Intensity Modulated Radiotherapy Using Multiple in Fields Compared to Wedged Fields in Breast Irradiation: Clinical Impact on Early Skin Reaction and Organs at Risk Doses

Zaghloul, Hala

doi:10.4172/2155-9619.1000176

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…A lower HI means better homogeneity, thus implying that IMRT and VMAT led to a more homogenous dose distribution than 3D-CRT. A more homogenous dose distribution translates to a better cosmetic outcome and a significant reduction in acute skin reaction incidence, as proposed by Zaghloul et al [ 25 ]. In comparison, Sudha et al [ 18 ] gave the value of HI for VMAT as 0.23±0.105 and 0.16±0.075 for 3D-CRT.…”

Section: Discussionmentioning

confidence: 99%

A Dosimetric Study Comparing 3D-CRT vs. IMRT vs. VMAT in Left-Sided Breast Cancer Patients After Mastectomy at a Tertiary Care Centre in Eastern India

Majumdar¹,

Amritt²,

Dhar³

et al. 2022

Cureus

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Introduction Post-mastectomy radiation in left-sided breast cancer in women continues to pose a significant risk to the underlying lungs and heart. This study analyzed the difference in planning target volume (PTV) coverage and dose to the organs at risk (OAR) by using three different planning methods for the same patient - three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT). Material and methods Thirty-five left-sided breast cancer patients’ post-mastectomy were included in this study, and three different plans for adjuvant radiation were created using 3D-CRT, IMRT, and VMAT. The prescribed dose was 50Gy in 25 fractions. Kruskal-Wallis analysis of variance (ANOVA) was done, followed by a pairwise t-test to establish a hierarchy of plan quality and dosimetric benefits. The plans were compared with PTV 95 , homogeneity index (HI), conformity index (CI), hotspot (V 107% ), left lung V 20Gy , mean lung dose, heart V 25Gy , mean heart dose, and integral dose (ID) to the body. Results Both VMAT and IMRT led to improved PTV 95% coverage (95.63±1.82%, p=0.000 in VMAT; 93.70±2.16 %, p=0.000; 81.40±6.27% in 3D-CRT arm) and improved CI (0.91±0.06 in IMRT [p<0.05] and 0.96±0.02 for VMAT plans [p<0.05]) as compared to 3D-CRT (0.66±0.11), which was statistically significant on pairwise analysis. In contrast, the difference in HI and reduction in hotspots were not significantly different. Left lung V 20 was statistically very different between the three arms with the highest values in IMRT (36.64±4.45) followed by 3D-CRT (34.80±2.24) and the most negligible value in VMAT (33.03±4.20). Mean lung dose was also statistically different between the three arms. There was a statistically significant difference in mean heart dose between the three arms on pairwise analysis. Both the inverse planning methods led to a statistically significant increase in low dose volume (V 5 and V 10 ) of the ipsilateral lung, opposite lung, and heart, and increased ID to the body excluding the PTV. Conclusion While both the inverse planning modalities led to increased coverage, better CI, and better HI and decreased high dose volumes in OARs, there was increased low volume irradiation of heart, lungs, and body with VMAT faring marginally better than IMRT in coverage and decreasing lung irradiation with comparable heart irradiation.

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Section: Discussionmentioning

confidence: 99%

A Dosimetric Study Comparing 3D-CRT vs. IMRT vs. VMAT in Left-Sided Breast Cancer Patients After Mastectomy at a Tertiary Care Centre in Eastern India

Majumdar¹,

Amritt²,

Dhar³

et al. 2022

Cureus

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“…This was observed as true in this study, with Ecomp producing the best HI among all techniques, having the value closest to the ideal value of 1.0. Zaghloul et al [ 23 ] reported a correlation between improved PTV HI and significant reduction of acute skin reaction incidence. This correlation between the clinical outcome and PTV HI can be applicable to the findings in this study that indicates Ecomp as having the potential of reducing risk of acute skin toxicities compared to the other techniques.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric comparative study of 3DCRT, IMRT, VMAT, Ecomp, and Hybrid techniques for breast radiation therapy

