Radiotherapy Applications Research Articles

Nanoparticle-Based Radiosensitizers in Radiotherapy Applications.

In this article, it was examined whether the combined application of nanoparticle-based radiosensitizers with radiotherapy is beneficial. Nanoparticular or nanoparticle-based radiosensitizers appear promising in terms of feasibility, safety, and efficacy, as evidenced by preliminary results of ongoing studies. However, this method has its own advantages and disadvantages. According to current knowledge, it is impossible to mention that this method is the definitive treatment method because cancer is an individual disease and the treatments may differ from person to person. With the studies to be done, the application methods of optimal combinations with radiotherapy should be defined.

Özellikli çalıştaylar ile jinekolojik onkoloji hemşirelerinin öğrenim düzeyinin arttırılması

Aim: To evaluate the educational level of nurses through a pre and post-test after a gynecologic oncology workshop. Material and method: During the ‘Basic and Advanced Nursing Activities in Gynecologic Oncology’ workshop, pre and post-test were applied to 33 nurses. The lessons consisted of patient care before and after basic surgical procedures in gynecologic oncology; pelvic and paraaortic lymphadenectomy, radical hysterectomy, radical vulvectomy with inguinofemoral lymphadenectomy, with the additional patient care managements for bowel operations, stoma formation, chemotherapy administration, radiotherapy and brachytherapy applications. Additionally, enhanced recovery after surgery and palliative care options were also discussed. Nurses scaled their pre and post-course knowledge ranging between 1-5 points. The post-course evaluation was held at the end of the first month after the workshop. Results: Attending nurses were from all servicing parts of the hospital irrespective of their previous experience, education level or employment in gynecologic oncology. There was a statistically significant improvement of knowledge in all aspects of the course (p<0.05). Conclusion: There is a need for a structured post-graduate educational program specific for nurses, and the dedicated workshops will achieve this.

Radioiodine-131 therapy (RIT) in benign thyroid diseases: Personalized prescription based on objectives with optional use of pharmacological modulators

131I therapy (RIT) in benign thyroid diseases is the oldest and most currently used application of internal radiotherapy. With the new molecular 123I-TS images one may identify 15 presentations that can benefit from RIT. With three groups of activity determination corresponding to a dozen approaching protocols, several judgmental criteria (eu-, hypo-, hyperthyroidism, relapses etc.) and varying timeframes to assess the success, a “best method of activity calculation” makes little sense. Four clinical objectives must be first identified (goal): antitoxic (euthyroidism), ablative (hypothyroidism), reductive (to reduce a targeted volume) and preventive (to prevent progression from compensated to overt hyperthyroidism) 131I-RIT. A dose response relationship as regards the target volume reduction is firmly established in the short term (1-year) and explains the clinical outcome in Thyroid Functional Autonomy (TFA). In Grave's disease (GD), other factors may interfere that make the long-term function less predictable. Pharmacological modulators of 131I-RIT such as antithyroid drugs (ATDs) and LT3 must be skillfully handled. ATDs interfere with iodine kinetics, enhance the heterogeneity of the spatial dose deposition and diminish the accuracy of absorbed dose deposition, especially when using poorly controlled dosimetric approaches. Short LT3 administration suppresses TSH that allows direct targeting of the autonomously functioning thyroid tissue. The three main groups and variants of activity calculation are presented in detail. Calculating the activity allows a 50% average reduction in the 131I administered dose. Medical strategy should favour the informed patient's choice, after excluding the rare medical causes prompting discussion of an ablative approach. In TFA, low occurrence of hypothyroidism is the rule provided the treatment be given with a TSH<0.1mU/L, spontaneously or after LT3 suppression (compensated variety). In GD a long-term remission is rare (<30%) and should be thoroughly discussed since it leads to euthyroidism in approximately 50% after a 12-year follow-up. Depending on the etiology (GD/TFA) and the 4 clinical goals, 131I RIT planning is presented with optional choice of a patient adapted method of activity calculation and appropriate management of pharmacological modulators.

Technical challenges for FLASH proton therapy.

