Analysis of irradiated lung and heart volumes using virtual simulation in postoperative treatment of stage I breast carcinoma

M.C. Leonardi, M.G. Brambilla, S. Zurrida, M. Intra, A. Frasson, G. Severi, C. Robertson, R. Orecchia

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Aims and background: Although pituitary adenomas are usually benign lesions, their growth rate is highly variable and unpredictable. Apoptosis appears to be an important process in neoplastic lesions. The purpose of this study was to investigate the expression of apoptosis-related proteins including Bcl-2, bax and p53 in pituitary adenomas and its correlation with hormone function, tumor size, local control, and proliferative activity. Aims and background: The aim of the study was to assess the usefulness of virtual simulation in postoperative radiotherapy treatment planning of early-stage breast cancer and to evaluate its potential to reduce the volume of critical structures exposed compared to treatment plans produced by a conventional 2D system. Methods and study design: Eighteen patients undergoing breast radiotherapy following conservative surgery for small breast carcinomas were studied. Scans from spiral CT equipment (with the patient in the treatment position) were transferred to a virtual simulator. From the screen images the operator contoured breast, lung and heart. Calculations were made of the extent to which the heart and lung were included in the irradiation fields (50% isodose line of tangential fields). Results: Manual contouring was time-consuming, but when virtual simulation was used, the mean volume of the lung included in the radiation fields was significantly reduced compared to the 2D treatment plan (4.5% vs 5.4%, P = 0.034); in addition, a slight reduction was observed for the heart (0.5% to 1.2%), but this was not statistically significant. Conclusions: With a 3D system we obtained optimal target coverage and a reduction of the dose to critical structures (statistically significant only for the lung). From a clinical point of view, this 0.9% reduction in the mean irradiated lung volume is probably not significant, as the percentage irradiated with a 2D system is considerably below the recommended value. Furthermore, our analysis was performed in a relatively small group of patients; for a reliable estimate larger series would be required. Consequently, the 3D system should not be considered in routine treatment after breast conserving surgery for early stage carcinomas; for the time being it should be reserved for selected cases.
LanguageEnglish
Pages60-67
Number of pages7
JournalTumori
Volume89
Issue number1
Publication statusPublished - Jan 2003

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Cardiac Volume
Breast Neoplasms
Lung
Pituitary Neoplasms
Breast
Radiotherapy
Apoptosis
Neoplastic Processes
Therapeutics
Segmental Mastectomy
Spiral Computed Tomography
Hormones
Radiation
Carcinoma
Equipment and Supplies
Growth
Neoplasms
Proteins

Keywords

  • breast cancer
  • interactive computer graphics
  • radiotherapy
  • 3D treatment planning

Cite this

Leonardi, M. C., Brambilla, M. G., Zurrida, S., Intra, M., Frasson, A., Severi, G., ... Orecchia, R. (2003). Analysis of irradiated lung and heart volumes using virtual simulation in postoperative treatment of stage I breast carcinoma. Tumori, 89(1), 60-67.
Leonardi, M.C. ; Brambilla, M.G. ; Zurrida, S. ; Intra, M. ; Frasson, A. ; Severi, G. ; Robertson, C. ; Orecchia, R. / Analysis of irradiated lung and heart volumes using virtual simulation in postoperative treatment of stage I breast carcinoma. In: Tumori. 2003 ; Vol. 89, No. 1. pp. 60-67.
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abstract = "Aims and background: Although pituitary adenomas are usually benign lesions, their growth rate is highly variable and unpredictable. Apoptosis appears to be an important process in neoplastic lesions. The purpose of this study was to investigate the expression of apoptosis-related proteins including Bcl-2, bax and p53 in pituitary adenomas and its correlation with hormone function, tumor size, local control, and proliferative activity. Aims and background: The aim of the study was to assess the usefulness of virtual simulation in postoperative radiotherapy treatment planning of early-stage breast cancer and to evaluate its potential to reduce the volume of critical structures exposed compared to treatment plans produced by a conventional 2D system. Methods and study design: Eighteen patients undergoing breast radiotherapy following conservative surgery for small breast carcinomas were studied. Scans from spiral CT equipment (with the patient in the treatment position) were transferred to a virtual simulator. From the screen images the operator contoured breast, lung and heart. Calculations were made of the extent to which the heart and lung were included in the irradiation fields (50{\%} isodose line of tangential fields). Results: Manual contouring was time-consuming, but when virtual simulation was used, the mean volume of the lung included in the radiation fields was significantly reduced compared to the 2D treatment plan (4.5{\%} vs 5.4{\%}, P = 0.034); in addition, a slight reduction was observed for the heart (0.5{\%} to 1.2{\%}), but this was not statistically significant. Conclusions: With a 3D system we obtained optimal target coverage and a reduction of the dose to critical structures (statistically significant only for the lung). From a clinical point of view, this 0.9{\%} reduction in the mean irradiated lung volume is probably not significant, as the percentage irradiated with a 2D system is considerably below the recommended value. Furthermore, our analysis was performed in a relatively small group of patients; for a reliable estimate larger series would be required. Consequently, the 3D system should not be considered in routine treatment after breast conserving surgery for early stage carcinomas; for the time being it should be reserved for selected cases.",
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Leonardi, MC, Brambilla, MG, Zurrida, S, Intra, M, Frasson, A, Severi, G, Robertson, C & Orecchia, R 2003, 'Analysis of irradiated lung and heart volumes using virtual simulation in postoperative treatment of stage I breast carcinoma' Tumori, vol. 89, no. 1, pp. 60-67.

