published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Breast cancer is the most common cancer among women worldwide. Millions of new breast cancer cases are diagnosed every year, accounting for one-tenth of all new cancer cases. Because of the proof of equivalent efficacy between breast-conserving therapy (BCT) plus radiotherapy and mastectomy, increasing number of patients received breast irradiation during the past three decades, and radiotherapy plays a more and more important role in managing breast cancer. With the advancement of technology, the radiotherapy treatment techniques changed from conventional wedged technique to intensity modulated radiotherapy (IMRT), resulting in an improvement in the dose homogeneity. Regardless of the treatment techniques, peripheral dose to the contralateral breast is inevitable. The possibility of the peripheral dose causing contralateral breast cancer (CBC) has re-attracted the interest. However, the variation of the peripheral dose with different treatment techniques has not been well identified. Thus this study aims to compare the contralateral breast dose from the primary breast irradiation using various radiotherapy treatment techniques and types of shielding. Six treatment plans by different treatment techniques, including paired physical wedges (PW-P), a lateral physical wedge only(PW-L), paired enhanced dynamic wedges (EDW-P), a lateral enhanced dynamic wedge only(EDW-L), field-in-field tangential opposing (TO-FiF), and inverse-planned intensity modulated radiotherapy (IMRT-IP), were generated using a female Rando phantom. The phantom was treated by all plans, and 15 metal oxide semiconductor field effect transistor(MOSFET)detectors on the surface and inside the contralateral breast were utilized for measuring the contralateral breast dose for each plan. Measurement was repeated with the application of 0.2, 0.3 and 0.5cm lead sheets or 0.5 and 1cm superflab (SF) on the TO-FiF to demonstrate the effect of shielding on the contralateral breast dose. The measured contralateral breast doses were: 2.05Gy for PW-P, 1.44Gyfor PW-L, 1.51Gyfor EDW-P, 1.52Gyfor EDW-L, 1.25Gyfor TO-FiF, and 1.17Gyfor IMRT-IP, corresponding to 2.35% to 4.11% of total dose. PW-P producedthe highest contralateral breast dose while IMRT-IP producedthe lowest. For the addition of shielding, the doses were: 1.25Gy for no shielding, 0.65Gy for 0.2cm lead, 0.61Gy for 0.3cm lead, 0.49Gy for 0.5cm lead, 0.76Gy for 0.5cm SF, and 0.72Gy for 1cm SF. Lead sheet with 0.5cm thickness most effectively reduced the contralateral breast dose by 60%.All techniques showed that the surface dose was much higher than the dose at depth, and the dose dropped exponentially from the surface to the internal. Low energy radiation constitutes a large portion of the contralateral breast dose, so all types of shielding could decrease the surface dose effectively, but not the internal dose. The radiation-induced CBC risks were estimated to be about 0.77% to 1.36%. To conclude, it is important that the contralateral breast dose to patients, especially those under 45, is maintained minimal. Therefore, TO-FiF or IMRT-IP are recommended to be the treatment of choices. The used of shielding, either lead or SF, is also advisable. / published_or_final_version / Diagnostic Radiology / Master / Master of Medical Sciences

A simple method to verify the total treatment time generated by the treatment planning system (TPS) when the CONTURA MLB or the SAVI applicator are used for APBI treatments has been developed. The method compares the time generated by the TPS to a predicted time, calculated by inserting parameters obtained from the TPS in equations generated in this Thesis. The equations were generated by linearly fitting data from clinical cases that had been treated using the Contura MLB or the SAVI applicator at the Lynn Cancer Institute of the Boca Raton Regional Hospital. The parameters used were the PTV coverage, Air Kerma Strength, Balloon Volume (Contura data fit) and Evaluation PTV (SAVI data fit). As an outcome of this research, it is recommended that the plan should be reevaluated when the percent difference between the generated and the predicted times exceeds 5% for the Contura MLB, or 10% for the SAVI. / by Andreas Kyriacou. / Thesis (M.S.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

