Dosimetric comparison study of intensity modulated radiotherapy technique (IMRT/VMAT) with three dimensional field-in-field tangents for left breast cancer irradiation

Alaa Abou Khadra; Mohamed Abouelfetouh; Abdelazim Hussein; Yasser Rashed

doi:10.53730/ijhs.v6nS8.13584

Authors

Alaa Abou Khadra
Alaa.ahmed.h2018@gmail.com
Faculty of Medicine, Clinical Oncology and Nuclear Medicine Department, Medical Physics Unit, Menoufia University, Shibin El-Koom, Egypt
Mohamed Abouelfetouh Faculty of Medicine, Clinical Oncology and Nuclear Medicine Department, Menoufia University, Shibin El-Koom, Egypt
Abdelazim Hussein Faculty of Science, Physics Department, Menoufia University, Shibin El-Koom, Egypt
Yasser Rashed Faculty of Medicine, Clinical Oncology and Nuclear Medicine Department, Medical Physics Unit, Menoufia University, Shibin El-Koom, Egypt

Keywords:

left-sided breast cancer, VMAT, IMRT, 3D-CRT

Abstract

Purpose: To retrospectively compare dosimetrically three dimensional field-in-field tangents (3D F-in-F), Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) left breast irradiation plans. Materials and Methods: A total of 30 patients were included in this study. All patients diagnosed with early–stage malignant neoplasm of the breast prior to treatment. Patients were contoured with three main PTV-Chest wall (PTV_CW), PTV-Axilla (PTV_AX), and PTV-IMC (PTV_IMC). Monaco treatment planning system was used to create the plans. For each patient, three treatment plans were created; three dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). The dose coverage of PTVs and the dose constraints of Organ-at-Risks (OARs) were compared and analyzed. Results: The dose objective to cover the PTVs; PTV_CW, PTV_AX, and PTV_IMC were V40.43Gy (95%) ≥ 95%, V38.3Gy (90%) ≥ 95%, and V34.05Gy (80%) ≥ 95% respectively. Comparing the dose coverage of PTV_CW between 3D-CRT and VMAT, resulted in a significant difference (P= 0.003) and the VMAT was superior for the coverage of target than 3D-CRT. For PTV_AX, the coverage was 45.80±0.55, 45.96±0.73, and 45.58±0.63 for 3D-CRT, IMRT, and VMAT respectively. For PTV_IMC, the coverage was 45.80±0.55, 45.96±0.73, and 45.58±0.63 for 3D-CRT, IMRT, and VMAT respectively.

Downloads

Download data is not yet available.

References

Abo-Madyan Y, Aziz MH, Aly MM, Schneider F, Sperk E, Clausen S, Giordano FA, Herskind C, Steil V, Wenz F, Glatting G. Second cancer risk after 3d-crt, imrt and vmat for breast cancer. Radiother Oncol. 2014;110:471–6.

Amitpal Singh Saini, Catherine S. Hwang, Matthew C. Biagioli, Indra J. Das. Evaluation of sparing organs at risk (OARs) in left-breast irradiation in the supine and prone positions and with deep inspiration breath-hold. J Appl Clin Med Phys 2018; 19:4:195–204.

Behnam GHADIMI, Nasrollah JABBARI, Laya KARIMKHANI, Kamal MOSTAFANEZHAD. Field-in-Field Technique Improves the Dosimetric Outcome of Treatment Plans Compared with the Three-Dimensional Conformal Radiation Therapy for Esophageal Cancer Radiotherapy. International Journal of Hematology and Oncology, Number: 2 Volume: 28 Year: 2018.

Brunt, et al. "Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial." The Lancet 395, 2020: , no. 10237 : 1613-1626.

Buijsen J, et al. Prone breast irradiation for pendulous breasts. Radiother Oncol. 2007;82:337–340.

CE, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet. 2017;390(10099):1048–60. https://doi.org/10.1016/S0140-6736(17)31145-5.

Clarke M, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366: 2087–2106.

Cozzi L, et al. Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer. Radiat Oncol. 2017;12:200. https://doi.org/10.1186/s13014-017-0935-4.

Darby SC, McGale P, Taylor CW, Peto R. Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300,000 women in US SEER cancer registries. Lancet Oncol. 005;6: 557–565.

Ferrari A, Ivaldi G, et al. Prone breast radiotherapy in a patient with early stage breast cancer and a large pendulous breast. Tumori. 2009;95:394–397.

Gentile MS, Usman AA, Neuschler EI, Sathiaseelan V, Hayes JP, Small Jr W. Contouring guidelines for the axillary lymph nodes for the delivery of radiation therapy in breast cancer: Evaluation of the RTOG Breast Cancer Atlas. Int J Radiat Oncol Biol Phys 2015; 93: 257-265.

Henson KE, McGale P, Taylor C, Darby SC. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer. 2013;108: 179–182.

Hidekazu Tanaka, Masaya Ito, Takahiro Yamaguchi, Kae Hachiya, Takahiko Yajima, Masashi Kitahara, Katsuya Matsuyama, Satoshi Goshima,1 Manabu Futamura, and Masayuki Matsuo. High Tangent Radiation Therapy with Field-in-Field Technique for Breast Cancer. Breast Cancer (Auckl). 2017; 11

Kirby AM, Evans PM, Donovan EM, Convery HM, Haviland JS, Yarnold JR. Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother Oncol. 2010;96:178–184.

Korreman SS, Pedersen AN, Aarup LR, Nottrup TJ, Specht L, Nystrom H. Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiotherapy for breast cancer. Int J Radiat Oncol Biol Phys. 2006;65:1375–1380.

