PURPOSE: In order to reduce heart dose, DIBH has become a common practice in left-sided whole breast irradiation. This technique involves a significant strain on patients due to the breath-hold requirements. We hereby investigate the dosimetric and delivery feasibility of using flattening filter free (FFF) energies with electronic tissue compensation (ECOMP) planning technique to reduce the required breath-hold lengths and increase patient compatibility. METHODS: Fifteen left-sided, postlumpectomy patients previously receiving DIBH whole-breast radiotherapy (266cGy x 16fx) were retrospectively planned using ECOMP for both 6X and 6X-FFF. A dosimetric comparison was made between the two plans for each patient using various dosimetric constraints. Delivery feasibility was analyzed by recalculating the 6X ECOMP plan with 6X-FFF without replanning (6X-FFF QA) and delivering both plans for a one-to-one comparison using Gamma analysis. Beam-on times for the 6X and 6X-FFF plans were measured. For all tests, Wilcoxon signed-rank test was used with P < 0.05 as significant. RESULTS: No statistical difference was observed between 6X and 6X-FFF plans for most dosimetric endpoints except contralateral breast Dmax (P = 0.0008) and skin Dmax (p = 0.03) and Dmin (P = 0.01) for which 6X-FFF showed favorable results when compared with 6X. 6X-FFF significantly reduced beam-on times for all patients by 22%-42% (average 32%). All plan QAs passed departmental gamma criteria (10% low-dose threshold, 3%/3mm, >95% passing). CONCLUSION: ECOMP planning with FFF was found feasible for left-sided breast patients with DIBH. Plan quality is comparable, if not better, than plans using flattened beams. FFF ECOMP could significantly reduce beam-on time and required breath-hold lengths thereby increasing patient compatibility for this treatment while offering satisfactory plan quality and delivery accuracy.
PURPOSE: In order to reduce heart dose, DIBH has become a common practice in left-sided whole breast irradiation. This technique involves a significant strain on patients due to the breath-hold requirements. We hereby investigate the dosimetric and delivery feasibility of using flattening filter free (FFF) energies with electronic tissue compensation (ECOMP) planning technique to reduce the required breath-hold lengths and increase patient compatibility. METHODS: Fifteen left-sided, postlumpectomy patients previously receiving DIBH whole-breast radiotherapy (266cGy x 16fx) were retrospectively planned using ECOMP for both 6X and 6X-FFF. A dosimetric comparison was made between the two plans for each patient using various dosimetric constraints. Delivery feasibility was analyzed by recalculating the 6X ECOMP plan with 6X-FFF without replanning (6X-FFF QA) and delivering both plans for a one-to-one comparison using Gamma analysis. Beam-on times for the 6X and 6X-FFF plans were measured. For all tests, Wilcoxon signed-rank test was used with P < 0.05 as significant. RESULTS: No statistical difference was observed between 6X and 6X-FFF plans for most dosimetric endpoints except contralateral breast Dmax (P = 0.0008) and skin Dmax (p = 0.03) and Dmin (P = 0.01) for which 6X-FFF showed favorable results when compared with 6X. 6X-FFF significantly reduced beam-on times for all patients by 22%-42% (average 32%). All plan QAs passed departmental gamma criteria (10% low-dose threshold, 3%/3mm, >95% passing). CONCLUSION:ECOMP planning with FFF was found feasible for left-sided breast patients with DIBH. Plan quality is comparable, if not better, than plans using flattened beams. FFF ECOMP could significantly reduce beam-on time and required breath-hold lengths thereby increasing patient compatibility for this treatment while offering satisfactory plan quality and delivery accuracy.
Authors: Kees H Spruijt; Max Dahele; Johan P Cuijpers; Marloes Jeulink; Derek Rietveld; Ben J Slotman; Wilko F A R Verbakel Journal: Int J Radiat Oncol Biol Phys Date: 2012-06-05 Impact factor: 7.038
Authors: Jimmy J Caudell; Jennifer F De Los Santos; Kimberly S Keene; John B Fiveash; Wenquan Wang; Janice D Carlisle; Richard Popple Journal: Int J Radiat Oncol Biol Phys Date: 2007-08-01 Impact factor: 7.038
Authors: Alex K Bryant; Matthew P Banegas; Maria Elena Martinez; Loren K Mell; James D Murphy Journal: Cancer Epidemiol Biomarkers Prev Date: 2017-01-17 Impact factor: 4.254
Authors: Marilyn Stovall; Susan A Smith; Bryan M Langholz; John D Boice; Roy E Shore; Michael Andersson; Thomas A Buchholz; Marinela Capanu; Leslie Bernstein; Charles F Lynch; Kathleen E Malone; Hoda Anton-Culver; Robert W Haile; Barry S Rosenstein; Anne S Reiner; Duncan C Thomas; Jonine L Bernstein Journal: Int J Radiat Oncol Biol Phys Date: 2008-06-14 Impact factor: 7.038
Authors: Robert Morris; Eric Laugeman; Jessica Hilliard; Imran Zoberi; Ana Heerman; Geoffrey Hugo; Sasa Mutic; Bin Cai Journal: J Appl Clin Med Phys Date: 2019-10-16 Impact factor: 2.102
Authors: Fionnbarr O'Grady; Andrew R Barsky; Shibu Anamalayil; Gary M Freedman; Christopher Kennedy; Bin Cai; Eric Laugeman; Lei Dong; Geoffrey D Hugo; James M Metz; Sasa Mutic; Neil K Taunk; Taoran Li Journal: Adv Radiat Oncol Date: 2019-08-21