The purpose of this study is to investigate the changes of the pericardial dose at different respiratory phases and statuses in accelerated partial breast irradiation (APBI) using Cyberknife M6™ multileaf collimators (CK-MLC). Anonymous 6 female patient files with respiration gated four-dimensional computed tomography (4DCT) sets, and 6 left breast cancer cases with CT images in free-breathing (FB) and deep inhalation breath-hold (BH) were selected. One CT image set from each patient was planned for APBI in Accuray Multiplan™ 5.2, and respectively compared its pericardial dose with those from CT sets of other respiratory phases. All the comparable CT images were fused in the planning system according to the left chest wall, among which the lung gap anterior to the pericardium varies by the lung expansion. For the purpose of this study, the tumor volume was outlined in the media-lower quadrant of the left breast where this lung gap is relatively small. All the plans in this study met the requirements set by the National Surgical Adjuvant Breast and Bowel Project/Radiation Therapy Oncology Group (NSABP/RTOG), specifically protocol B-39/RTOG 0413. From the comparisons in this investigation, the mean relative pericardial dose of the BH CT group showed significant or 45% (p < 0.01) lower value than that of FB CT group. However, in FB 4DCT group, 3 of 6 cases indicated a meaningful reduction (p < 0.05) in 100% inhalation phase when compared with the mean dose over other phases. The inconsistent pericardial doses were displayed in FB 4DCT group due to minimal changes in the anterior lung gap of the pericardium, when the diaphragmatic breathing was dominant in those patients. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

The purpose of this study is to verify and validate the dose at various points of interest in accelerated partial breast irradiation (APBI) treated with the Strut Adjusted Volume Implant (SAVI) applicator using Thermoluminescent Dosimeters (TLDs). A set of CT images were selected from a patient’s data who had received APBI using the SAVI applicator. The images were used to make 3D models. TLDs were calibrated for Brachytherapy. Various points of interest were marked out and slots were carved in the 3D models to fit the TLDs. CT scans were taken of the 3D models with expanded SAVI applicator inserted. A plan was made following B-39 protocol. The TLDs were read and the absorbed doses were calculated and compared to the delivered doses. The results of this study show that the overall average reading of the TLDs is within expected value. The TPS shows overestimated dose calculations for brachytherapy. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Most breast cancer patients undergo radiation diagnostics and are also treated with radiotherapy. In addition to being an important treatment modality, ionizing radiation (IR) is a potent tumour-causing agent that has been linked to breast cancer development. However, the exact molecular etiology of IR-induced mammary gland carcinogenesis remains unknown. We set out to analyze the role of DNA methylation in mammary gland responses to low dose IR using a well-established rat model. We also studied low dose IR effects on global gene expression and microRNAome. We found that exposure to low, mammography-like dose of IR led to a significant loss of global DNA methylation in rat mammary gland tissue. Furthermore, low dose IR significantly affected rat mammary gland transcriptome and microRNAome. The datasets generated within the scope of this thesis may be used to identify novel predictive biomarkers for assessment of the magnitude of IR effects on mammary gland tissue. / xi, 120 leaves ; 29 cm

