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NCI CANCERLIT® Search: Radiotherapy for Breast Cancer - February 2002
National Cancer Institute®
Last Modified: February 1, 2002
Table of Contents
1
UI - 11757135
AU - Joensuu H
TI -
[Postoperative radiotherapy should be given also to women with breast
cancer that are over 55 years]
SO - Duodecim 1998;114(24):2607-9
2
UI - 11521809
AU - Veronesi U; Marubini E; Mariani L; Galimberti V; Luini A; Veronesi P;
TI -
Salvadori B; Zucali R
Radiotherapy after breast-conserving surgery in small breast carcinoma:
long-term results of a randomized trial.
SO - Ann Oncol 2001 Jul;12(7):997-1003
AD - Department of Senology, European Institute of Oncology, Milano, Italy.
umberto.veronesi@ieo.it
BACKGROUND: Breast-conserving surgery followed by radiotherapy is a
widely accepted form of treatment in patients with breast cancer of
limited extent. Many attempts have been made to identify subgroups of
patients who might avoid radiotherapy. PATIENTS AND METHODS: Between
1987 and 1989, 579 women with carcinoma of the breast were randomly
assigned to quadrantectomy, axillary dissection and radiotherapy (299)
and to quadrantectomy with axillary dissection without radiotherapy
(280). Eligible patients were women with a breast carcinoma less than
2.5 cm in maximum diameter up to 70 years of age. Primary endpoints were
intra-breast tumour reappearance (IBTR) and all-cause mortality.
RESULTS: The number of IBTRs was significantly higher in patients
treated with surgery alone (59 cases out of 273; 10-year crude
cumulative incidence of 23.5%) than in patients treated with surgery
plus radiotherapy (16 cases out of 294; 10-year crude cumulative
incidence of 5.8%). The difference in IBTR frequency between the two
treatments appeared to be particularly high in women up to 45 years of
age, tending to decrease with increasing age up to no apparent
difference in women older than 65 years. Overall survival curves for the
two groups, did not differ significantly (P = 0.326). However, a limited
survival advantage was evident after radiotherapy for node-positive
women. CONCLUSIONS: After breast-conserving surgery radiotherapy appears
indicated in all patients up to 55 years of age, in patients with
positive axillary nodes, and in patients with extensive intraductal
component at histology. The data suggest that radiotherapy may be
avoided in patients older than 65, and may be optional in women aged
56-65 years with negative nodes.
3
UI - 11791117
AU - Morrow M
TI -
Treatment selection in ductal carcinoma in situ.
SO - Breast Cancer 2001;8(4):275-82
AD - Lynn Sage Breast Cancer Program and Department of Surgery, Northwestern
University, Chicago, IL 60611, USA. mmorrow@nmh.org
4
UI - 10219800
AU - Marks LB; Hardenbergh PH; Winer ET; Prosnitz LR
TI -
Assessing the cost-effectiveness of postmastectomy radiation therapy.
SO - Int J Radiat Oncol Biol Phys 1999 Apr 1;44(1):91-8
AD - Department of Radiation Oncology, Duke University Medical Center,
Durham, NC 27710, USA.
PURPOSE: To assess the cost-effectiveness of postmastectomy
local-regional radiation therapy (RT) for patients with breast cancer
with regard to local-regional relapse (LRR) and quality-adjusted life
years (QALY). METHODS AND MATERIALS: Data from the literature are used
to estimate the risk of LRR, and the impact of RT on the risk of LRR and
survival. The risk of LRR is related linearly to the number of positive
axillary nodes 1% rate of LRR = 10 + (4 x number of positive nodes)]. RT
reduces the risk of LRR by 67%. LRRs are treated with excision or biopsy
followed by RT; half being controlled locally and half receiving
additional salvage surgery and chemotherapy. Absolute improvements in
10-year overall survival due to RT are assumed to vary between 1 and
12%; and accrue linearly during the initial 10-year follow-up period.
Professional and technical charges are used as a surrogate for costs.