2020

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To assess and compare the dosimetric parameters obtained between three-dimensional conformal radiotherapy (3DCRT), three-dimensional field-in-field (3DFIF), 5-field intensity-modulated radiotherapy (IMRT MF5), tangential IMRT (tIMRT), tangential volumetric modulated arc therapy (tVMAT), electronic tissue compensation (Ecomp), and Hybrid treatment plans. Material and Methods: Thirty planning computed tomography datasets obtained from patients previously treated with whole breast radiation therapy (WBRT) were utilized in this study. Treatment plans were created for 3DCRT, 3DFIF, IMRT MF5, tIMRT, tVMAT, Ecomp, and Hybrid techniques using Eclipse Treatment Planning System (version 13.6) with a prescribed dose of 42.5 Gy in 16 fractions. Results: Techniques with tangential beams produced statistically significantly better organs-at-risk (OARs) dosimetry (p < 0.001). Planning target volume Homogeneity Index (HI) was found to be significantly different among all techniques (p < 0.001), with Ecomp resulting in better HI (1.061 ± 0.029). Ecomp was also observed to require relatively shorter planning time (p < 0.001). Conclusions: Techniques using tangential fields arrangements produced improved OARs dosimetry. Of all the treatment planning techniques employed in this study, Ecomp was found to be relatively easy to plan and produce acceptable dosimetry for WBRT in a short time.

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“…A randomised clinical trial by Pignol et al 20 showed that IMRT could significantly improve the dose distribution, resulted in lowering the proportion of moist desquamation which was correlated with the pain score, global health status scale and breast status scale. Besides this, Zaghloul et al 31 compared the conventional physical wedges or dynamic wedges technique with the multiple fields in field (MFIF) technique, in which the results concurred that MFIF technique had higher HI and also reduced skin toxicity. This correlation of HI and clinical outcome may be applicable to our study which means that IMRT and ECOMP may cause less skin toxicity compared with 3D-CRT.…”

Section: Discussionmentioning

confidence: 93%

Dosimetric study of three-dimensional conformal radiotherapy, electronic compensator technique, intensity-modulated radiation therapy and volumetric-modulated arc therapy in whole breast irradiation

et al. 2017

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BackgroundWhole breast irradiation is an essential treatment after breast-conserving surgery (BCS). However, there are some adverse effects from inhomogeneity and dose to adjacent normal tissues.ObjectiveAim of this study was to compare dosimetry among standard technique, three-dimensional conformal radiotherapy (3D-CRT), and advanced techniques, electronic compensator (ECOMP), inverse intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).MethodsWhole breast irradiation treatment plans of patients who had underwent BCS and whole breast irradiation were re-planned with all four techniques. Clinical target volume was contoured according to the Radiation Therapy Oncology Group atlas for breast only in patients who had negative node or ductal carcinoma in situ and breast with chest wall for patients with positive node. Planning target volume was non-uniformly expanded. Dose prescription was 50 Gy in 25 fractions with 6 MV photon energy.ResultsIn total, 25 patients underwent whole breast irradiation with computed tomography simulation from November 2013 to November 2014 were included. Six patients with positive nodes were re-planned for breast with chest wall irradiation and 19 patients with negative nodes were re-planned for breast only irradiation. Primary outcome, radical dose homogeneity index (HI) of 3D-CRT, ECOMP, IMRT and VMAT were 0·865, 0·889, 0·890 and 0·866, respectively. ECOMP and IMRT showed significant higher HI than 3D-CRT (p-value<0·001). Secondary outcome, conformity index (CI) of advanced technique were significantly better than 3D-CRT. Lung V20, mean ipsilateral lung dose (MILD), mean heart dose (MHD), heart V25, heart V30 of advanced techniques were also lower than 3D-CRT. ECOMP had better mean lung dose (MLD), mean contralateral lung dose (MCLD) and mean contralateral breast dose (MCBD) when compared with 3D-CRT. Monitor units of advanced techniques were significantly higher than 3D-CRT.ConclusionsHI of ECOMP and IMRT were significantly higher than 3D-CRT technique. All advanced techniques showed statistically better in CI. Lung V20, MILD, heart V25 and heart V30 of advanced techniques were lower than 3D-CRT. However, only ECOMP showed decreased MLD, MHD, MCLD and MCBD when compared with 3D-CRT.

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Intensity Modulated Radiotherapy Using Multiple in Fields Compared to Wedged Fields in Breast Irradiation: Clinical Impact on Early Skin Reaction and Organs at Risk Doses

Cited by 3 publications

References 27 publications

A Dosimetric Study Comparing 3D-CRT vs. IMRT vs. VMAT in Left-Sided Breast Cancer Patients After Mastectomy at a Tertiary Care Centre in Eastern India

A Dosimetric Study Comparing 3D-CRT vs. IMRT vs. VMAT in Left-Sided Breast Cancer Patients After Mastectomy at a Tertiary Care Centre in Eastern India

Dosimetric comparative study of 3DCRT, IMRT, VMAT, Ecomp, and Hybrid techniques for breast radiation therapy

Dosimetric study of three-dimensional conformal radiotherapy, electronic compensator technique, intensity-modulated radiation therapy and volumetric-modulated arc therapy in whole breast irradiation

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