Dose comparison between hybrid volumetric modulated arc therapy, volumetric modulated arc therapy, and three-dimensional conformal radiotherapy for breast/chest wall irradiation, including regional lymph node irradiation using deep inspiration breath-hold technique

IF 1.5 4区医学 Q4 ONCOLOGY

Cancer Radiotherapie Pub Date : 2025-02-01 DOI:10.1016/j.canrad.2025.104589

Zainab Alsaihaty , Wamied Abdel-Rahman , Karunakaran Balaji , Mashaal Alkhaldi , Abdulraouf Alghufaili , Shama Alghadban , Hala El Lathy , Hanani Abdul Manan , Akmal Sabarudin , Noorazrul Yahya

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引用次数: 0

Abstract

Purpose

Breast radiation treatment has been linked to complications such as pneumonitis and cardiac toxicity, necessitating dose optimization. This study aims to determine the optimal integration plan of volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) in a deep inspiration breath-hold regimen.

Materials and methods

CT imaging data from twenty patients with breast or chest wall cancer, either right or left-sided, and with supraclavicular and internal mammary chain lymph nodes were retrieved. The CT data planned with a hybrid VMAT of three different weighting proportions: 30 % using 3DCRT and 70 % using VMAT, 50 % using 3DCRT and 50 % using VMAT, and 70% using 3DCRT and 30 % using VMAT and compared with full 3DCRT and full VMAT plan (classic and five arc design).

Results

The homogeneity and conformity indices were better in the hybrid VMAT plans than in plans using VMAT or 3DCRT alone (P < 0.005). Results of all hybrid VMAT plans showed a considerable drop of volumes receiving more than 4 Gy, 8 Gy or 16 Gy in the ipsilateral lung compared to the full VMAT plan (P < 0.001). There was a noticeable decrease in the mean dose to the heart and the dose in 5% of the contralateral breast in the plan using 70 % 3DCRT and 30 % VMAT compared to full VMAT (P < 0.001). The plan using 70 % 3DCRT and 30% VMAT achieved a balance between the target and surrounding areas, compared to using only 3DCRT or VMAT.

Conclusion

A hybrid plan using 70 % 3DCRT contribution achieved a balanced outcome for breast or chest wall irradiation, considering both planning target volume and organs at risk. Utilizing our VMAT arc design, incorporating one shortened arc can significantly reduce doses to organs at risk further. It is important to consider the patient's anatomy when making this decision.

查看原文本刊更多论文

混合体积调弧线治疗、体积调弧线治疗与乳腺/胸壁三维适形放疗的剂量比较，包括采用深吸气屏气技术的局部淋巴结照射

目的乳房放射治疗与肺炎和心脏毒性等并发症有关，需要优化剂量。本研究旨在确定深度吸气屏气方案中体积调制弧线治疗（VMAT）与三维适形放疗（3DCRT）的最佳整合方案。材料与方法收集20例右侧或左侧乳腺或胸壁癌伴锁骨上淋巴结和乳腺内链淋巴结患者的sct影像资料。采用三种不同权重比例的混合VMAT计划CT数据：30%使用3DCRT， 70%使用VMAT， 50%使用3DCRT， 50%使用VMAT， 70%使用3DCRT， 30%使用VMAT，并与全3DCRT和全VMAT计划（经典和五弧设计）进行比较。结果混合VMAT方案均优于单独VMAT或3DCRT方案(P <；0.005)。所有混合VMAT计划的结果显示，与完整VMAT计划相比，同侧肺接受超过4 Gy， 8 Gy或16 Gy的体积明显下降(P <；0.001)。与完全VMAT相比，使用70% 3DCRT和30% VMAT的计划中心脏的平均剂量和5%对侧乳房的剂量明显降低(P <；0.001)。与仅使用3DCRT或VMAT相比，使用70% 3DCRT和30% VMAT的计划在目标和周围区域之间实现了平衡。结论采用3DCRT占比70%的混合方案，兼顾了计划靶体积和受累器官，达到了乳房或胸壁照射的平衡效果。利用我们的VMAT电弧设计，结合一个缩短的电弧可以进一步显著减少对器官的危害。在做这个决定时，考虑病人的解剖结构是很重要的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Radiotherapie 医学-核医学

CiteScore

2.20

自引率

23.10%

发文量

129

审稿时长

63 days

期刊介绍： Cancer/radiothérapie se veut d''abord et avant tout un organe francophone de publication des travaux de recherche en radiothérapie. La revue a pour objectif de diffuser les informations majeures sur les travaux de recherche en cancérologie et tout ce qui touche de près ou de loin au traitement du cancer par les radiations : technologie, radiophysique, radiobiologie et radiothérapie clinique.