Korreman SS, Pedersen AN, Nottrup TJ, Specht L, Nystrom H. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique. Radiother Oncol. 2005;76:311–318.

Krug D, Baumann R, Budach W, Duma M. N, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Piroth M, D, Sedlmayer F, Souchon R, Wenz F, Sauer R: Commercially available gene expression assays as predictive tools for adjuvant radiotherapy? A critical review. Breast Care (Basel). 2020;15(2).

Kylie L Dundas, Elise M Pogson, Vikneswary Batumalai, Miriam M Boxer, Mei Ling Yap, Geoff P Delaney, Peter Metcalfe and Lois Holloway. Australian survey on current practices for breast radiotherapy. Journal of Medical Imaging and Radiation Oncology; 2015.

Laugaard Lorenzen E, Christian Rehammar J, Jensen MB, Ewertz M, Brink C. Radiation-induced risk of ischemic heart disease following breast cancer radiotherapy in Denmark, 1977-2005. Radiother Oncol. 2020;152: 103–10. https://doi.org/10.1016/j.radonc.2020.08.007.

Lawrence B. Marks, Ellen D. Yorke, Andrew Jackson, Randall K. Ten Haken, Louis S. Constine, Avraham Eisbruch, Søren M. Bentzen, Jiho Nam, and Joseph O. Deasy. Use of normal tissue complication probability models in the clinic. Int. J. Radiation Oncology Biol. Phys., Vol. 76, No. 3, Supplement, pp. S10–S19, 2010.

Lymberis SC, et al. Prospective assessment of optimal individual position (prone versus supine) for breast radiotherapy: volumetric and dosimetric correlations in 100 patients. Int J Radiat Oncol Biol Phys. 2012;84:902–909.

M.S. Thomsen a,⇑, M. Berg b, S. Zimmermann c, C.M. Lutz a, S. Makocki d, I. Jensen e, M.H.B. Hjelstuen f, S. Pensold g, M.P. Hasler h, M.-B. Jensen i, B.V. Offersen. Dose constraints for whole breast radiation therapy based on the quality assessment of treatment plans in the randomised Danish breast cancer group (DBCG) HYPO trial. Clinical and Translational Radiation Oncology. 2021 ; 28; 118–123.

Mukesh MB, et al. Randomized controlled trial of intensity-modulated radiotherapy for early breast cancer: 5-year results confirm superior overall cosmesis. J Clin Oncol. 2013;31(36):4488–95. https://doi.org/10.1200/JCO.2013.49.7842.

Muren LP, Maurstad G, Hafslund R, Anker G, Dahl O. Cardiac and pulmonary doses and complication probabilities in standard and conformal tangential irradiation in conservative management of breast cancer. Radiother Oncol. 2002;62:173–183.

Offersen BV, et al. Hypofractionated versus standard fractionated radio-therapy in patients with early breast cancer or ductal carcinoma in situ in a randomized phase III trial: the DBCG HYPO trial. J Clin Oncol. 2020;38(31):3615–25. https://doi.org/10.1200/JCO.20.01363.

Orit Kaidar-Person and Icro Meattini Philip Poortmans. Breast Cancer Radiation Therapy. A Practical Guide for Technical Applications. Springer Nature Switzerland AG, 2022.

Philippe Giraud and Annie Houle. Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits. Hindawi Publishing Corporation ISRN Pulmonology Volume 2013, Article ID 519602.

Rajamanickam Baskar, Kuo Ann Lee, Richard Yeo, and Kheng-Wei Yeoh. Cancer and Radiation Therapy: Current Advances and Future Directions. Int J Med Sci. 2012; 9(3): 193–199.

S WEBB. The physical basis of IMRT and inverse planning. Review article. The British Journal of Radiology, 2003;76, 678–689.

Schubert LK, et al. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiother Oncol. 2011;100:241–246.

Taylor CW, et al. Cardiac dose from tangential breast cancer radiotherapy in the year 2006. Int J Radiat Oncol Biol Phys. 2008;72: 501–507.

Thomsen MS, Berg M, Zimmermann S, Lutz CM, Makocki S, Jensen I, Hjelstuen MHB, Pensold S, Hasler MP, Jensen M-B, Offersen BV (2021) Dose constraints for whole breast radiation therapy based on the quality assessment of treatment plans in the ran¬domised Danish breast cancer group (DBCG) HYPO trial. Clinical and Translational Radiation Oncology 28118–123 https://doi.org/10.1016/j.ctro.2021.03.009.

White J, Tai A, Arthur D, Buchholz T, MacDonald S, Marks L, Pierce L, Recht A, Rabinovitch R, Taghian A, Vicini F, Woodward W, Li XL. Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions. Available at: Click Here. (Accessed: July 2020).

Wong JW, et al. The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys .1999 44:911–9. doi:10.1016/ S0360-3016(99)00056-5.

Yang-Kyun Park, Tae-geun Son, Hwiyoung Kim, Jaegi Lee, Wonmo Sung, II Han Kim, Kunwoo Lee, Young-bong Bang, and Sung-Joon Ye. Development of real-time motion verification system using in-room optical images for respiratory-gated radiotherapy. Journal of Applied Clinical Medical Physics, Vol. 14, No. 5, 2013

Yin Y, et al. Dosimetric research on intensity-modulated arc radiotherapy planning for left breast cancer after breast preservation surgery. Med Dosim. 2012;37:287–292.