Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow ang...Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow angle, resulting in significant attenuation. Our planners account for this attenuation by adding field-in-field dose to the deep part of the breast, through the board. Concern was raised about how accurate the treatment delivery is when the inherent uncertainties of patients’ positions are accounted for. Furthermore, transmission measurements are usually carried out perpendicular to the board, a non-clinical situation. The goal of this study is to evaluate the dosimetric effect of the board and the robustness of the plan to positional uncertainty. Materials and Methods: Twenty-two breast patients treated on a commercial prone breast board between 2017 and 2020 were selected for this retrospective study. To evaluate the board’s attenuation, we compared the plans with the board removed from the dose calculation. To quantify the robustness of this technique, we moved the beam isocenter with respect to the patient and board. Results: Our results showed that when the breast board is removed from a plan which was designed to account for the board attenuation, the average point dose increases by 7.48%, with a maximum of 22%. Comparing results with a mixed Analysis of Variance (ANOVA) and a least-square means analysis, our robustness evaluation indicates that anterior shifts at every magnitude (1 mm through 5 mm) make a significant difference in all dose statistics (D95, max, 95% prescription coverage and homogeneity index) investigated. In/out and right/left shifts resulted in an insignificant change in dose statistics. Conclusion: Prone breast boards can add significant dosimetric uncertainty into the treatment delivery process. Accounting for plan robustness in the design of the plan is highly recommended. A prone breast board design with support moved away from the beam path is warranted.展开更多
Introduction: Multidisciplinary breast conference (BC) that discusses different clinicopathological aspects of disease creates a sound, complete and unique treatment plan for each patient. The aim of this study was to...Introduction: Multidisciplinary breast conference (BC) that discusses different clinicopathological aspects of disease creates a sound, complete and unique treatment plan for each patient. The aim of this study was to investigate the role of weekly breast tumor boards in patient management and treatment modifications. Methods: From June 2010 to June 2011, 242 patients (Stage 0 to Stage 4 breast cancer) were prospectively presented before a multidisciplinary team. Presentation included clinical data, imaging and pathological review followed by prospective treatment plan formulated by the physician group. If postoperative presentation, final histopathology of the tumor and adjuvant treatment relevant to each patient was discussed. Breast conference was performed via teleconference, including video projection of pathology slides and images. Feedback evaluations were completed and returned to the Tumor Registry for consistent weekly improvement of BC. Results: 102 patients (42%) had modified management after being presented at BC, ?38% (n = 39) surgical, 33% (n = 34) medical (chemotherapy/endocrine therapy), 17% (n = 17) radiation, 6% (n = 6) both medical and radiation treatment and 6% (n = 6) imaging changes. Majority of changes were made to patients with Stage IA (27%) followed by Stage 0 (21%) breast cancer. Conclusion: Breast conference presents a significant impact on patient management and serves as a model for best practice in cancer care. Consultative discussion of each case permits every team member to be acutely aware of the patient’s condition, contribute to treatment plan and permit a harmonious and cooperative team approach while assuring best treatment for the patient.展开更多
文摘Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow angle, resulting in significant attenuation. Our planners account for this attenuation by adding field-in-field dose to the deep part of the breast, through the board. Concern was raised about how accurate the treatment delivery is when the inherent uncertainties of patients’ positions are accounted for. Furthermore, transmission measurements are usually carried out perpendicular to the board, a non-clinical situation. The goal of this study is to evaluate the dosimetric effect of the board and the robustness of the plan to positional uncertainty. Materials and Methods: Twenty-two breast patients treated on a commercial prone breast board between 2017 and 2020 were selected for this retrospective study. To evaluate the board’s attenuation, we compared the plans with the board removed from the dose calculation. To quantify the robustness of this technique, we moved the beam isocenter with respect to the patient and board. Results: Our results showed that when the breast board is removed from a plan which was designed to account for the board attenuation, the average point dose increases by 7.48%, with a maximum of 22%. Comparing results with a mixed Analysis of Variance (ANOVA) and a least-square means analysis, our robustness evaluation indicates that anterior shifts at every magnitude (1 mm through 5 mm) make a significant difference in all dose statistics (D95, max, 95% prescription coverage and homogeneity index) investigated. In/out and right/left shifts resulted in an insignificant change in dose statistics. Conclusion: Prone breast boards can add significant dosimetric uncertainty into the treatment delivery process. Accounting for plan robustness in the design of the plan is highly recommended. A prone breast board design with support moved away from the beam path is warranted.
文摘Introduction: Multidisciplinary breast conference (BC) that discusses different clinicopathological aspects of disease creates a sound, complete and unique treatment plan for each patient. The aim of this study was to investigate the role of weekly breast tumor boards in patient management and treatment modifications. Methods: From June 2010 to June 2011, 242 patients (Stage 0 to Stage 4 breast cancer) were prospectively presented before a multidisciplinary team. Presentation included clinical data, imaging and pathological review followed by prospective treatment plan formulated by the physician group. If postoperative presentation, final histopathology of the tumor and adjuvant treatment relevant to each patient was discussed. Breast conference was performed via teleconference, including video projection of pathology slides and images. Feedback evaluations were completed and returned to the Tumor Registry for consistent weekly improvement of BC. Results: 102 patients (42%) had modified management after being presented at BC, ?38% (n = 39) surgical, 33% (n = 34) medical (chemotherapy/endocrine therapy), 17% (n = 17) radiation, 6% (n = 6) both medical and radiation treatment and 6% (n = 6) imaging changes. Majority of changes were made to patients with Stage IA (27%) followed by Stage 0 (21%) breast cancer. Conclusion: Breast conference presents a significant impact on patient management and serves as a model for best practice in cancer care. Consultative discussion of each case permits every team member to be acutely aware of the patient’s condition, contribute to treatment plan and permit a harmonious and cooperative team approach while assuring best treatment for the patient.
