Savino Cilla1, Carmela Romano2, Gabriella Macchia3, Mariangela Boccardi3, Livia P De Vivo3, Vittoria E Morabito2, Milly Buwenge4, Lidia Strigari5, Luca Indovina6, Vincenzo Valentini6,7, Francesco Deodato3,7, Alessio G Morganti4,8. 1. Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy. savinocilla@gmail.com. 2. Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy. 3. Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy. 4. Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 5. Medical Physics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. 6. Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. 7. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy. 8. DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy.
Abstract
PURPOSE: To develop an automated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT). MATERIALS AND METHODS: Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with a VMAT semi-arc beam. Open fields were setup to include the whole breast with a 2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal-Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. RESULTS: No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min. CONCLUSIONS: HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.
PURPOSE: To develop an automated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT). MATERIALS AND METHODS: Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with a VMAT semi-arc beam. Open fields were setup to include the whole breast with a 2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal-Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. RESULTS: No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min. CONCLUSIONS: HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.
Authors: Yerko O Borghero; Mohammad Salehpour; Marsha D McNeese; Marilyn Stovall; Susan A Smith; Jennifer Johnson; George H Perkins; Eric A Strom; Julia L Oh; Steven M Kirsner; Wendy A Woodward; Tse-Kuan Yu; Thomas A Buchholz Journal: Radiother Oncol Date: 2006-12-08 Impact factor: 6.280
Authors: Stefanie Corradini; Hendrik Ballhausen; Helmut Weingandt; Philipp Freislederer; Stephan Schönecker; Maximilian Niyazi; Cristoforo Simonetto; Markus Eidemüller; Ute Ganswindt; Claus Belka Journal: Strahlenther Onkol Date: 2017-09-15 Impact factor: 3.621
Authors: J M Immink; H Putter; H Bartelink; J S Cardoso; M J Cardoso; M H V van der Hulst-Vijgen; E M Noordijk; P M Poortmans; C C Rodenhuis; H Struikmans Journal: Ann Oncol Date: 2012-04-12 Impact factor: 32.976
Authors: Harry Bartelink; Jean-Claude Horiot; Philip M Poortmans; Henk Struikmans; Walter Van den Bogaert; Alain Fourquet; Jos J Jager; Willem J Hoogenraad; S Bing Oei; Carla C Wárlám-Rodenhuis; Marianne Pierart; Laurence Collette Journal: J Clin Oncol Date: 2007-06-18 Impact factor: 44.544
Authors: Mariana Guerrero; X Allen Li; Matthew A Earl; Mehrdad Sarfaraz; Edward Kiggundu Journal: Int J Radiat Oncol Biol Phys Date: 2004-08-01 Impact factor: 7.038
Authors: Bernard Fisher; Stewart Anderson; John Bryant; Richard G Margolese; Melvin Deutsch; Edwin R Fisher; Jong-Hyeon Jeong; Norman Wolmark Journal: N Engl J Med Date: 2002-10-17 Impact factor: 91.245
Authors: Moamen M O M Aly; Gerhard Glatting; Lennart Jahnke; Frederik Wenz; Yasser Abo-Madyan Journal: Radiat Oncol Date: 2015-07-09 Impact factor: 3.481