Tuomas Koivumäki1, Antonella Fogliata2, Michele Zeverino3, Eeva Boman4, Joanna Sierpowska5, Raphaël Moeckli3, Véronique Vallet3, Luca Cozzi6, Janne Heikkilä7, Anssi Väänänen7, Kristiina Vuolukka7, Saara Sillanmäki8, Jan Seppälä7. 1. Cancer Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Finland; Department of Radiotherapy, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland. Electronic address: tuomas.koivumaki@ksshp.fi. 2. Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, via Manzoni 56, 20089 Milan-Rozzano, Italy. 3. Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland. 4. Department of Oncology, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland; Department of Medical Physics, Tampere University Hospital, PO BOX 2000, FI-33521 Tampere, Finland; Department of Radiation Oncology, Wellington Blood and Cancer Centre, Wellington Hospital, Wellington 6242, New Zealand. 5. Radiotherapy Unit, North Carelia Central Hospital, Tikkamäentie 16, 80210 Joensuu, Finland. 6. Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, via Manzoni 56, 20089 Milan-Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, via Manzoni 113, 20089 Milan-Rozzano, Italy. 7. Cancer Center, Kuopio University Hospital, PO Box 100, 70029 KYS, Finland. 8. Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO Box 100, 70029 KYS, Finland.
Abstract
PURPOSE: The dosimetric differences between four radiation therapy techniques for left sided whole breast irradiation were evaluated side by side in the same patient population. METHODS: Radiotherapy treatment plans were retrospectively created with Accuray TomoDirect (TD), Elekta Volumetric Modulated Arc Therapy (E-VMAT), Varian RapidArc (RA) and Field-in-field (FinF) technique for 20 patients, who had received left breast irradiation during deep-inspiration breath-hold. Dose characteristics of planning target volume and organs at risk were compared. RESULTS: The E-VMAT, TD and RA treatment plans had higher target coverage (V95%) than FinF plans (97.7-98.3% vs. 96.6%). The low-dose spillage to contralateral breast and lung was smaller with FinF and TD (mean 0.1 and 0.3 Gy) compared to E-VMAT and RA (mean 0.6 and 0.9 Gy). E-VMAT, RA and TD techniques were more effective than FinF in sparing left anterior descending artery (mean 4.0, 4.2 and 4.7 Gy vs. 6.1 Gy, respectively). CONCLUSIONS: In whole breast irradiation TD, E-VMAT and RA plans generated in this study achieved higher dose coverage and sparing of organs from the high dose in the vicinity of the PTV. The advantage of calculated FinF plans is the lowest dose on contralateral organs. The choice of the technique used should be weighted by each institution taking into account the dose characteristics of each technique and its fit with patient anatomy bearing in mind the increased workload of using modulated techniques and the increased beam on time.
PURPOSE: The dosimetric differences between four radiation therapy techniques for left sided whole breast irradiation were evaluated side by side in the same patient population. METHODS: Radiotherapy treatment plans were retrospectively created with Accuray TomoDirect (TD), Elekta Volumetric Modulated Arc Therapy (E-VMAT), Varian RapidArc (RA) and Field-in-field (FinF) technique for 20 patients, who had received left breast irradiation during deep-inspiration breath-hold. Dose characteristics of planning target volume and organs at risk were compared. RESULTS: The E-VMAT, TD and RA treatment plans had higher target coverage (V95%) than FinF plans (97.7-98.3% vs. 96.6%). The low-dose spillage to contralateral breast and lung was smaller with FinF and TD (mean 0.1 and 0.3 Gy) compared to E-VMAT and RA (mean 0.6 and 0.9 Gy). E-VMAT, RA and TD techniques were more effective than FinF in sparing left anterior descending artery (mean 4.0, 4.2 and 4.7 Gy vs. 6.1 Gy, respectively). CONCLUSIONS: In whole breast irradiation TD, E-VMAT and RA plans generated in this study achieved higher dose coverage and sparing of organs from the high dose in the vicinity of the PTV. The advantage of calculated FinF plans is the lowest dose on contralateral organs. The choice of the technique used should be weighted by each institution taking into account the dose characteristics of each technique and its fit with patient anatomy bearing in mind the increased workload of using modulated techniques and the increased beam on time.
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