Money spent and benefits recognized in future years are discounted to
1997 values using a 3% annual rate. Quality factors are used to adjust
for treatment, disease, and toxicity status. RESULTS: The cost per LRR
prevented with the addition of routine postmastectomy RT is highly
dependent upon the number of positive axillary nodes and ranges from
$100,000-$200,000 for patients with 0-2 nodes, and $25,000-$75,000 for >
or = 4 nodes. The cost per QALY gained at 10 years is $10,000-$110,000
for survival benefits > or = 3%. CONCLUSIONS: The cost per LRR prevented
decreases with increasing numbers of positive axillary nodes. There is
not a sharp cutoff at the < or = 3 vs. > or = 4 lymph node number,
suggesting that using this cutoff for recommending or not recommending
RT following mastectomy is not economically logical. The cost per QALY
of $10,000-$100,000 compares favorably to that of other accepted medical
procedures. Modest changes in the quantitative assumptions do not
qualitatively alter the results. Concerns regarding costs should not
generally preclude the use of postmastectomy RT.
5
UI - 11072153
AU - Dunscombe P; Samant R; Roberts G
TI -
A cost-outcome analysis of adjuvant postmastectomy locoregional
radiotherapy in premenopausal node-positive breast cancer patients.
SO - Int J Radiat Oncol Biol Phys 2000 Nov 1;48(4):977-82
AD - Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada.
pdunscombe@neorcc.on.ca
PURPOSE: To calculate cost-effectiveness and cost-utility ratios for
adjuvant postmastectomy locoregional radiotherapy in premenopausal
node-positive breast cancer patients and to place these ratios in the
context of generally accepted medical expenditures. MATERIALS AND
METHODS: A spreadsheet-based activity costing model using 1997 Canadian
(cdn) capital, operating, and administrative costs has been used to
identify, from the institutional perspective, the incremental cost of
adding radiotherapy to surgery and chemotherapy for this group of
patients. Outcome data were derived from two recently published clinical
trials and were converted to discounted incremental life years and
quality-adjusted life years gained. Recommended health economics
principles were employed in the quantification of both costs and
outcomes, and a sensitivity analysis was performed. Three referenced
publications provide a context within which to evaluate the calculated
cost-effectiveness and cost-utility ratios. RESULTS: The incremental
cost of adjuvant radiotherapy for this group of patients is calculated
to be approximately $7,000cdn in 1997 Canadian dollars and in the
Canadian socialized health-care environment. Based on published work the
discounted incremental outcome benefit is calculated to be 0.5 life
years or 0.45 quality-adjusted life years at ten years. Thus, cost
effectiveness and cost-utility ratios are estimated to be $14,000cdn and
$15,600cdn, respectively. CONCLUSION: Within the context of generally
accepted medical expenditures, adjuvant postmastectomy locoregional
radiotherapy for premenopausal node-positive breast cancer patients
would be regarded as a cost-effective treatment strategy.
6
UI - 11503614
AU - Samant R; Dunscombe P; Roberts G
TI -
A cost-outcome analysis of adjuvant postmastectomy locoregional
radiotherapy in high-risk postmenopausal breast cancer patients.
SO - Int J Radiat Oncol Biol Phys 2001 Aug 1;50(5):1376
7
UI - 11688515
AU - Schootman M; Aft R
TI -
Rural-urban differences in radiation therapy for ductal carcinoma
in-situ of the breast.
SO - Breast Cancer Res Treat 2001 Jul;68(2):117-25
AD - Department of Pediatrics, Washington University School of Medicine,
Saint Louis, MO, USA. mschootm@im.wustl.edu
PURPOSE: Rural women in the United States are at a documented
disadvantage with regard to breast cancer detection, diagnosis, and
treatment and generally do not receive state-of-the-art therapy. The
objective of the study was to determine if, and to what extent, rural
women were less likely to receive radiation therapy (XRT) following
breast conserving surgery (BCS) for ductal carcinoma in-situ (DCIS).
METHODS: Our analyses were based on 1991-1996 data provided by the
Surveillance, Epidemiology, and End Results (SEER) Program. Only women
who were diagnosed with their first primary, microscopically confirmed
DCIS breast cancer were included. BCS and XRT were defined according to
SEER definitions. Multiple logistic regression was used in the analysis.
RESULTS: During this time period, 6,988 women were treated with BCS for
DCIS, 50.1% of whom received XRT. In multivariate analysis, rural women
in general (OR = 0.58) and younger women (<65) in particular (OR = 0.38)
were less likely to receive XRT. Local availability of XRT was not
associated with receipt among younger women, while older women without
this availability were less likely to receive XRT (OR = 0.48).
CONCLUSIONS: Barriers to XRT following BCS for DCIS may be different
between younger and older rural women relative to their urban
counterparts.
