Abstract
Purpose:To determine if bolus electron conformal therapy (Bolus‐ECT) combined with intensity modulated x‐ray therapy (IMXT) and flattening filter free volumetric modulated arc therapy (FFF‐VMAT (6x and 10x)) can maintain equal or better dose coverage than standard volumetric modulated arc therapy (Std‐VMAT) while reducing doses to organs at risk (OARs).Methods:Bolus‐ECT with IMXT, FFF‐VMAT, and Std‐VMAT treatment plans were produced for ten post‐mastectomy radiotherapy (PMRT) patients previously treated at our clinic. The treatment plans were created on commercially available treatment planning system (TPS) and all completed treatment plans were reviewed and approved by a radiation oncologist. The plans were evaluated based on planning target volume (PTV) coverage, tumor control probability (TCP), dose homogeneity index (DHI), conformity index (CI), and dose to organs at risk (OAR).Results:All techniques produced clinically acceptable PMRT plans. Overall, Bolus‐ECT with IMXT exhibited higher maximum dose compared to all VMAT techniques. Bolus‐ECT with IMXT and FFF‐VMAT10x had slightly improved TCP over FFF‐VMAT6x and Std‐VMAT. However, all VMAT techniques showed improved CI and DHI over Bolus‐ECT with IMXT. All techniques showed very similar mean lung dose. Bolus‐ECT with IMXT exhibited a reduced mean heart dose over Std‐VMAT. Both FFF‐VMAT techniques had higher mean heart dose compared to Std‐VMAT. In addition, Bolus‐ECT with IMXT was able to reduce mean dose to the contralateral breast compared to Std‐VMAT and both FFF‐VMAT techniques had comparable but slightly reduced dose compared to Std‐VMAT.Conclusion:This work has shown that Bolus‐ECT with IMXT produces clinically acceptable plans while reducing OAR doses. Both FFF‐VMAT techniques are comparable to Std‐VMAT with slight improvements. Even though all VMAT techniques produce more homogenous and conformal dose distributions, Bolus‐ECT with IMXT is a viable option for treating post‐mastectomy patients possibly leading to reduced risks of normal tissue complications.
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