Multi-criteria optimization for comparing free-breathing and breath-hold techniques in helical and volumetric treatment of locoregional left-sided breast cancer

IF 2.7 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Physica Medica-European Journal of Medical Physics Pub Date : 2025-09-19 DOI:10.1016/j.ejmp.2025.105175

Romain Cayez , Thomas Lacornerie , Séverine Risbourg , Kaoutar Lodyga , Alexandre Ba , Frederik Crop

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引用次数: 0

Abstract

Purpose

Combining breath-hold (BH) with volumetric modulated arc therapy (VMAT) or helical treatment can be challenging for locoregional left-sided breast cancer. We aimed to use multi-criteria optimization (MCO) to provide objective comparisons of BH with free breathing (FB) techniques.

Methods

Thirty-one consecutive treatment plans were optimized using pareto-navigated MCO for FB tomotherapy (TFB), FB VMAT Halcyon (HFB), and BH VMAT Halcyon (HDIBH). The heart dose was minimized while maintaining target coverage. Quantitative comparisons focused on dose indicators, correlations and adherence to constraints, whereas blinded qualitative ratings, along with planning study guidelines, were used to identify possible biases.

Results

VMAT provided better-than-required coverage (D95% 38.6 Gy vs. 37.7 Gy for TFB), whereas TFB offered better sparing of the left anterior descending artery (LAD) and contralateral breast dose. HDIBH resulted in a mean heart dose Dm(heart) of 3.7 Gy compared to 5.2 Gy in HFB and TFB groups. Dm(heart), 2 % LAD and mean LAD in DIBH resulted in 70–74 % of the FB dose, but with residual standard deviation of ± 0.9, 6 and 3.5 Gy respectively. Qualitative ratings showed a significant preference order: HDIBH, HFB, and TFB. No significant lung dose improvements were observed for DIBH. Finally, Dm(heart) showed correlations with FB V17Gy and D2% heart but not in DIBH and also not with both 2 % LAD or mean LAD.

Conclusion

Trade-offs were observed between VMAT and tomotherapy techniques while DIBH improved heart doses by 30%, albeit with per-patient variability. Additionally, mean heart dose correlation with other indicators varied between structures and techniques.

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多标准优化比较自由呼吸和屏气技术在螺旋和容积治疗局部区域性左侧乳腺癌

目的将屏气（BH）与体积调节弧线治疗（VMAT）或螺旋治疗相结合，对局部区域性左侧乳腺癌具有挑战性。我们的目标是使用多标准优化（MCO）来提供BH与自由呼吸（FB）技术的客观比较。方法采用pareto导航MCO对31例FB ct （TFB）、FB VMAT Halcyon （HFB）和BH VMAT Halcyon （HDIBH）的连续治疗方案进行优化。心脏剂量最小化，同时保持目标覆盖。定量比较侧重于剂量指标、相关性和对约束的依从性，而盲法定性评分以及计划研究指南用于确定可能的偏差。结果vmat提供了更好的覆盖范围（D95%为38.6 Gy， TFB为37.7 Gy），而TFB提供了更好的左前降支（LAD）和对侧乳房剂量节约。HDIBH导致平均心脏剂量Dm（心脏）为3.7 Gy，而HFB和TFB组为5.2 Gy。Dm（心脏），2% LAD和DIBH的平均LAD导致FB剂量的70 - 74%，但剩余标准偏差分别为±0.9,6和3.5 Gy。定性评分显示了显著的偏好顺序：HDIBH、HFB和TFB。DIBH未观察到明显的肺剂量改善。最后，Dm（心脏）与FB V17Gy和D2%心脏相关，但与DIBH无关，也与2% LAD或平均LAD无关。结论VMAT和断层治疗技术之间存在权衡，而DIBH可将心脏剂量提高30%，尽管每个患者存在差异。此外，平均心脏剂量与其他指标的相关性因结构和技术而异。

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

Physica Medica-European Journal of Medical Physics 生物-生物物理

CiteScore

6.80

自引率

14.70%

发文量

493

审稿时长

78 days

期刊介绍： Physica Medica, European Journal of Medical Physics, publishing with Elsevier from 2007, provides an international forum for research and reviews on the following main topics: Medical Imaging Radiation Therapy Radiation Protection Measuring Systems and Signal Processing Education and training in Medical Physics Professional issues in Medical Physics.