Dosimetric Comparison of the Simultaneous Integrated Boost in Whole-Breast Irradiation after Breast-Conserving Surgery: IMRT, IMRT plus an Electron Boost and VMAT

Wu, San‐Gang; Lai, Youqun; He, Zhenyu; Yuan, Zhigang; Chen, Shanyu; Mingming, Dai; Zhou, Juan; Lin, Qin; Chi, Feng

doi:10.1371/journal.pone.0120811

Cited by 15 publications

(27 citation statements)

References 25 publications

(31 reference statements)

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“…The entire radiation treatment may last 6–7 weeks. This regimen is also called sequential boost technique (SBT) 2 , 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

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Advantages of a technique using two 50 degree arcs in simultaneous integrated boost radiotherapy for left-sidebreast cancer

Ding

et al. 2017

Sci Rep

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This study evaluated radiotherapy techniques with 15 cases for simultaneous integrated boost to treat whole left breast and tumor bed following breast conserving surgery. Treatment plans were generated using three techniques: volumetric modulated arc therapy (VMAT) with a partial arc of 190° (1ARC), VMAT with two tangential mini-arcs of 50° each (2TARC) and intensity modulated radiation therapy with four fixed angle fields (4IMRT). Dosimetric parameters for the whole breast (Target), the boost tumor bed (Boost), and surrounding normal organs were compared. Chair Index (CHI) was introduced to evaluate the dose homogeneity in Target given the two levels of prescription dose. The dose coverage in Target was better in 1ARC and 2TARC than that in 4IMRT. The mean CHI in 1ARC (2.47) and 2TARC (2.62) were higher than that in 4IMRT (1.71, p < 0.05), and this indicated the dose homogeneity of Target was better in 1ARC and 2TARC than that in 4IMRT. The mean doses to right lung, and contralateral breast in 4IMRT were lower than those in 2TARC but the differences between them were small. 2TARC was better than 4IMRT with respect to the dose to ipsilateral lung and heart. Overall, 2TARC was optimal among three techniques.

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“…The entire radiation treatment may last 6–7 weeks. This regimen is also called sequential boost technique (SBT) 2 , 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

“…An alternative method to SBT, is the simultaneous integrated boost technique (SIB) 7 – 9 , in which 60–66 Gy is prescribed to the tumor bed and to be delivered simultaneously with the standard treatment to the whole breast. The overall treatment time by SIB is reduced.…”

Section: Introductionmentioning

confidence: 99%

Advantages of a technique using two 50 degree arcs in simultaneous integrated boost radiotherapy for left-sidebreast cancer

Ding

et al. 2017

Sci Rep

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“…The tumor-bed boost can be delivered either sequentially after WBI or with SIB technique. Previous dosimetric studies demonstrated feasibility of SIB with 3D-CRT, IMRT, and VMAT (7,11,12,(15)(16)(17). Furthermore, the dosimetric advantages of SIB over SB have been previously demonstrated (14, 15,22).…”

Section: Discussionmentioning

confidence: 97%

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Onal

Efe

Güler

et al. 2019

In Vivo

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Background/Aim: To compare simultaneousintegrated boost (SIB) versus sequential-boost (SB) delivered in the context of whole-breast irradiation (WBI) via volumetricmodulated arc therapy (VMAT) and helical-tomotherapy (HT). Materials and Methods: Planning target-volume (PTV) dosimetric parameters and organs at risk (OAR) were analyzed for SB plan (50 Gy plus 16 Gy boost) and SIB plan (50.4 Gy WBI and 64.4 Gy tumor bed boost) in VMAT and HT techniques. Results: Conformity and homogeneity for targetvolume doses were better in HT plans compared to VMAT plans. There were no significant differences in ipsilateral lung doses between VMAT and HT plans for SB/SIB techniques, except for a significantly higher lung V5 value with VMAT-SB, and lung V13 value with HT-SIB technique. HT provided a statistically significant decrease in contralateral lung mean V5. Conclusion: The SIB technique showed better target-volume dose distribution in both HT and VMAT plans, and better sparing heart in HT compared to the SB technique. Breast cancer (BC) is the most common cancer and is a major cause of cancer-related death in women (1). Currently, adjuvant radiotherapy (RT), especially whole-breast irradiation (WBI) after breast-conserving surgery (BCS), is accepted as standard-of-care for early BC patients as this multimodal treatment increases local control and improves overall survival in early BC (2, 3). Additional tumor-bed boost after WBI has also been shown to reduce local recurrence (4); however, a long-term follow-up study found that inhomogeneous radiation in tumor-bed boosts, and use of photon beam boosts led to poorer cosmetic outcomes in patients (5). Therefore, in the past few decades, a lot of attention has focused on the development of new techniques to achieve a homogeneous dose distribution, better local control, and improve cosmetic outcomes for WBI after BCS. Breast RT techniques range from conventional tangential field RT, field-in-field conformal RT (CRT), intensity modulated RT (IMRT), volumetric arc therapy (VMAT) to helical tomotherapy (6-11). For tumor-bed boost, relatively simple electron or hybrid techniques (i.e., a combination of different techniques for WBI and boosts), have been used. Recent dosimetric studies have demonstrated that multi-field 3D-CRT, IMRT, or VMAT are superior to electron therapy with respect to the target-volume coverage and sparing normal tissues (12-15). Moreover, simultaneous-integrated boost (SIB), which is a technique wherein a boost is delivered to the tumor bed concurrently with WBI, has been reported to be technically and dosimetrically feasible (11-13, 15-17). The rationale underlying the SIB technique is to escalate radiation doses in the area at highest risk without prolonging treatment duration. This dose escalation provides improved patient comfort while shortening the duration of RT, and also exploits the higher sensitivity of breast tumor cells to larger single doses. However, more advanced techniques are required to increase the uniformity of the radiation dose to improve p...