8
UI - 11583188
AU - Vaidya JS; Baum M; Tobias JS; D'Souza DP; Naidu SV; Morgan S; Metaxas M;
TI -
Harte KJ; Sliski AP; Thomson E
Targeted intra-operative radiotherapy (Targit): an innovative method of
treatment for early breast cancer.
SO - Ann Oncol 2001 Aug;12(8):1075-80
AD - Department of Surgery, University College London, UK. j.vaidya@ucl.ac.uk
INTRODUCTION: We believe that conservative treatment of early breast
cancer may not require radiotherapy that encompasses the whole breast.
We present here the clinico-pathological basis for this view, as well as
a novel therapeutic approach that allows intra-operative radiotherapy to
be safely and accurately delivered to the target tissues in a standard
operating theatre. THE RATIONALE: Whole-organ analysis of mastectomy
specimens reveals that 80% of occult cancer foci are situated remote
from the index quadrant. In contrast, over 90% of local recurrences
after breast conservative therapy occur near the original tumour, even
when radiotherapy is not given. Therefore, the remote occult cancer foci
may be clinically irrelevant and radiotherapy to the index quadrant
alone might be sufficient. A NOVEL TECHNIQUE: The Photon Radiosurgery
System (PRS) is an ingenious portable electron-beam driven device that
can typically deliver intra-operative doses of 5-20 Gy, respectively, to
1 cm and 0.2 cm from the tumour bed over about 22 min. The pliable
breast tissue--the target--wraps around the source, providing perfect
conformal radiotherapy. Being soft X-rays, the dose attenuates rapidly
(alpha approximately 1/r3), reducing distant damage. RESULTS: In our
pilot study of 25 patients (age 30-80 years, T = 0.42-4.0 cm), we
replaced the routine post-operative tumour bed boost with targeted
intra-operative radiotherapy. There have been no major complications and
no patient has developed local recurrence, although the median follow-up
time is short, at 24 months. CONCLUSION: It is safe and feasible to
deliver targeted intraoperative radiotherapy (Targit) for early breast
cancer. We have begun a randomised trial--the first of its
kind--comparing Targit with conventional six-week course of
radiotherapy. If proven equivalent in terms of local recurrence and
cosmesis, it could eliminate the need for the usual six-week course of
post-operative radiotherapy.
9
UI - 11583190
AU - Pergolizzi S; Settineri N; Santacaterina A; Spadaro P; Maisano R;
TI -
Caristi N; Adamo V; De Renzis C; Mesiti M; Cascinu S
Ipsilateral supraclavicular lymph nodes metastases from breast cancer as
only site of disseminated disease. Chemotherapy alone vs. induction
chemotherapy to radical radiation therapy.
SO - Ann Oncol 2001 Aug;12(8):1091-5
AD - Institute of Radiological Science, Department of Radiation Oncology
University of Messina, Italy. pergoste@solnet.it
BACKGROUND: To define the role of radiotherapy (RT) in the treatment of
ipsilateral supraclavicular lymph-nodes metastases (ISLM) from breast
cancer as only site of disseminated disease, we started a prospective
non-randomized clinical trial in 1989. Here we report the final results
with a median follow-up of 8.75 years. PATIENTS AND METHODS:
Thirty-seven patients (pts), with ISLM from breast cancer, were
consecutively enrolled into two arms. Arm A (18 pts): chemotherapy (CT)
for six courses. Arm B (19 pts): CT for three courses followed by RT to
the site of ISLM at 'radical' dose of 50-60 Gy. RESULTS: In arm A, a
median Time to Progression (TtP) of 7 months with a median Overall
Survival (OS) of 28 months was recorded. In comparison, patients in arm
B had a longer median TtP with 20 months as well as a better median OS
with 41 months, respectively. An actuarial five-year disease-free
survival of 5.5% was obtained in arm A vs. 21% in arm B. A statistically
significant difference in TtP was demonstrated between the two groups (P
= 0.01). CONCLUSIONS: These data demonstrate that a better event-free
survival could be achieved in patients with ISLM submitted to induction
CT and radical irradiation. This also translated into a longer survival
although this did not achieve statistical significance. We want to
stress the importance of local control by RT since it does imply that
not all of these patients have micrometastases at the time of relapse in
the supraclavicular fossa.
