Evaluation of fixed‐jaw IMRT and tangential partial‐VMAT radiotherapy plans for synchronous bilateral breast cancer irradiation based on a dosimetric study

Huang, Jianghua; Wu, Xiuxiu; Lin, Xiao; Shi, Juntian; Ma, Yujia; Duan, Song; Huang, Xiaobo

doi:10.1002/acm2.12688

Cited by 24 publications

(20 citation statements)

References 35 publications

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“…In the treatment of breast cancer, several methods, such as field-in-field technique (13,14) and IMRT (15), are used to provide homogenous radiation dose to target tissues. Helical IMRT is a rotational IMRT dedicated machine that is available for whole-body IMRT.…”

Section: Discussionmentioning

confidence: 99%

Robust Treatment Planning in Intrafraction Motion Using TomoDirect™ Intensity-modulated Radiotherapy for Breast Cancer

Hongo

Koichi

Sakae³

et al. 2021

In Vivo

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Background/Aim: To evaluate the robustness of radiotherapy treatment planning optimization for respiratorymoving breast cancer using fixed-angle beams planning TomoDirect™ intensity-modulated radiotherapy (IMRT). Materials and Methods: A minimax optimisation algorithm was applied to 10 breast cancer patients. Two sets of treatment plans with or without robust techniques were prepared considering anterior-posterior and head-tail movements due to respiration. Parameters were compared between treatment plans: 95% planned target volume (PTV) dose, conformal index and homogeneity index (HI), and organs at risk (OAR) parameters including the lung volume receiving 20 Gy or more (V20) and 5 Gy (V5). Results: Robust planning significantly improved parameters of 95% PTV dose and HI, without deteriorating V20 or V5 in the anterior-posterior movement, while it slightly improved 95% PTV and slightly deteriorated V20 in the head-tail movement. Conclusion: Robust treatment planning improves coverage of targets moving because of respiration in the treatment of breast cancer using TomoDirect; however, normal lung doses should be cautiously evaluated on a case-by-case basis.

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Section: Discussionmentioning

confidence: 99%

Robust Treatment Planning in Intrafraction Motion Using TomoDirect™ Intensity-modulated Radiotherapy for Breast Cancer

Hongo

Koichi

Sakae³

et al. 2021

In Vivo

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“…This study verified the superior CI and significantly reduced MUs of the VMAT technique in comparison with that in the IMRT technique, as proposed in several articles. [20][21][22] Compared to the IMRT groups, the VMAT groups had substantially lower irradiation doses to most OARs, especially total lung (V 20Gy and V 30Gy ) and heart. However, VMAT increased the V 5Gy of the total lung.…”

Section: Discussionmentioning

confidence: 99%

Comparison of combinations of irradiation techniques and jaw conditions in intensity‐modulated radiotherapy for lung cancer

Peng

Shi

Zhang

et al. 2021

J Applied Clin Med Phys

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Purpose: To assist in the selection of a suitable combination of an irradiation technique and jaw condition in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc radiotherapy (VMAT) for lung cancer treatment plans. Materials and methods: Thirty patients with lung cancer who underwent radiotherapy were enrolled retrospectively. They were categorized as having central lung cancer, peripheral lung cancer with mediastinal lymph node metastasis (peripheral E lung cancer), and peripheral lung cancer without mediastinal lymph node metastasis (peripheral N lung cancer). Four treatment plans were designed for each patient: fixed jaw and adaptive jaw IMRT technique (FJ-IMRT and JA-IMRT), and fixed jaw and jaw tracking VMAT technique (FJ-VMAT and JT-VMAT). The dose parameters of the four group plans were compared and analyzed. Results: Compared to FJ-IMRT, JA-IMRT significantly reduced the mean dose (D mean ) and volume percentage of 5 Gy (V 5Gy ) of the total lung in central and peripheral N lung cancer. Similarly, compared to FJ-VMAT, JT-VMAT provided better protection to most organs at risk (OARs), particularly for total lung and heart. In comparison with IMRT, VMAT significantly improved the conformity index (CI) of the planning target volume for the three lung cancer classifications, and it reduced the dose of almost all OARs except V 5Gy and D mean of the total lung. Moreover, the mean monitor units of the VMAT groups were far lower than the IMRT groups. Conclusion: Based on the dosimetric findings and considering clinical data published on lung and heart side effects, we propose recommendations on the preferred treatment technique based on tumor location and pulmonary function. For central lung cancer with normal pulmonary function, we advise JT-VMAT techniques. Conversely, for central lung cancer with poor pulmonary function, we recommend JA-IMRT techniques. We advocate JA-IMRT for peripheral E lung cancer. For peripheral N lung cancer, JT-VMAT techniques are strongly recommended.

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“…Finally, Huang et al investigated the fixed-jaw IMRT (F-IMRT) and tangential partial VMAT (tP-VMAT) treatment plans for SBBC patients. They assessed that both techniques were of high quality and feasible for SBBC patients [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Synchronous bilateral breast cancer treated with a 3-week hypofractionated radiotherapy schedule: clinical and dosimetric outcomes

et al. 2021

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Background and purpose Synchronous bilateral breast cancer (SBBC) accounts for 1–3.5% of breast cancer patients. The aim of this study was to evaluate dosimetric issues, clinical outcomes, and acute toxicities for SBBC patients receiving synchronous bilateral hypofractionated radiotherapy (SBHRT) and to compare them with patients treated with synchronous bilateral normofractionated RT schedule (SBNRT). Materials and methods From April 2016 to March 2020, 39 SBBC patients were referred to our institution. Patients were divided according to their prescription dose: Group A: 50 Gy/25fx (fractions), B: 60–64 Gy/25fx, C: 40.05 Gy/15fx; D: 48 Gy/15fx. Toxicity was evaluated using Common Terminology Criteria for Adverse Events (CTCAE)v.5.0. Results 34 patients were finally evaluated. Median follow-up was 24 months for NF schedule and 9 months for HF schedule. In the HF schedule, no acute side-effects > G2 were observed and no dermatitis was reported in 6 th month´s assessments. 95% of patients have no evidence of disease and only 1 patient presented local relapse in the first mammography after RT. No distant failures or deaths were observed. Regarding dosimetric issues, the inter-patient average D mean for the heart was: Group A: 5.0 Gy (4.6–5.5), Group B: 4.4 Gy (4.1–5.4), Group C: 4.8 Gy (4.5–5.1) and Group D: 5.3 Gy (4.4–5.6). For the lungs, the inter-patient average D mean was: Group A: 10.8 Gy (9.8–12.2), Group B: 11.5 Gy (11.3–12), Group C: 9.8 Gy (9.3–10.5) and Group D: 10.5 Gy (10–11.3). Conclusions This is the first study reporting the safety, feasibility, and tolerability of 40.05 Gy/15fx over 3 weeks for the treatment of SBBC patients. Further study with larger accrual is mandatory.

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Evaluation of fixed‐jaw IMRT and tangential partial‐VMAT radiotherapy plans for synchronous bilateral breast cancer irradiation based on a dosimetric study

Cited by 24 publications

References 35 publications

Robust Treatment Planning in Intrafraction Motion Using TomoDirect™ Intensity-modulated Radiotherapy for Breast Cancer

Robust Treatment Planning in Intrafraction Motion Using TomoDirect™ Intensity-modulated Radiotherapy for Breast Cancer

Comparison of combinations of irradiation techniques and jaw conditions in intensity‐modulated radiotherapy for lung cancer

Synchronous bilateral breast cancer treated with a 3-week hypofractionated radiotherapy schedule: clinical and dosimetric outcomes

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