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“…Recent technical advances have resulted in a transition away from conventional tangential approaches and towards more complex methodologies, such as inverse planned intensity modulated radiation therapy (IP‐IMRT) and helical techniques 3, 4. These advances have sought to enhance normal tissue sparing and improve target homogeneity, as well as provide a platform for a simultaneous integrated boost to the tumour bed 5, 6…”

Section: Introductionmentioning

confidence: 99%

“…3,4 These advances have sought to enhance normal tissue sparing and improve target homogeneity, as well as provide a platform for a simultaneous integrated boost to the tumour bed. 5,6 TomoTherapy (Accuray, Sunnyvale, CA) has recently introduced topotherapy, 7 a static form of tomotherapy, to increase the versatility of its helical system. Branded TomoDirect TM (TD), the technology enables fixed beam treatments by moving the patient through the machine bore while maintaining specified beam angles.…”

Section: Introductionmentioning

confidence: 99%

Static beam tomotherapy as an optimisation method in whole‐breast radiation therapy (WBRT)

Squires

Byrne³

et al. 2017

J of Medical Radiation Sci

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IntroductionTomoTherapy (Accuray, Sunnyvale, CA) has recently introduced a static form of tomotherapy: TomoDirect™ (TD). This study aimed to evaluate TD against a contemporary intensity modulated radiation therapy (IMRT) alternative through comparison of target and organ at risk (OAR) doses in breast cancer cases. A secondary objective was to evaluate planning efficiency by measuring optimisation times.MethodsTreatment plans of 27 whole‐breast radiation therapy (WBRT) patients optimised with a tangential hybrid IMRT technique were replanned using TD. Parameters included a dynamic field width of 2.5 cm, a pitch of 0.251 and a modulation factor of 2.000; 50 Gy in 25 fractions was prescribed and planning time recorded. The planning metrics used in analysis were ICRU based, with the mean PTV minimum (D99) used as the point of comparison.ResultsBoth modalities met ICRU50 target heterogeneity objectives (TD D99 = 48.0 Gy vs. IMRT = 48.1 Gy, P = 0.26; TD D1 = 53.5 Gy vs. IMRT = 53.0 Gy, P = 0.02; Homogeneity index TD = 0.11 vs. IMRT = 0.10, P = 0.03), with TD plans generating higher median doses (TD D50 = 51.1 Gy vs. IMRT = 50.9 Gy, P = 0.03). No significant difference was found in prescription dose coverage (TD V50 = 85.5% vs. IMRT = 82.0%, P = 0.09). TD plans produced a statistically significant reduction in V5 ipsilateral lung doses (TD V5 = 23.2% vs. IMRT = 27.2%, P = 0.04), while other queried OARs remained comparable (TD ipsilateral lung V20 = 13.2% vs. IMRT = 14.6%, P = 0.30; TD heart V5 = 2.7% vs. IMRT = 2.8%, P = 0.47; TD heart V10 = 1.7% vs. IMRT = 1.8%, P = 0.44). TD reduced planning time considerably (TD = 9.8 m vs. IMRT = 27.6 m, P < 0.01), saving an average planning time of 17.8 min per patient.ConclusionsTD represents a suitable WBRT treatment approach both in terms of plan quality metrics and planning efficiency.

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Dosimetric Comparison of the Simultaneous Integrated Boost in Whole-Breast Irradiation after Breast-Conserving Surgery: IMRT, IMRT plus an Electron Boost and VMAT

Cited by 15 publications

References 25 publications

Advantages of a technique using two 50 degree arcs in simultaneous integrated boost radiotherapy for left-sidebreast cancer

Advantages of a technique using two 50 degree arcs in simultaneous integrated boost radiotherapy for left-sidebreast cancer

Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery

Static beam tomotherapy as an optimisation method in whole‐breast radiation therapy (WBRT)

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