A radioterapia externa pós-operatória em mulheres diagnosticadas com câncer de mama em estágio inicial é tido como um procedimento padrão, no entanto durante o planejamento para irradiação do volume alvo as possíveis incertezas dosimétricas introduzidas dado o movimento respiratório intrínseco da paciente são desconsideradas. Este estudo avalia não apenas a influência da respiração na distribuição tridimensional da dose, mas como essa distribuição se modifica dado a técnica radioterápica empregada para o tratamento. Três técnicas de planejamento foram analisadas: a radioterapia conformacional tridimensional (3D-RT) com filtros, a radioterapia com intensidade modulada (IMRT) usando planejamento direto e o IMRT inverso. A fim de simular o movimento de contração e expansão da caixa torácica, utilizou-se uma plataforma com amplitudes de oscilação pré-determinadas, sendo a frequência de oscilação provida por uma fonte de tensão variável. Para simular a mama usou-se objetos simuladores semiesféricos preenchidos com gel dosimétrico (MAGIC-f). Os planejamentos para cada técnica foram realizados sobre a mesma tomografia computadorizada (CT) do objeto simulador preenchido com água no modo estático. Foram produzidos três lotes de dosímetro gel para o projeto, cada lote foi irradiado com uma técnica radioterápica diferente, sendo que cada lote inclui cinco objetos simuladores e um conjunto de nove tubos de calibração preenchidos com gel MAGIC-f. O primeiro dos objetos simuladores é utilizado como referência, o segundo é irradiado no modo estático, os demais são irradiados em diferentes amplitudes, respectivamente: 0,34 cm, 0,88 cm e 1,22 cm. A informação volumétrica de dose foi obtida utilizando imagens por ressonância magnética nuclear (IRMN), para cada lote foram adquiridos IRMN com sequência multi spin echo e os mapas de relaxometria, que são associados à dose, foram extraídos em um software desenvolvido e aprimorado pelo nosso grupo de pesquisa. A comparação quantitativa dos mapas de relaxometria dos objetos simuladores em movimento em relação ao modo estático foi realizado pelo índice gamma tridimensional (3% / 3mm / 15% Threshold). Para o 3D-RT a porcentagem de pontos aprovados do objeto estático em relação ao oscilante na amplitude de 0,34 cm foi de 96,44%, para amplitude de 0,88 cm foi de 93,23% e para amplitude de 1,22 cm foi de 91,65%. Para o IMRT direto a porcentagem de pontos aprovados do objeto estático em relação ao oscilante na amplitude de 0,34 cm foi de 98,42%, para amplitude de 0,88 cm foi de 95,66% e para amplitude de 1,22 cm foi de 94,31%. Para o IMRT inverso a porcentagem de pontos aprovados do objeto estático em relação ao oscilante na amplitude de 0,34 cm foi de 94,49%, para amplitude de 0,88 cm foi de 93,51% e para amplitude de 1,22 cm foi de 86,62%. A partir dos resultados, infere-se que a movimentação respiratória de baixa amplitude, para tratamentos de câncer de mama, não é um fator preocupante para a rotina clínica, porém o aumento da amplitude da oscilação aumenta a inomogeneidade de dose e pode afetar os parâmetros dosimétricos da cobertura do volume alvo em relação ao planejamento do tratamento. Observou-se em conjunto que a distribuição de dose se modifica claramente com a técnica em uso e no caso do IMRT inverso para amplitude de oscilação de 1,22 cm a aprovação no índice gamma foi menor que 90% / External postoperative radiotherapy in women diagnosed with early stage breast cancer is considered as a standard procedure, however during planning for target volume irradiation as possible dosimetric uncertainties reabsorption of the patient\'s intrinsic respiratory movement are disregarded. This study evaluates not only the influence of respiration on the three-dimensional distribution of the dose but how this distribution is modified due to the radiotherapy technique used for treatment. Three planning techniques were analyzed: three-dimensional conformational radiotherapy (3D-RT) with filters, intensity-modulated radiotherapy (IMRT) using direct planning and inverse IMRT. In order to simulate the movement of contraction and expansion of the chest wall, a platform with predetermined oscillation amplitudes was used, the oscillation frequency was provided by a variable voltage source. To simulate the breast, semi-spherical simulator objects filled with dosimetric gel (MAGIC-f) were used. The plannnings for each technique were performed on the computerized tomography (CT) of the simulator object filled with water in static mode. Three batches of gel dosimeters were prepared for the project, each batch was irradiated with a different radiothermic technique and comprised five simulator objects and a set of nine calibration tubes filled with MAGIC-f gel. The first simulator objects is used as reference, the second is irradiated in the static mode, the others are irradiated using different