Heart and Cardiac Substructure Dose Sparing in Synchronous Bilateral Breast Radiotherapy: A Dosimetric Study of Proton and Photon Radiation Therapy

Sun, Tao; Lin, Xiaona; Tong, Ying; Liu, Xiao; Pan, Lingjing; Cheng, Tao; Duan, Jinghao; Yin, Yong

doi:10.3389/fonc.2019.01456

Cited by 34 publications

(31 citation statements)

References 37 publications

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“…In the same study, VMAT-DIT plans demonstrated higher compatibility and significantly decreased lung, heart, LV, and LAD doses than VMAT-MIT plans. 16 In our study, the V25Gy value was 3.9% in MIT and 4% in DIT and the dose for the heart was acceptable.…”

Section: Discussionsupporting

confidence: 44%

Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

Mermut

Ata

Trabulus

2021

Polish Journal of Medical Physics and Engineering

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Objective: We compared mono-isocenter and dual-isocenter plans in synchronous bilateral breast cancer (SBBC), which is defined as tumours occurring simultaneously in both breasts, and evaluated the effects of these differences in plans on organs-at-risk (OARs). Materials and methods: We evaluated 10 women with early stage, nod negative (Tis-2N0M0) SBBC. The treatment dose was determined to be 50 Gy. We used mean dose and VXGy to evaluate the OARs. To evaluate the effectiveness of treatment plans, Homogeneity index (HI), conformity index (CI) and sigma index (SI) and monitor units (MU) of monoisocenter (MIT) and dual-isocenter (DIT) plans were compared. During bilateral breast planning, for the single-centre plan, the isocenter was placed at the center of both breasts at a depth of 3-4 cm. For the two-center plan, dual-isocenters were placed on the right and left breasts. Results: No significant difference between the techniques in terms of the scope of the target volume was observed. Statistically significant results were not achieved in MIT and DIT plans for OARs. Upon comparing MIT and DIT, the right-side monitor unit (MU) value in DIT (p = 0.011) was statistically significantly lower than that in MIT. Upon comparing right-left side MIT and DIT, the MU value (p = 0.028) was significantly lower in DIT than MIT. Conclusion: SBBC irradiation is more complex than unilateral breast radiotherapy. No significant difference between both techniques and OARs was observed. However, we recommend MIT as a priority technique due to the ability to protect OARs, ease of administration during treatment, and the fact that the patient stays in the treatment unit for a shorter period of time.

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Section: Discussionsupporting

confidence: 44%

Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

Mermut

Ata

Trabulus

2021

Polish Journal of Medical Physics and Engineering

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“…It has been proven that volumetric modulated arc therapy (VMAT) can improve the quality of the plan and the delivery e ciency in bilateral breast cancer [8][9][10]. A previous study found that the partial-arc VMAT plans signi cantly reduced the cardiopulmonary dose compared with the whole-arc VMAT plans in unilateral breast radiotherapy [11].…”

Section: Introductionmentioning

confidence: 99%

Treatment planning comparison of volumetric modulated arc therapy with Trilogy and Halcyon for bilateral breast cancer

Sun

Lin

Zhang

et al. 2021

Preprint

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Background: The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods: On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann-Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results:Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p<0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion: For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.

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“…It has been proven that volumetric modulated arc therapy (VMAT) can improve the quality of the plan and the delivery efficiency in bilateral breast cancer [ 8 – 10 ]. A previous study found that the partial-arc VMAT plans significantly reduced the cardiopulmonary dose compared with the whole-arc VMAT plans in unilateral breast radiotherapy [ 11 ].…”

mentioning

confidence: 99%

Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer

et al. 2021

Self Cite

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Background The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann–Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p < 0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.

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Heart and Cardiac Substructure Dose Sparing in Synchronous Bilateral Breast Radiotherapy: A Dosimetric Study of Proton and Photon Radiation Therapy

Cited by 34 publications

References 37 publications

Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

Quantitative and dosimetric analysis for treating synchronous bilateral breast cancer using two radiotherapy planning techniques

Treatment planning comparison of volumetric modulated arc therapy with Trilogy and Halcyon for bilateral breast cancer

Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer

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