There is growing interest in the radiotherapy community in the application of FLASH radiotherapy, wherein the dose is delivered to the entire treatment volume in less than a second. Early pre-clinical evidence suggests that these extremely high dose rates provide significant sparing of healthy tissue compared to conventional radiotherapy without reducing the damage to cancerous cells. This interest has been reflected in the proton therapy community, with early tests indicating that the FLASH effect is also present with high dose rate proton irradiation. In order to deliver clinically relevant doses at FLASH dose rates significant technical hurdles must be overcome in the accelerator technology before FLASH proton therapy can be realised. Of these challenges, increasing the average current from the present clinical range of 1-10 nA to in excess of 100 nA is at least feasible with existing technology, while the necessity for rapid energy adjustment on the order of a few milliseconds is much more challenging, particularly for synchrotron-based systems. However, the greatest challenge is to implement full pencil beam scanning, where scanning speeds 2 orders of magnitude faster than the existing state-of-the-art will be necessary, along with similar improvements in the speed and accuracy of associated dosimetry. Hybrid systems utilising 3D-printed patient specific range modulators present the most likely route to clinical delivery. However, to correctly adapt and develop existing technology to meet the challenges of FLASH, more pre-clinical studies are needed to properly establish the beam parameters that are necessary to produce the FLASH effect.

Beam Monitors for Tomorrow: The Challenges of Electron and Photon FLASH RT

The emergent FLASH RadioTherapy (RT) uses ultrahigh dose-rate irradiation (up to 107 Gy/s instantaneous dose-rate in each μs pulse) to deliver a single high dose of irradiation in a very short time (less than 200 milliseconds). Pre-clinical studies at ultrahigh dose-rates recently showed an increased ratio between tumoricidal effect and normal tissue toxicity (therapeutic index), compared to conventional RT at standard Gy/min dose-rates. If confirmed by biological in vivo validations, this could represent a breakthrough in cancer treatment. However, the reliability and the accuracy of experimental studies are nowadays limited by the lack of detectors able to measure online the beam fluence at FLASH dose-rates. The behaviour of standard beam monitors (gas-filled ionization chambers) is compromised by the volume recombination caused by the amount of charges created per unit volume and unit time, due to the large dose-rate. Moreover, due to the lack of proper monitoring devices and to the uncertainties of its future applications, very few facilities are able to deliver at present FLASH irradiations. In this contribution, we report about the physical and technological challenges of monitoring high and ultra-high dose-rates with electrons and photon beams, starting from the pre-clinical and clinical constraints for new devices. Based on the extensive experience in silicon detectors for monitoring applications in RT with external beams, the work then investigates silicon sensors as a possible option to tackle such extreme requirements and a rugged thin and large (e.g. 10×10 cm2) flat detector (silicon-based sensor + readout electronics) is therefore outlined. This study aims at presenting the FLASH-RT dosimetry problem and analysing the possibilities for a silicon sensor to be employed as sensing device for several FLASH scenarios, including some ideas on the readout part. However, more detailed simulations and studies are demanded to delineate more precisely the technical choices to be undertaken in order to tackle the clinical accuracy required on the beam fluence, typically a few %, during photon and electron high and ultra-high irradiations, the required minimal perturbation of the beam and the high level of radiation resistance.

Palladium Nanosheets as Safe Radiosensitizers for Radiotherapy.

Many noble metal-based nanoparticles have emerged for applications in cancer radiotherapy in recent years, but few investigations have been carried out for palladium nanoparticles. Herein, palladium nanosheets (Pd NSs), which possess a sheetlike morphology with a diameter of ∼14 nm and a thickness of ∼2 nm, were utilized as a sensitizer to improve the performance of radiotherapy. It was found that Pd NSs alone did not decrease the cell viability after treatment for as long as 130 h, suggesting the excellent cytocompatibility of the nanoagents. However, the viability of cancer cells treated with X-ray irradiation became lower, and the viability became even lower if the cells were co-treated with X-ray and Pd NSs, indicating the radiosensitization effect of Pd NSs. Additionally, compared with X-ray irradiation, the combined treatment of Pd NSs and X-ray irradiation induced the generation of more DNA double-stranded breaks and reactive oxygen species within cancer cells, which eventually caused elevated cell apoptosis. Moreover, in vivo experiments also verified the radiosensitization effect and the favorable biocompatibility of Pd NSs, indicating their potential for acquiring satisfactory in vivo radiotherapeutic effect at lower X-ray doses. It is believed that the present research will open new avenues for the application of noble metal-based nanoparticles in radiosensitization.

