An in silico comparative dosimetric study of postmastectomy locoregional irradiation using intensity-modulated vs 3-dimensional conventional radiotherapy

Khullar, Pooja; Garg, Chanchal; Sinha, Sudha; Kaur, Inderjit; Datta, Niloy Ranjan

doi:10.1016/j.meddos.2017.12.001

Cited by 3 publications

(3 citation statements)

References 26 publications

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“…A study done by Garg and Kumar has shown that V 25 to the heart with 3D-CRT was 14.13 and IMRT 27.74 Gy [12]. In a dosimetric study comparing post-mastectomy IMRT and 3D-CRT, Khullar et al showed that except for the mean dose to the opposite breast, the compliance to DVH constraints for PTV and OARs was significantly improved with IMRT [13]. A systematic review and metaanalysis by Taylor et al showed that in left-sided breast cancer, the mean heart dose averaged over 149 studies from 28 countries was 5.4 Gy [11].…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Ahmad¹,

Das²,

Kharade³

et al. 2022

Cureus

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IntroductionRecently, the one-week hypofractionated radiotherapy regimen (26 Gy in 5 fractions) for adjuvant breast radiotherapy has been shown to be non-inferior to other hypofractionated regimens (15-16 fractions). The aim of the present dosimetric study is to compare Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (VMAT) and 3D Conformal Radiotherapy (3D-CRT) for a one-week hypofractionated radiotherapy regimen (26 Gy in 5 fractions) for adjuvant breast radiotherapy. MethodsA total of 30 patients with histologically proven invasive carcinoma of the breast after breast conservation surgery (BCS) or modified radical mastectomy (MRM) were considered for in silico planning study. The dose prescription used was 26 Gy in 5 fractions as used in the FAST Forward protocol. Targets were contoured according to standard guidelines. The heart, ipsilateral lung, and contralateral breast were contoured as organs at risk. ResultsPlanning Target Volume (PTV) coverage: For IMRT, VMAT and 3D-CRT, respectively, the volumes that received at least 95% of the prescription dose (V 95 ) were 95.7 ± 2.12, 92.47 ± 3.83, 90.87 ± 5.13; mean PTV doses (D mean ) were 26.1 ± 0.6, 25.7 ± 0.7, and 28 ± 4.39 (3D-CRT has higher D mean compared to other techniques). Maximum PTV doses (D max ) were 28.23 ± 0.72, 28.73 ± 0.64, and 29.8 ± 1.03. IMRT had a better V 95 coverage and conformity index.Organs At Risk (OARs): The volumes that received at least 25% of the prescription dose (V 25 ) of the heart were 3.41 ± 4.7, 1.8 ± 2.02 and 4.3 ± 6.98 in IMRT, VMAT and 3D-CRT, respectively. The volumetric (V 25 ) comparison of heart dose in left-sided breast cancer was significantly different between VMAT and 3D-CRT (p=0.04, Wilcoxon signed-rank test). The volume that received at least 5% of the prescription dose (V 5 ) was less than 25% in the 3D-CRT plan (12.55).

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Section: Discussionmentioning

confidence: 99%

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Ahmad¹,

Das²,

Kharade³

et al. 2022

Cureus

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“…No clinical studies comparing outcomes in IMRT and 3DCRT have been reported from India. Several dosimetric studies have examined the feasibility of using volumetric modulated arc therapy (VMAT) instead of tangents and have reported better coverage of the breast/chest wall target volume 14 15 . Of these, an in silico trial reported a significant increase in the contralateral breast dose with the use of these techniques 14 .…”

Section: Technological Advancesmentioning

confidence: 99%

Adjuvant radiation therapy in breast cancer: Recent advances & Indian data

Chakraborty

Chatterjee

2021

Indian J Med Res

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“…To achieve individualized radiotherapy, treatment planning and long-term toxicity reaction in each patient should also be taken seriously [6][7][8][9][10][11][12][13]. Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) have been increasingly used to improve plan quality for PMRT and shown to achieve better conformity and homogeneity of PTV, but more scattering doses are obtained in critical organs especially for ipsilateral lung and heart [14][15][16][17][18]. While many studies have discussed the bene t of IMRT and VMAT for PMRT, the e ciency of IMRT has been reported to show more monitor units (MUs) and longer delivery time [19,20].…”

Section: Introductionmentioning

confidence: 99%

An Innovative VMAT Technique for Left-sided Breast Cancer Patients With Postmastectomy Radiotherapy (PMRT) Evaluated by Ratio of Heart Volume in Tangent Line (RHVTL)

Zhang¹,

Li²,

Peng³

et al. 2021

Preprint

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For patients with left-sided breast cancer (LBC), postmastectomy radiotherapy (PMRT) has been shown to improve the overall survival and many advanced planning techniques was adopted in PMRT. We aim to use an innovative VMAT technique to enhance the conformity of PTV and reduce the scattering dose of surrounding OARs, thereby reducing the long-term toxicity of the heart as well as ipsilateral lung (IL). The study further analyzes the more appropriate treatment planning techniques for personalized LBC patients with PMRT. 35 LBC patients were retrospectively selected undergoing PMRT. The PTV included lymph nodes, chest walls, excluding internal mammary nodes, where 95% of PTV receiving the prescription dose of 50Gy (2Gy/fraction) with three different techniques, VMAT, IMRT, Hybrid VMAT. Furthermore, the ratio of Heart Volume in Tangent line and heart volume (RHVTL) was proposed to evaluate the relative antonymy position between patient's heart and PTV, which hypothetically represents the complexity of treatment planning. The data from this study showed that for LBC patients undergoing PMRT, the CI from VMAT was 0.85 (IMRT and H-VMAT were 0.77 and 0.83), the heart D mean was 502.9cGy (IMRT and H-VMAT were 675.6cGy and 687cGy) and the V20 of IL was 21.3 as the lowest of the three techniques, but the dose of the contralateral breast (CB) and contralateral lung increased noticeably. In H-VMAT and IMRT, the mean heart dose was significantly related to RHVTL, with R-values of 0.911 and 0.892 respectively, while the values in VMAT was 0.613, thus the VMAT technique was relatively unaffected by the difficulty of treatment plan. For RHVTL values exceed than 0.06, the mean heart dose under VMAT technique raised by 98.7cGy compared to the RHVTL value of less than 0.06, but H-VMAT and IMRT increased by 233cGy and 261.58cGy individually. This study illustrates that separated fields and adjacent fields in VMAT technique obtained the optimal conformality and lowest doses of heart in three techniques for LBC with PMRT. Thus, based on the results of our preliminary study, the VMAT technique is highly recommended when RHVTL is exceeded 0.06.

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An in silico comparative dosimetric study of postmastectomy locoregional irradiation using intensity-modulated vs 3-dimensional conventional radiotherapy

Cited by 3 publications

References 26 publications

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Dosimetric Study Comparing 3D Conformal Radiotherapy (3D-CRT), Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in Hypofractionated One-Week Radiotherapy Regimen in Breast Cancer

Adjuvant radiation therapy in breast cancer: Recent advances & Indian data

An Innovative VMAT Technique for Left-sided Breast Cancer Patients With Postmastectomy Radiotherapy (PMRT) Evaluated by Ratio of Heart Volume in Tangent Line (RHVTL)

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