Intensity Modulated Radiotherapy Using Multiple in Fields Compared to Wedged Fields in Breast Irradiation: Clinical Impact on Early Skin Reaction and Organs at Risk DosesHala A Zaghloul1,2*, Yasser A Rashed1,3, Arif A Shaukat1, Yousry A Rostom2 and Samy E Badawy1
- *Corresponding Author:
- Hala Ahmed Zaghloul El Lathy
Department of Radiation Oncology
king Fahad Specialist Hospital Al Dammam KSA & Clinical Oncology
Alexanderia University, Egypt
Tel: +00966 540 367076
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E-mail: [email protected]
Received date : April 10, 2014; Accepted date : June 20, 2014; Published date : June 30, 2014
Citation: Zaghloul HA, Rashed YA, Shaukat AA, Rostom YA, Badawy SE (2014) Intensity Modulated Radiotherapy Using Multiple in Fields Compared to Wedged Fields in Breast Irradiation: Clinical Impact on Early Skin Reaction and Organs at Risk Doses. J Nucl Med Radiat Ther 5:176. doi:10.4172/2155-9619.1000176
Copyright: © 2014 Zaghloul HA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: To measure the impact of multiple fields in filed (MFIF) technique on dose homogeneity, doses to organs at risk (OARs) and acute skin toxicity in comparison to physical wedged (PW) tangential technique. Methods: The study population consisted of 75 patients who had breast-conserving surgery and whole-breast radiation using MFIF. These patients were matched one-to-one to a control group of 75 patients treated with PW tangents, following ethical board approval and signing informed consents. Acute skin reaction was graded by CTCAE 3.0 scoring and multiple regression analysis of covariates was performed. Results: CTCAE grade2 acute skin reaction occurred in 61.3% PW vs. 32% MFIF while grade 3 was encountered in 24% PW vs. 10.7% MFIF patients (P<0.01). Multiple regression analysis confirmed the excessive skin reaction to the related radiation therapy technique (P=0.0002) and whole breast PTV (P<0.001). Homogeneity index within PTV was significantly improved in MFIF plans (0.84 ± 0.7) compared with PW (0.94 ± 0.15) with a (P<0.01). There was also a significant reduction, in lung V20 from 14.3% ± 1.1 to 10.6 % ± 1.4 (P<0.01), heart V30 from 7% ± 5.8 to 6% ± 4.9 (p<0.001). Contralateral breast volume receiving dose more than 2 Gy was also reduced 2.3% ± 0.5 PW to 1.2% ± 0.2 MFIF (P<0.01). Conclusion: The MFIF technique significantly improved PTV dose homogeneity index, while significantly reduced the incidence of grade 2/3 acute skin reaction and doses to OARs when compared to PW tangential fields in whole breast radiotherapy.