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. 2022 Jun;69(2):227-235.
doi: 10.1002/jmrs.530. Epub 2021 Sep 22.

New fractionations in breast cancer: a dosimetric study of 3D-CRT versus VMAT

Antonio Piras  1 , Sebastiano Menna  2 , Andrea D'Aviero  3 , Fabio Marazzi  2 , Alberto Mazzini  3 , Davide Cusumano  2 , Mariangela Massaccesi  2 , Gian Carlo Mattiucci  2   3 , Antonino Daidone  1 , Vincenzo Valentini  2   3 , Luca Boldrini  2   3
Affiliations

New fractionations in breast cancer: a dosimetric study of 3D-CRT versus VMAT

Antonio Piras et al. J Med Radiat Sci. 2022 Jun.

Abstract

Introduction: Adjuvant radiation therapy (RT) following primary surgery in women affected by early breast cancer (EBC) plays a central role in reducing local recurrences and overall mortality. The FAST-FORWARD trial recently demonstrated that 1-week hypofractionated adjuvant RT is not inferior to the standard schedule in terms of local relapse, cosmetic outcomes and toxicity. The aim of this in silico study was to evaluate the dosimetric aspects of a 1-week RT course, administered through volumetric modulated arc therapy (VMAT), compared with traditional three-dimensional conformal radiation therapy (3D-CRT) with tangential fields.

Methods: Patients affected by left-side EBC undergoing adjuvant RT were selected. ESTRO guidelines for the clinical target volume (CTV) delineation and FAST-FORWARD protocol for CTV to planning target volume (PTV) margin definition were followed. Total prescribed dose was 26 Gy in five fractions. The homogeneity index (HI) and the global conformity index (GCI) were taken into account for planning and dose distribution optimisation purposes. Both 3D-CRT tangential fields and VMAT plans were generated for each patient.

Results: The analysis included 21 patients. PTV coverage comparison between 3D-CRT and VMAT plans showed significant increases for GCI (P < 0.05) in VMAT technique; no statistically significant differences were observed regarding HI. For organs at risks (OAR), statistically significant increases were observed in terms of skin V103% (P < 0.002) and ipsilateral lung V30% (P < 0.05) with 3D-CRT and of heart V5% (P < 0.05) with VMAT technique.

Conclusions: This in silico study showed that both 3D-CRT and VMAT are dosimetrically feasible techniques in the framework of 1-week hypofractionated treatments for left EBC.

Keywords: early breast cancer; hypofractionated treatment; radiotherapy; three-dimensional conformal radiation therapy; volumetric modulated arc therapy.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Dose distribution isodose geometry for 3D‐CRT (A) and VMAT (B) DIBH plans of representative patient.
Figure 2
Figure 2
Dose volume histogram (DVH) comparison for 3D‐CRT and VMAT: PTV of representative patient. Triangle = 3D‐CRT; square = VMAT.
Figure 3
Figure 3
Dose volume histogram (DVH) comparison for 3D‐CRT and VMAT: skin (A), ipsilateral lung (B) and heart (C) of representative patient. Triangle = 3D‐CRT; square = VMAT.
See this image and copyright information in PMC

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