scholarly journals Dosimetric and Radiobiological Comparison of Five Techniques for Postmastectomy Radiotherapy with Simultaneous Integrated Boost

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Du Tang ◽  
Zhan Liang ◽  
Fada Guan ◽  
Zhen Yang
Keyword(s):  
Breast Cancer ◽  
Organs At Risk ◽  
Intensity Modulated Radiotherapy ◽  
Normal Tissue Complication Probability ◽  
Simultaneous Integrated Boost ◽  
Conformity Index ◽  
Postmastectomy Radiotherapy ◽  
Integrated Boost ◽  
Similar Good ◽  
Delivery Efficiency

Purpose. To compare five techniques for the postmastectomy radiotherapy (PMRT) with simultaneous integrated boost (SIB). Materials and Methods. Twenty patients with left-sided breast cancer were retrospectively selected. Five treatment plans were created for each patient: TomoDirect (TD), unblocked helical TomoTherapy (unb-HT), blocked HT (b-HT), hybrid intensity-modulated radiotherapy (hy-IMRT), and fixed-field IMRT (ff-IMRT). A dose of 50.4 Gy in 28 fractions to PTVtotal and 60.2 Gy in 28 fractions to PTVboost were prescribed. The dosimetric parameters for targets and organs at risk (OARs), the normal tissue complication probability (NTCP), the second cancer complication probability (SCCP) for OARs, and the treatment efficiency were assessed and compared. Results. TD plans and hy-IMRT plans had similar good dose coverage and homogeneity for both PTVboost and PTVtotal and superior dose sparing for the lungs and heart. The ff-IMRT plans had similar dosimetric results for the target volumes compared with the TD and hy-IMRT plans, but gave a relatively higher NTCP and SCCP for the lungs. The unb-HT plans exhibited the highest OAR mean dose, highest NTCP for the lungs (0.97±1.25‰) and heart (4.58±3.62%), and highest SCCP for the lungs (3.57±0.05%) and contralateral breast (2.75±0.29%) among all techniques. The b-HT plans significantly outperformed unb-HT plans with respect to the sparing of the lungs and heart. This technique also showed the best conformity index (0.73±0.08) for PTVboost and the optimal NTCP for the lungs (0.03±0.03‰) and heart (0.61±0.73%). Concerning the delivery efficiency, the hy-IMRT and ff-IMRT achieved much higher delivery efficiency compared with TomoTherapy plans. Conclusion. Of the five techniques studied, TD and hy-IMRT are considered the preferable options for PMRT with SIB for left-sided breast cancer treatment and can be routinely applied in clinical practice.

Dosimetric comparison between intensity-modulated radiotherapy and volumetric-modulated arc therapy in hippocampus sparing in brain metastasis treated by whole-brain irradiation and simultaneous integrated boost

2019 ◽  
Vol 19 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Ehab Saad ◽  
Khaled Elshahat ◽  
Hussein Metwally
Keyword(s):  
Brain Metastasis ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Intensity Modulated Radiotherapy ◽  
Simultaneous Integrated Boost ◽  
Conformity Index ◽  
Whole Brain ◽  
Intensity Modulated ◽  
Arc Therapy ◽  
Integrated Boost

AbstractBackground:While treating brain metastasis with whole-brain radiotherapy incorporating a simultaneous integrated boost (WBRT-SIB), the risk of hippocampus injury is high. The aim of this study is to compare dosimetrically between intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in sparing of hippocampus and organs at risk (OARs) and planning target volume (PTV) coverage.Methods:In total, 16 patients presenting with more than one brain metastases were previously treated and then retrospectively planned using VMAT and IMRT techniques. For each patient, a dual-arc VMAT and another IMRT (five beams) plans were created. For both techniques, 30 Gy in 10 fractions was prescribed to the whole brain (WB) minus the hippocampi and 45 Gy in 10 fractions to the tumour with 0·5 cm margin. Dose–volume histogram (DVH), conformity index (CI) and homogeneity index (HI) of PTV, hippocampus mean and maximum dose and other OARs for both techniques were calculated and compared.Results:A statistically significant advantage was found in WB-PTV CI and HI with VMAT, compared to IMRT. There were lower hippocampus mean and maximum doses in VMAT than IMRT. The maximum hippocampus dose ranged between 15·5 and 19·2 Gy and between 18·4 and 20·6 Gy in VMAT and IMRT, respectively. The mean dose of the hippocampus ranged between 11·5 and 17·7 Gy and between 13·2 and 18·3 Gy in VMAT and IMRT, respectively.Conclusion:Using WBRT-SIB technique, VMAT showed better PTV coverage with less mean and maximum doses to the hippocampus than IMRT. Clinical randomised studies are needed to confirm safety and clinical benefit of WBRT-SIB.

