectomy or [...] Read more.
The current study aims to determine whether exclusion of lung tissue from planning treatment volume (PTV) is a valid organ at risk (OAR)-sparing technique during internal mammary irradiation (IMNI). Twenty patients with left-sided breast cancer undergoing adjuvant radiotherapy including IMNI after mastectomy or lumpectomy with daily ConeBeam CT (CBCT; median n = 28) were enrolled in the current study. The daily dose distribution of the patients was estimated by recalculating treatment plans on CBCT-scans based on a standard PTV (PTV margin: 5mm-STD) and a modified PTV, which excluded overlapping lung tissue (ExLung). Using 3D-deformable dose accumulation, the dose coverage in the target volume was estimated in dependence of the PTV-margins. The estimated delivered dose in the IMN-CTV was significantly lower for the ExLung PTV compared to the STD PTV: ExLung: V95%: 76.6 ± 22.9%; V90%: 89.6 ± 13.2%, STD: V95%: 95.6 ± 7.4%; V90%: 99.1 ± 2.7%. Daily CBCT imaging cannot sufficiently compensate the anatomic changes and intrafraction movement throughout the treatment. Therefore, to ensure adequate delivery of the prescribed dose to the IMN-CTV, exclusion of lung tissue from the PTV to spare the OARs is not recommended. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancers)
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13 pages, 2328 KiB  
Article
Clinical Implications of Geometric and Dosimetric Uncertainties of Inter- and Intra-Fractional Movement during Volumetric Modulated Arc Therapy for Breast Cancer Patients
by Jason Joon Bock Lee, Ik Jae Lee, Yeonho Choi, Mi Jin Jeon, Il Hun Jung and Ho Lee
Cancers 2021, 13(7), 1651; https://doi.org/10.3390/cancers13071651 - 01 Apr 2021
Cited by 3 | Viewed by 2120
Abstract
With the introduction of modern sophisticated radiotherapy (RT) techniques, the significance of accuracy has increased considerably. This study evaluated the necessity of pre-treatment and intra-fractional cone-beam computed tomography (CBCT) by analyzing inter- and intra-fractional CBCT images of breast cancer patients receiving RT. From [...] Read more.
With the introduction of modern sophisticated radiotherapy (RT) techniques, the significance of accuracy has increased considerably. This study evaluated the necessity of pre-treatment and intra-fractional cone-beam computed tomography (CBCT) by analyzing inter- and intra-fractional CBCT images of breast cancer patients receiving RT. From 57 patients, 1206 pre-treatment CBCT and 1067 intra-fractional CBCT images were collected. Geometric movements of patients were measured quantitively in both inter- and intra-fractional CBCT, and changes in dosimetric parameters were evaluated in selected patients with extreme intra-fractional movement. For right-sided breast cancer patients, left-sided breast cancer patients treated using deep-inspiration breath hold (DIBH), and left-sided breast cancer patients treated using continuous positive airway pressure (CPAP), median inter-fractional deviations were 0.53 (range 0.06–2.98) cm, 0.66 (range 0.08–4.41) cm, and 0.69 (range 0.04–3.80) cm, and median intra-fractional deviations were 0.14 (range 0.00–0.62) cm, 0.23 (range 0.02–0.96) cm, and 0.24 (0.00–1.15) cm, respectively. Modified plans reflecting large changes in intra-fractional position in 10 selected cases revealed insufficient target coverage in seven cases and more than 20-fold increase in the volume of heart receiving at least 25 Gy in two cases. Intra-fractional verification, as well as pre-treatment verification, might be considered in patients using DIBH or CPAP. Full article
(This article belongs to the Special Issue Radiation Therapy for Breast Cancers)
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