Characterization of novel polydiacetylene gel dosimeter for radiotherapy

Polymer gel dosimeters are instrumental for clinical and research applications in radiotherapy. These dosimeters possess the unique ability to record dose distribution in three dimensions. A Polymer gel dosimeter is composed of organic molecules in a gel matrix, which upon irradiation polymerize to form a conjugated polymer with optical absorbance proportional to the irradiated dose. Other required characteristics of a radiotherapy clinical dosimeter are soft-tissue equivalency, linear dose-response in a range of clinical treatments, and long term stability for the duration of the analysis. The dosimeter presented in this paper is based on diacetylene bearing fatty acid aggregates embedded in a soft-tissue equivalent gel matrix, Phytagel™, which upon irradiation polymerize to form a blue phase polydiacetylene with a strong optical absorption. Initial characterization showed that PDA-gel irradiated with 160 kV x-ray responded linearly to the irradiated dose, and the calculated diffusion coefficient is what is very low. It was also found that the percentage depth dose (PDD) curve of the PDA-gel in a 4 × 4 cm2 field, irradiated with 6 MV x-rays, was with good agreement with the literature. PDA-gel has the potential to detect absorbed dose in a range of clinical radiological irradiation regimes.

Luminescence characterizations of YAG:Ce crystal via sol-gel method for radiotherapy

Abstract Cerium doped yttrium aluminum garnet (YAG:Ce) crystal powders were synthesized using the sol-gel method. The effects of doping concentration and sintering atmosphere were investigated via X-ray diffraction (XRD), photoluminescence (PL), and cathodoluminescence (CL). The XRD measurement indicates that doping ions do not change the crystal lattice structure of YAG crystal. PL results show that YAG:Ce samples sintered in inert atmosphere have better luminescence property around 550 nm and the optimum Ce doping concentration is 0.5 mol% as an optimal YAG:Ce powder to fabricate a dosimeter probe. Radioluminescence (RL) properties of crystal dosimeter also has been studied using clinical linear accelerator at the ultra-low dose from 3.6 to 27 cGy with dose rate from 80 to 600 cGy/min. RL measurements for dose rate and total dose show a good linear response of intensity, indicating potential applications in remote radiotherapy and radiation monitoring.

Optimal Interventions for Robust Optimization under Time-Dependent Uncertainty with Application to Radiotherapy

Uncertainties can be time-dependent, particularly in areas such as machine repair, maintenance scheduling, and cancer radiotherapy, where the condition of the system (or patient) can change during the course of the operation (or treatment). When solving such problems, it is crucial to intervene and observe the condition of the system prior to adapting the decisions. However, observations can be costly, and the timing of observations are directly impacted by time-dependent uncertainties. We address these challenges by developing an optimally-intervened robust optimization model that employs a time-dependent uncertainty set. We formulate counterparts of robust linear programs and propose an algorithm to compute adaptive robust solutions. Then, optimal intervention policies are derived that recommend the optimal number and timing of observations as functions of the observation cost and parameters of the uncertainty set. The proposed methodology is demonstrated using an application in cancer radiotherapy, where the optimally-intervened robust model improves tumor dose by up to 3% subject to nominal, best-case, and worst-case conditions, compared to a naive robust model that employs a single intervention. Furthermore, the optimally-intervened model improves tumor dose by up to 20% compared to three deterministic approaches used in the clinic; this method also reduces dose to healthy organs by up to 18%. Improvements in tumor and organ dose criteria can lead to a better quality of life for the patient. The proposed methodology is generic and can be applied to other time-dependent processes, such as machine repair or maintenance scheduling.

Spontaneous regression of ALK fusion protein-positive non-small cell lung carcinoma: a case report and review of the literature

