In search of a one plan solution for VMAT post‐mastectomy chest wall irradiation

Monajemi, Thalat; Oliver, Patricia; Day, A. C.; Yewondwossen, Mammo

doi:10.1002/acm2.12948

Cited by 7 publications

(14 citation statements)

References 24 publications

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“…VMAT planning resulted in a decreased dose on the lateral aspect of the phantom consistent with an increased curvature of the surface. In contrast to Monajemi et al who reported negligible variability for the central 8 cm of the treatment area, 14 the data in this manuscript are reported for approximately 20 cm along the chest wall and shows significant variability. We believe that our measurements demonstrate similar profiles over smaller sections of the chest wall, but acknowledge that deviations may be a result of the planning process.…”

Section: Discussioncontrasting

confidence: 99%

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Comparing brass mesh to tissue equivalent bolus materials for volumetric modulated arc therapy chest wall irradiation

Keiper

Kisling

Hua

et al. 2023

J Applied Clin Med Phys

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PurposeTo compare the superficial dose when using brass mesh bolus (BMB), no bolus, or 3 mm tissue‐equivalent bolus with a pseudo‐flash volumetric modulated arc therapy (VMAT) breast treatment planning technique.MethodsTwo different beam arrangements for right‐sided irradiation and one beam arrangement for bilateral irradiation were planned on an inhomogeneous thorax phantom in accordance with our clinical practice for VMAT postmastectomy radiotherapy (PMRT). Plans were optimized using pseudo‐flash and representative critical organ optimization structures were used to shape the dose. Plans were delivered without bolus, with 3 mm tissue‐equivalent bolus (TEB), or with one‐layer BMB. Optically stimulated luminescence dosimeter (OSLD) and radiochromic film measurements were taken and analyzed to determine the superficial dose in each case and the relative enhancement from the no bolus delivery.ResultsSuperficial dose measured with OSLDs was found to be 76.4 ± 4.5%, 103.0 ± 6.1%, and 98.1 ± 5.8% of prescription for no physical bolus (NB), TEB, and BMB, respectively. Superficial dose was observed to increase from lateral to medial points when measured with film. However, the relative increase in superficial dose from NB was consistent across the profile with an increase of 43 ± 2.1% and 34 ± 3.3% of prescription for TEB and BMB, respectively. The results are in good agreement with expectations from the literature and the experience with tangential radiotherapy.ConclusionThree millimeter TEB and one‐layer BMB were shown to provide similar enhancement to the superficial dose compared to delivery without bolus. BMB, which does not significantly affect dose at depth and is more conformal to the patient surface, is an acceptable alternative to 3 mm TEB for chest wall PMRT patients treated with pseudo‐flash PMRT.

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Section: Discussioncontrasting

confidence: 99%

“…Monajemi et al reported the dose enhancement for different p-bolus regimens using pseudo-flash VMAT to 83% for BMB and 96% for 3 mm TEB using a custom phantom based on a specific patient. 14 This work included the pseudo-flash VMAT component but lacks a variety of field arrangements to confirm the robust process of this planning strategy.…”

Section: Introductionmentioning

confidence: 99%

Comparing brass mesh to tissue equivalent bolus materials for volumetric modulated arc therapy chest wall irradiation

Keiper

Kisling

Hua

et al. 2023

J Applied Clin Med Phys

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“…The RD ≥Grade 2 (38.7%) was lower than that reported in other studies 38–40 . As in previous reports, the frequency of ≥Grade 2 RD was 40%–90% for patients treated with a conventional technique, 35 and 42% for patients treated with IMRT 39 . The results of Arsenault's study (38%) are similar to our findings 40 .…”

Section: Discussionsupporting

confidence: 88%

“…In addition to the effect of the air gap on the dose distribution of the OAR and targets, the thickness of the bolus will also change the dose to the skin 35‒37 . Monajemi et al showed that average skin doses in postmastectomy VMAT treatments with a 3, 5, and 10 mm bolus were 0.96, 1.03, and 1.04, respectively 32 .…”

Section: Discussionmentioning

confidence: 99%

A clinical trial to compare a 3D‐printed bolus with a conventional bolus with the aim of reducing cardiopulmonary exposure in postmastectomy patients with volumetric modulated arc therapy

