Dosimetric comparison between volumetric-modulated arc therapy and a hybrid volumetric-modulated arc therapy and segmented field-in-field technique for postmastectomy chest wall and regional lymph node irradiation

Lang, Karen; Loritz, Brianne; Schwartz, Adam; Hunzeker, Ashley; Lenards, Nishele; Culp, Lee; Finley, Randi R.; Corbin, Kimberly S.

doi:10.1016/j.meddos.2019.08.001

Cited by 12 publications

(17 citation statements)

References 17 publications

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“…Because of this, the hybrid plans in the present study showed almost similar results to the PTVs and OARs dosimetric parameters. Table 4 displays the dosimetric parameter appraisal of favoured technique from other published studies 9,[25][26][27] and the present study.…”

Section: Discussionmentioning

confidence: 97%

“…However, the inclusion of internal mammary node (IMN) irradiates more volumes of heart and ipsilateral lung (IL) by the wide tangent fields of the 3DCRT plan. 9 Intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques provide conformal and homogeneous doses to the planning target volumes (PTVs). These techniques reduce the high dose irradiation to NT while delivering increased low dose bath than the 3DCRT.…”

Section: Introductionmentioning

confidence: 99%

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Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques

Balaji

Ramasubramanian

2021

J Radiother Pract

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Aim: This study compares three different hybrid plans, for left-sided chest wall (CW) and nodal stations irradiation using a hypofractionated dose regimen. Materials and methods: Planning target volumes (PTVs) of 25 breast cancer patients that included CW, supraclavicular (SCL) and internal mammary node (IMN) were planned with 3 different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT and IMRT+VMAT. All hybrid plans were generated with a hypofractionated dose prescription of 40·5 Gy in 15 fractions. Seventy per cent of the dose was planned with the base-dose component and remaining 30% of the dose was planned with the hybrid component. All plans were evaluated based on the PTVs and organs at risk (OARs) dosimetric parameters. Results: The results for PTVs parameters have shown that the 3DCRT+IMRT and 3DCRT+VMAT plans were superior in uniformity index to the IMRT+VMAT plan. The OARs dose parameters were comparable between hybrid plans. The IMRT+VMAT plan provided a larger low dose volume spread to the heart and ipsilateral lung (p < 0·001). The 3DCRT+VMAT plan required less monitor units and treatment time (p = 0·005) than other plans. Conclusion: The 3DCRT+VMAT hybrid plan showed superior results with efficient treatment delivery and provide clinical benefit by reducing both low and high dose levels.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques

Balaji

Ramasubramanian

2021

J Radiother Pract

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“…Other solutions aiming to mimic the dose distribution of the tangential beam setting did focus on hybrid solutions with various combinations of tangential 3D conformal or IMRT beams with VMAT [ 20 , 21 ]. These approaches outlined the difficulty of breast planning, which might be enhanced for particular anatomies, where the full VMAT solution improves the quality of the resulting doses [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most explored technique reduced the breast en-face entrance, with the so-called "butterfly" or "bow-tie" technique, using short arcs mimicking a more tangential approach [8][9][10][11][12][13][14][15][16][17][18][19]. Other proposals have been hybrid techniques (VMAT and IMRT, or more common VMAT and 3DCRT) [20,21] or noncoplanar settings [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Knowledge-based DVH estimation and optimization for breast VMAT plans with and without avoidance sectors

et al. 2022

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Background To analyze RapidPlan knowledge-based models for DVH estimation of organs at risk from breast cancer VMAT plans presenting arc sectors en-face to the breast with zero dose rate, feature imposed during the optimization phase (avoidance sectors AS). Methods CT datasets of twenty left breast patients in deep-inspiration breath-hold were selected. Two VMAT plans, PartArc and AvoidArc, were manually generated with double arcs from ~ 300 to ~ 160°, with the second having an AS en-face to the breast to avoid contralateral breast and lung direct irradiation. Two RapidPlan models were generated from the two plan sets. The two models were evaluated in a closed loop to assess the model performance on plans where the AS were selected or not in the optimization. Results The PartArc plans model estimated DVHs comparable with the original plans. The AvoidArc plans model estimated a DVH pattern with two steps for the contralateral structures when the plan does not contain the AS selected in the optimization phase. This feature produced mean doses of the contralateral breast, averaged over all patients, of 0.4 ± 0.1 Gy, 0.6 ± 0.2 Gy, and 1.1 ± 0.2 Gy for the AvoidArc plan, AvoidArc model estimation, RapidPlan generated plan, respectively. The same figures for the contralateral lung were 0.3 ± 0.1 Gy, 1.6 ± 0.6 Gy, and 1.2 ± 0.5 Gy. The reason was found in the possible incorrect information extracted from the model training plans due to the lack of knowledge about the AS. Conversely, in the case of plans with AS set in the optimization generated with the same AvoidArc model, the estimated and resulting DVHs were comparable. Whenever the AvoidArc model was used to generate DVH estimation for a plan with AS, while the optimization was made on the plan without the AS, the optimizer evidentiated the limitation of a minimum dose rate of 0.2 MU/°, resulting in an increased dose to the contralateral structures respect to the estimation. Conclusions The RapidPlan models for breast planning with VMAT can properly estimate organ at risk DVH. Attention has to be paid to the plan selection and usage for model training in the presence of avoidance sectors.

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“…Traditionally, two opposing tangential fields and a mono-isocentric half-beam-blocked anterior field or two opposing anterior–posterior fields have been employed to treat the chest wall area and supraclavicular nodes, respectively [4] , [5] , [6] , [7] . Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) have been proposed for the treatment of locoregional breast cancer to improve dose homogeneity and conformity, and base-tangential hybrid techniques have been reported to optimize the balance between the target coverage and organ-at-risk (OAR) sparing [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] . We use a combination of three-dimensional conformal radiation therapy (3D-CRT) plan with a dose gradient of chest wall area and the VMAT plan of supraclavicular area to provide better target coverage and dose homogeneity [17] .…”

Section: Introductionmentioning

confidence: 99%

Improved treatment robustness of postoperative breast cancer radiotherapy including supraclavicular nodes

Miura

Doi

Nakao

et al. 2022

Physics and Imaging in Radiation Oncology

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Dosimetric comparison between volumetric-modulated arc therapy and a hybrid volumetric-modulated arc therapy and segmented field-in-field technique for postmastectomy chest wall and regional lymph node irradiation

Cited by 12 publications

References 17 publications

Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques

Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques

Knowledge-based DVH estimation and optimization for breast VMAT plans with and without avoidance sectors

Improved treatment robustness of postoperative breast cancer radiotherapy including supraclavicular nodes

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