Discussion
pneumonitis, tumors, RP, breast cancer
PNEUMONITIS, INVASIVE BREAST CANCER, BREAST CANCERS, BREAST CANCER, COMPLICATION, TUMORS
In this study, we developed a deep-learning-based lead wire marker detection model. The model resulted in high AP and AR in both the internal and external testing cohorts. The proposed organ feature built upon the automatically detected lead wire marker correlated with the lung V20 in patients with early invasive breast cancer who received breast-conserving surgery.The lung is a critical dose-limiting organ during adjuvant radiotherapy in breast cancer, with radiation pneumonitis being a common complication. Ipsilateral lung V20 has been widely used as a critical dosimetric indicator for RP in breast cancer. It is reported to be positively related to the incidence of RP [DL in predicting irradiation dose has been explored in various tumors and has shown promising results [The relative variability of the clinical target volume of breast cancer radiotherapy is small, and radiotherapy is mainly delivered by tangent beams. Therefore, the radiation dose to the ipsilateral lung may be correlated with the patient's chest geometry. In breast cancer, a dose prediction model was developed based on DL and was demonstrated to accurately predict patient-specific doses. Ahn et al. conducted a study on the prediction of dose volume histogram using 50 volumetric modulated arc therapy plans of left-sided breast cancer patients with a prescription of 4320 cGy in 16 fractions. The mean absolute error and one standard deviation between the clinical and DL dose prediction models were − 1.16 ± 2.58% for the ipsilateral lung [Importantly, the aforementioned three studies exclusively focused on left-sided breast cancers, which introduces potential sampling bias concerns. In contrast, our study encompassed patients irrespective of the lesion location, ensuring a more comprehensive evaluation. Furthermore, irradiation to the whole breast with a boost to tumorbed is the standard treatment for invasive breast cancer who received breast-conserving surgery. However, the previous studies only evaluated models without a boost dose. Different from these studies, patients tested in our model were prescribed a 50 Gy to whole breast and a boost of 10 Gy to tumorbed which were more fit for clinical practice. Besides, the mentioned studies consisted of single-center data. There may be confounding factors. To our knowledge, our study was the first multicenter study with real-world external validation, and the sample size was larger than previously reported. A total of 64 patients formed the testing cohort, including 22 patients in the external testing cohort. In addition, previous articles focused on developing different prediction models to help reduce the time required to produce clinical plans. Our investigation attempted to identify a personal geometric feature that could predict lung V20 and further select more appropriate irradiation techniques for individual patients.Our study had several limitations. First, this pilot study only evaluated the lung irradiation dose. Other organs at risk and more dose parameters could be further investigated. Second, only the correlation coefficient was analyzed in this study. We are working on the multiparameter prediction model of the lung irradiation dose.