BackgroundALK-rearrangement is observed in < 5% non-small cell lung cancer (NSCLC) cases and prior to the advent of oral tyrosine kinase inhibitors, the natural history of oncogenic NSCLC was typically poor. Literature relating to regression of treatment-naïve NSCLC is limited, and regression without treatment has not been noted in the ALK-rearranged sub-population.Case presentationA 76 year old ‘never smoker’ female with an ALK-rearranged left upper lobe T2 N0 NSCLC experienced a stroke following elective DC cardioversion for new atrial fibrillation. Following a good recovery, updated imaging demonstrated complete regression of the left upper lobe lesion and a reduction of the previously documented mediastinal lymph node. Remaining atelectasis was non-avid on repeat PET-CT imaging, 8 months from the baseline PET-CT. When the patient developed new symptoms 6 months later a further PET-CT demonstrated FDG-avid local recurrence. She completed 55 Gy in 20 fractions but at 18 months post-radiotherapy there was radiological progression in the lungs with new pulmonary metastases and effusion and new bone metastases. Owing to poor performance status, she was not considered fit for targeted therapy and died 5 months later.ConclusionAll reported cases of spontaneous regression in lung cancer have been collated within. Documented precipitants of spontaneous regression across tumour types include biopsy and immune reconstitution; stroke has not been reported previously. The favourable response achieved with radical radiotherapy alone in this unusual case of indolent oncogenic NSCLC reinforces the applicability of radiotherapy in locally advanced ALK-rearranged tumours, in cases not behaving aggressively. As a common embolic event affecting the neurological and pulmonary vasculature is less likely, an immune-mediated mechanism may underpin the phenomenon described in this patient, implying that hitherto unharnessed principles of immuno-oncology may have relevance in oncogenic NSCLC. Alternatively, high electrical voltage applied percutaneously adjacent to the tumour during cardioversion in this patient may have induced local tumour cell lethality.

Deforming to Best Practice: Key considerations for deformable image registration in radiotherapy.

Image registration is a process that underlies many new techniques in radiation oncology – from multimodal imaging and contour propagation in treatment planning to dose accumulation throughout treatment. Deformable image registration (DIR) is a subset of image registration subject to high levels of complexity in process and validation. A need for local guidance to assist in high‐quality utilisation and best practice was identified within the Australian community, leading to collaborative activity and workshops. This report communicates the current limitations and best practice advice from early adopters to help guide those implementing DIR in the clinic at this early stage. They are based on the state of image registration applications in radiotherapy in Australia and New Zealand (ANZ), and consensus discussions made at the ‘Deforming to Best Practice’ workshops in 2018. The current status of clinical application use cases is presented, including multimodal imaging, automatic segmentation, adaptive radiotherapy, retreatment, dose accumulation and response assessment, along with uptake, accuracy and limitations. Key areas of concern and preliminary suggestions for commissioning, quality assurance, education and training, and the use of automation are also reported. Many questions remain, and the radiotherapy community will benefit from continued research in this area. However, DIR is available to clinics and this report is intended to aid departments using or about to use DIR tools now.

Evolution of Care of Orbital Tumors with Radiation Therapy.

Orbital tumors are rare lesions comprising 0.1% of all tumors and less than 20% of all ocular diseases. These lesions in children and adults differ significantly in their incidence, tumor type, and treatment management. Although surgery and systemic therapies are commonly used in the management of these diseases, radiation therapy has become a widely used treatment for both benign and malignant tumors of the orbit. Radiotherapy is used as a definitive treatment to provide local control while avoiding morbidity associated with surgery for some tumors while it is used as an adjuvant treatment following surgical resection for others. For many tumors, radiation provides excellent tumor control with preservation of visual function. This article is dedicated for presenting the most common applications of orbital radiotherapy. A brief overview of the commonly available radiation therapy modalities is given. Dose constraint goals are reviewed and acute and long-term side effects are discussed. Orbital tumors covered in this article include optic glioma, ocular melanoma, retinoblastoma, orbital rhabdomyosarcoma, orbital lymphoma, and lacrimal gland tumors. Background information, indications for radiotherapy, and goals of treatment for each case example are described.

Optimizing MR-Guided Radiotherapy for Breast Cancer Patients.

Current research in radiotherapy (RT) for breast cancer is evaluating neoadjuvant as opposed to adjuvant partial breast irradiation (PBI) with the aim of reducing the volume of breast tissue irradiated and therefore the risk of late treatment-related toxicity. The development of magnetic resonance (MR)–guided RT, including dedicated MR-guided RT systems [hybrid machines combining an MR scanner with a linear accelerator (MR-linac) or 60Co sources], could potentially reduce the irradiated volume even further by improving tumour visibility before and during each RT treatment. In this position paper, we discuss MR guidance in relation to each step of the breast RT planning and treatment pathway, focusing on the application of MR-guided RT to neoadjuvant PBI.

Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery.

