Abstract
Removing a flattening filter or replacing it with a thinner filter alters the characteristics of a photon beam, creating a forward peaked intensity profile to make the photon beam nonflat. This study is to investigate the feasibility of applying nonflat photon beams to the whole‐breast irradiation with breath holds for a potential of delivery time reduction during the gated treatment. Photon beams of 6 MV with flat and nonflat intensity profiles were commissioned. Fifteen patients with early‐stage breast cancer, who received whole‐breast radiation without breathing control, were retrospectively selected for this study. For each patient, three plans were created using a commercial treatment planning system: (a) the clinically approved plan using forward planning method (FP); (b) a hybrid intensity‐modulated radiation therapy (IMRT) plan where the flat beam open fields were combined with the nonflat beam IMRT fields using direct aperture optimization method (mixed DAO); (c) a hybrid IMRT plan where both open and IMRT fields were from nonflat beams using direct aperture optimization (nonflat DAO). All plans were prescribed for ≥95% of the breast volume receiving the prescription dose of 50 Gy (2.0 Gy per fraction). In comparison, all plans achieved a similar dosimetric coverage to the targeted volume. The average homogeneity index of the FP, mixed DAO, and nonflat DAO plans were 0.882±0.024, 0.879±0.023, and 0.867±0.027, respectively. The average percentage volume of V105 was 57.66%±5.21%, 34.67%±4.91%, 41.64%±5.32% for the FP, mixed, and nonflat DAO plans, respectively. There was no significant difference (p>0.05) observed for the defined endpoint doses in organs at risk (OARs). In conclusion, both mixed DAO and nonflat DAO plans can achieve similar plan quality as the clinically approved FP plan, measured by plan homogeneity and endpoint doses to the ORAs. Nonflat beam plans may reduce treatment time in breath‐hold treatment, especially for hypofractionated treatment.PACS number: 87.55
Highlights
58 Wang et al.: Nonflat photon beams for whole-breast irradiation to five times higher than that of the conventional flat beam
The purpose of this study is to investigate whether a comparable plan quality can be achieved with the nonflat beams using the inverse planned intensity-modulated radiation therapy (IMRT) technique when compared to the plans with the conventional flat beams using the forward-planning technique for breast treatment with breath holding
The average monitor units (MUs) for nonflat direct aperture optimization (DAO) was 35% more MUs than that of the mixed DAO plans, which was 21% higher than the average MU for the forward planning method (FP) plans
Summary
58 Wang et al.: Nonflat photon beams for whole-breast irradiation to five times higher than that of the conventional flat beam This drastically increased dose rate may substantially shorten the beam-on time, especially for patients receiving treatments under breathing holds, or automatic gating. Using a different treatment planning system, Ahunbay and colleagues and Descovich et al[8] reported that a mixed open field with intensity-modulated fields, which they called hybrid direct aperture-based IMRT plans, achieved similar the plan quality as FP-IMRT techniques. The purpose of this study is to investigate whether a comparable plan quality can be achieved with the nonflat beams using the inverse planned IMRT technique when compared to the plans with the conventional flat beams using the forward-planning technique for breast treatment with breath holding
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