Dosimetric comparison of TomoDirect, helical tomotherapy, and volumetric modulated arc therapy for postmastectomy treatment

Nobnop, Wannapha; Phakoetsuk, Panchalee; Chitapanarux, Imjai; Tippanya, Damrongsak; Khamchompoo, Darat

doi:10.1002/acm2.12989

Cited by 22 publications

(18 citation statements)

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“…Tomotherapy treatment planning can be classified into two modes, TomoHelical (HT) and TomoDirect (TD). The HT plans showed better target coverage and OARs sparing for the chest wall and regional nodal radiation with higher plan quality scores when compared with TD plans [22]. In our center, large numbers of post-mastectomy breast cancer patients required radiation to the chest wall and whole regional lymph node area.…”

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confidence: 82%

The advantages of abdominal compression with shallow breathing during left-sided postmastectomy radiotherapy by Helical TomoTherapy

et al. 2021

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Background Left-sided post-mastectomy radiotherapy (PMRT) certainly precedes some radiation dose to the cardiopulmonary organs causing many side effects. To reduce the cardiopulmonary dose, we created a new option of the breathing adapted technique by using abdominal compression applied with a patient in deep inspiration phase utilizing shallow breathing. This study aimed to compare the use of abdominal compression with shallow breathing (ACSB) with the free breathing (FB) technique in the left-sided PMRT. Materials and methods Twenty left-sided breast cancer patients scheduled for PMRT were enrolled. CT simulation was performed with ACSB and FB technique in each patient. All treatment plans were created on a TomoTherapy planning station. The target volume and dose, cardiopulmonary organ volume and dose were analyzed. A linear correlation between cardiopulmonary organ volumes and doses were also tested. Results Regarding the target volumes and dose coverage, there were no significant differences between ACSB and FB technique. For organs at risk, using ACSB resulted in a significant decrease in mean (9.17 vs 9.81 Gy, p<0.0001) and maximum heart dose (43.79 vs 45.45 Gy, p = 0.0144) along with significant reductions in most of the evaluated volumetric parameters. LAD doses were also significantly reduced by ACSB with mean dose 19.24 vs 21.85 Gy (p = 0.0036) and the dose to 2% of the volume (D2%) 34.46 vs 37.33 Gy (p = 0.0174) for ACSB and FB technique, respectively. On the contrary, the lung dose metrics did not show any differences except the mean V5 of ipsilateral lung. The positive correlations were found between increasing the whole lung volume and mean heart dose (p = 0.05) as well as mean LAD dose (p = 0.041) reduction. Conclusions The ACSB technique significantly reduced the cardiac dose compared with the FB technique in left-sided PMRT treated by Helical TomoTherapy. Our technique is uncomplicated, well-tolerated, and can be applied in limited resource center.

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Section: Introductionmentioning

confidence: 82%

The advantages of abdominal compression with shallow breathing during left-sided postmastectomy radiotherapy by Helical TomoTherapy

et al. 2021

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“…These OARs were protected by adjusting the priority values to reduce the maximum percent dose and scatter dose. Compared with our IMRT plans and other studies of VMAT plans, the mean dose to the heart was comparably lower in our VMAT plans, 5.2 ± 0.9 Gy, while it was 13.5 ± 5.0 Gy according to Zhang [ 17 ], 7.2 ± 2.3 Gy according to Zhao [ 18 ], 9.31 ± 1.62 Gy according to Hu [ 19 ], 11.9 ± 5.06 Gy according to Ma [ 20 ], 7.7 ± 1.1 Gy according to Xie [ 21 ] and 7.4 ± 1.4 Gy according to Wang [ 22 ],15.2 ± 2.2 Gy according to Nobnop [ 24 ], 9.3 ± 1.1 Gy according to Zhang [ 26 ]. The low and medium doses received by the heart were also significantly lower with the VMAT technique than with the IMRT technique, except for V 2.5 .…”

Section: Discussionmentioning

confidence: 99%

“…However, the research of Ma [ 20 ], Xie [ 21 ] and Wang [ 22 ] demonstrates that IMRT has dosimetric advantages in the heart and left lung, compared with VMAT plans. Furthermore, the mean dose to the heart of VMAT plans in these studies is still relatively high (> 7.8 Gy)[ 16 – 26 ], even up to 15.2 Gy [ 24 ]. According to Darby [ 6 ], the rates of major coronary events increase linearly with the mean dose to the heart by 7.4% per gray; therefore, it is important to further reduce the radiation dose to the heart.…”

