Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score
Background: A 2-level factorial pilot study was conducted in 2007 just before starting a randomized clinical trial comparing tomotherapy and conventional radiotherapy (CR) to reduce cardiac and pulmonary adverse effects in breast cancer, considering tumor laterality (left/right), target volume (with...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2020-09-01
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| Series: | Technology in Cancer Research & Treatment |
| Online Access: | https://doi.org/10.1177/1533033820947759 |
| _version_ | 1818265743971581952 |
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| author | Steve Heymann MD Giovanna Dipasquale MS Nam P. Nguyen MD Meymey San MD Olena Gorobets MD Nicolas Leduc MS, MD Dirk Verellen PhD Guy Storme MD, PhD Hilde Van Parijs MD Mark De Ridder MD, PhD Vincent Vinh-Hung MS, MD, PhD |
| author_facet | Steve Heymann MD Giovanna Dipasquale MS Nam P. Nguyen MD Meymey San MD Olena Gorobets MD Nicolas Leduc MS, MD Dirk Verellen PhD Guy Storme MD, PhD Hilde Van Parijs MD Mark De Ridder MD, PhD Vincent Vinh-Hung MS, MD, PhD |
| author_sort | Steve Heymann MD |
| collection | DOAJ |
| description | Background: A 2-level factorial pilot study was conducted in 2007 just before starting a randomized clinical trial comparing tomotherapy and conventional radiotherapy (CR) to reduce cardiac and pulmonary adverse effects in breast cancer, considering tumor laterality (left/right), target volume (with/without nodal irradiation), surgery (tumorectomy/mastectomy), and patient position (prone/supine). The study was revisited using a penalty score based on the recently developed mean absolute dose deviation (MADD). Methods: Eight patients with a unique combination of laterality, nodal coverage, and surgery underwent dual tomotherapy and CR treatment planning in both prone and supine positions, providing 32 distinct combinations. The penalty score was applied using the weighted sum of the MADDs. The Lenth method for unreplicated 2-level factorial design was used in the analysis. Results: The Lenth analysis identified nodal irradiation as the active main effect penalizing the dosimetry by 1.14 Gy (P = 0.001). Other significant effects were left laterality (0.94 Gy), mastectomy (0.61 Gy), and interactions between left mastectomy (0.89 Gy) and prone mastectomy (0.71 Gy), with P-values between 0.005 and 0.05. Tomotherapy provided a small reduction in penalty (reduction of 0.54 Gy) through interaction with nodal irradiation (P = 0.080). Some effects approached significance with P-values > 0.05 and ≤ 0.10 for interactions of prone × mastectomy × left (0.60 Gy), nodal irradiation × mastectomy (0.59 Gy), and prone × left (0.55 Gy) and the main effect prone (0.52 Gy). Conclusions: The historical dosimetric analysis previously revealed the feasibility of tomotherapy, but a conclusion could not be made. The MADD-based score is promising, and a new analysis highlights the impact of factors and hierarchy of priorities that need to be addressed if major gains are to be attained. |
| first_indexed | 2024-12-12T19:55:40Z |
| format | Article |
| id | doaj.art-b3dfe7eb4595435db52206d8c90f1dac |
| institution | Directory Open Access Journal |
| issn | 1533-0338 |
| language | English |
| last_indexed | 2024-12-12T19:55:40Z |
| publishDate | 2020-09-01 |
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| record_format | Article |
| series | Technology in Cancer Research & Treatment |
| spelling | doaj.art-b3dfe7eb4595435db52206d8c90f1dac2022-12-22T00:13:54ZengSAGE PublishingTechnology in Cancer Research & Treatment1533-03382020-09-011910.1177/1533033820947759Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty ScoreSteve Heymann MD0Giovanna Dipasquale MS1Nam P. Nguyen MD2Meymey San MD3Olena Gorobets MD4Nicolas Leduc MS, MD5Dirk Verellen PhD6Guy Storme MD, PhD7Hilde Van Parijs MD8Mark De Ridder MD, PhD9Vincent Vinh-Hung MS, MD, PhD10 Strasbourg Oncologie Liberale, Strasbourg, France Geneva University Hospitals, Geneva, Switzerland Department of Radiation Oncology, Howard University, Washington, DC, USA Khmer Soviet Friendship Hospital, Cambodia University Hospital of Martinique, Site Clarac, Martinique, France University Hospital of Martinique, Site Clarac, Martinique, France Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, BelgiumBackground: A 2-level factorial pilot study was conducted in 2007 just before starting a randomized clinical trial comparing tomotherapy and conventional radiotherapy (CR) to reduce cardiac and pulmonary adverse effects in breast cancer, considering tumor laterality (left/right), target volume (with/without nodal irradiation), surgery (tumorectomy/mastectomy), and patient position (prone/supine). The study was revisited using a penalty score based on the recently developed mean absolute dose deviation (MADD). Methods: Eight patients with a unique combination of laterality, nodal coverage, and surgery underwent dual tomotherapy and CR treatment planning in both prone and supine positions, providing 32 distinct combinations. The penalty score was applied using the weighted sum of the MADDs. The Lenth method for unreplicated 2-level factorial design was used in the analysis. Results: The Lenth analysis identified nodal irradiation as the active main effect penalizing the dosimetry by 1.14 Gy (P = 0.001). Other significant effects were left laterality (0.94 Gy), mastectomy (0.61 Gy), and interactions between left mastectomy (0.89 Gy) and prone mastectomy (0.71 Gy), with P-values between 0.005 and 0.05. Tomotherapy provided a small reduction in penalty (reduction of 0.54 Gy) through interaction with nodal irradiation (P = 0.080). Some effects approached significance with P-values > 0.05 and ≤ 0.10 for interactions of prone × mastectomy × left (0.60 Gy), nodal irradiation × mastectomy (0.59 Gy), and prone × left (0.55 Gy) and the main effect prone (0.52 Gy). Conclusions: The historical dosimetric analysis previously revealed the feasibility of tomotherapy, but a conclusion could not be made. The MADD-based score is promising, and a new analysis highlights the impact of factors and hierarchy of priorities that need to be addressed if major gains are to be attained.https://doi.org/10.1177/1533033820947759 |
| spellingShingle | Steve Heymann MD Giovanna Dipasquale MS Nam P. Nguyen MD Meymey San MD Olena Gorobets MD Nicolas Leduc MS, MD Dirk Verellen PhD Guy Storme MD, PhD Hilde Van Parijs MD Mark De Ridder MD, PhD Vincent Vinh-Hung MS, MD, PhD Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score Technology in Cancer Research & Treatment |
| title | Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score |
| title_full | Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score |
| title_fullStr | Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score |
| title_full_unstemmed | Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score |
| title_short | Two-Level Factorial Pre-TomoBreast Pilot Study of Tomotherapy and Conventional Radiotherapy in Breast Cancer: Post Hoc Utility of a Mean Absolute Dose Deviation Penalty Score |
| title_sort | two level factorial pre tomobreast pilot study of tomotherapy and conventional radiotherapy in breast cancer post hoc utility of a mean absolute dose deviation penalty score |
| url | https://doi.org/10.1177/1533033820947759 |
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