New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

Tekiki,Nouha; Kuroda,Masahiro; Ishizaka,Hinata; Khasawneh,Abdullah; Barham,Majd; Hamada,Kentaro; Konishi,Kohei; Sugimoto,Kohei; Katsui,Kuniaki; Sugiyama,Soichi; Watanabe,Kenta; Yoshio,Kotaro; Katayama,Norihisa; Ogata,Takeshi; Ihara,Hiroki; Kanazawa,Susumu; Asaumi,Junichi

doi:10.3892/mco.2021.2355

New field‑in‑field with two reference points method for whole breast radiotherapy: Dosimetric analysis and radiation‑induced skin toxicities assessment

Authors:
- Nouha Tekiki
- Masahiro Kuroda
- Hinata Ishizaka
- Abdullah Khasawneh
- Majd Barham
- Kentaro Hamada
- Kohei Konishi
- Kohei Sugimoto
- Kuniaki Katsui
- Soichi Sugiyama
- Kenta Watanabe
- Kotaro Yoshio
- Norihisa Katayama
- Takeshi Ogata
- Hiroki Ihara
- Susumu Kanazawa
- Junichi Asaumi
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Affiliations: Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan, Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700‑8558, Japan, Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700‑8558, Japan, Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama 700‑8558, Japan, Department of Radiology, Okayama University Hospital, Okayama 700‑8558, Japan, Department of Radiology, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760‑8557, Japan, Department of Radiology, Iwakuni Clinical Center, Iwakuni, Yamaguchi 740‑8510, Japan, Department of Radiology, Tsuyama Chuo Hospital, Okayama 708‑0841, Japan, Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700‑8558, Japan
Published online on: July 21, 2021 https://doi.org/10.3892/mco.2021.2355
Article Number: 193
Copyright: © Tekiki et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The usefulness of the field‑in‑field with two reference points (FIF w/ 2RP) method, in which the dose reference points are set simultaneously at two positions in the irradiation field and the high‑dose range is completely eliminated, was examined in the present study with the aim of decreasing acute skin toxicity in adjuvant breast radiotherapy (RT). A total of 573 patients with breast cancer who underwent postoperative whole breast RT were classified into 178 cases with wedge (W) method, 142 cases with field‑in‑field without 2 reference points (FIF w/o 2RP) method and 253 cases with FIF w/ 2RP method. Using the FIF w/ 2RP method, the high‑dose range was the lowest among the three irradiation methods. The planning target volume (PTV) V105% and the breast PTV for evaluation (BPe) V105% decreased to 0.09 and 0.10%, respectively. The FIF w/ 2RP method vs. the FIF w/o 2RP method had a strong association (η) with PTV V105% (η=0.79; P<0.001) and BPe V105% (η=0.76; P<0.001). The FIF w/ 2RP method had a significant impact on lowering the skin toxicity grade in weeks 3 and 4, and increasing the occurrence of skin toxicity grade 0. The FIF w/ 2RP method vs. the W method had a moderate association with skin toxicity grade at week 3 (η=0.49; P<0.001). Using the FIF w/ 2RP method, the high‑dose range V105% of the target decreased to 0%, and skin adverse events were decreased in conjunction. For patients with early‑stage breast cancer, particularly patients with relatively small‑sized breasts, the FIF w/ 2RP method may be an optimal irradiation method.

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