Abstract
This study aimed to evaluate the robustness against geometric uncertainties in the hybrid intensity-modulated radiation therapy (IMRT) plans generated by commercially available software for automated breast planning (ABP). The ABP plans were compared with commonly used forward-planned field-in-field (FIF) technique plans. The planning computed tomography datasets of 20 patients who received left-sided breast-conserving surgery were used for both the ABP and FIF plans. Geometric uncertainties were simulated by shifting beam isocenters by 2, 3, 5, and 10 mm in the six directions: anterior/posterior, left/right, and superior/inferior. A total of 500 plans (20 patients and 25 scenarios, including the original plan) were created for each of the ABP and FIF plans. The homogeneity index of the target volume in the ABP plans was significantly better (p < 0.001) than the value in the FIF plans in the scenarios of shifting beam isocenters by 2, 3, and 5 mm. Mean heart dose and percentage volume of lungs receiving a dose more than 20 Gy were clinically acceptable in all scenarios. The hybrid IMRT plans generated by commercially available ABP software provided better robustness against geometric uncertainties than forward-planned FIF plans.
Highlights
This study aimed to evaluate the robustness against geometric uncertainties in the hybrid intensitymodulated radiation therapy (IMRT) plans generated by commercially available software for automated breast planning (ABP)
This study confirmed that ABP plans were more homogeneous for the target dose than FIF plans in the situations of shifting the beam isocenters within 5 mm
The minimum dose represented by D98% values of the target region was equal between FIF and ABP plans, and the maximum dose represented by D2% values of ABP plans was lower compared with FIF plans
Summary
This study aimed to evaluate the robustness against geometric uncertainties in the hybrid intensitymodulated radiation therapy (IMRT) plans generated by commercially available software for automated breast planning (ABP). The hybrid IMRT plans generated by commercially available ABP software provided better robustness against geometric uncertainties than forward-planned FIF plans. Breast conservation therapy is the standardized treatment for early-stage breast cancer, and whole breast irradiation after breast-conserving surgery has been established for reducing local recurrence and breast cancer mortality[2,3,4,5] Several advanced techniques such as intensity-modulated radiation therapy (IMRT) have been developed in the past 20 years. This study aimed to evaluate the robustness against geometric uncertainties in the hybrid IMRT plans generated by commercially available ABP software. The ABP approach was compared with clinical treatment plans that comprised forward-planned field-in-field (FIF) technique in terms of the target dose and the dose for the organ at risk
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