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Review
. 2022 Dec 22:39:100564.
doi: 10.1016/j.ctro.2022.100564. eCollection 2023 Mar.

Adaptive radiotherapy for breast cancer

C De-Colle  1 , A Kirby  2 , N Russell  3 , S F Shaitelman  4 , A Currey  5 , E Donovan  6 , E Hahn  7 , K Han  7 , C N Anandadas  8 , F Mahmood  9 , E L Lorenzen  9 , D van den Bongard  10 , M L Groot Koerkamp  11 , A C Houweling  11 , M Nachbar  12 , D Thorwarth  12   13 , D Zips  1   13
Affiliations
Review

Adaptive radiotherapy for breast cancer

C De-Colle et al. Clin Transl Radiat Oncol. .

Abstract

Research in the field of local and locoregional breast cancer radiotherapy aims to maintain excellent oncological outcomes while reducing treatment-related toxicity. Adaptive radiotherapy (ART) considers variations in target and organs at risk (OARs) anatomy occurring during the treatment course and integrates these in re-optimized treatment plans. Exploiting ART routinely in clinic may result in smaller target volumes and better OAR sparing, which may lead to reduction of acute as well as late toxicities. In this review MR-guided and CT-guided ART for breast cancer patients according to different clinical scenarios (neoadjuvant and adjuvant partial breast irradiation, whole breast, chest wall and regional nodal irradiation) are reviewed and their advantages as well as challenging aspects discussed.

Keywords: Adaptive radiotherapy; Breast cancer; MR-linac; Partial breast irradiation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The MR-Linac research program is funded by the German Research Council (to D.T. and D.Z., ZI 736/2-1). Radiation Oncology Tübingen receives financial and technical support from Elekta AB, Kaiku Health and TheraPanacea under a research agreement. C.D.C. is supported by the Medical Faculty Tübingen (TüFF). Odense University Hospital has research agreements with Elekta and Philips.

Figures

Fig. 1
Fig. 1
A: Planning CT: clip is bright and visible, whereas seroma can hardly be recognized. B: Planning MR T2W sequence: clip is visible as signal void, seroma is bright, can be distinguished from the rest of the gland and pectoral muscle.
Fig. 2
Fig. 2
A: Daily MR acquired before treatment plan adaptation and treatment delivery at the 1.5 T MR-linac, T2W sequence. The seroma can be exactly recognized as well as the breast tissue. B: On daily cone beam CT acquired before treatment delivery, neither the breast tissue nor the seroma can be recognized. C: Matching between planning CT and daily MR is accurate (in A and C the same patient is displayed, in B a different patient is displayed).
Fig. 3
Fig. 3
Changes of the heart position during radiotherapy for left sided breast cancer. In purple the planning CT (reference), in green the CBCT. Structures displayed: CTV breast, PTV breast, CTV boost (tumor bed), PTV boost, contralateral breast, heart, left ventricle, thoracic aorta. A: Fraction 6. B: Fraction 10.
See this image and copyright information in PMC

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