Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Clinical Application of Individualized 3D-Printed Chest Wall Conformal Device in IMRT for Post-mastectomy Breast Cancer

Author(s): Jiaqi Wang, Haitao Ji, Shilin Zhang, Xu Guo, Tianyi Fu, Lisong Zhao and Chunbo He*

Volume 20, 2024

Published on: 04 April, 2023

Article ID: e220223213882 Pages: 9

DOI: 10.2174/1573405619666230222093137

Price: $65

Abstract

Background: Breast cancer is the most common malignant tumour in women. Radical mastectomy with postoperative radiotherapy is now the standard treatment for locally advanced breast cancer. Intensity-modulated radiotherapy (IMRT) has now been developed, which employs linear accelerators to deliver precise radiation to a tumour while minimizing the dose to surrounding normal tissue. It significantly improves the efficacy of breast cancer treatment. However, there are still some flaws that must be addressed.

Objective: To assess the clinical application of the three-dimensional (3D)-printed chest wall conformal device for breast cancer patients who need to be treated by chest wall intensity modulated radiotherapy (IMRT) after radical mastectomy.

Methods: The 24 patients were divided into three groups. During a computed tomography (CT) scan, patients in the study group were fixed by a 3D-printed chest wall conformal device, nothing in control group A, and a traditional 1-cm thick silica gel compensatory pad on the chest wall in control group B. The parameters of mean Dmax, Dmean, D2%, D50%, D98%, the conformity index (CI), and the homogeneity index (HI) of the planning target volume (PTV) are compared.

Results: The study group had the best dose uniformity (HI = 0.092) and the highest conformation (CI = 0.97), the worst in control group A (HI = 0.304, CI = 0.84). The mean Dmax, Dmean, and D2% of the study group were lower than control groups A and B (p<0.05). The mean D50% was higher than control group B (p<0.05), while the mean D98% was higher than control groups A and B (p<0.05). The mean Dmax, Dmean, D2%, and HI of control group A were higher than control group B (p<0.05), whereas the mean D98% and CI were lower than control group B (p<0.05).

Conclusion: By improving the efficacy of postoperative radiotherapy for breast cancer, using 3D-printed chest wall conformal devices may greatly improve the accuracy of repeating position fixation, increase the dose on the skin surface of the chest wall, optimise the dose distribution of the target area, and thus further reduce tumour recurrence and prolong patients' survival.

