Dosimetric comparison of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for left-sided chest wall and lymphatic irradiation

Abstract

Introduction: The aim of this study was to compare five different techniques for chest wall (CW) and lymphatic irradiation in patients with left-sided breast carcinoma.

Methods: Three-dimensional conformal radiotherapy (3DCRT), forward-planned intensity-modulated radiotherapy (FP-IMRT), inverse-planned IMRT (IP-IMRT; 7- or 9-field), and hybrid IP-/FP-IMRT were compared in 10 patients. Clinical target volume (CTV) included CW and internal mammary (IM), supraclavicular (SC), and axillary nodes. Planning target volumes (PTVs), CTVs, and organs at risks (OARs) doses were analyzed with dose-volume histograms (DVHs).

Results: No differences could be observed among the techniques for doses received by 95% of the volume (D95%) of lymphatics. However, the FP-IMRT resulted in a significantly lower D95% dose to the CW-PTV compared to other techniques (P = 0.002). The 9-field IP-IMRT achieved the lowest volumes receiving higher doses (hotspots). Both IP-IMRT techniques provided similar mean doses (Dmean) for the left lung which were smaller than the other techniques. There was no difference between the techniques for maximum dose (Dmax) of right breast. However, FP-IMRT resulted in lower Dmean and volume of right breast receiving at least 5 Gy doses compared to other techniques.

Conclusion: The dose homogeneity in CW-CTV was better using IMRT techniques compared to 3DCRT. Especially 9-field IP-IMRT provided a more homogeneous dose distribution in IM and axillary CTVs. Moreover, the OARs volumes receiving low radiation doses were larger with IP-IMRT technique, while volumes receiving high radiation doses were larger with FP-IMRT technique. Hybrid IMRT plans were found to have the advantages of both FP- and IP-IMRT techniques.

Keywords: breast cancer; chest wall irradiation; intensity-modulated radiotherapy; lymphatic irradiation; three-dimensional conformal radiotherapy.

Figure 1

Impact of different treatment techniques on dose distribution in an axial image of same patient (a) Three‐dimensional conformal radiotherapy, (b) forward‐planned intensity modulated radiotherapy (IMRT), (c) 7‐field inverse‐planned IMRT, (d) 9‐field IP‐IMRT, (e) hybrid IMRT.

Figure 2

Dose–volume histogram parameters for heart (1), contralateral breast (2), and left lung (3) of five different techniques in an axial image of same patient: (a) three‐dimensional conformal radiotherapy, (b) forward‐planned intensity‐modulated radiotherapy (IMRT), (c) 7‐field inverse‐planned‐IMRT, (d) 9‐field IP‐IMRT, (e) Hybrid IMRT.