Section: Introductionmentioning

confidence: 99%

A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer

et al. 2021

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Background To compare the dosimetric, normal tissue complication probability (NTCP), secondary cancer complication probabilities (SCCP), and excess absolute risk (EAR) differences of volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for left-sided breast cancer after mastectomy. Methods and materials Thirty patients with left-sided breast cancer treated with post-mastectomy radiation therapy (PMRT) were randomly enrolled in this study. Both IMRT and VMAT treatment plans were created for each patient. Planning target volume (PTV) doses for the chest wall and internal mammary nodes, PTV1, and PTV of the supraclavicular nodes, PTV2, of 50 Gy were prescribed in 25 fractions. The plans were evaluated based on PTV1 and PTV2 coverage, homogeneity index (HI), conformity index, conformity number (CN), dose to organs at risk, NTCP, SCCP, EAR, number of monitors units, and beam delivery time. Results VMAT resulted in more homogeneous chest wall coverage than did IMRT. The percent volume of PTV1 that received the prescribed dose of VMRT and IMRT was 95.9 ± 1.2% and 94.5 ± 1.6%, respectively (p < 0.001). The HI was 0.11 ± 0.01 for VMAT and 0.12 ± 0.02 for IMRT, respectively (p = 0.001). The VMAT plan had better conformity (CN: 0.84 ± 0.02 vs. 0.78 ± 0.04, p < 0.001) in PTV compared with IMRT. As opposed to IMRT plans, VMAT delivered a lower mean dose to the ipsilateral lung (11.5 Gy vs 12.6 Gy) and heart (5.2 Gy vs 6.0 Gy) and significantly reduced the V5, V10, V20, V30, and V40 of the ipsilateral lung and heart; only the differences in V5 of the ipsilateral lung did not reach statistical significance (p = 0.409). Although the volume of the ipsilateral lung and heart encompassed by the 2.5 Gy isodose line (V2.5) was increased by 6.7% and 7.7% (p < 0.001, p = 0.002), the NTCP was decreased by 0.8% and 0.6%, and SCCP and EAR were decreased by 1.9% and 0.1% for the ipsilateral lung. No significant differences were observed in the contralateral lung/breast V2.5, V5, V10, V20, mean dose, SCCP, and EAR. Finally, VMAT reduced the number of monitor units by 31.5% and the treatment time by 71.4%, as compared with IMRT. Conclusions Compared with IMRT, VMAT is the optimal technique for PMRT patients with left-sided breast cancer due to better target coverage, a lower dose delivered, NTCP, SCCP, and EAR to the ipsilateral lung and heart, similar doses delivered to the contralateral lung and breast, fewer monitor units and a shorter delivery time.

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“…Tomotherapy treatment planning can be classi ed into two modes, TomoHelical (HT) and TomoDirect (TD). The HT plans showed better target coverage and OARs sparing for the chest wall and regional nodal radiation with higher plan quality scores when compared with TD plans [22]. In our center, large numbers of post-mastectomy breast cancer patients required radiation to the chest wall and whole regional lymph node area.…”

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confidence: 82%

The Advantages of Abdominal Compression with Shallow Breathing During Left-sided Postmastectomy Radiotherapy by Helical Tomotherapy

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Chitapanarux

et al. 2021

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BackgroundLeft-sided post-mastectomy radiotherapy (PMRT) certainly precedes some radiation dose to the cardiopulmonary organs causing many side effects. To reduce the cardiopulmonary dose, we created a new option of the breathing adapted technique by using abdominal compression applied with a patient in deep inspiration phase utilizing shallow breathing. This study aimed to compare the use of abdominal compression with shallow breathing (ACSB) with the free breathing (FB) technique in the left-sided PMRT.MethodsTwenty left-sided breast cancer patients scheduled for PMRT were enrolled. CT simulation was performed with ACSB and FB technique in each patient. All treatment plans were created on a TomoTherapy planning station. The target volume and dose, cardiopulmonary organ volume and dose were analyzed. A linear correlation between cardiopulmonary organ volumes and doses were also tested.ResultsRegarding the target volumes and dose coverage, there were no significant differences between ACSB and FB technique. For organs at risk, using ACSB resulted in a significant decrease in mean (9.17 vs 9.81 Gy, p < 0.0001) and maximum heart dose (43.79 vs 45.45 Gy, p = 0.0144) along with significant reductions in most of the evaluated volumetric parameters. LAD doses were also significantly reduced by ACSB with mean dose 19.24 vs 21.85 Gy (p = 0.0036) and the dose to 2% of the volume (D2%) 34.46 vs 37.33 Gy (p = 0.0174) for ACSB and FB technique, respectively. On the contrary, the lung dose metrics did not show any differences except the mean V5 of ipsilateral lung. The positive correlations were found between increasing the whole lung volume and mean heart dose (p = 0.05) as well as mean LAD dose (p = 0.041) reduction.ConclusionsThe ACSB technique significantly reduced the cardiac dose compared with the FB technique in left-sided PMRT treated by Helical Tomotherapy. Our technique is uncomplicated, well-tolerated, and can be applied in daily clinical practice.Trial registrationThai Clinical Trials Registry (TCTR), TCTR20201215008. Registered 14 December 2020 - Retrospectively registered, http:// http://www.clinicaltrials.in.th/ TCTR20201215008

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Dosimetric comparison of TomoDirect, helical tomotherapy, and volumetric modulated arc therapy for postmastectomy treatment

Cited by 22 publications

References 16 publications

The advantages of abdominal compression with shallow breathing during left-sided postmastectomy radiotherapy by Helical TomoTherapy

The advantages of abdominal compression with shallow breathing during left-sided postmastectomy radiotherapy by Helical TomoTherapy

A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer

The Advantages of Abdominal Compression with Shallow Breathing During Left-sided Postmastectomy Radiotherapy by Helical Tomotherapy

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