Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-24T12:43:27.669Z Has data issue: false hasContentIssue false
  • English
  • Français

Left-sided breast radiotherapy after conservative surgery: comparison of techniques between volumetric modulated arc therapy, forward-planning intensity-modulated radiotherapy and conventional technique

Published online by Cambridge University Press:  15 November 2016

Upendra Kumar Giri ,
Biplab Sarkar ,
Kanan Jassal ,
Anusheel Munshi ,
Tharmar Ganesh ,
Bidhu Mohanti  and
Anirudh Pradhan
Upendra Kumar Giri*
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Biplab Sarkar
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Kanan Jassal
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Anusheel Munshi
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Tharmar Ganesh
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Bidhu Mohanti
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Anirudh Pradhan
Affiliation:
Department of Mathematics, GLA University, Mathura, Uttar Pradesh, India
*
Correspondence to: Upendra Kumar Giri, Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana 122002, India. Tel: +91 9650778852. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

This study was conducted for comparison of techniques between volumetric modulated arc therapy (VMAT), forward-planning intensity-modulated radiotherapy (FIMRT) and conventional technique for left-sided breast radiotherapy after conservative surgery.

Methods

In all, 20 postoperative left breast carcinoma patients were included in this study. In all plans the planning target volume (PTV) was the breast tissue with appropriate margin as per our institutional protocol. The contouring was done on a Monaco Sim (V5.00.02) contouring workstation. All patient were planned using partial arc VMAT in Monaco treatment planning system (TPS) (V5.00.02) and treated on Elekta Synergy linear accelerator. The 3D conformal radiotherapy (3DCRT) and FIMRT planning were done in CMS XIO (V5.00.01.1) TPS. The 3DCRT planning consisted of conventional medial and tangential wedge portals with multileaf collimator field shaping conforming to the target volume. For all the plans generated the following metrics were scored: V105%, V100%, V95%, mean dose (for PTV), V5%, V20%, D2cc and mean dose (for organs at risk).

Results

The mean PTV volume for 20 patients was 1,074·6±405·1 cc. The highest PTV dose coverage was observed in the 3DCRT technique with 94·1±1·8% of the breast PTV receiving 95% of the prescription dose (V95%). However, it was also observed that this technique resulted in 21·3±10% of the PTV receiving more than 105% of the prescription dose (V105%), which was highest among the three techniques. In contrast, VMAT yielded lowest V95% of 93·0±1·8 and 3·3±5·5% of V105%.

Conclusion

This study concluded equivalent result between FIMRT and VMAT. However, VMAT was found to be the choice of radiotherapy technique as it produces lesser dose distribution to heart compared with any other technique.

