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Radiotherapy using multiple fractions per day
036~3016/83/081245~303.00/0 Copyright 6 1983 Pergamon Press Ltd.
Int. J. Rodiarion Oncdogy Bid. Phys.. Vol. 9. pp. 1245-l 248 Printed in the U.S.A. All rights reserved.
??Correspondence The patient was seen in the Radiotherapy Center at Lutheran General Hospital. The entirety of the right breast, as well as the paraclavicular and internal mammary lymph node groups received a tumor dose of 5000 rad with telecobalt irradiation in a five week interval. We elected not to use an iridium implant because of the silicone implant beneath the breast tissue. We used an ultrasound examination of the breast for treatment planning. This was done to determine the electron energy best suited for treating the tissues overlying the implant. A I5 MeV electron beam was used to ensure adequate margin between the skin surface and the silicone. A 7 x 7 cm field size was used. An additional 2000 rad in IO fractions of 200 rad each was given in this fashion in a two week interval. The patient tolerated the treatments satisfactorily. She continues under follow-up for her breast cancer. Ultrasound can be used for evaluation of the breast.‘,6,‘~8 This is usually done in conjunction with mammography. The ultrasonic findings with silicone implants have recently been published.’ The use of ultrasound for determining the thickness of the chest wall in the treatment planning of patients who have had mastectomy is well known.‘,’ This assists in choosing appropriate electron energy in patients who require internal mammary and chest wall irradiation. The presence of silicone in the breast provides a good sonic window separating the breast tissue from the breast wall. This differential allows accurate measurement of the thickness of mammary tissue. This patient presents an unusual situation of carcinoma developing after silicone implant. In this case, ultrasound provides information which greatly facilitates the treatment planning. An ultrasound of any breast can easily give accurate information as to the thickness of breast tissue. As more patients are treated with primary breast irradiation, we believe that this procedure will be helpful in treatment planning for both iridium implant and electron beam boost therapy.
Letters to the Editor will be published if they are suitable and if space permits. The Letter should be typewritten (double spaced) and must not exceed lye pages including references; submit in triplicate. The Letter may be edited and shortened in our Editorial Office. A letter regarding a recent Journal article should be received within six weeks of the article’s publication date.
RADIOTHERAPY
USING MULTIPLE
FRACTIONS PER DAY
To the Edifor: Within the last few years non-standard fractionation consisting of more than one dose (fraction) per day is being tested in clinical trials. Four papers describing such regimens were published in the November 1982 issue of this journal, and three of them used the wrong term “MDF.” I am writing to ask you to make sure that in your influential journal such schedules are not in future described as “Multiple Daily Fractions (MDF).” That phrase is completely ambiguous. It could obviously just as well be applied to the present practice of “many daily doses,” for example 30 daily doses given over a period of 6 weeks. Readers looking back in a few years’ time are likely to be confused. The correct phase is “Multiple Fractions per Day (MFD).” It is then perfectly clear to any reader what is being done. The change in initials is minimal and should not create confusion. It has been widely accepted already but these three papers must have been submitted too long ago to make the change. J. FOWLER, D.Sc., PH.D. Gray Laboratory Mount Vernon Hospital Northwood Middlesex HA6 2RN England
BREAST TREATMENT PLANNING USING ULTRASOUND PATIENT WITH SILICONE IMPLANTS
RICHARD
L.
PHILLIPS,
MICHAEL
S.
SIEGFRIED,
M.D. M.D.
