Optimizing Adjuvant Radiation Planning Outcomes in Patients with Synchronous Bilateral Breast Cancer

Background: Breast cancer is the most common cancer diagnosed worldwide, synchronous bilateral breast cancer accounts for unique entity of the disease, particularly post-operative radiotherapy for Synchronous Bilateral Breast Cancer (SBBC) is challenging with lack of evidence about the best irradiation technique. In this study, we tried to explore the optimum radiotherapy technique regarding the dosimetric parameters. Methods: We recruited 15 SBBC patients in whom post-operative radiotherapy was indicated and we established three plans for each patient using 3DCRT, IMRT and VMAT, and then we compared the three plans as regard target volume coverage parameters and organs at risk (OAR) doses. Results: We found that PTV coverage parameter was superior with IMRT compared with 3DCRT and VMAT in terms of Dmean (p = 0.001), D95% (p = 0.001), Dmax (p = 0.0001), conformity index (p = 0.0001) and HI (p = 0.0001). Doses to OAR were not significantly different between the three techniques in cardiac dose and LAD maximum dose, but 3DCRT was superior in LAD mean dose (p = 0.03) and lung volume receiving 20 Gy (V20) and 10 Gy (V10) (p = 0.0001), but this difference was non-significant between 3DCRT and IMRT (p = 0.4 and 0.06 respectively), while VMAT led to the highest doses to LAD and lung. Conclusions: IMRT showed the best target coverage parameters in post-operative radiotherapy for SBBC compared with 3DCRT and VMAT. For OAR doses IMRT showed comparable results with 3DCRT, while VMAT delivered a significantly higher dose to OAR.