10
UI - 11711308
AU - Wang J; Chen P; Su ZF; Vallis K; Sandhu J; Cameron R; Hendler A; Reilly
TI -
RM
Amplified delivery of indium-111 to EGFR-positive human breast cancer
cells.
SO - Nucl Med Biol 2001 Nov;28(8):895-902
AD - Division of Nuclear Medicine, University Health Network, Toronto General
Hospital, Toronto, ON, Canada.
A method is described to amplify the delivery of 111In to human breast
cancer cells utilizing a novel human serum albumin-human EGF (HSA-hEGF)
bioconjugate substituted preferentially in the HSA domain with multiple
DTPA metal chelators for 111In. 111In-DTPA-HSA-hEGF exhibited a lower
receptor-binding affinity than 111In-DTPA-hEGF but was rapidly and
specifically bound, internalized and translocated to the nucleus in
EGFR-positive MDA-MB-468 breast cancer cells. 111In-DTPA-HSA-hEGF was
cytotoxic in vitro mainly through the emission of short-range Auger
electrons and partially through the effects of the hEGF moiety to
MDA-MB-468 cells overexpressing EGFR (1-2 x 10(6) receptors/cell) but
not towards MCF-7 breast cancer cells with a 100-fold lower level of
EGFR on their surface. The cytotoxicity in vitro against MDA-MB-468
cells of 111In-DTPA-HSA-hEGF substituted with nine DTPA chelators was
enhanced 4-fold compared to 111In-DTPA-hEGF monosubstituted with DTPA.
Studies are planned to further evaluate 111In-DTPA-HSA-hEGF in vivo as a
new imaging and targeted radiotherapeutic agent for breast cancer.
11
UI - 11756722
AU - Formenti SC; Rosenstein B; Skinner KA; Jozsef G
TI -
T1 stage breast cancer: adjuvant hypofractionated conformal radiation
therapy to tumor bed in selected postmenopausal breast cancer
patients--pilot feasibility study.
SO - Radiology 2002 Jan;222(1):171-8
AD - Department of Radiation Oncology, New York University School of
Medicine, 566 First Ave, New York, NY 10016, USA.
PURPOSE: To explore the feasibility of a short course of
hypofractionated conformal radiation therapy to the tumor bed as part of
a breast preservation protocol in postmenopausal patients with
nonpalpable pT1N0 stage breast cancer. MATERIALS AND METHODS: The tumor
bed was imaged at computed tomography (CT) in the prone position on a
dedicated table. The same table and position were used for treatment
with a 4-MV linear accelerator. The planning target volume was the tumor
bed plus a 1-2-cm margin defined at postmastectomy CT. A regimen of five
fractions was tested in this pilot dose study. Cosmesis was assessed by
patients and physicians before treatment and 36 months after treatment.
RESULTS: Ten consecutive patients who were eligible for the study were
assigned to one of three dose-per-fraction regimens; nine were treatable
with the proposed technique on the basis of CT findings. Patients
received five fractions over 10 days (total dose range, 25-30 Gy): Three
received 5.0 Gy per fraction; four, 5.5 Gy; and two, 6.0 Gy. At minimum
follow-up of 36 months (range, 36-53 months), all patients were alive
and disease free with good to excellent cosmesis. CONCLUSION:
Hypofractionated conformal breast radiation therapy is feasible. Further
studies are warranted.
12
UI - 11830920
AU - Pribylova O; Petruzelka L; Honova H; Fischer J; Bustova I; Siffnerova H;
TI -
Kuta M; Miller V; Hacklova M; Machacek J; Kohoutek M; Vodvarka P; Kysela
T; Tajblova J; Suk J; Dorazilova V; Vedralova J; Bauer J
[Tamoxifen or tamoxifen in combination with chemotherapy in adjuvant
therapy of breast carcinoma. Results of a multicenter randomized study]
SO - Sb Lek 2001;102(1):65-76
AD - Onkologicka klinika 1: lekarske fakulty Univerzity Karlovy, U nemocnice
2, 128 08 Praha 2, Czech Republic. onkol@lf1.cuni.cz
pT1c-3a, pN0-1, M0, were randomised after surgery to adjuvant tamoxifen
(20 mg per day) or to tamoxifen plus CMF (C 500 mg/m2, M 40 mg/m2 and F
600 mg/m2 on days 1st and 8th q 28 day) in 6 cycles. The median age
(49-72 years, median 58), tumour size, number of involved lymphnodes
(0-3), estrogens receptor status, grade (I-III) and type of operation
were well balanced among the 50 pts on tamoxifen and the 53 pts on
tamoxifen plus CMF pts, preferably postmenopausal. RESULTS: Grade of
toxicity according to WHO criteria was not higher then two in both arms.
