Chest wall radiotherapy with volumetric modulated arcs and the potential role of flattening filter free photon beams

Subramaniam, Sudhakar; Thirumalaiswamy, S.; Srinivas, C.; Gandhi, G.A.; Kathirvel, M; Kumar, Kapil; Mallik, S.; Babaiah, M.; Pawar, Y. S.; Clivio, Alessandro; Fogliata, A.; Mancosu, P.; Nicolini, G.; Vanetti, Eugenio; Cozzi, Luca

doi:10.1007/s00066-012-0075-6

Cited by 35 publications

(19 citation statements)

References 27 publications

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“…The treatment of choice is radical surgery with wide safety margins. Because recurrences after surgery alone are observed in 40-80% of cases, RT plays an important role in achieving local control in the primary or postoperative setting [2,4,5,12,14,16,17,18]; indications for RT are primarily unresectable or recurrent tumors and non-in-sano resected tumors. RT has a long tradition in the treatment of desmoids: In 1928, James Ewing, who was the first to propose RT as a treatment option, described that desmoid lesions respond ‘slowly but satisfactorily' to RT [19].…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

et al. 2014

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Background: Desmoids (aggressive fibromatosis) are defined as benign neoplasms of the connective tissue that arise from the deep muscle fascia, aponeurosis, tendons, and scar tissue. Recurrence rates between 40 and 80% were reported after surgery alone. We addressed the impact of radiation therapy (RT) in the management of aggressive fibromatosis. Patients and Methods: A large literature review was performed, and the data was compared with the results of a multicenter study of the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD). Results: This analysis included 52 patients treated with RT. 37 patients received postoperative RT (20 patients after R2 resection and 17 patients after R1 resection). 15 patients received RT alone (6 patients with inoperable primary tumor and 9 patients with inoperable recurrent tumor). In the case of postoperative RT, a median dose of 50 Gy (range 50-60 Gy) was used; for definitive RT, a median dose of 55 Gy (range 55-65 Gy) was used. The local control rate was 79% for the whole group. The median follow-up was 44 month (range 8-62 months). Conclusion: Given the large number of patients, these data show that RT is highly effective in the treatment of desmoid tumors. RT is an attractive alternative to mutilating surgery.

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Section: Discussionmentioning

confidence: 99%

Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

et al. 2014

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“…For C-VMAT plans, 8 as shown in Figure 2A, double ipsilateral partial arcs with a maximum individual length of 240° starting from the mid-stermum were adopted in this study. In clockwise direction (CW), collimator angles were ranged from 15° to 30°, and 6MV photon beams were used.…”

Section: Methodsmentioning

confidence: 99%

“…Nevertheless, the influence of target motion on dose homogeneity and conformity degree will be increased with the increase of beam on times (BOT) for static gantry IMRT. 8,9 Several authors have investigated the application of volumetric-modulated arc therapy (VMAT) for whole or partial breast treatment. 10–14 It is clear that VMAT may improve dosimetry and reduce treatment time compared with multiple-field IMRT.…”

Section: Introductionmentioning

confidence: 99%

Modified Volumetric Modulated Arc Therapy in Left Sided Breast Cancer After Radical Mastectomy With Flattening Filter Free Versus Flattened Beams

Lai

Chen

et al. 2016

Medicine

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Conventional volumetric modulated arc therapy (C-VMAT) for breast cancer after radical mastectomy had its limitation that resulted in larger volumes of normal tissue receiving low doses. We explored whether there was a way to deal with this disadvantage and determined the potential benefit of flattening filter-free (FFF) beams.Twenty patients with breast cancer after radical mastectomy were subjected to 3D conformal radiotherapy (3DCRT) and VMAT treatment planning. For VMAT plans, 3 different designs were employed with RapidArc form: conventional-VMAT plan (C-VMAT), modified-VMAT plan (M-VMAT), and modified-VMAT plan using FFF beams (M-VMAT-F). Plan quality and efficiency were assessed for all plans.For each technique in homogeneity, there were no statistically significant differences. VMAT plans showed superiority compared with 3DCRT in conformity. C-VMAT plans were obviously not only superior to 3DCRT in the medium to high-dose regions (about 15–50 Gy) but also resulted in larger volumes in low-dose regions (about 0–10 Gy). M-VMAT plans were similar to M-VMAT-F. Both of them might significantly reduce the regions of low dose compared with C-VMAT (V5lung: ∼ 11.5%; V5heart: ∼ 23.8%, P < 0.05), even less than 3DCRT in heart irradiation (V2.5heart, 9.4%, P < 0.05). For liver, contralateral breast, and lung irradiation, M-VMAT-F plans were slightly superior to M-VMAT with a reduction of ∼0.08, 0.2, and 0.24 Gy in the respective mean doses (P < 0.05).C-VMAT plans showed superiority compared with 3DCRT, while also resulted in larger volumes of normal tissue receiving low doses. M-VMAT and M-VMAT-F plans might not only reduce the region in the medium to high doses but also have lower volumes in low-dose regions. M-VMAT-F plans were slightly superior compared with M-VMAT due to further contralateral organs sparing.

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“…VMAT has been shown to provide dose distributions comparable to fixed-beam IMRT while improving treatment efficiency for a variety of cases [2-5], including PMRT [6,7]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of volumetric modulated arc therapy for postmastectomy treatment

et al. 2014

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PurposeTo examine the feasibility of volumetric modulated arc therapy (VMAT) for post mastectomy radiotherapy (PMRT).Methods and materialsFifteen PMRT patients previously treated at our clinic with helical tomotherapy (HT) were identified for the study. Planning target volumes (PTV) included the chest wall and regional lymph nodes. A systematic approach to constructing VMAT that met the clinical goals was devised. VMAT plans were then constructed for each patient and compared with HT plans with which they had been treated. The resulting plans were compared on the basis of PTV coverage; dose homogeneity index (DHI) and conformity index (CI); dose to organs at risk (OAR); tumor control probability (TCP), normal tissue complication probability (NTCP) and secondary cancer complication probability (SCCP); and treatment delivery time. Differences were tested for significance using the paired Student’s t-test.ResultsBoth modalities produced clinically acceptable PMRT plans. VMAT plans showed better CI (p < 0.01) and better OAR sparing at low doses than HT plans, particularly at doses less than 5 Gy. On the other hand, HT plans showed better DHI (p < 0.01) and showed better OAR sparing at higher doses. Both modalities achieved nearly 100% tumor control probability and approximately 1% NTCP in the lungs and heart. VMAT showed lower SCCP than HT (p < 0.01), though both plans showed higher SCCP values than conventional mixed beam (electron-photon) plans reported by our group previously. VMAT plans required 66.2% less time to deliver than HT.ConclusionsBoth VMAT and HT provide acceptable treatment plans for PMRT. Both techniques are currently utilized at our institution.

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Chest wall radiotherapy with volumetric modulated arcs and the potential role of flattening filter free photon beams

Cited by 35 publications

References 27 publications

Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

Radiotherapy Is Effective for Desmoid Tumors (Aggressive Fibromatosis) - Long-Term Results of a German Multicenter Study

Modified Volumetric Modulated Arc Therapy in Left Sided Breast Cancer After Radical Mastectomy With Flattening Filter Free Versus Flattened Beams

Evaluation of volumetric modulated arc therapy for postmastectomy treatment

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