Dosimetric and radiobiological comparison of external beam radiotherapy using simultaneous integrated boost technique for esophageal cancer in different location.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15505-e15505
Author(s):  
Lu Wang ◽  
Jinming Yu
Keyword(s):  
Esophageal Cancer ◽  
External Beam Radiotherapy ◽  
Intensity Modulated Radiotherapy ◽  
Target Volume ◽  
Simultaneous Integrated Boost ◽  
Conformity Index ◽  
Tumor Control ◽  
Tumor Control Probability ◽  
Integrated Boost ◽  
Treatment Plans

e15505 Background: Based on dosimetry and radiobiology to compare treatment plans for esophageal cancer (EC) in different location using intensity modulated radiotherapy (IMRT), volumetric modulated arc radiotherapy (VMAT) and helical tomotherapy(HT) with simultaneous integrated boost (SIB) technique. Methods: A total of 20 patients including 5 cases respectively located in the cervix, upper, middle and lower thorax were generated for IMRT, VMAT and HT plans. The dose volume histogram statistics, conformity index (CI), homogeneity index (HI), tumor control probability (TCP) and normal tissues control probability (NTCP) were analyzed to evaluate treatment plans. Results: HT showed significantly improvement over IMRT and VMAT in terms of CI(0.93±0.03), HI(0.07±0.03) and TCP(88.08±0.82%) in cervical EC(p<0.05). IMRT greatly developed TCP(88.29±1.79%;85.11±0.79%), and offered superior CIs (0.87±0.04;0.90±0.01) and HIs(0.10±0.01; 0.06±0.01) compared with VMAT and HT in upper and middle thoracic EC(p<0.05). Meanwhile, the V30(33.30±6.49%), mean dose (2559.00±219.64cGy) and NTCP(0.50±0.61%) of heart for IMRT were significantly reduced than other two techniques in middle thoracic EC. Patients with lower thoracic EC yielded the similar CIs and HIs(all p>0.05) for the 3 techniques, but VMAT showed the lowest NTCP of lungs (0.01±0.01%) with improved TCP (84.84±1.13%). Conclusions: HT was a good option with little lung and heart involvement as it achieved superior dose conformality and uniformity. IMRT was a perfect strategy with large thoracic involvement. It significantly improved tumor local control and reduced heart dose and complications with acceptable dose to lungs. VMAT was preferred with a smaller target volume but surrounded by more heart and less lungs. Individually choosing optimal technique for EC in different location will be warranted.

Comorbidities and intensity-modulated radiotherapy with simultaneous integrated boost in elderly breast cancer patients

2017 ◽  
Vol 30 (5) ◽  
pp. 533-538 ◽  
Author(s):  
Alba Fiorentino ◽  
Rosario Mazzola ◽  
Niccolò Giaj Levra ◽  
Sergio Fersino ◽  
Francesco Ricchetti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Intensity Modulated Radiotherapy ◽  
Simultaneous Integrated Boost ◽  
Breast Cancer Patients ◽  
Intensity Modulated ◽  
Integrated Boost

scholarly journals Accelerated Hypofractionated Radiotherapy With Simultaneous Integrated Boost With Volumetric Modulated Arc Technique in Patients With Breast Cancer: a Phase 2 Study.

2021 ◽  
Author(s):  
Budhi Singh Yadav ◽  
Shipra Gupta ◽  
Divya Dahiya ◽  
Ankita Gupta ◽  
Arun Oinam
Keyword(s):  
Breast Cancer ◽  
Organs At Risk ◽  
Disease Free Survival ◽  
Skin Toxicity ◽  
Simultaneous Integrated Boost ◽  
Hypofractionated Radiotherapy ◽  
Acute Skin Toxicity ◽  
Integrated Boost ◽  
Left And Right ◽  
Accelerated Hypofractionated Radiotherapy

Abstract PurposeTo assess feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) with volumetric modulated arc technique (VMAT) in patients with breast cancer.Methods Total 27 patients after breast conserving surgery (BCS) were included in this study. Patients were planned on 4-dimensional computerized tomogram (4D-CT) and contouring was done using RTOG guidelines. Dose delivered was 34 Gy/10#/2wk to the breast and 40 Gy/10#/2wk to the tumor bed as SIB with VMAT technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs at risk were calculated. Toxicities and cosmesis were assessed using RTOG LENT-SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) was calculated with Kaplan Meier curves.ResultsMean age of the patients was 42 years. Left and right breast cancer was seen in 17 (63%) and 10 (37%) patients, respectively. Ipsilateral lung mean V16 and contralateral lung V5 was 16.01% and 3.73%, respectively. Mean heart dose from the left and right breast was 7.25Gy and 4.37Gy, respectively. Mean dose to the contralateral breast, oesophagus and spinal cord was 2.64Gy, 3.69Gy and 3.15Gy, respectively. Thyroid V25 mean was 19.69%.Grade 1 and 2 acute skin toxicity was observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema and induration were observed in 1 (3.7%), 2 (7.4%) and 4(14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient each. Median follow-up was 48 months (range 12-58 months). At 4 years breast induration, edema and fibrosis each were observed in 1(3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred 1(3.7%) and 2(7.4%) patients, respectively. DFS and OS at 3-years was 88% and 92%, respectively.ConclusionWith this RT schedule acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS and OS were good.

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