Dosimetric comparison of three?dimensional conformal radiation therapy, intensity?modulated radiation therapy, and volumetric?modulated arc therapy for free?breathing whole?breast irradiation: A planning study
Loading...
Date
2023-06
Journal Title
Journal ISSN
Volume Title
Publisher
Wolters Kluwer - Medknow
Abstract
Background: Currently, recommended heart dose constraints are difficult to meet in whole?breast irradiation (WBI) for left?sided breast cancer patients, who cannot be treated with the deep inspiration breath hold. We performed a radiotherapy planning study to establish if the use of intensity?modulated radiation therapy (IMRT) or volumetric?modulated arc therapy (VMAT) allows for better sparing of the heart and its subvolumes than the three?dimensional conformal radiation therapy (3D?CRT), and how these attempts affect the dose delivered to the other organs. Methods: A total of 17 left?sided and 10 right?sided consecutive patients treated with free?breathing WBI were retrospectively included. The 3D?CRT, IMRT, and VMAT plans were generated. Several dose杤olume parameters and plan quality indices were compared, separately for the left? and right?sided plans. Results: All the techniques fulfilled the planning objectives. In the left?sided plans, there was no heart or left ventricle dose reduction with IMRT, nor with VMAT; the maximum dose in the left anterior descending coronary artery was reduced with VMAT (P = 0.005); V5 for the contralateral breast, contralateral lung, and total?body increased markedly in VMAT, and for the ipsilateral lung (V5IL) also in IMRT, compared with 3D?CRT (P < 0.001). In the right?sided plans, the V5 values, except for V5IL, did not differ between the three techniques. Conclusions: IMRT and VMAT had a limited heart?sparing benefit in the left?sided free?breathing WBI, at the cost of increased low?dose volumes, measured by V5. The low?dose volumes are not increased by IMRT or VMAT in the right?sided WBI, where heart sparing is not a problem, but the attempts to reduce cardiac doses in the left?sided WBI increase them.
Description
Keywords
Breast neoplasms, breath holding, conformal radiotherapy, heart, intensity?modulated, radiotherapy
Citation
Czeremszynska Beata, Socha Joanna, Rygielska Anna, Walewska Agnieszka, Gabor Marta, Pruska?Pich Dorota, Osowiecka Karolina, Kepka Lucyna. Dosimetric comparison of three?dimensional conformal radiation therapy, intensity?modulated radiation therapy, and volumetric?modulated arc therapy for free?breathing whole?breast irradiation: A planning study. Indian Journal of Cancer . 2023 Jun; 60(2): 258-265