amplitudes, respectively: 0,34 cm, 0,88 cm and 1,22 cm. Volumetric dose information was obtained using Nuclear Magnetic Resonance Imaging, each batch was scanned with a multi spin echo sequence and the dose-related relaxometry maps were extracted in a software developed and improved by our Group of research. The quantitative comparison of the relaxometry maps of the moving simulator objects with respect to the static mode was performed by the three-dimensional gamma index (3% / 3mm / 15% threshold). For the 3D-RT, the percentage of approved points of the static object with respect to the oscillator in the amplitude of 0.34 cm was 96.44%, for amplitude of 0.88 cm was 93.23% and for amplitude of 1.22 cm was 91.65%. For the direct IMRT the percentage of approved points of the static object in relation to the oscillator in the amplitude of 0.34 cm was 98.42%, for amplitude of 0.88 cm was 95.66% and for amplitude of 1.22 cm was 94.31%. For the inverse IMRT, the percentage of approved points of the static object in relation to the oscillator in the amplitude of 0.34 cm was 94.49%, for amplitude of 0.88 cm was 93.51% and for amplitude of 1.22 cm was 86.62%. From the results, it is inferred that a low-amplitude respiratory movement, for breast cancer treatments, is not a worrying factor for clinical routine, however, increasing the amplitude of the oscillation increases the inomogeneity of the dose and this affects the dosimetry parameters of the target volume coverage. It was observed that the dose distribution changes with the technique in use and in the case of the inverse IMRT for amplitude of oscillation of 1.22 cm, less than 90% of points were approved in the gamma index evaluation

Ο σκοπός της διπλωματικής εργασίας ήταν η βελτιστοποίηση του πλάνου θεραπείας στο μαστό για τα 2 εφαπτόμενα συνεπίπεδα πεδία ενέργειας 6 MV. Η ανάγκη αυτή πρόκυψε από το γεγονός της εμφάνισης ελλείμματος στην κατανομή της δόσης καθώς όπως φαίνεται και στις παρακάτω εικόνες (στην αξονική και στην οβελιαία τομή) είχαμε ικανοποιητική κάλυψη του CTV στην περιφέρεια του μαστού αλλά στο κέντρο του CTV και σε μεγαλύτερα βάθη όχι. Για την πραγματοποίηση του παραπάνω σκοπού εφαρμόστηκαν 4 τεχνικές ακτινοβόλησης: 1. Δύο εφαπτόμενα συνεπίπεδα πεδία ενέργειας 6 MV, 2. Δύο εφαπτόμενα συνεπίπεδα πεδία ενέργειας 15 MV, 3. Δύο εφαπτόμενα συνεπίπεδα πεδία ενέργειας 6 MV + 1 Field In a Filed (FiF) πεδίο ενέργειας 15 MV και 4. . Δύο εφαπτόμενα συνεπίπεδα πεδία ενέργειας 6 MV + 2 Field In a Filed (FiF) πεδία ενέργειας 15 MV. Η παραπάνω μεθοδολογία εφαρμόστηκε σε πλήθος Ν=100 ασθενών, κατά 95% μεγέθους όγκου Τ1 (έως 2cm) και Τ2 (2-5 cm) και με αριθμό διηθημένων λεμφαδένων Ν<3. Ο υλικοτεχνικός εξοπλισμός που χρησιμοποιήθηκε για την υλοποίηση της εργασίας ήταν: 1. Αξονικός τομογράφος- Simulator Somatom Duo Siemens, 2. Σύστημα διαχείρισης (RVS) ακτινοθεραπευτικού τμήματος ARIA της VARIAN, 3. Σύστημα σχεδιασμού θεραπείας (TPS) Eclipse της VARIAN, 4. Σύστημα κλασσικού εξομοιωτή Aquity της VARIAN και 5. Γραμμικός Επιταχυντής ELEKTA SL 15. Για την στατιστική επεξεργασία των αποτελεσμάτων για πλήθος Ν=100 ασθενών χρησιμοποιήθηκε το πρόγραμμα IBM SPSS (Statistical Package for Social Sciences) έκδοση 20. Η στατιστική επεξεργασία έδειξε ότι μέσος όρος της μέσης δόσης για τις διάφορες τεχνικές ήταν 96.5%, 98.9%, 100.7%, 101.9% για τα 6MV, 15MV, 6MV + 1FIF 15MV και 6MV + 2FIF 15MV, αντίστοιχα. Τα 95% διαστήματα εμπιστοσύνης (Confidence Intervals) ήταν (96.2-96.8), (98.6-99.1), (100.4-100.9), (101.7-102.1) αντίστοιχα. Η ανάλυση έδειξε πως όλες οι ομάδες διέφεραν μεταξύ τους σε επίπεδο στατιστικής σημαντικότητας p < 0.001. Τα αποτελέσματα της εργασίας ήταν ότι η μέση δόση αυξάνεται από μέθοδο σε μέθοδο όπως έδειξε και η στατιστική ανάλυση, ο δείκτης ομοιογένειας μειώνεται αντίστοιχα από μέθοδο σε μέθοδο και αυτό αποτελεί δείγμα βελτίωσης της κατανομής της δόσης. Ακόμα ότι από ένα συγκεκριμένο όγκο του CTV και πάνω η καλύτερη μέθοδος αποδείχτηκε ότι είναι η 6MV + 2FIF 15MV, ενώ από ένα συγκεκριμένο όγκο του CTV και κάτω οι μέθοδοι έχουν περίπου την ίδια αποτελεσματικότητα. Τέλος όσον αφορά τα φυσιολογικά όργανα (organs at risk), τον αντίστοιχο πνεύμονα και την καρδιά, μετρήθηκε το V20 (ο όγκος του οργάνου που λαμβάνει από 2000 cGy και πάνω) και αποδείχτηκε ότι είναι ανεξάρτητο από την τεχνική ακτινοβόλησης. / The