Left Breast Radiotherapy With Multi Fields Hybrid Intensity Modulated Radiotherapy (IMRT) Versus Volumetric Modulated Arc Therapy (VMAT): Balance Between Left Anterior Descending Artery Sparing and Secondary Cancer Induction Risk

2021 ◽  
Author(s):  
Xiaoyong Xiang ◽  
Zhen Ding ◽  
Kailian Kang ◽  
Zhitao Dai ◽  
Wenjue Zhang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Volumetric Modulated Arc Therapy ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
High Dose ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Breast Cancer Radiotherapy ◽  
Arc Therapy

Abstract To explore the feasibility of using Volumetric-Modulated Arc Therapy (VMAT) to protect left anterior descending branch (LAD) after breast-conserving surgery for left breast cancer. 15 left breast cancer patients after breast-conserving surgery were selected. 7F-IMRT and 2A-VMAT treatment plans were designed with Varian Eclipse TPS (13.6version). The prescriptions of PTV and PTV Boost were 43.5Gy and 49.5Gy in 15 fractions. The dosimetric parameters, OARs dose sparing and second cancer risk (SCR) were compared between the two plans using a paired t-test. The VMAT plans obtain better PTV conformity and higher mean dose. VMAT plans show a better dose distribution in high dose areas and better sparing of OARs, including left lung, heart, and LAD. The Dmax and Dmean of LAD decreased significantly in VMAT plans. The SCRs of the contralateral lung and breast significantly increased with a higher mean dose. We recommend that contouring and evaluating the dose of LAD and LAD helping structures in left breast cancer radiotherapy. SCR should be evaluated for younger patients.

scholarly journals So sánh các thông số liều lượng của kỹ thuật vmat và 3d-crt trong xạ trị ung thư vú trái và hạch vùng

2020 ◽  
Author(s):  
Đình Long Nguyễn
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Volumetric Modulated Arc Therapy ◽  
Left Lung ◽  
Conformal Radiotherapy ◽  
Left Breast ◽  
Three Dimension ◽  
Breast Cancer Patients ◽  
Arc Therapy ◽  
3D Crt

COMPARISON OF DOSIMETRIC PARAMETERS OF VOLUMETRIC MODULATED ARC THERAPY AND THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY FOR LEFT SIDE BREAST AND REGIONAL NODES Objective: Comparative study of dose parameters of Volumetric modulated arc therapy (VMAT) and three-dimension radiotherapy (3D-CRT) in patients after left breast surgery with radiation therapy with regional lymph nodes. Materials and Methods: Twenty-four plans of 12 left-breast cancer patients were treated with VMAT with 4 partial arc and 3D-CRT plans were added to compare each other, from 1/2018 to 3/2019 at the Vinmec TimesCity International Hospital. Results: The average coverage dose to the treatment volume (PTV) of VMAT plans is better than the 3D-CRT plan (99.10 ± 0.17 % compared to 98.7 ± 0.34 %; p = 0.01). Conformity index (CI), homogeneity index (HI) for VMAT plans also better results CI: 0.99 vs. 0.98; p = 0.26 and HI: 0.096 compared to 0.119; p = 0.02). Organs at risk, at low doses V5Gy, V10Gy VMAT plans do not avoid good doses by 3D-CRT plans: V5Gy for left lung (78.8 ± 4.6 % compared to 55.37 ± 4.38 %) and heart (77.15 ± 9.52 % compared to 19.15 ± 7.93 %) (p <0.001). However, at high doses, 3D-CRT plans are much higher than VMAT: Dose to left lung V20Gy (36.22 ± 3.9 % compared to 22.62 ± 2.43 %), V30Gy (30.6 ± 5.97 % compared to 11.77 ± 2.53 %) and V40Gy (24.73 ± 8.59 % compared to 3.63 ± 2.02 %) (P <0.001). Similarly, the cardiac arrival dose of the 3D-CRT plan is higher than that of VMAT: V20Gy (11.54 ± 5.83 % compared to 9.49 ± 6.00 %, p> 0.05), V30Gy (9.25 ± 5.56 % compared to 2.13 ± 1.89 %) and V40 Gy (7.54 ± 5.03 % compared with 0.2 ± 0.25 %). Dose to coronary arteries also decreased significantly for VMAT plans compared to 3D-CRT: V20Gy (0.8 ± 1.01 % compared to 27.29 ± 15.19 %) V30Gy (0.00 % compared to 23.09 ± 10.73 %). Conclusion: VMAT is dosimetrically superior to the 3D-CRT for left‑sided breast cancer patients with regional nodes by dose coverage to PTV and good ability to avoid heart and lung and coronary arteries than. Key words: Breast cancer, Postmastectomy radiotherapy, Three-dimension conformal radiotherapy, Volumetric modulated arc therapy.