Division of Radiology Section of Diagnostic Radiology Lutheran General Hospital Park Ridge, IL 60068 I. Brascho, D.J.: Radiation Therapy Planning With Ultrasound. The Radiologic Clinics of North America, Index 197331975, pp. 505521. 2. Exstrand. K.E., Blake, D.D., Dixon, R.L.: Ultrasonography of the chest wall. J. Clin. Ultrasound. 2:1 17-l 18, 1974. 3. Harper, P., Kelly-Fry, E.: Ultrasound utilization of the breast in symptomatic patients. Radiology 137:456-469, 1980. 4. Hellman, S., Harris, J.R., Levene, M.B.: Radiation therapy of early carcinoma of the breast without mastectomy. CAN 46(Suppl.):988994, 1980. 5. Rosenbaum, J.L., Bernardino, M.E., Thomas, J.L., Wigley K.D.: Ultrasonic findings in silicone augmented breasts, Sou. Med. J. 74:455458, 198 I. 6. Rosner, D., Weiss, L., Norman, M.: Ultrasound in the diagnosis of breast disease. .I. Surg. One. 1 l:83-96, 1980. 7. Rubin, C.S., Kirtz, A.B., Goldberg, B.B., Feig, S., Cole-Beuglet, C.: Ultrasonic mammographic parenchymal patterns: A preliminary report. Radiology 130:5 I 5-5 17, 1980. 8. Texidor, H.S., Kasam, E.: Combined mammographic-sonographic evaluation of breast masses. Am. J. Roenfgenol. 128409, 1977. 9. Umberto, V., Saccozzi, R., Del Vecchio, M., Banfi, A., Clements. C., De Lena, M., Callus, G., Greco, M., Luini, A,, Marubini, E., Muscolino, G.. Rilke, F., Salvadori. B.. Zecchini. A,. Zucali. R.: Comparing radical mastectomy with quadrantectomy,‘axillary’dissection and radiotherapy in patient with small cancer of the breast. NEMJ 305:6-l I, 1981.
IN
To the Edifor; Most radiation therapy departments are seeing a greater number of patients who refuse mastectomy and are being treated with lumpectomy, segmentectomy and primary breast irradiation.4.9 The classic breast techniques with or without lymph node irradiation are well known. These are designed to deliver 5000 rad to the breast and/or surrounding lymph nodes in a five to five and a half week interval. A boost to the primary tumor site can be done either with an interstitial iridium implant or electrons. Ultrasound has been used in determining the thickness of the chest wall.‘,* In this case we used it to determine thickness of breast tissue superior to a breast silicone implant. This was done in order to determine the electron beam energy required to deliver appropriate treatment. Case History
This 35 year-old premenopausal white female, Gravida III, Para III, presented in March 1979, for bilateral breast augmentation with silicone implants. This was done without complication. This patient presented in August 1981, with a mass in the upper midportion of the right breast. This mass was about 1 cm. It was excised and revealed ductal adenocarcinoma. The patient refused mastectomy. She had an axillary dissection performed and none of the 30 lymph nodes removed contained metastatic carcinoma.
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Int. J. Rodiarion Oncdogy Bid. Phys.. Vol. 9. pp. 1245-l 248 Printed in the U.S.A. All rights reserved.
??Correspondence The patient was seen in the Radiotherapy Center at Lutheran General Hospital. The entirety of the right breast, as well as the paraclavicular and internal mammary lymph node groups received a tumor dose of 5000 rad with telecobalt irradiation in a five week interval. We elected not to use an iridium implant because of the silicone implant beneath the breast tissue. We used an ultrasound examination of the breast for treatment planning. This was done to determine the electron energy best suited for treating the tissues overlying the implant. A I5 MeV electron beam was used to ensure adequate margin between the skin surface and the silicone. A 7 x 7 cm field size was used. An additional 2000 rad in IO fractions of 200 rad each was given in this fashion in a two week interval. The patient tolerated the treatments satisfactorily. She continues under follow-up for her breast cancer. Ultrasound can be used for evaluation of the breast.‘,6,‘~8 This is usually done in conjunction with mammography. The ultrasonic findings with silicone implants have recently been published.’ The use of ultrasound for determining the thickness of the chest wall in the treatment planning of patients who have had mastectomy is well known.‘,’ This assists in choosing appropriate electron energy in patients who require internal mammary and chest wall irradiation. The presence of silicone in the breast provides a good sonic window separating the breast tissue from the breast wall. This differential allows accurate measurement of the thickness of mammary tissue. This patient presents an unusual situation of carcinoma developing after silicone implant. In this case, ultrasound provides information which greatly facilitates the treatment planning. An ultrasound of any breast can easily give accurate information as to the thickness of breast tissue. As more patients are treated with primary breast irradiation, we believe that this procedure will be helpful in treatment planning for both iridium implant and electron beam boost therapy.
Letters to the Editor will be published if they are suitable and if space permits. The Letter should be typewritten (double spaced) and must not exceed lye pages including references; submit in triplicate. The Letter may be edited and shortened in our Editorial Office. A letter regarding a recent Journal article should be received within six weeks of the article’s publication date.