purpose of this thesis is to optimize the breast cancer treatment planning for the coplanar tangential fields of 6MV energy. The need for this arose as the dose distribution appears deficient both at the center and deeper in the CTV, as shown in the CT and sagittal images below, whereas the dose is satisfactory distributed at the perimeter of the breast. In order to accomplish that, there were applied 4 radiation techniques: 1. Two coplanar tangential fields of 6MV energy, 2. Two coplanar tangential fields of 15MV energy, 3. Two coplanar tangential fields of 6MV energy with Field in a Field (FiF) of 15MV energy and 4. Two coplanar tangential fields of 6MV energy with two Fields in a Field (FiF’s) of 15MV energy. The method above was applied on 100 patients. 95% of them had T1 tumor (T<2cm), T2 tumor (T=2-5cm) and a number of infiltrated lymph N<3. The equipment that has been used for the materialization of the procedure was: 1. A Computed Tomographer Somatom Duo Siemens, 2. An RVS system of VARIAN, 3. A TPS Eclipse system of VARIAN, 4. A Simulator Aquity of VARIAN and 5. A linear accelerator ELEKTA SL 15. Using the program IBM SPSS 20 (Statistical Package for Social Sciences), for a hundred patients, the statistical analysis showed that the average of the mean dose was 96.5% for the 6MV, 98.9% for the 15MV, 100.7% for the 6MV + 1 FIF of 15MV and 101.9% for the 6MV + 2 FIF of 15MV respectively (95% CI, p<0.001). There was an interaction between CTV size and mean dose, notably for large breasted patients (CTV>750cc). In this particular clinical scenario two 6MV tangential fields with 2 FIFs consistently outperformed the others. Minimum dose was also statistically different among all groups (p<0.05) except for the two FIF-less tangential fields with 6 and 15 MV. Interestingly, minimum dose (%) lacked a dependence on volume size. The result of this procedure was that the mean dose increases from method to method as it was obvious from the statistical analysis. The homogeneity index decreases respectively from method to method which indicates improvement of the dose distribution. It was also proved that, for certain large volumes of CTV the best method was the 6MV with two FIF’s of 15MV energy, whereas for smaller volumes of CTV the other three methods were of the same effectiveness. In conclusion, as far as the organs at risk concern, it has been found that the V20, of the heart and the right or left lung each time, is irrelevant of the technique that has been used each time.

A radioterapia externa pós-operatória em mulheres diagnosticadas com câncer de mama em estágio inicial é tido como um procedimento padrão, no entanto durante o planejamento para irradiação do volume alvo as possíveis incertezas dosimétricas introduzidas dado o movimento respiratório intrínseco da paciente são desconsideradas. Este estudo avalia não apenas a influência da respiração na distribuição tridimensional da dose, mas como essa distribuição se modifica dado a técnica radioterápica empregada para o tratamento. Três técnicas de planejamento foram analisadas: a radioterapia conformacional tridimensional (3D-RT) com filtros, a radioterapia com intensidade modulada (IMRT) usando planejamento direto e o IMRT inverso. A fim de simular o movimento de contração e expansão da caixa torácica, utilizou-se uma plataforma com amplitudes de oscilação pré-determinadas, sendo a frequência de oscilação provida por uma fonte de tensão variável. Para simular a mama usou-se objetos simuladores semiesféricos preenchidos com gel dosimétrico (MAGIC-f). Os planejamentos para cada técnica foram realizados sobre a mesma tomografia computadorizada (CT) do objeto simulador preenchido com água no modo estático. Foram produzidos três lotes de dosímetro gel para o projeto, cada lote foi irradiado com uma técnica radioterápica diferente, sendo que cada lote inclui cinco objetos simuladores e um conjunto de nove tubos de calibração preenchidos com gel MAGIC-f. O primeiro dos objetos simuladores é utilizado como referência, o segundo é irradiado no modo estático, os demais são irradiados em diferentes amplitudes, respectivamente: 0,34 cm, 0,88 cm e 1,22 cm. A informação volumétrica de dose foi obtida utilizando imagens por ressonância magnética nuclear (IRMN), para cada lote foram adquiridos IRMN com