Toxicity both haematological and non-haematological was higher in the
group treated with chemotherapy (0 vs 32 resp. 20%) except weight gain
(52% in both group). After median follow-up of 42 mos five recurrences
in tamoxifen and seven in tamoxifen plus CMF pts were observed (p = NS).
The projected 3-y DFS is 92% for tamoxifen and 88% for tamoxifen plus
CMF (p = NS). The 3-y OS is 88% for tamoxifen and 80% for tamoxifen plus
CMF pts (p = NS). CONCLUSIONS: Both regimens are equally effective with
higher toxicity in the group with combined chemo- and hormonal therapy.
13
UI - 11811349
AU - Wengstrom Y; Haggmark C; Forsberg C
TI -
Coping with radiation therapy: effects of a nursing intervention on
coping ability for women with breast cancer.
SO - Int J Nurs Pract 2001 Feb;7(1):8-15
AD - Department of Oncology, Karolinska Institutet, Stockholm, Sweden.
yvowen@mbox.ki.se
A randomized study was carried out to investigate whether a nursing
intervention, using Orem's self-care theory as a framework, would affect
the coping ability of women with breast cancer during and following
radiation therapy. The intervention consisted of promoting of behaviours
to support the patient to restore, maintain or increase their abilities
to interact with the situation and adapt to the demands of radiation
treatment. The control and experimental groups both consisted of 67
patients. The Wheel Questionnaire was used to evaluate the effect of the
intervention. Our results showed that the intervention provided patients
older than 59 years the ability to cope with the treatment (df = 2, F =
3.463, P = > 0.05). The present study supports the idea that individual
interventions aimed at improving well-being helps patients. It also
highlights the fact that individual approaches to improving well-being
are needed. Such interventions should be directed to patients at risk
for poor adjustment, such as those older than 50 years of age.
14
UI - 11845581
AU - Rudman F; Stanec S; Stanec M; Margaritoni M; Stanec Z; Zic R; Milanovic
TI -
R
[Surgical treatment of irradiation-induced sarcoma after treatment for
breast carcinoma, personal experience: 4 case reports] ]
SO - Lijec Vjesn 2001 Sep-Oct;123(9-10):251-4
AD - Odjel za plasticnu kirurgiju Klinike za kirurgiju, KB Dubrava, Av. Gojka
Suska 6b, 10000 Zagreb.
In the Department of Plastic Surgery of "Dubrava" University Hospital
from 1993 to 1999 four patients were treated for radiation induced
sarcoma. All of the patients were formerly operated for breast cancer
and irradiated postoperatively. The mean time span between radiotherapy
and development of sarcoma was 4.75 years. Four patients were treated
with wide excision and immediate reconstruction with local flaps. One of
the patients had fibrosarcoma, two patients had lymphangiosarcoma, and
one patient had osteosarcoma. Two patients died within two years.
Radiation induced sarcomas are therapy resistant, and the review of
literature did not show large controlled investigations which would
offer the most optimal treatment. Most frequently a rapid progression of
the disease is seen.
15
UI - 11769858
AU - Recht A
TI -
Rheumatologic disorders and radiotherapy.
SO - Cancer J 2001 Nov-Dec;7(6):475-6
AD - Department of Radiation Oncology, Beth Israel Deaconess Medical Center,
and Harvard Medical School, Boston, Massachusetts 02215, USA.
16
UI - 11769859
AU - Pierce LJ
TI -
Minimizing cardiotoxicity following breast radiotherapy: treatment
planning is the key.
SO - Cancer J 2001 Nov-Dec;7(6):477-9
AD - Department of Radiation Oncology, University of Michigan School of
Medicine, Ann Arbor, USA.
17
UI - 11769860
AU - Chen AM; Obedian E; Haffty BG
TI -
Breast-conserving therapy in the setting of collagen vascular disease.
SO - Cancer J 2001 Nov-Dec;7(6):480-91
AD - Department of Therapeutic Radiology, Yale University School of Medicine,
New Haven, CT 06520, USA.
