Uncertainties in estimating heart doses from 2D-tangential breast cancer radiotherapy.
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ABSTRACT: Background and purpose
We evaluated the accuracy of three methods of estimating radiation dose to the heart from two-dimensional tangential radiotherapy for breast cancer, as used in Denmark during 1982-2002.Material and methods
Three tangential radiotherapy regimens were reconstructed using CT-based planning scans for 40 patients with left-sided and 10 with right-sided breast cancer. Setup errors and organ motion were simulated using estimated uncertainties. For left-sided patients, mean heart dose was related to maximum heart distance in the medial field.Results
For left-sided breast cancer, mean heart dose estimated from individual CT-scans varied from <1Gy to >8Gy, and maximum dose from 5 to 50Gy for all three regimens, so that estimates based only on regimen had substantial uncertainty. When maximum heart distance was taken into account, the uncertainty was reduced and was comparable to the uncertainty of estimates based on individual CT-scans. For right-sided breast cancer patients, mean heart dose based on individual CT-scans was always <1Gy and maximum dose always <5Gy for all three regimens.Conclusions
The use of stored individual simulator films provides a method for estimating heart doses in left-tangential radiotherapy for breast cancer that is almost as accurate as estimates based on individual CT-scans.
SUBMITTER: Lorenzen EL
PROVIDER: S-EPMC4871929 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Navigation is an indispensable component of ground and aerial mobile robots. Although there is a plethora of path planning algorithms, most of them generate paths that are not smooth and have angular turns. In many cases, it is not feasible for the robots to execute these sharp turns, and a smooth trajectory is desired. We present 'ITC: Infused Tangential Curves' which can generate smooth trajectories for mobile robots. The main characteristics of the proposed ITC algorithm are: (1) The curves are tangential to the path, thus maintaining G 1 continuity, (2) The curves are infused in the original global path to smooth out the turns, (3) The straight segments of the global path are kept straight and only the sharp turns are smoothed, (4) Safety is embedded in the ITC trajectories and robots are guaranteed to maintain a safe distance from the obstacles, (5) The curvature of ITC curves can easily be controlled and smooth trajectories can be generated in real-time, (6) The ITC algorithm smooths the global path on a part-by-part basis thus local smoothing at one point does not affect the global path. We compare the proposed ITC algorithm with traditional interpolation based trajectory smoothing algorithms. Results show that, in case of mobile navigation in narrow corridors, ITC paths maintain a safe distance from both walls, and are easy to generate in real-time. We test the algorithm in complex scenarios to generate curves of different curvatures, while maintaining different safety thresholds from obstacles in vicinity. We mathematically discuss smooth trajectory generation for both 2D navigation of ground robots, and 3D navigation of aerial robots. We also test the algorithm in real environments with actual robots in a complex scenario of multi-robot collision avoidance. Results show that the ITC algorithm can be generated quickly and is suitable for real-world scenarios of collision avoidance in narrow corridors.
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Project description:BackgroundTo report clinical outcomes and late toxicities of a 2-week hypofractionated post-operative loco-regional radiotherapy in patients with breast cancer.Materials and methodsThis trial was approved by the Institutional Ethics Committee and registered with gov, no. NCT02460744. Between June 2013 and October 2014, 50 patients with breast cancer, post mastectomy or breast conserving surgery (BCS) were included in this study, of whom 10 had BCS. Patients were planned on a 2-dimentional (2D) simulator with 2 tangential fields and an incident supraclavicular field. Radiotherapy dose was 34 Gy/10#/2 weeks and a sequential boost of 10 Gy/5#/1 wk in BCS patients. The primary endpoint was the rate of acute skin toxicities previously reported. Here, we report the secondary end points of late toxicities, cosmesis, local recurrence, disease-free survival (DFS) and overall survival (OS). Late skin toxicities were recorded according to the Radiotherapy and Oncology Group (RTOG) scoring criteria. Cosmetic outcomes were assessed using the Harvard/National Surgical Adjuvant Breast and Bowel Project (NSABP)/RTOG breast cosmesis and the Late Effects Normal Tissue/Subjective Objective Management Analytic (LENT/SOMA) scales for the breast and chest wall, respectively. Kaplan-Meier estimates of DFS and OS were calculated, and 5-year DFS and OS rates (with approximate 95% CIs) were estimated.ResultsLate grade ≥ 2 chest wall induration, hypopigmentation and subcutaneous fibrosis were seen in 3 (6%), 3 (6%) and 1 (2%) patients, respectively. Chest wall cosmesis was excellent/good in 34 (72%) and fair/bad in 13 (28%) patients. In BCS patients, grade 2 skin induration, subcutaneous fibrosis and edema was observed in 1 patient (11%) each. Cosmesis was excellent/good in 7 (78%) and fair/bad in 2 (22%) patients. Late grade ≥ 2 arm edema, pain and shoulder stiffness were reported by 1 (2%), 2 (4%) and 2 (4%) patients, respectively. No local recurrences were observed. Five patients developed distant metastases (10%). Seven patients died (14%). The 5-year DFS and OS rate was 90% (95% CI: 77-96%) and 88% (95% CI: 75-94%), respectively.ConclusionHypofractionated radiotherapy in 2 weeks in patients with breast cancer was associated with minimal late toxicity, good cosmetic outcome and excellent local control. This trial may be of relevance for developing countries where resources are limited.
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