Keywords

3DCRTFIMRTleft-sided breast radiotherapyvolumetric modulated arc therapy (VMAT)
Type
Technical Note
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 1 , March 2017 , pp. 101 - 108
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ferlay, J, Soerjomataram, I, Dikshit, R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (5): E359–E386.CrossRefGoogle ScholarPubMed
2. Sardaro, A, Petruzzelli, M F, D’Errico, M P, Grimaldi, L, Pili, G, Portaluri, M. Radiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechanisms, radiobiology, and dosimetric constraints. Radiother Oncol 2012; 103 (2): 133–142.CrossRefGoogle ScholarPubMed
3. McLaughlin, S A, Ochoa-Frongia, L M, Patil, S M, Cody, H S, Sclafani, L M. Influence of frozen-section analysis of sentinel lymph node and lumpectomy margin status on reoperation rates in patients undergoing breast-conservation therapy. J Am Coll Surg 2008; 206 (1): 76–82.CrossRefGoogle ScholarPubMed
4. Early Breast Cancer Trialists’ Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011; 378 (9804): 1707–1716.CrossRefGoogle Scholar
5. Darby, S C, Ewertz, M, McGale, P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368 (11): 987–998.CrossRefGoogle ScholarPubMed
6. Henson, K E, McGale, P, Taylor, C, Darby, S C. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer 2013; 108 (1): 179–182.CrossRefGoogle ScholarPubMed
7. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2006; 366 (9503): 2087–2106.Google Scholar
8. Paszat, L F, Mackillop, W J, Groome, P A, Schulze, K, Holowaty, E. Mortality from myocardial infarction following postlumpectomy radiotherapy for breast cancer: a population-based study in Ontario, Canada. Int J Radiat Oncol Biol Phys 1999; 43 (4): 755–762.CrossRefGoogle ScholarPubMed
9. Teoh, M, Clark, C H, Wood, K, Whitaker, S, Nisbet, A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol 2011; 84 (1007): 967–996.CrossRefGoogle ScholarPubMed
10. Zhao, H, He, M, Cheng, G et al. A comparative dosimetric study of left sided breast cancer after breast-conserving surgery treated with VMAT and IMRT. Radiat Oncol 2015; 10 (1): 1.CrossRefGoogle ScholarPubMed
11. Jin, G H, Chen, L X, Deng, X W, Liu, X W, Huang, Y, Huang, X B. A comparative dosimetric study for treating left-sided breast cancer for small breast size using five different radiotherapy techniques: conventional tangential field, filed-in-filed, tangential-IMRT, multi-beam IMRT and VMAT. Radiation Oncol 2013; 8 (1): 1.CrossRefGoogle ScholarPubMed
12. Donovan, E M, Yarnold, J R, Adams, E J, Morgan, A, Warrington, A P, Evans, P M. An investigation into methods of IMRT planning applied to breast radiotherapy. Br J Radiol 2008; 81 (94): 311–322.CrossRefGoogle ScholarPubMed
13. Keller, L M, Sopka, D M, Li, T et al. Five-year results of whole breast intensity modulated radiation therapy for the treatment of early stage breast cancer: the Fox Chase Cancer Center experience. Int J Radiat Oncol Biol Phys 2012; 84 (4): 881–887.CrossRefGoogle ScholarPubMed
14. Donovan, E, Bleakley, N, Denholm, E et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 2007; 82 (3): 254–264.CrossRefGoogle ScholarPubMed
15. Manikandan, A, Sarkar, B, Holla, R, Vivek, T R, Sujatha, N. Quality assurance of dynamic parameters in volumetric modulated arc therapy. Br J Radiol 2012; 85 (1015): 1002–1010.CrossRefGoogle ScholarPubMed
16. Badakhshi, H, Kaul, D, Nadobny, J, Wille, B, Sehouli, J, Budach, V. Image-guided volumetric modulated arc therapy for breast cancer: a feasibility study and plan comparison with three-dimensional conformal and intensity-modulated radiotherapy. Br J Radiol 2013; 86 (1032): 20130515.CrossRefGoogle ScholarPubMed
17. Tyran, M, Mailleux, H, Tallet, A et al. Volumetric-modulated arc therapy for left-sided breast cancer and all regional nodes improves target volumes coverage and reduces treatment time and doses to the heart and left coronary artery, compared with a field-in-field technique. J Radiat Res 2015; 56 (6): 927–937.CrossRefGoogle Scholar
18. Osman, S O, Hol, S, Poortmans, P M, Essers, M. Volumetric modulated arc therapy and breath-hold in image-guided locoregional left-sided breast irradiation. Radiother Oncol 2014; 112 (1): 17–22.CrossRefGoogle ScholarPubMed
19. Edge, S B, Compton, C C. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17 (6): 1471–1474.CrossRefGoogle ScholarPubMed
20. Stewart, J R, Fajardo, L F. Radiation-induced heart disease: an update. Prog Cardiovasc Dis 1984; 27 (3): 173–194.CrossRefGoogle ScholarPubMed
21. Early Breast Cancer Trialists’ Collaborative Group. Effects of radiotherapy and surgery in early breast cancer—an overview of the randomized trials. N Engl J Med 1995; 333: 1444–1456.CrossRefGoogle Scholar
22. Rutqvist, L E, Lax, I, Fornander, T, Johansson, H. Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 1992; 22 (5): 887–896.CrossRefGoogle Scholar