Study DesignRetrospective study.PurposeTo investigate the incidence of symptomatic and asymptomatic implant failure in spinal metastasis surgery and identify potential risk factors.Overview of LiteratureSurgical stabilization with instrumentation is an established method for the treatment of spinal metastasis. However, very few studies have investigated the incidence and risk factors for implant failure after spinal instrumentation surgery for the treatment of spinal metastasis.MethodsThis study recruited 88 patients who received surgical stabilization with instrumentation for the treatment of spinal metastasis. Their medical records and postoperative X-rays were reviewed for evidence of implant failure. Statistical analysis with logistic regression was performed to assess nine potential risk factors for the development of implant failure, including patient’s age at operation, gender, survival, primary tumor, spinal level involved, construct length, decompression levels, fusion material utilization, and radiotherapy application either before or after surgery, to identify potential contributing risk factors.ResultsImplant failure was identified in nine out of 88 cases (10.2%) with two cases requiring implant removal: one case included a progressive kyphosis that resulted in nonhealing sore and the other involved a deep-seated wound infection that spread to the implants. Another case required wound debridement due to superficial wound infection. The remaining six cases were asymptomatic, despite postoperative X-rays demonstrating evidence of implant failure. No patient required implant revision. Logistic regression analysis demonstrated that patients who received radiotherapy either before or after surgery were less likely to develop implant failure.ConclusionsThe development of radiological implant failure following surgical treatment of spinal metastasis is common. However, symptomatic implant failure leading to revision surgery is uncommon. Our findings suggest that radiotherapy, either before or after spinal surgery, is not associated with the development of implant failure.

Composite PEEK/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series

Radiotherapy (RT) is frequently applied as an adjuvant therapy during spinal tumors treatment. Metallic implants can interfere with RT planning and execution, as it is known that metallic implants produce a backscattering effect that can limit RT accuracy and their presence can be associated with unwanted dose increase. PEEK/carbon fiber implants are designed to reduce these problems but their application in the cervical spine is limited, due to the reduced number and types of implants, the screw dimensions and the absence of lateral mass screws. We propose a hybrid system made of carbon rods and screws coupled with subliminal polyester bands with titanium clamps. We designed this hybrid construct to enclose the cervical region in the area of instrumentation without limiting the application of postoperative radiotherapy. Six patients in which the hybrid hardware was implanted were retrospectively examined. Data on demographics, intraoperative and postoperative events, tumor details and staging and cervical alignment were collected pre- and postoperatively. No intraoperative complications occurred. En bloc resection was performed in two patients, while the remaining four received an intralesional resection. Three out of six patients received postoperative RT, without any alteration in its planning and administration. Hybrid implants made of composite PEEK/carbon fiber screws and rods and sublaminar bands are a helpful solution for spinal reconstruction in the cervical and cervico-thoracic regions after spine tumor surgery. The implants do not produce artifacts at postoperative images, easing the planning and execution of postoperative radiotherapy.

Tailored Ge-doped fibres for passive electron radiotherapy dosimetry.

Study has been made of the thermoluminescence yield of various novel tailor-made silica fibres, 6 and 8 mol % Ge-doped, with four differing outer dimensions, comprised of flat and cylindrical shapes, subjected to electron irradiation. Main thermoluminescence dosimetric characteristics have been investigated, including the glow curve, dose response, energy dependence, minimum detectable dose, effective atomic number, linearity of index and sensitivity of the fibres. The studies have also established the uncertainties involved as well as the stability of response in terms of fading effect, reproducibility and annealing. In addition, dose-rate dependence was accounted for as this has the potential to be a significant factor in radiotherapy applications. The 6 and 8 mol % fibres have been found to provide highly linear dose response within the range 1 to 4 Gy, the smallest size flat fibre, 6 mol% Ge-doped, showing the greatest response by a factor of 1.1 with respect to the highly popular LiF phosphor-based medium TLD100. All of the fibres also showed excellent reproducibility with a standard deviation of < 2% and < 4% for 6 and 8 mol % Ge-doped fibres respectively. For fading evaluation, the smallest 6 mol% Ge-doped dimension flat fibre, i.e., 85 × 270 μm displayed the lowest signal loss within 120 days post-irradiation, at around 26.9% also showing a response superior to that of all of the other fibres. Moreover, all the fibres and TLD-100 chips showed independence with respect to electron irradiation energy and dose-rate. Compared with the 8 mol% Ge-doped optical fibres, the 6 mol% Ge-doped flat optical fibres have been demonstrated to possess more desirable performance features for passive dosimetry, serving as a suitable alternative to TLD-100 for medical irradiation treatment applications.