scholarly journals Dosimetric comparison of Volumetric Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy during Post Mastectomy left chest wall Irradiation

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Breast Cancer ◽  
Volumetric Modulated Arc Therapy ◽  
Three Dimensional ◽  
Left Lung ◽  
Conformal Radiotherapy ◽  
Breast Cancer Patients ◽  
Arc Therapy ◽  
Three Dimensional Conformal Radiotherapy ◽  
Higher Doses ◽  
3D Crt

Aims: To dosimetrically evaluate the Volumetric Modulated Arc Therapy (VMAT) technique and compare it with Three-Dimensional Conformal Radiotherapy (3D-CRT) for postmastectomy breast cancer therapy. Methods and Material: Ten consecutively treated left sided breast cancer patients were selected for this study. VMAT plans were generated from each of the patients planning CT and compared with 3D-CRT plans. Statistical analysis used: Two tailed paired t test Results: The VMAT technique provided statistically significant homogenous and conformal dose distribution with mean HI of (0.1±0.02) and mean CI of (1.1±0.06) when compared mean HI of (0.3±0.02) and mean CI of (1.7±0.2) in the 3D-CRT technique. VMAT plans showed reduced V30 of the heart (10±4.54) when compared to 3D-CRT plans (15.1±8.53). Except V30, VMAT plans resulted in higher doses to heart. The mean doses received by left lung was (17.50±6.27) and was significantly higher than that of 3D-CRT plans (10.20±3.72). VMAT plans also gave higher doses to the contralateral lung and the opposite breast. Conclusions: VMAT plans in post mastectomy breast cancers provide more homogenous and conformal plans as compared to 3DCRT plans but higher doses to normal tissues.

scholarly journals Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-sided Breast Cancers After Breast-conserving Surgery: a Planning Study

2021 ◽  
Author(s):  
Liuwei Tang ◽  
Yojiro Ishikawa ◽  
Kengo Ito ◽  
Takaya Yamamoto ◽  
Rei Umezawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Organs At Risk ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Breath Hold ◽  
Breast Cancer Patients ◽  
Lung Dose ◽  
Dose Reductions

Abstract Background This paper aims to compare dosimetric parameters of the organs at risk (OARs) among three different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath hold (DIBH) position. Three-dimensional radiotherapy (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH position. A 3DCRT plan was also created in the FB position. Dose-volume histogram (DVH) was used to analyze each evaluation index of OARs. The principal outcome was heart dose, left anterior descending coronary artery (LADCA) dose and left lung dose.Results For the 3D-CRT plans, significant dose reductions were demonstrated in all evaluation parameters to heart, LADCA and left lung dose in the DIBH position compared with the FB position (p < 0.05). In DIBH position, significant dose reductions were founded in heart and LADCA in VMAT plan compared to 3DCRT plan (p < 0.05). There were no significant differences between 3DCRT and VMAT plan for the left lung dose in DIBH position.Conclusion DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity

scholarly journals Treatment Planning Comparison of Volumetric Modulated Arc Therapy With Trilogy and Halcyon for Bilateral Breast Cancer 

2020 ◽  
Author(s):  
Tao Sun ◽  
Xiutong Lin ◽  
Guifang Zhang ◽  
Qingtao Qiu ◽  
Chengqiang Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Volumetric Modulated Arc Therapy ◽  
Bilateral Breast Cancer ◽  
Skin Dose ◽  
High Dose ◽  
Delivery Time ◽  
Breast Cancer Radiotherapy ◽  
Dose Volume ◽  
Arc Therapy ◽  
The Mean