[1]
Chen W, Sun K, Zheng R, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res 2018; 30(1): 1-12.
[http://dx.doi.org/10.21147/j.issn.1000-9604.2018.01.01] [PMID: 29545714]
[2]
Morrow M, Strom EA, Bassett LW, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin 2002; 52(5): 277-300.
[http://dx.doi.org/10.3322/canjclin.52.5.277] [PMID: 12363326]
[3]
Gao L, Wu Y, Li Y, Huang J. Application of breast bracket in intensity-modulated radiation therapy after breast-conserving surgery for breast cancer. Lingnan Modern Clinical Surgery 2011; 11: 199-201.
[4]
Lei F, Gu D, Bai Y, Li M, Liu Y, Liu X. Volumetric rotational intensity modulated radiotherapy and conventional radiotherapy in the early breast cancer after breast conserving surgery. J Pract Lab 2014; 30: 1278-80.
[5]
Bhatia R, Singh RK. Introductory Chapter: Protein kinases as promising targets for drug design against cancer. In: Singh RK, Ed. Protein Kinases - Promising Targets for Anticancer Drug Research. London: IntechOpen 2021.
[http://dx.doi.org/10.5772/intechopen.100315]
[6]
Bahadur YA, Constantinescu CT, Hassouna AH. Significant inter-fraction variations during tangential breast irradiation. An indication for image-guided radiotherapy for simultaneously integrated boost. Saudi Med J 2011; 32(3): 241-8.
[PMID: 21384058]
[7]
Zhao Q, Luo F, Zhang Y, He X, Ma X, Zhu Z. Quality control of 60CO radiotherapy placement after breast cancer surgery. The current generation of oncology medicine 2007; 15: 1499-500.
[8]
Kim LH, Goyal S, Haffty BG, Taunk NK, Yue NJ. Using respiratory motion to guide planning target volume margins for external beam partial breast irradiation. Int J Radiat Oncol Biol Phys 2012; 82(4): 1303-6.
[http://dx.doi.org/10.1016/j.ijrobp.2011.11.048] [PMID: 22385703]
[9]
Qi XS, White J, Rabinovitch R, et al. Respiratory organ motion and dosimetric impact on breast and nodal irradiation. Int J Radiat Oncol Biol Phys 2010; 78(2): 609-17.
[http://dx.doi.org/10.1016/j.ijrobp.2009.11.053] [PMID: 20472366]
[10]
Cao H, Ren W, Yu H, Gao M, Wu X, Bai Y. Analysis of positioning error of vacuum pad in radiotherapy for breast cancer and its superior potential. Chin J Cancer 2012; 22: 283-6.
[11]
Strydhorst JH, Caudrelier JM, Clark BG, Montgomery LA, Fox G, MacPherson MS. Evaluation of a thermoplastic immobilization system for breast and chest wall radiation therapy. Med Dosim 2011; 36(1): 81-4.
[http://dx.doi.org/10.1016/j.meddos.2010.01.001] [PMID: 20346646]
[12]
Ling H, Fuxi L, Feng S, et al. Thermoplastic membrane fixation technique should be used in postoperative radiotherapy of breast cancer. China Medical Herald 2013; 10(18): 108-9.
[13]
Ling H, Liao F, Feng S, Li H, Meng H. Study on the improved method of postural fixation in individualized radiotherapy for breast cancer. Zhonghua Linchuang Yishi Zazhi 2014; 22: 1259-62.
[14]
Butson MJ, Cheung T, Yu P, Metcalfe P. Effects on skin dose from unwanted air gaps under bolus in photon beam radiotherapy. Radiat Meas 2000; 32(3): 201-4.
[http://dx.doi.org/10.1016/S1350-4487(99)00276-0]
[15]
Li C, Hu J, Zhang A, Xu L. Effect of tissue equivalent compensation film and human air gap on surface dose of 6MV X-ray. Chin Med Equ J 2011; 32: 83-4.
[16]
Figliuzzi M, Mangano F, Mangano C. A novel root analogue dental implant using CT scan and CAD/CAM: selective laser melting technology. Int J Oral Maxillofac Surg 2012; 41(7): 858-62.
[http://dx.doi.org/10.1016/j.ijom.2012.01.014] [PMID: 22377004]
[17]
Camilleri J, Laprie A, Kerjean P, et al. Ep-1242, optimization on dose prescription in skin carcinomas radiotherapy: How to use boluses effectively? Radiother Oncol 2012; 103: S475-6.
[http://dx.doi.org/10.1016/S0167-8140(12)71575-X]
[18]
Tan X, Hu M, Liu C, Liu H, Liu S. Clinical analysis of 12 cases of orthognathic surgery assisted by digital virtual surgery design. Shanghai Kou Qiang Yi Xue 2014; 23: 322-7.
[PMID: 25102876]
[19]
Wang J, Cai S, Zheng H, Liao A, Jiang P, Jiang Y. 3D printing template auxiliary CT guided radioactive iodine I125 particle implantation for the treatment of tumor experts consensus. Chinese J Radiol Med Protec 2017; 37: 161-70.
[20]
China Anti-Cancer Association Breast Cancer Diagnosis and Treatment Guidelines and Regulations (2013 Edition). Chin J Cancer 2013; 23: 637-84.
[21]
Ding J, Tu W, Hu H, Shi H, Kong Y. Design of individualized oral radiotherapy stent based on 3D printing technology. Zhongguo Yi Liao Qi Xie Za Zhi 2017; 41(6): 458-9.
[PMID: 29862711]
[22]
Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347(16): 1227-32.
[http://dx.doi.org/10.1056/NEJMoa020989] [PMID: 12393819]
[23]
Singh RK, Kumar S, Prasad DN, Bhardwaj TR. Therapeutic journery of nitrogen mustard as alkylating anticancer agents: Historic to future perspectives. Eur J Med Chem 2018; 151(151): 401-33.
[http://dx.doi.org/10.1016/j.ejmech.2018.04.001] [PMID: 29649739]
[24]
Dhiman A, Sharma R, Singh RK. Target-based anticancer indole derivatives and insight into structure‒activity relationship: A mechanistic review update (2018–2021). Acta Pharm Sin B 2022; 12(7): 3006-27.
[http://dx.doi.org/10.1016/j.apsb.2022.03.021] [PMID: 35865090]
[25]
Singh RK. Key Heterocyclic Cores for Smart Anticancer Drug–Design Part II. Bentham Science Publishers 2022.
[http://dx.doi.org/10.2174/97898150400741220101]
[26]
Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet 2005; 366(9503): 2087-106.
[http://dx.doi.org/10.1016/S0140-6736(05)67887-7] [PMID: 16360786]
[27]
Darby S, McGale P, Correa C, et al. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011; 378(9804): 1707-6.
[28]
Xie Q, Shi J, Zhang L, Teng J, Liu C. Research on improved methods of postoperative radiotherapy for individualized breast cancer. Zhonghua Linchuang Yishi Zazhi 2014; 8: 1259-62.
[29]
Zhang R, Andreozzi JM, Gladstone DJ, et al. Cherenkoscopy based patient positioning validation and movement tracking during post-lumpectomy whole breast radiation therapy. Phys Med Biol 2015; 60(1): L1-L14.
[http://dx.doi.org/10.1088/0031-9155/60/1/L1] [PMID: 25504315]
[30]
Huang F. The effect of two posture fixation techniques on placement error in breast cancer after breast conserving surgery. Occupational Health and Injury 2015; 30: 123-5.
[31]
Moody AM, Mayles WPM, Bliss JM, et al. The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 1994; 33(2): 106-12.
[http://dx.doi.org/10.1016/0167-8140(94)90063-9] [PMID: 7708953]
[32]
Perkins GH, McNeese MD, Antolak JA, Buchholz TA, Strom EA, Hogstrom KR. A custom three-dimensional electron bolus technique for optimization of postmastectomy irradiation. Int J Radiat Oncol Biol Phys 2001; 51(4): 1142-51.
[http://dx.doi.org/10.1016/S0360-3016(01)01744-8] [PMID: 11704339]
[33]
Park SY, Choi CH, Park JM, Chun M, Han JH, Kim J. A patient-specific polylactic acid bolus made by a 3D printer for breast cancer radiation therapy. PLoS One 2016; 11(12): e0168063.
[http://dx.doi.org/10.1371/journal.pone.0168063] [PMID: 27930717]
[34]
Lobb E. Bolus-dependent dosimetric effect of positioning errors for tangential scalp radiotherapy with helical tomotherapy. Med Dosim 2014; 39(1): 93-7.
[http://dx.doi.org/10.1016/j.meddos.2013.10.005] [PMID: 24355911]
[35]
Zhang M, Zhao B, Yin J, Liu S, Gao X, Qin S, et al. Study on radiotherapy application of new 3D printed tissue compensator. Chin J Radiat Oncol 2017; 26: 210-4.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy