BACKGROUND: For breast cancer patients, radiotherapy increases the risk of cardiac disease. Conventional three-dimensional conformal radiotherapy (3D-CRT) in deep inspiration breath-hold (DIBH) has demonstrated substantial reduction in cardiac doses as compared to treatment in free breathing. The purpose of this treatment planning study is to investigate if dynamic techniques in combination with DIBH could improve the quality of the treatment plans and further reduce the doses to the heart and other organs at risk for early-stage breast cancer patients. MATERIAL AND METHODS: CT series in DIBH of 16 patients from a previous study were used. For each patient, treatment plans were generated with the following three techniques: 3D-CRT, tangential intensity-modulated radiotherapy (tIMRT) and volumetric modulated arc therapy with partial arcs (pVMAT). The treatment planning was performed focusing on planning target volume (PTV) coverage, V95% >95%. Dose-volume histograms were calculated and compared. Doses to the heart, left anterior descending (LAD) coronary artery, ipsilateral and contralateral lung as well as the contralateral breast (CB) were assessed. RESULTS: All plans fulfilled the criterion on PTV coverage. Compared to 3D-CRT, the dynamic plans obtained better dose homogeneity and conformity. The mean heart dose was similar for 3D-CRT and tIMRT, 1.3 and 1.1 Gy, respectively, but significantly higher for pVMAT, 1.6 Gy. The median V25 Gy to the heart was 0% for all techniques. The LAD doses were generally lower with the dynamic techniques. The mean doses to the ipsi- and contralateral lung and CB were similar with tIMRT and 3D-CRT but significantly higher with pVMAT. V20 Gy to the ipsilateral lung was significantly lower with tIMRT compared to 3D-CRT. CONCLUSION: tIMRT and 3D-CRT with DIBH are better techniques for sparing heart tissue and other organs at risk without compromising target coverage in early-stage breast cancer irradiation compared to VMAT.
BACKGROUND: For breast cancerpatients, radiotherapy increases the risk of cardiac disease. Conventional three-dimensional conformal radiotherapy (3D-CRT) in deep inspiration breath-hold (DIBH) has demonstrated substantial reduction in cardiac doses as compared to treatment in free breathing. The purpose of this treatment planning study is to investigate if dynamic techniques in combination with DIBH could improve the quality of the treatment plans and further reduce the doses to the heart and other organs at risk for early-stage breast cancerpatients. MATERIAL AND METHODS: CT series in DIBH of 16 patients from a previous study were used. For each patient, treatment plans were generated with the following three techniques: 3D-CRT, tangential intensity-modulated radiotherapy (tIMRT) and volumetric modulated arc therapy with partial arcs (pVMAT). The treatment planning was performed focusing on planning target volume (PTV) coverage, V95% >95%. Dose-volume histograms were calculated and compared. Doses to the heart, left anterior descending (LAD) coronary artery, ipsilateral and contralateral lung as well as the contralateral breast (CB) were assessed. RESULTS: All plans fulfilled the criterion on PTV coverage. Compared to 3D-CRT, the dynamic plans obtained better dose homogeneity and conformity. The mean heart dose was similar for 3D-CRT and tIMRT, 1.3 and 1.1 Gy, respectively, but significantly higher for pVMAT, 1.6 Gy. The median V25 Gy to the heart was 0% for all techniques. The LAD doses were generally lower with the dynamic techniques. The mean doses to the ipsi- and contralateral lung and CB were similar with tIMRT and 3D-CRT but significantly higher with pVMAT. V20 Gy to the ipsilateral lung was significantly lower with tIMRT compared to 3D-CRT. CONCLUSION: tIMRT and 3D-CRT with DIBH are better techniques for sparing heart tissue and other organs at risk without compromising target coverage in early-stage breast cancer irradiation compared to VMAT.
Authors: Brock Lamprecht; Erika Muscat; Amanda Harding; Kate Howe; Elizabeth Brown; Tamara Barry; G Tao Mai; Margot Lehman; Anne Bernard; Catriona Hargrave; Jennifer Harvey Journal: J Med Radiat Sci Date: 2021-08-25
Authors: Marc Vogel; Jonas Gade; Bernd Timm; Michaela Schürmann; Hendrik Auerbach; Frank Nüsken; Christian Rübe; Patrick Melchior; Yvonne Dzierma Journal: Front Oncol Date: 2022-07-27 Impact factor: 5.738
Authors: María Adela Poitevin-Chacón; Rubí Ramos-Prudencio; José Alfonso Rumoroso-García; Alejandro Rodríguez-Laguna; Julio Cesar Martínez-Robledo Journal: Rep Pract Oncol Radiother Date: 2019-12-19
Authors: M S Thomsen; M Berg; S Zimmermann; C M Lutz; S Makocki; I Jensen; M H B Hjelstuen; S Pensold; M P Hasler; M-B Jensen; B V Offersen Journal: Clin Transl Radiat Oncol Date: 2021-04-06