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. 2020 Nov 29;9(12):3884.
doi: 10.3390/jcm9123884.

Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer

Yi-Chi Liu  1   2 , Hung-Ming Chang  3 , Hsin-Hon Lin  4   5   6 , Chia-Chun Lu  7 , Lu-Han Lai  8
Affiliations

Dosimetric Comparison of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy and Hybrid Three-Dimensional Conformal Radiotherapy/Intensity-Modulated Radiotherapy Techniques for Right Breast Cancer

Yi-Chi Liu et al. J Clin Med. .

Abstract

This study aimed to compare different types of right breast cancer radiotherapy planning techniques and to estimate the whole-body effective doses and the critical organ absorbed doses. The three planning techniques are intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT; two methods) and hybrid 3D-CRT/IMRT (three-dimensional conformal radiotherapy/intensity-modulated radiotherapy). The VMAT technique includes two methods to deliver a dose: non-continuous partial arc and continuous partial arc. A thermoluminescent dosimeter (TLD) is placed in the RANDO phantom to estimate the organ absorbed dose. Each planning technique applies 50.4 Gy prescription dose and treats critical organs, including the lung and heart. Dose-volume histogram was used to show the planning target volume (V95%), homogeneity index (HI), conformity index (CI), and other optimized indices. The estimation of whole-body effective dose was based on the International Commission on Radiation Protection (ICRP) Publication 60 and 103. The results were as follows: Continuous partial arc and non-continuous partial arc showed the best CI and HI. The heart absorbed doses in the continuous partial arc and hybrid 3D-CRT/IMRT were 0.07 ± 0.01% and 0% (V5% and V10%, respectively). The mean dose of the heart was lowest in hybrid 3D-CRT/IMRT (1.47 Gy ± 0.02). The dose in the left contralateral lung (V5%) was lowest in continuous partial arc (0%). The right ipsilateral lung average dose and V20% are lowest in continuous partial arc. Hybrid 3D-CRT/IMRT has the lowest mean dose to contralateral breast (organs at risk). The whole-body effective doses for ICRP-60 and ICRP-103 were highest in continuous partial arc (2.01 Sv ± 0.23 and 2.89 Sv ± 0.15, respectively). In conclusion, the use of VMAT with continuous arc has a lower risk of radiation pneumonia, while hybrid 3D-CRT/IMRT attain lower secondary malignancy risk and cardiovascular complications.

Keywords: hybrid 3D-CRT/IMRT; intensity-modulated radiotherapy; right breast cancer; volumetric modulated arc therapy.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
The green area is the planning target volume (PTV), the red area is the true PTV (tPTV), and yellow area is the reduced PTV (rPTV).
Figure 2
Figure 2
Treatment planning using (a) intensity-modulated radiotherapy (IMRT), (b) hybrid 3D conformal radiotherapy (3D-CRT)/IMRT, (c) non-continuous partial arc, and (d) continuous partial arc.
Figure 3
Figure 3
RANDO phantom.
Figure 4
Figure 4
Dose-volume histogram of (a) IMRT, (b) hybrid 3D-CRT/IMRT, (c) non-continuous partial arc, and (d) continuous partial arc. CTV, clinical target volume; PTV, planning target volume.
Figure 5
Figure 5
Dose distribution of (a) IMRT, (b) hybrid 3D-CRT/IMRT, (c) non-continuous partial arc, and (d) continuous partial arc.
Figure 5
Figure 5
Dose distribution of (a) IMRT, (b) hybrid 3D-CRT/IMRT, (c) non-continuous partial arc, and (d) continuous partial arc.
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