Analysis of irradiated lung and heart volumes using virtual simulation in postoperative treatment of stage I breast carcinoma. / Leonardi, M.C.; Brambilla, M.G.; Zurrida, S.; Intra, M.; Frasson, A.; Severi, G.; Robertson, C.; Orecchia, R.

In: Tumori, Vol. 89, No. 1, 01.2003, p. 60-67.

Research output: Contribution to journalArticle

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AU - Leonardi, M.C.

AU - Brambilla, M.G.

AU - Zurrida, S.

AU - Intra, M.

AU - Frasson, A.

AU - Severi, G.

AU - Robertson, C.

AU - Orecchia, R.

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AB - Aims and background: Although pituitary adenomas are usually benign lesions, their growth rate is highly variable and unpredictable. Apoptosis appears to be an important process in neoplastic lesions. The purpose of this study was to investigate the expression of apoptosis-related proteins including Bcl-2, bax and p53 in pituitary adenomas and its correlation with hormone function, tumor size, local control, and proliferative activity. Aims and background: The aim of the study was to assess the usefulness of virtual simulation in postoperative radiotherapy treatment planning of early-stage breast cancer and to evaluate its potential to reduce the volume of critical structures exposed compared to treatment plans produced by a conventional 2D system. Methods and study design: Eighteen patients undergoing breast radiotherapy following conservative surgery for small breast carcinomas were studied. Scans from spiral CT equipment (with the patient in the treatment position) were transferred to a virtual simulator. From the screen images the operator contoured breast, lung and heart. Calculations were made of the extent to which the heart and lung were included in the irradiation fields (50% isodose line of tangential fields). Results: Manual contouring was time-consuming, but when virtual simulation was used, the mean volume of the lung included in the radiation fields was significantly reduced compared to the 2D treatment plan (4.5% vs 5.4%, P = 0.034); in addition, a slight reduction was observed for the heart (0.5% to 1.2%), but this was not statistically significant. Conclusions: With a 3D system we obtained optimal target coverage and a reduction of the dose to critical structures (statistically significant only for the lung). From a clinical point of view, this 0.9% reduction in the mean irradiated lung volume is probably not significant, as the percentage irradiated with a 2D system is considerably below the recommended value. Furthermore, our analysis was performed in a relatively small group of patients; for a reliable estimate larger series would be required. Consequently, the 3D system should not be considered in routine treatment after breast conserving surgery for early stage carcinomas; for the time being it should be reserved for selected cases.

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Leonardi MC, Brambilla MG, Zurrida S, Intra M, Frasson A, Severi G et al. Analysis of irradiated lung and heart volumes using virtual simulation in postoperative treatment of stage I breast carcinoma. Tumori. 2003 Jan;89(1):60-67.