sequência multi spin echo e os mapas de relaxometria, que são associados à dose, foram extraídos em um software desenvolvido e aprimorado pelo nosso grupo de pesquisa. A comparação quantitativa dos mapas de relaxometria dos objetos simuladores em movimento em relação ao modo estático foi realizado pelo índice gamma tridimensional (3% / 3mm / 15% Threshold). Para o 3D-RT a porcentagem de pontos aprovados do objeto estático em relação ao oscilante na amplitude de 0,34 cm foi de 96,44%, para amplitude de 0,88 cm foi de 93,23% e para amplitude de 1,22 cm foi de 91,65%. Para o IMRT direto a porcentagem de pontos aprovados do objeto estático em relação ao oscilante na amplitude de 0,34 cm foi de 98,42%, para amplitude de 0,88 cm foi de 95,66% e para amplitude de 1,22 cm foi de 94,31%. Para o IMRT inverso a porcentagem de pontos aprovados do objeto estático em relação ao oscilante na amplitude de 0,34 cm foi de 94,49%, para amplitude de 0,88 cm foi de 93,51% e para amplitude de 1,22 cm foi de 86,62%. A partir dos resultados, infere-se que a movimentação respiratória de baixa amplitude, para tratamentos de câncer de mama, não é um fator preocupante para a rotina clínica, porém o aumento da amplitude da oscilação aumenta a inomogeneidade de dose e pode afetar os parâmetros dosimétricos da cobertura do volume alvo em relação ao planejamento do tratamento. Observou-se em conjunto que a distribuição de dose se modifica claramente com a técnica em uso e no caso do IMRT inverso para amplitude de oscilação de 1,22 cm a aprovação no índice gamma foi menor que 90% / External postoperative radiotherapy in women diagnosed with early stage breast cancer is considered as a standard procedure, however during planning for target volume irradiation as possible dosimetric uncertainties reabsorption of the patient\'s intrinsic respiratory movement are disregarded. This study evaluates not only the influence of respiration on the three-dimensional distribution of the dose but how this distribution is modified due to the radiotherapy technique used for treatment. Three planning techniques were analyzed: three-dimensional conformational radiotherapy (3D-RT) with filters, intensity-modulated radiotherapy (IMRT) using direct planning and inverse IMRT. In order to simulate the movement of contraction and expansion of the chest wall, a platform with predetermined oscillation amplitudes was used, the oscillation frequency was provided by a variable voltage source. To simulate the breast, semi-spherical simulator objects filled with dosimetric gel (MAGIC-f) were used. The plannnings for each technique were performed on the computerized tomography (CT) of the simulator object filled with water in static mode. Three batches of gel dosimeters were prepared for the project, each batch was irradiated with a different radiothermic technique and comprised five simulator objects and a set of nine calibration tubes filled with MAGIC-f gel. The first simulator objects is used as reference, the second is irradiated in the static mode, the others are irradiated using different amplitudes, respectively: 0,34 cm, 0,88 cm and 1,22 cm. Volumetric dose information was obtained using Nuclear Magnetic Resonance Imaging, each batch was scanned with a multi spin echo sequence and the dose-related relaxometry maps were extracted in a software developed and improved by our Group of research. The quantitative comparison of the relaxometry maps of the moving simulator objects with respect to the static mode was performed by the three-dimensional gamma index (3% / 3mm / 15% threshold). For the 3D-RT, the percentage of approved points of the static object with respect to the oscillator in the amplitude of 0.34 cm was 96.44%, for amplitude of 0.88 cm was 93.23% and for amplitude of 1.22 cm was 91.65%. For the direct IMRT the percentage of approved points of the static object in relation to the oscillator in the amplitude of 0.34 cm was 98.42%, for amplitude of 0.88 cm was 95.66% and for amplitude of 1.22 cm was 94.31%. For the inverse IMRT, the percentage of approved points of the static object in relation to the oscillator in the amplitude of 0.34 cm was 94.49%, for amplitude of 0.88 cm was 93.51% and for amplitude of 1.22 cm was 86.62%. From the results, it is inferred that a low-amplitude respiratory movement, for breast cancer treatments, is not a worrying factor for clinical routine, however, increasing the amplitude of the oscillation increases the inomogeneity of the dose and this affects the dosimetry parameters of the target volume coverage. It was observed that the dose distribution changes with the technique in use and in the case of the inverse IMRT for amplitude of oscillation of 1.22 cm, less than 90% of points were approved in the gamma index evaluation

