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      A comparative dosimetric study of left sided breast cancer after breast-conserving surgery treated with VMAT and IMRT

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          Abstract

          Background and purposes

          This study compared VMAT and IMRT plans for intact breast radiotherapy for left sided breast cancer and evaluated the irradiated dose of planning target volume and OARs, especially focusing on heart and coronary artery.

          Materials and methods

          Eleven patients with left sided breast cancer whose breast was relatively smaller (the mean volumes is 296 cc) treated with breast-conserving surgery were prescribed radiotherapy of 50 Gy in 25 fractions using two or four-field step and shoot IMRT (2 or 4-F IMRT), and one or two-arc VMAT (1 or 2-arc VMAT). The 10 Gy electron boost to the tumor bed after delivery of 50 Gy was not included in the analysis. Multiple planning parameters for the PTV and the PRV-OARs were measured and analyzed.

          Results

          Treatment plans generated using VMAT had better PTV homogeneity than the IMRT plans. For the PRV-OARs, the 1-arc VMAT had significantly higher D mean and V5 for left lung and heart, and showed worse D mean for liver, esophagus, spinal cord, contralateral lung and breast. In contrast, the 2-arc VMAT and the 2-F or 4-F IMRT plans showed better results for the PRV-OARs than the 1-arc VMAT. However, for the heart and coronary artery, the 1-arc VMAT showed better V20 and V40 compared with the other plans. Moreover, the 2 F-IMRT had specially advantage on V5 and V20 for heart and V5 for coronary arteries, the 2-F IMRT also showed a greater MU and treatment times. Using the table of quality score to evaluate the plans, we found that 2-F IMRT had the highest scores of 13, followed by the 2-arc VMAT plan (10 points) and 1-arc VMAT plan (8 points), and finally the 4-F IMRT plan (6 points). Moreover, when a dose comparison for heart minus coronary artery was calculated, the V20 and V40 for the rest of heart in all plans were very small and closed, indicating the dose to the coronary artery contributed dramatically to the high dose volumes for the entire heart.

          Conclusions

          Compared to other plans, the 2-F IMRT plan with fewer monitor units and shorter delivery time is an appropriate technique for left sided breast cancer, which achieved good PTV coverage and sparing of organs at risk besides for the heart and coronary artery.

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          Most cited references26

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          Intensity-modulated radiation therapy, protons, and the risk of second cancers.

          Eric Hall (2006)
          Intensity-modulated radiation therapy (IMRT) allows dose to be concentrated in the tumor volume while sparing normal tissues. However, the downside to IMRT is the potential to increase the number of radiation-induced second cancers. The reasons for this potential are more monitor units and, therefore, a larger total-body dose because of leakage radiation and, because IMRT involves more fields, a bigger volume of normal tissue is exposed to lower radiation doses. Intensity-modulated radiation therapy may double the incidence of solid cancers in long-term survivors. This outcome may be acceptable in older patients if balanced by an improvement in local tumor control and reduced acute toxicity. On the other hand, the incidence of second cancers is much higher in children, so that doubling it may not be acceptable. IMRT represents a special case for children for three reasons. First, children are more sensitive to radiation-induced cancer than are adults. Second, radiation scattered from the treatment volume is more important in the small body of the child. Third, the question of genetic susceptibility arises because many childhood cancers involve a germline mutation. The levels of leakage radiation in current Linacs are not inevitable. Leakage can be reduced but at substantial cost. An alternative strategy is to replace X-rays with protons. However, this change is only an advantage if the proton machine employs a pencil scanning beam. Many proton facilities use passive modulation to produce a field of sufficient size, but the use of a scattering foil produces neutrons, which results in an effective dose to the patient higher than that characteristic of IMRT. The benefit of protons is only achieved if a scanning beam is used in which the doses are 10 times lower than with IMRT.
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            A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note.

            I Paddick (2000)
            A conformity index is a measure of how well the volume of a radiosurgical dose distribution conforms to the size and shape of a target volume. Because the success of radiosurgery is related to the extremely conformal irradiation of the target, an accurate method for describing this parameter is important. Existing conformity ratios and indices used in radiosurgery are reviewed and criticized. It will be demonstrated that previously proposed measurements of conformity can, under certain conditions, give false perfect scores. A new conformity index is derived that gives an objective score of conformity for a treatment plan and gives no false scores. An analysis of five different treatment plans is made using both the existing scoring methods and the new conformity index.
            Article 0 comments Cited 199 times – based on 0 reviews     Review now
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              [The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT)].

              N Hodapp (2012)
              Article 0 comments Cited 140 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Guanghui Cheng: +86-0431-84995415 , chengghcjuh@sina.com
                Journal
                Journal ID (nlm-ta): Radiat Oncol
                Journal ID (iso-abbrev): Radiat Oncol
                Title: Radiation Oncology (London, England)
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1748-717X
                Publication date (Electronic): 17 November 2015
                Publication date PMC-release: 17 November 2015
                Publication date Collection: 2015
                Volume: 10
                Electronic Location Identifier: 231
                Affiliations
                [ ]Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, 130033 China
                [ ]Department of Radiation Physics, Elekta China Co. Ltd, Beijing, 100101 China
                Article
                Publisher ID: 531
                DOI: 10.1186/s13014-015-0531-4
                PMC ID: 4650319
                PubMed ID: 26577189
                SO-VID: 6b9a7216-09a5-4403-b4d7-1377a321c889
                Copyright © © Zhao et al. 2015
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 2 February 2015
                Date accepted : 28 October 2015
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: left sided breast cancer,imrt,vmat,dosimetry
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: left sided breast cancer, imrt, vmat, dosimetry

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