O Ashby1, P Bridge2. 1. School of Health Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK. 2. School of Health Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK. Electronic address: pete.bridge@liverpool.ac.uk.
Abstract
INTRODUCTION: Volumetric modulated arc therapy (VMAT) to the breast offers the potential for excellent dose conformity with the possibility of integrating a simultaneous boost within the treatment plan. This technique, however, also delivers a low dose to a large amount of healthy tissue. This systematic review aimed to determine if VMAT offers a clinically significant difference in late effects compared with conformal radiotherapy techniques for breast radiotherapy. METHODS: A systematic review and quality appraisal of primary studies evaluating VMAT to the breast was performed, adopting the PRISMA checklist. RESULTS: A total of 8 studies were included in the review. These demonstrated variation in prescription, outcome measures and cohort characteristics. Findings supported the value of VMAT for reducing organ at risk (OAR) doses but also confirmed the potential secondary cancer risk arising from the low dose bath. Hybrid techniques combining VMAT with tangential intensity modulated or standard radiotherapy showed promise when tangential plans failed to meet objectives. CONCLUSION: VMAT alone does not offer any significant benefit to late effects over conventional for breast radiotherapy due to the creation of a low dose bath, despite improving OAR doses. More research into hybrid techniques is warranted to identify the most appropriate treatment for different patient subgroups and tumour locations. IMPLICATIONS FOR PRACTICE: VMAT may not be the optimal technique for breast radiotherapy; hybrid plans combining tangential IMRT with VMAT are recommended.
INTRODUCTION: Volumetric modulated arc therapy (VMAT) to the breast offers the potential for excellent dose conformity with the possibility of integrating a simultaneous boost within the treatment plan. This technique, however, also delivers a low dose to a large amount of healthy tissue. This systematic review aimed to determine if VMAT offers a clinically significant difference in late effects compared with conformal radiotherapy techniques for breast radiotherapy. METHODS: A systematic review and quality appraisal of primary studies evaluating VMAT to the breast was performed, adopting the PRISMA checklist. RESULTS: A total of 8 studies were included in the review. These demonstrated variation in prescription, outcome measures and cohort characteristics. Findings supported the value of VMAT for reducing organ at risk (OAR) doses but also confirmed the potential secondary cancer risk arising from the low dose bath. Hybrid techniques combining VMAT with tangential intensity modulated or standard radiotherapy showed promise when tangential plans failed to meet objectives. CONCLUSION: VMAT alone does not offer any significant benefit to late effects over conventional for breast radiotherapy due to the creation of a low dose bath, despite improving OAR doses. More research into hybrid techniques is warranted to identify the most appropriate treatment for different patient subgroups and tumour locations. IMPLICATIONS FOR PRACTICE: VMAT may not be the optimal technique for breast radiotherapy; hybrid plans combining tangential IMRT with VMAT are recommended.
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