Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients—comparative analysis of dose distribution and estimation of projected secondary cancer risk

Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital

“…Three of the reviewed articles on second cancer risk are based on Eclipse TPS, while the remaining one is based on Monaco. [ 1 , 17 18 19 ] All three articles about Eclipse, including the recently published article by Racka et al . (2022),[ 1 ] categorically indicated that LA-VMAT and m-IMRT were inferior to 3DCRT.…”

“…[ 1 , 17 18 19 ] All three articles about Eclipse, including the recently published article by Racka et al . (2022),[ 1 ] categorically indicated that LA-VMAT and m-IMRT were inferior to 3DCRT. [ 1 , 18 , 19 ] The lone article in Monaco TPS calculated secondary cancer risk by comparing LA-VMAT and m-IMRT with W3DCRT and t-IMRT to establish.…”

“…Tangential beam three-dimensional conformal radiotherapy (3D-CRT) or field-in-field (FiF) technique is still the most commonly used technique in breast (Br) radiotherapy. [ 1 ] Volumetric-modulated arc therapy (VMAT) for the breast radiotherapy was first described by Popescu et al . in 2010 using Otto’s algorithm, which was later adopted in the Eclipse planning system.…”

“…Nonetheless, as reflected in the published literature, a nonuniform, planning system-dependent adaptation of IMRT/VMAT has been observed among users. [ 1 2 3 , 5 6 7 8 9 10 11 12 13 14 15 16 ] The classical tangential beam wedged 3DCRT (W3DCRT) or FiF technique has been replaced by the following different intensity-modulated techniques: large arc (≥210°) VMAT (LA-VMAT), half-arc VMAT (HA-VMAT) (≈180°), tangential arc (30° ×2) VMAT (t-VMAT), multiple IMRT beams distributed over a large arc (multi-field IMRT [m-IMRT]), and tangential field IMRT (t-IMRT). Two primary changes have occurred for Eclipse (Varian Medical Systems, Palo Alto, CA, USA) and RayStation (RaySearch Laboratories, Stockholm, Sweden) where w3DCRT/FiF was replaced by LA-VMAT, HA-VMAT, or m-IMRT and the complex generation of the flash margins.…”

“…[ 7 , 8 , 14 , 15 ] With a wide variety of planning systems, the varied adaptation of the breast radiotherapy arc/beam angles yields a difference in organ doses, low-dose bath, and predictive second cancer risk. [ 1 , 17 18 19 ] Therefore, the question is, while adopting VMAT from a W3DCRT/FiF technique, why has the arc angle increased so much? The large arc angle adaptation violates the fundamental solid geometrical equivalence between 3DCRT and VMAT/IMRT.…”