Abstract
Objective:This study intends at a dosimetric comparison of four different hybrid plans which is a combination of different radiation therapy techniques, for synchronous bilateral breast cancer (SBBC) irradiation using a hypofractionated dose regimen. Methods:Four different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT, IMRT+VMAT, and VMAT+IMRT were planned using computed tomography (CT) images of fifteen SBBC patients. All hybrid plans were generated using a hypofractionated dose prescription of 40.5 Gy in 15 fractions. 70% of the dose was planned with a base-dose component and the remaining 30% of the dose was planned with a hybrid component. The plans were evaluated based on the PTV and organs at risk (OARs) dosimetric parameter results and computed a plan quality score for each plan. Results:The results for PTV parameters have shown that the 3DCRT+VMAT and 3DCRT+IMRT plans were better than other plans. The 3DCRT±IMRT plan was provided better results for OARs, while IMRT±VMAT and VMAT+IMRT plans were increased the low dose volumes to the heart and lungs. The 3DCRT+VMAT plan was required less monitor units and treatment time compared to other plans. Conclusion:The overall plan quality score that integrated the dosimetric parameters of PTV and OARs indicated that the 3DCRT+VMAT hybrid plan is superior for SBBC treatment.
Highlights
Synchronous bilateral breast cancer (SBBC) is a rare entity defined as tumors occurring concurrently in both breasts
The results for planning target volume (PTV) parameters have shown that the 3DCRT+volumetric modulated arc therapy (VMAT) and 3DCRT+Intensity modulated radiation therapy (IMRT) plans were better than other plans
radiation therapy (RT) of synchronous bilateral breast cancer (SBBC) is more difficult than unilateral breast due to larger target volume and involvement of both lungs
Summary
Synchronous bilateral breast cancer (SBBC) is a rare entity defined as tumors occurring concurrently in both breasts. Though the incidence of SBBC is lower compared to that of unilateral breast cancer, the burden of disease is relatively high in terms of complications and survival (Kheirelseid et al, 2011). As like unilateral breast cancer, adjuvant radiation therapy (RT) is an integral part of the multi modal management of SBBC patients. RT of SBBC is more complex, owing to multiple fields for a wider treatment volume and with the irradiation of both the lungs and heart. The reduction of RT-related toxicities to the lungs and heart as well as the better cosmetic outcome of breasts are highly anticipated. In a recent clinical study, Gadea et al, (2021) evaluated the feasibility, safety, and toxicity of hypofractionated RT (40.05 Gy in 15 fractions) for SBBC and showed better clinical outcomes in comparison with conventional fractionation (50 Gy in 25 fractions)
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