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. 2023 Jul 18;64(4):677-684.
doi: 10.1093/jrr/rrad045.

Comparative dosimetric and radiobiological assessment of left-sided whole breast and regional nodes with advanced radiotherapy techniques

Yuling Huang  1   2 , Changfei Gong  1   2 , Mingming Luo  1   2 , Xingxing Yuan  1   2 , Shenggou Ding  1   2 , Xiaoping Wang  1   2 , Yun Zhang  1   2
Affiliations

Comparative dosimetric and radiobiological assessment of left-sided whole breast and regional nodes with advanced radiotherapy techniques

Yuling Huang et al. J Radiat Res. .

Abstract

The aim of this study was to analyze the dosimetric and radiobiologic differences of the left-sided whole breast and regional nodes in intensity-modulated radiotherapy (IMRT), volume-modulated arc therapy (VMAT), and helical tomotherapy (HT). The IMRT, VMAT, and HT plans in this study were generated for thirty-five left-sided breast cancer patients after breast-conserving surgery (BCS). The planning target volume (PTV) included the whole breast and supraclavicular nodes. PTV coverage, homogeneity index (HI), conformity index (CI), dose to organs at risk (OARs), secondary cancer complication probability (SCCP), and excess absolute risk (EAR) were used to evaluate the plans. Compared to IMRT, the VMAT and HT plans resulted in higher PTV coverage and homogeneity. The VMAT and HT plans also delivered a lower mean dose to the ipsilateral lung (9.19 ± 1.36 Gy, 9.48 ± 1.17 Gy vs. 11.31 ± 1.42 Gy) and heart (3.99 ± 0.86 Gy, 4.48 ± 0.62 Gy vs. 5.53 ± 1.02 Gy) and reduced the V5Gy, V10Gy, V20Gy, V30Gy, and V40Gy of the ipsilateral lung and heart. The SCCP and EAR for the ipsilateral lung were reduced by 3.67%, 3.09% in VMAT, and 22.18%, 19.21% in HT, respectively. While were increased for the contralateral lung and breast. This study showed that VMAT plans provide a more homogeneous dose distribution to the PTV, minimizing exposure to ipsilateral structures and significantly reducing SCCP and EAR, and slightly increasing dose to contralateral structures. Overall, the VMAT plan can be considered a beneficial technique for BCS patients whose PTV includes the whole breast and regional nodes.

Keywords: excess absolute risk; helical tomotherapy; left-sided breast-conserving surgery; radiation dosimetry; secondary cancer complication probabilities; volumetric modulated arc therapy.

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Conflict of interest statement

The authors declare that they have no potential conflict of interest.

Figures

Fig. 1
Fig. 1
A direct comparison of dose distribution in IMRT (A), VMAT (B) and HT (C).
Fig. 2
Fig. 2
Average DVH for PTV and OARs with IMRT, VMAT and HT plans.
See this image and copyright information in PMC

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