Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

Cozzi, Luca; Lohr, Frank; Fogliata, Antonella; Franceschini, Davide; Rose, F. De; Filippi, Andrea Riccardo; Guidi, G.; Vanoni, Valentina; Scorsetti, Marta

doi:10.1186/s13014-017-0935-4

Cited by 29 publications

(29 citation statements)

References 86 publications

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“…In terms of lymph node level movements, a significant movement in the anterior (y) and cranial (z) dimensions was observed for all lymph node levels K (Table 2), without reaching significance for levels III, IV, and internal mammary. The latter results were similar to those published by Borm et al [15]. In terms of dose variability, the present analysis showed a significant mean dose reduction of -3.09 Gy in level I (p < 0.001), -1.28 Gy in level II (p < 0.001), and -0.36 Gy in Rotter LN (p = 0.008), while there was no significant difference in levels III-IV or internal mammary.…”

Section: Discussionsupporting

confidence: 93%

“…In fact, the analysis conducted by Darby et al estimated a linear correlation between the mean heart dose and coronary events [12]. For this reason, several cardiac dose-sparing and avoidance techniques are nowadays utilized to optimize left-sided breast RT such as, for example, the deepinspiration breath hold (DIBH) technique [13][14][15][16][17][18]. DIBH is considered a safe and reproducible technique for heart sparing, while ensuring good planning target volume (PTV) coverage [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold

et al. 2018

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold

et al. 2018

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“…Volumetric modulated arc therapy (VMAT) has been evaluated for breast treatment in several publications as attested in a recent review 5. For now, only six publications report a clinical experience dominated by simultaneous integrated boost studies6, 7, 8, 9 or accelerated partial breast irradiation10 and only one in the setting of nodal involvement 11.…”

Section: Introductionmentioning

confidence: 99%

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

Tyran

Tallet

Resbeut

et al. 2018

J Applied Clin Med Phys

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PurposeThis study evaluates the benefit of a virtual bolus method for volumetric modulated arc therapy (VMAT) plan optimization to compensate breast modifications that may occur during breast treatment.MethodsTen files were replanned with VMAT giving 50 Gy to the breast and 47 Gy to the nodes within 25 fractions. The planning process used a virtual bolus for the first optimization, then the monitors units were reoptimized without bolus, after fixing the segments shapes. Structures and treatment planning were exported on a second scanner (CT) performed during treatment as a consequence to modifications in patient's anatomy. The comparative end‐point was clinical target volume's coverage. The first analysis compared the VMAT plans made using the virtual bolus method (VB‐VMAT) to the plans without using it (NoVB‐VMAT) on the first simulation CT. Then, the same analysis was performed on the second CT. Finally, the level of degradation of target volume coverage between the two CT using VB‐VMAT was compared to results using a standard technique of forward‐planned multisegment technique (Tan‐IMRT).ResultsUsing a virtual bolus for VMAT does not degrade dosimetric results on the first CT. No significant result in favor of the NoVB‐VMAT plans was noted. The VB‐VMAT method led to significant better dose distribution on a second CT with modified anatomies compared to NoVB‐VMAT. The clinical target volume's coverage by 95% (V95%) of the prescribed dose was 98.9% [96.1–99.6] on the second CT for VB‐VMAT compared to 92.6% [85.2–97.7] for NoVB‐VMAT (P = 0.0002). The degradation of the target volume coverage for VB‐VMAT is not worse than for Tan‐IMRT: the median differential of V95% between the two CT was 0.9% for VMAT and 0.7% for Tan‐IMRT (P = 1).ConclusionThis study confirms the safety and benefit of using a virtual bolus during the VMAT planning process to compensate potential breast shape modifications.

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“…11 Subsequently, treatment planning was performed using field-in-field (FiF) intensity modulated radiotherapy technique (IMRT), inverse optimized IMRT, and volumetric modulated arc therapy (VMAT). [12][13][14][15][16][17][18][19] To minimize interobserver variation, one radiation oncologist performed delineation of all structures on a single treatment planning system (Varian Eclipse v13. 5 Plan quality assessment was performed using an objective plan quality metric (PQM) scale.…”

Section: Methodsmentioning

confidence: 99%

Can the Choice of Radiotherapy Delivery Technique Influence Which Target Delineation Protocol to Use? A Plan-Quality-Based Analysis in Left Breast Cancer

Ahmad

Chufal

Bhatt³

et al. 2021

ASJO

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Introduction This study investigates the optimal target delineation protocol stratified by treatment planning technique in patients undergoing whole breast radiotherapy after breast conservation surgery. Materials and Methods Target delineation using Tangent (RTOG 0413 Whole Breast Irradiation Protocol), European SocieTy for Radiotherapy and Oncology (ESTRO), and Radiation Therapy & Oncology Group (RTOG) guidelines was performed on 10 randomly selected treatment planning computed tomography datasets of patients with left-sided breast cancer. An objective plan quality metric (PQM) scoring schema was defined and communicated to the medical physicist prior to commencement of treatment planning. Treatment planning was performed using field-in-field (FiF) intensity modulated radiotherapy technique (IMRT), inverse IMRT, and volumetric modulated arc therapy (VMAT), for each type of target. Two-way repeated measures, analysis of variance was utilized to compare the total PQM scores and dosimetric variables, stratified by treatment planning method. Results Total PQM score of plans for FiF, IMRT, and VMAT revealed that Tangent and ESTRO delineations were equivalent regardless of planning technique (Tangent vs. ESTRO for FiF, p = 0.099; Tangent vs. ESTRO for IMRT, p = 0.029; Tangent vs. ESTRO for VMAT, p = 0.438). Both delineation protocols were significantly superior to RTOG for all treatment planning techniques. Conclusion For all treatment planning techniques, ESTRO and Tangent delineation were equivalent and both achieved significantly higher scores than RTOG delineation.

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Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

Cited by 29 publications

References 86 publications

Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold

Dose variability in different lymph node levels during locoregional breast cancer irradiation: the impact of deep-inspiration breath hold

Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy

Can the Choice of Radiotherapy Delivery Technique Influence Which Target Delineation Protocol to Use? A Plan-Quality-Based Analysis in Left Breast Cancer

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