Abstract
The aim of this study was to identify a rational strategy for the selection of multi-beam IMRT in patients with right breast cancer through the comparison of dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) using five different radiotherapy modalities. This was a retrospective study using computed tomography scans from ten patients with early-stage right breast cancer who had been treated previously. Three dimensional conformal radiotherapy (3DCRT), forward-planned IMRT (for-IMRT), inverse-planned IMRT (inv-IMRT), helical tomotherapy (HT), and volumetric-modulated arc therapy (VMAT) were planned for each patient. The plans were compared according to dose–volume histogram analysis. The most significant impact of inverse-planned multi-beam modalities for right breast cancer was the reduction of Dmax, Dmean, V53.5 and prescribed dose volume (cc) outside of the PTV (breast) (OB-V50) of the PTV. HT decreased the ipsilateral OAR volumes receiving higher doses. In exchange, HT also increased the volumes receiving low doses, which is known to lead to an increased rate of radiation-induced secondary malignancies. The heart, LAD, and contralateral doses for 3DCRT and for-IMRT were significantly lower than those for inv-IMRT, HT, and VMAT. In addition, inv-IMRT demonstrated an increase in exposed volume of heart, LAD, ipsilateral lung, and contralateral lung compared with those parameters for HT or VMAT. Although it is known to reduce cardiac toxicity with breath hold technique in left sided breast cancer, similarly it is possible for 3DCRT and for-IMRT techniques in right sided breast cancer even in free breathing.
Highlights
Breast cancer is the most common cancer in females worldwide, and radiotherapy (RT)is a vital component in breast cancer management (Overgaard et al 1997; Ragaz et al.1997)
The objective of this study was to compare the dosimetric characteristics of inverse planned multi-beam (IPMB) and forward planned tangential fields (FPTF) (3DCRT and for-intensity-modulated radiotherapy (IMRT)) techniques and to evaluate the characteristics of each modality when applied to the whole right breast in the early stage of the breast cancer
This study suggests that IPMB reduced the maximum dose to the target volume over that achieved by FPTF; the maximum doses to ipsilateral organs at risk (OARs) were reduced as well
Summary
Breast cancer is the most common cancer in females worldwide, and radiotherapy (RT)is a vital component in breast cancer management (Overgaard et al 1997; Ragaz et al.1997). There are various methods to employ radiotherapy for breast cancer. Three dimensional conformal radiotherapy (3DCRT) using wedged tangential fields after breast-conserving surgery improves disease control and breast-cancer related survival. With the advent of advanced sophisticated treatment planning software and multileaf collimators (MLC), intensity-modulated radiotherapy (IMRT) is becoming increasingly popular and widely used for the treatment of breast carcinoma. IMRT is thought to result in a preferred dose distribution compared to 3DCRT after conservative surgery or mastectomy (Cozzi et al 2005; Fong et al 2009; Johansen et al 2009; Vatanen et al 2009). The IMRT allows the user to modulate the intensity of each radiation beam, so each field may have one or many areas of high intensity radiation and any number of lower intensity areas within the same field
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