RADIOTHERAPY
USING MULTIPLE
FRACTIONS PER DAY
To the Edifor: Within the last few years non-standard fractionation consisting of more than one dose (fraction) per day is being tested in clinical trials. Four papers describing such regimens were published in the November 1982 issue of this journal, and three of them used the wrong term “MDF.” I am writing to ask you to make sure that in your influential journal such schedules are not in future described as “Multiple Daily Fractions (MDF).” That phrase is completely ambiguous. It could obviously just as well be applied to the present practice of “many daily doses,” for example 30 daily doses given over a period of 6 weeks. Readers looking back in a few years’ time are likely to be confused. The correct phase is “Multiple Fractions per Day (MFD).” It is then perfectly clear to any reader what is being done. The change in initials is minimal and should not create confusion. It has been widely accepted already but these three papers must have been submitted too long ago to make the change. J. FOWLER, D.Sc., PH.D. Gray Laboratory Mount Vernon Hospital Northwood Middlesex HA6 2RN England
BREAST TREATMENT PLANNING USING ULTRASOUND PATIENT WITH SILICONE IMPLANTS
RICHARD
L.
PHILLIPS,
MICHAEL
S.
SIEGFRIED,
M.D. M.D.
Division of Radiology Section of Diagnostic Radiology Lutheran General Hospital Park Ridge, IL 60068 I. Brascho, D.J.: Radiation Therapy Planning With Ultrasound. The Radiologic Clinics of North America, Index 197331975, pp. 505521. 2. Exstrand. K.E., Blake, D.D., Dixon, R.L.: Ultrasonography of the chest wall. J. Clin. Ultrasound. 2:1 17-l 18, 1974. 3. Harper, P., Kelly-Fry, E.: Ultrasound utilization of the breast in symptomatic patients. Radiology 137:456-469, 1980. 4. Hellman, S., Harris, J.R., Levene, M.B.: Radiation therapy of early carcinoma of the breast without mastectomy. CAN 46(Suppl.):988994, 1980. 5. Rosenbaum, J.L., Bernardino, M.E., Thomas, J.L., Wigley K.D.: Ultrasonic findings in silicone augmented breasts, Sou. Med. J. 74:455458, 198 I. 6. Rosner, D., Weiss, L., Norman, M.: Ultrasound in the diagnosis of breast disease. .I. Surg. One. 1 l:83-96, 1980. 7. Rubin, C.S., Kirtz, A.B., Goldberg, B.B., Feig, S., Cole-Beuglet, C.: Ultrasonic mammographic parenchymal patterns: A preliminary report. Radiology 130:5 I 5-5 17, 1980. 8. Texidor, H.S., Kasam, E.: Combined mammographic-sonographic evaluation of breast masses. Am. J. Roenfgenol. 128409, 1977. 9. Umberto, V., Saccozzi, R., Del Vecchio, M., Banfi, A., Clements. C., De Lena, M., Callus, G., Greco, M., Luini, A,, Marubini, E., Muscolino, G.. Rilke, F., Salvadori. B.. Zecchini. A,. Zucali. R.: Comparing radical mastectomy with quadrantectomy,‘axillary’dissection and radiotherapy in patient with small cancer of the breast. NEMJ 305:6-l I, 1981.
IN
To the Edifor; Most radiation therapy departments are seeing a greater number of patients who refuse mastectomy and are being treated with lumpectomy, segmentectomy and primary breast irradiation.4.9 The classic breast techniques with or without lymph node irradiation are well known. These are designed to deliver 5000 rad to the breast and/or surrounding lymph nodes in a five to five and a half week interval. A boost to the primary tumor site can be done either with an interstitial iridium implant or electrons. Ultrasound has been used in determining the thickness of the chest wall.‘,* In this case we used it to determine thickness of breast tissue superior to a breast silicone implant. This was done in order to determine the electron beam energy required to deliver appropriate treatment. Case History
This 35 year-old premenopausal white female, Gravida III, Para III, presented in March 1979, for bilateral breast augmentation with silicone implants. This was done without complication. This patient presented in August 1981, with a mass in the upper midportion of the right breast. This mass was about 1 cm. It was excised and revealed ductal adenocarcinoma. The patient refused mastectomy. She had an axillary dissection performed and none of the 30 lymph nodes removed contained metastatic carcinoma.
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