Helical tomotherapy and volumetric modulated arc therapy: New therapeutic arms in the breast cancer radiotherapy

Background: For advanced breast cancer with lymph node involvement, adjuvant radiotherapy (RT) with regional nodal irradiation (RNI) has been indicated to reduce cancer recurrence and mortality. However, an extensive RT volume is associated with normal organ exposure, which increases the toxicity and affects patient outcomes. Modern arc RT techniques can improve normal organ sparing compared with conventional techniques. The aim of this study was to explore the optimal technique for left-breast RT with RNI. Methods: We retrospectively reviewed patients receiving RT with RNI for left-breast cancer. We used modern arc RT techniques with either volumetric-modulated arc therapy (VMAT) or helical tomotherapy (HT) with a novel block technique, and compared differences in dosimetry parameters between the two groups. Subgroup analysis of RNI with or without internal mammary node (IMN) volume was also performed. Results: A total of 108 eligible patients were enrolled between 2017 and 2020, of whom 70 received VMAT and 38 received HT. The median RT dose was 55 Gy. No significant differences were found regarding the surgery, RT dose, number of fractions, target volume, and RNI volume between the VMAT and HT groups. VMAT reduced the heart mean dose more than HT (3.82 vs. 5.13 Gy, p < 0.001), as well as the cardiac parameters of V5-V20, whole-lung mean dose, lung parameters of V5-V20, and contralateral-breast and esophagus mean dose. In the subgroup analysis of RNI with IMNs, the advantage of VMAT persisted in protecting the heart, lung, contralateral breast, and esophagus. HT was beneficial for lowering the thyroid mean dose. For RNI without IMN, VMAT improved the low-dose exposure of the heart and lung, but HT was similar to VMAT in terms of heart, whole-lung, and contralateral-breast mean dose. Conclusions: For patients with left-breast cancer receiving adjuvant RT with RNI, VMAT reduced the exposure dose to the heart, lung, contralateral breast, and esophagus compared with HT. VMAT was superior to HT in terms of normal organ sparing in the patients who underwent RNI with IMN irradiation. Considering the reduction in normal organ exposure and potential toxicity, VMAT is the optimal technique for patients receiving RNI when deep inspiration breath-hold is not available.

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Dosimetric comparison of volumetric-modulated arc therapy and helical tomotherapy for adjuvant treatment of bilateral breast cancer

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920000795 ◽

2020 ◽

pp. 1-9

Author(s):

Reena Phurailatpam ◽

Tabassum Wadasadawala ◽

Kamalnayan Chauhan ◽

Subhajit Panda ◽

Rajiv Sarin

Keyword(s):

Breast Cancer ◽

Helical Tomotherapy ◽

Treatment Time ◽

Volumetric Modulated Arc Therapy ◽

Bilateral Breast Cancer ◽

Whole Body ◽

Dosimetric Comparison ◽

Significant Difference ◽

Arc Therapy ◽

The Mean

Abstract Purpose: Dosimetric comparison between volumetric-modulated arc therapy (VMAT) and helical tomotherapy (HT) in the treatment of bilateral breast cancer (BBC). Materials and methods: Ten patients treated on HT were selected retrospectively. Dose prescription was 50 Gy in 25 fractions to breast/chest wall and supraclavicular fossa (SCF) while tumour bed was simultaneously boosted to 61 Gy in 25 fractions. VMAT plans were made with four mono-isocentric partial arcs. The monitoring unit (MU) and treatment time were used to quantify the treatment efficiency. Target volumes were compared for homogeneity index (HI), conformity index (CI) while organs at risk (OARs) were compared for relevant dose volumes and integral doses (IDs). Result: For targets, no significant difference is observed between VMAT and HT in CI but VMAT could give better HI. The mean lung dose, V20 and V5 is 10·6 Gy versus 8·4 Gy (p-value 0·03), 12% versus 11·5% (p-value 0·5) and 78·1% versus 43·4% (p-value 0·005), respectively. The mean heart dose, V30 and V5 is 4·9 Gy versus 4·7 Gy (p-value 0·88), 0·5% versus 1·5% (p-value 0·18) and 26·2% versus 22·8% (p-value 0·4). Integral dose (ID) for the whole body and heart are comparable: 289 Gy kg versus 299 Gy kg (p-value 0·24) and 2·9 Gy kg versus 2·8 Gy kg (p-value 0·80). ID for lungs was significantly higher with VMAT: 7·9 Gy kg versus 6·3 Gy kg (p-value 0·03). There is a 53% reduction in treatment time and 78% in MU with VMAT against HT. Conclusion: VMAT can generate clinically acceptable plans comparable to HT for BBC. HT shows better control over low dose spillage in lungs compared to VMAT thereby increasing ID to lungs. VMAT shows better homogeneity and efficient treatment delivery than HT.

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EP-1702: Cardiac dose evaluation in left breast cancer radiotherapy: Direct and Helical Tomotherapy

Radiotherapy and Oncology ◽

10.1016/s0167-8140(16)32953-x ◽

2016 ◽

Vol 119 ◽

pp. S795-S796

Author(s):

A. Fozza ◽

L. Berta ◽

S. Aimonetto ◽

F. Migliaccio ◽

A. Peruzzo Cornetto ◽

...

Keyword(s):

Breast Cancer ◽

Helical Tomotherapy ◽

Left Breast ◽

Cancer Radiotherapy ◽

Dose Evaluation ◽

Breast Cancer Radiotherapy ◽

Cardiac Dose

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Comparison of Unblocked, Directionally Blocked and Full Blocked Plans in Helical Tomotherapy for Breast Cancer Radiotherapy

Journal of Nuclear Medicine & Radiation Therapy ◽

10.4172/2155-9619.1000358 ◽

2018 ◽

Vol 09 (02) ◽

Author(s):

Eda Kucuktulu ◽

Ahmet Fatih Yurekli ◽

Eray Bilcan ◽

Mahmut Serdar Sisecioglu ◽

Murat Topbas and Uzer Kucuktulu

Keyword(s):

Breast Cancer ◽

Helical Tomotherapy ◽

Cancer Radiotherapy ◽

Breast Cancer Radiotherapy

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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

10.21203/rs.3.rs-255331/v1 ◽

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.

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

10.21203/rs.3.rs-92224/v1 ◽

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.

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