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2018-02-07T13:06:22Z No. of bitstreams: 1 ANA CAROLINA MASSAROTTO.pdf: 924874 bytes, checksum: 09a1ac55208a09df27e003db121d89d6 (MD5) / Made available in DSpace on 2018-02-07T13:06:22Z (GMT). No. of bitstreams: 1 ANA CAROLINA MASSAROTTO.pdf: 924874 bytes, checksum: 09a1ac55208a09df27e003db121d89d6 (MD5) Previous issue date: 2017-12-15 / Breast cancer is the second most common type of cancer in the world, and the most common among women, affecting men who account for 1% of all cases of the disease. The risk factors of the disease are related to age, endocrine / reproductive history, behavioral / environmental factors, and genetic / hereditary factors. The prognosis of the disease depends on its extension (staging), with greater curative potential when diagnosed at baseline.Among the types of treatment of breast cancer stand out surgery, radiotherapy, chemotherapy, hormone therapy and biological therapy. It is highlighted in the radiotherapy modality, Brachytherapy, which is the application of radiation in a more precise and localized way in the tumor. In this work we will focus on high-grade interstitial brachytherapy dose rate, partial and accelerated breast irradiation (IPAM), which has been shown to have better esthetic results, lower risk of injury from radiation from healthy adjacent tissues, shorter duration of treatment, and low recurrence rates. This is a retrospective, longitudinal, descriptive, analytical study, with a review of medical records of patients diagnosed with breast cancer, stages 0-I-II, between the years 2004 and 2013 who received IPAM using brachytherapy after conservative surgery of the breast at the Radium Institute of Campinas, Campinas-SP, Brazil.This work aims to report and evaluate the viability, acute and chronic toxicity, aesthetic aspects, efficacy and factors related to the use of Partial and Accelerated Breast Irradiation with high dose rate brachytherapy for patients with early stage of breast cancer. In addition to assessing recurrence rates and local control of the disease. / O c?ncer de mama ? o segundo tipo de c?ncer mais comum no mundo,e o mais frequente entre as mulheres, acometendo tamb?m homens que representam 1% do total de casos da doen?a. Os fatores de risco da doen?a est?o relacionados com idade, fatores end?crinos/hist?ria reprodutiva, fatores comportamentais/ambientais e fatores gen?ticos/heredit?rios. O progn?stico da doen?a depende da sua extens?o (estadiamento), com maior potencial curativo quando diagnosticada no in?cio. Entre os tipos de tratamento do c?ncer de mama destacam-se a cirurgia, radioterapia , quimioterapia, hormonioterapia e terapia biol?gica. Apresenta destaque na modalidade radioter?pica, a Braquiterapia, que trata-se da aplica??o de radia??o de forma mais precisa e localizada no tumor. Neste trabalho teremos como enfoque a braquiterapia intersticial de alta taxa de dose, irradia??o parcial e acelerada da mama (IPAM), que vem apresentando melhores resultados est?ticos, menor risco de les?o pela radia??o de tecidos adjacentes saud?veis, menor dura??o do tratamento, e baixas taxas de recorr?ncia. Trata-se de um estudo retrospectivo, longitudinal, descritivo, anal?tico, com revis?o de prontu?rios de pacientes com diagn?stico de c?ncer de mama, est?dios 0-I-II , entre os anos de 2004 e 2013 que receberam IPAM utilizando braquiterapia ap?s a cirurgia conservadora da mama no Instituto do Radium de Campinas, Campinas-SP, Brasil. Tal trabalho objetiva relatar e avaliar a viabilidade, toxicidade aguda e cr?nica, aspectos est?ticos, efic?cia e fatores relacionados com utiliza??o de Irradia??o Parcial e Acelerada da Mama com braquiterapia de alta taxa de dose para pacientes com est?dio inicial de c?ncer de mama. Al?m de avaliar as taxas de recorr?ncia e controle local da doen?a.