Life expectancy with glioblastoma at GMC, Bhopal

Life expectancy with glioblastoma at GMC, Bhopal - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2020.026, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Pre- and post-irradiation mild hyperthermia enabled by NIR-II for sensitizing radiotherapy

The clinical application of cancer radiotherapy is critically impeded by hypoxia-induced radioresistance, insufficient DNA damage, and multiple DNA repair mechanisms. Herein we demonstrate a dual-hyperthermia strategy to potentiate radiotherapy by relieving tumor hypoxia and preventing irradiation-induced DNA damage repair. The tumor hyperthermia temperature was well-controlled by a near infrared laser with minimal side effects using PEGylated nanobipyramids (PNBys) as the photo-transducer. PNBys have narrow longitudinal localized surface plasmon resonance peak in NIR-II window with a high extinction coefficient (2.0 × 1011 M−1 cm−1) and an excellent photothermal conversion efficiency (44.2%). PNBys-induced mild hyperthermia (MHt) prior to radiotherapy enables vessel dilation, blood perfusion, and hypoxia relief, resulting in an increased susceptibility of tumor cells response to radiotherapy. On the other hand, MHt after radiotherapy inhibits the repair of DNA damage generated by irradiation. The PNBys exert hierarchically superior antitumor effects by the combination of MHt pre- and post-radiotherapy in murine mammary tumor EMT-6 model. Consequently, different from the simple combination of RT and MHt, the coupling of pre- and post-MHt with RT by PNBys open intriguing avenues towards new promising antitumor efficacy.

Fast and accurate online sequential learning of respiratory motion with random convolution nodes for radiotherapy applications

Accurate prediction of tumor motion for motion adaptive radiotherapy has been a challenge as respiration-induced motion is non-stationary in nature and often subjected to irregularities. Despite having a plethora of works for predicting this motion, their tracking capabilities are usually prone to large prediction errors due to the time-varying irregularities and intra-trace variabilities. To overcome this, prediction models are re-trained at regular intervals. This solution however demands a trade-off between the re-training interval and prediction accuracy in estimating the future tumor location. This is because re-training with small interval increases the computational requirements whereas a larger interval hampers the prediction performance. To address these issues, a prediction model that relies on random convolution nodes (RCN) governed by local receptive fields (LRFs) is proposed for respiratory motion prediction. The innate nature of LRFs extracts the features that contribute to the local-patterns as well as the non-stationary patterns in recent samples and subsequently learn them using extreme learning machine (ELM) theories. To address the re-training issue, we propose an online sequential learning framework (OS-fRCN) that can update the model parameters at regular intervals. Suitability of the proposed OS-fRCN for respiratory motion prediction is evaluated on 304 respiratory motion traces. Performance analysis conducted at four prediction horizons (in-line with the commercially available radiotherapy systems) demonstrated that the proposed OS-fRCN method requires less computational complexity and yields robust, accurate prediction performance when compared with existing prediction methods.

Application of auto-planning in radiotherapy for breast cancer after breast-conserving surgery

To evaluate the quality of planning target volume (PTV) and organs at risk (OAR) generated by the manual Pinnacle planning (manP) and Auto-Planning (AP) modules and discuss the feasibility of AP in the application of radiotherapy for patients with breast cancer. Thirty patients who underwent breast-conserving therapy were randomly selected. The Philips Pinnacle 9.10 treatment planning system was used to design the manP and AP modules for PTV and OAR distribution on the same computed tomography. A physician compared the plans in terms of dosimetric parameters and monitor units (MUs) using blind qualitative scoring. Statistical differences were evaluated using paired two-sided Wilcoxon’s signed-rank test. On comparing the plans of AP and manP modules, the conformal index (P < 0.01) and D50 (P = 0.04) of PTV in the AP group was lower than those in the manP group, while D1 was higher (P = 0.03). In terms of dosimetry of OAR, ipsilateral lung V20 Gy (P < 0.01), V10 Gy (P < 0.01), V5 Gy (P < 0.05), and Dmean (P < 0.01) of the AP group were better than those of the manP group. Heart V40 Gy and Dmean of all patients with breast cancer in the AP group were lower than those in the manP group (P < 0.01). Moreover, 12 patients with left breast cancer had the same results (P < 0.01). The MU value of the intensity-modulated radiation therapy module designed using two different methods was higher in the AP group than in the manP group (P = 0.32), although there was no statistical significance. The AP module almost had an equal quality of PTV and dose distribution as the manP module, and its OAR was less irradiated.