et al. 2021

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Background We compared the dosimetry, application, and acute toxicity of a 3D‐printed and a conventional bolus for postmastectomy radiotherapy (PMRT) with volumetric modulated arc therapy (VMAT). Materials and Methods Eligible patients (n = 75) with PMRT breast cancer were randomly selected to receive VMAT with a conventional bolus or a 3D‐printed bolus. The primary endpoint was a 10% decrease in the mean heart dose to left‐sided breast cancer patients. The secondary endpoint was a 5% decrease in the mean ipsilateral lung dose to all patients. A comparative analysis was carried out of the dosimetry, normal tissue complication probability (NTCP), acute skin toxicity, and radiation pneumonitis. Results Compared to a conventional bolus, the mean heart dose in left‐sided breast cancer was reduced by an average of 0.8 Gy (5.5 ± 1.3 Gy vs. 4.7 ± 0.8 Gy, p = 0.035) and the mean dose to the ipsilateral lung was also reduced by an average of 0.8 Gy (12.4 ± 1.0 Gy vs. 11.6 ± 0.8 Gy, p < 0.001). The values for V50Gy of the PTV of the chest wall for the 3D‐printed and conventional boluses were 95.4 ± 0.6% and 94.8 ± 0.8% (p = 0.026) and the values for the CI of the entire PTV were 0.83 ± 0.02 and 0.80 ± 0.03 (p < 0.001), respectively. The NTCP for the 3D‐printed bolus was also reduced to an average of 0.14% (0.32 ± 0.19% vs. 0.18 ± 0.11%, p = 0.017) for the heart and 0.45% (3.70 ± 0.67% vs. 3.25 ± 0.18%, p < 0.001) for the ipsilateral lung. Grade 2 and Grade 1 radiation pneumonitis were 0.0% versus 7.5% and 14.3% versus 20.0%, respectively (p = 0.184). Conclusions The 3D‐printed bolus may reduce cardiopulmonary exposure in postmastectomy patients with volumetric modulated arc therapy.

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“…The main purpose of this study is to investigate impact of bolus thickness on robustness of VMAT against setup errors in PMRT of left-sided breast cancer. Dose distribution in the targets and the OARs in VMAT with different bolus thicknesses are also evaluated since most of the published reports only focused on skin dose [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Robustness of VMAT to setup errors in postmastectomy radiotherapy of left-sided breast cancer: Impact of bolus thickness

Chen

Gao

et al. 2023

PLoS ONE

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Background Volumetric modulated arc therapy (VMAT) with varied bolus thicknesses has been employed in postmastectomy radiotherapy (PMRT) of breast cancer to improve superficial target coverage. However, impact of bolus thickness on plan robustness remains unclear. Methods The study enrolled ten patients with left-sided breast cancer who received radiotherapy using VMAT with 5 mm and 10 mm bolus (VMAT-5B and VMAT-10B). Inter-fractional setup errors were simulated by introducing a 3 mm shift to isocenter of the original plans in the anterior-posterior, left-right, and inferior-superior directions. The plans (perturbed plans) were recalculated without changing other parameters. Dose volume histograms (DVH) were collected for plan evaluation. Absolute dose differences in DVH endpoints for the clinical target volume (CTV), heart, and left lung between the perturbed plans and the original ones were used for robustness analysis. Results VMAT-10B showed better target coverage, while VMAT-5B was superior in organs-at-risk (OARs) sparing. As expected, small setup errors of 3 mm could induce dose fluctuations in CTV and OARs. The differences in CTV were small in VMAT-5B, with a maximum difference of -1.05 Gy for the posterior shifts. For VMAT-10B, isocenter shifts in the posterior and right directions significantly decreased CTV coverage. The differences were -1.69 Gy, -1.48 Gy and -1.99 Gy, -1.69 Gy for ΔD95% and ΔD98%, respectively. Regarding the OARs, only isocenter shifts in the posterior, right, and inferior directions increased dose to the left lung and the heart. Differences in VMAT-10B were milder than those in VMAT-5B. Specifically, mean heart dose were increased by 0.42 Gy (range 0.10 ~ 0.95 Gy) and 0.20 Gy (range -0.11 ~ 0.72 Gy), and mean dose for the left lung were increased by 1.02 Gy (range 0.79 ~ 1.18 Gy) and 0.68 Gy (range 0.47 ~ 0.84 Gy) in VMAT-5B and VMAT-10B, respectively. High-dose volumes in the organs were increased by approximate 0 ~ 2 and 1 ~ 3 percentage points, respectively. Nevertheless, most of the dosimetric parameters in the perturbed plans were still clinically acceptable. Conclusions VMAT-5B appears to be more robust to 3 mm setup errors than VMAT-10B. VMAT-5B also resulted in better OARs sparing with acceptable target coverage and dose homogeneity. Therefore 5 mm bolus is recommended for PMRT of left-sided breast cancer using VMAT.

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In search of a one plan solution for VMAT post‐mastectomy chest wall irradiation

Cited by 7 publications

References 24 publications

Comparing brass mesh to tissue equivalent bolus materials for volumetric modulated arc therapy chest wall irradiation

Comparing brass mesh to tissue equivalent bolus materials for volumetric modulated arc therapy chest wall irradiation

A clinical trial to compare a 3D‐printed bolus with a conventional bolus with the aim of reducing cardiopulmonary exposure in postmastectomy patients with volumetric modulated arc therapy

Robustness of VMAT to setup errors in postmastectomy radiotherapy of left-sided breast cancer: Impact of bolus thickness

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