Abstract Background: To evaluate the dosimetry of 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 were conducted among the four plans to select an optimal setup field mode. The four setup-field plans were referred to as CBCT-H, CBCT-L, MV-H, MV-L. Whole and partial arc plans on Trilogy and Halcyon referred to as T-4arc, T-8arc, H-4arc and H-8arc were designed. The dosimetric differences between whole and partial arc plans in the same accelerator were compared to understand the most suitable field setting mode. The better Halcyon plan was selected to the further dosimetric comparison of the plan quality and delivery efficiency between Trilogy and Halcyon. Results: CBCT-H plans increased Dmean, D2 and V107 of planning target volume (PTV) and V5 and Dmean of the heart, left ventricle (LV) and lungs compared to other plans. No significantly dosimetric differences were observed in PTV and organs at risk (OARs) among CBCT-L, MV-H and MV-L. The mean dose and low dose volume of heart, lungs and liver were significantly decreased in T-8arc plans. In terms of V5, V20, V30, V40 and Dmean of the heart, V20, V30, V40 and Dmean of the LV, V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p<0.05). Compared to Trilogy’s plans, 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, V30 of lungs, there was no statistical difference between the two accelerators. Compared with Trilogy, plans on Halcyon significantly increased the skin dose, but also significantly reduced the delivery time. Conclusion: For Halcyon, the whole-arc plans has more dosimetric advantages in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the dose of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.

scholarly journals Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-Sided Breast Cancers After Breast-Conserving Surgery: A Planning Study

2021 ◽  
Vol 20 ◽  
pp. 153303382110487
Author(s):  
Liuwei Tang ◽  
Yojiro Ishikawa ◽  
Kengo Ito ◽  
Takaya Yamamoto ◽  
Rei Umezawa ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Left Lung ◽  
Breast Conserving Surgery ◽  
Left Breast ◽  
Breath Hold ◽  
Breast Cancer Patients ◽  
Lung Dose ◽  
Significant Difference ◽  
Dose Reductions

Background: Dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) were compared among 3 different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods: Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath-hold (DIBH) position. Three-dimensional conformal RT (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH positions. A 3DCRT plan was also created in the FB position. A dose-volume histogram (DVH) was used to analyze each evaluation index of PTV and OARs. The principal outcomes were PTV dose, heart dose, right breast dose, left anterior descending coronary artery (LADCA) dose, and left lung dose. Results: For 3DCRT plans, significant dose reductions were demonstrated in all evaluation parameters of the heart, LADCA, and left lung doses in the DIBH position compared with those in the FB position ( P < 0.05). In the DIBH position, significant dose reductions were found in the heart and LADCA in VMAT plans compared to those in 3DCRT plans ( P < 0.05). For the right breast, VMAT reduced Dmean significantly (0.32 Gy vs 0.08  Gy, P < 0.01). There were no significant differences between 3DCRT and VMAT plans for the left lung dose in the DIBH position. The indicators of PTV had no significant difference between the 3 plans. Conclusion: DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity.

Contribution of Magnetic Resonance Imaging in Determining Lumpectomy Cavity in Breast Radiotherapy

2020 ◽  
Vol 16 (8) ◽  
pp. 997-1003
Author(s):  
Ozlem Demircioglu ◽  
Huseyin Tepetam ◽  
Ayfer Ay Eren ◽  
Zerrin Ozgen ◽  
Fatih Demircioglu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Supine Position ◽  
Radiotherapy Planning ◽  
Breast Cancer Patients ◽  
Breast Radiotherapy ◽  
Lumpectomy Cavity ◽  
Breast Cancer Radiotherapy ◽  
Significant Difference ◽  
Mean Diameter ◽  
Ct And Mri

Background: Accurate localization of the lumpectomy cavity is important for breast cancer radiotherapy after breast-conserving surgery (BCS), but the LC localization based on CT is often difficult to delineate accurately. The study aimed to compare CT-defined LC planning to MRI-defined findings in the supine position for higher soft-tissue resolution of MRI. Methods: Fifty-nine breast cancer patients underwent radiotherapy CT planning in supine position followed by MR imaging on the same day. LC was contoured by the radiologist and radiation oncologist together by CT and MRI separately. T2 weighted MR images and tomography findings were combined and the LC volume, mean diameter and the longest axis length were measured after contouring. Subsequently, patients were divided into two groups according to seroma in LC and the above-mentioned parameters were compared. Results: We did not find any statistically significant difference in the LC volume, mean diameter and length at the longest axis between CT and MRI but based on the presence or absence of seroma, statistically significant differences were found in the LC volumes and the length at the longest axis of LC volumes. Conclusion: We believe that the supine MRI in the same position with CT will be more effective for radiotherapy planning, particularly in patients without a seroma in the surgical cavity.

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