BACKGROUND: It is unclear whether the presence of collagen vascular
disease should be considered a contraindication to irradiation. This
study was undertaken to determine whether women with pre-existing
collagen vascular disease have an increased incidence of complications
after breast-conserving therapy. METHODS AND MATERIALS: A cohort of 36
patients with documented collagen vascular disease was conservatively
treated for early-stage breast cancer between 1975 and 1998. All of
these patients were treated with conventional radiation therapy to a
total medium dose of 64 Gy. Seventeen had rheumatoid arthritis; four,
scleroderma; four, Raynaud's phenomenon; five, lupus erythematosus; two,
Sjogren's disease; and four, polymyositis. Each of these patients was
matched to two control patients without a history of collagen vascular
disease on the basis of age, radiation therapytechnique, chemotherapy or
hormone therapy use, tumor histology, and date of treatment. Acute and
late complications were assessed using a six-point scale from the
toxicity criteria of the Radiation Therapy Oncology Group and the
European Organization for Research and Treatment of Cancer. The scoring
system for both acute and late reactions ranged from 0 (no change over
baseline) to 5 (radiation led to death). For the purpose of statistical
analysis, patients were classified as having a significant complication
if they had a score of 3 or greater. RESULTS: With a median clinical
follow-up time of 12.5 years (range, 3.0-22.5 years), no significant
difference was detected between the collagen vascular disease and
control groups with respect to acute complications (14% vs 8%). With
respect to late complications, a significant difference was observed
(17% vs 3%) between the two groups. However, when patients in the
collagen vascular disease group were analyzed by specific disease, this
significance disappeared in all but the scleroderma group. CONCLUSIONS:
Patients with scleroderma have a statistically significant increased
incidence of radiation therapy complications after breast-conserving
surgery and radiation therapy. The presence of other collagen vascular
diseases should not be considered a contraindication for this treatment
modality.
18
UI - 11769861
AU - Storey MR; Munden R; Strom EA; McNeese MD; Buchholz TA
TI -
Coronary artery dosimetry in intact left breast irradiation.
SO - Cancer J 2001 Nov-Dec;7(6):492-7
AD - Department of Radiation Oncology and Radiology, The University of Texas
M.D. Anderson Cancer Center, Houston 77030, USA.
PURPOSE: The purpose of this article is to report dose-volume histograms
of coronary vessels from irradiation of the intact left breast. PATIENTS
AND METHODS: Fifteen women with cancer of the left breast underwent
computed tomographic treatment planning for radiation treatments of an
intact left breast. Images through the heart were reconstructed at 1-mm
increments to permit contouring of the coronary vessels. Five treatment
plans were created for each patient; one plan from the simulated
treatment fields and four additional plans that were generated from
virtual treatment fields created by shifting the isocenter 5 mm and 10
mm both superficially and deep. The radiation dose was calculated using
a three-dimensional treatment planning system that incorporated
heterogeneity correction factors. RESULTS: With no adjustment to the
perpendicular lung distance, a mean volume of 12% of the left anterior
descending coronary artery received 20 Gy, 6% received 30 Gy, and 3%
received 40 Gy. The dose to the left anterior descending coronary artery
varied significantly with changes in the perpendicular lung distance.
From the mean perpendicular lung distance of 1.87 for the simulated
fields, a 5-mm increase in the perpendicular lung distance resulted in
an increase of 20%, 15%, and 12% in the percentage of the left anterior
descending coronary artery treated to 20 Gy, 30 Gy, and 40 Gy,
respectively. With a 10-mm increase, the respective volumes were
increased to 49%, 41%, and 34%, respectively. A 5-mm reduction of lung
distance in the original plan resulted in a decrease of 10%, 5%, and 3%
in the percentage treated to 20 Gy, 30 Gy, and 40 Gy, respectively. The
dose to the left main coronary artery, the right main coronary artery,
and the left circumflex coronary artery was limited to scatter and was
less than 7 Gy. Changes in the perpendicular lung distance did not
significantly affect the dose administered to these vessels. DISCUSSION:
The left anterior descending coronary artery is anatomically located at
the edge of the cardiac silhouette on traditional treatment films. Small
changes in the perpendicular lung distance can significantly change the
dose delivered to this vessel. A fundamental change in the shape of the
dose-volume histogram occurs at a perpendicular lung distance of 2.3 cm,
whereas the dose is very low when the perpendicular lung distance is
less than 1.3 cm. These points may serve as clinically important values
in the treatment planning for cancer of an intact breast.
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