{"title":"肿块切除腔增强和区域淋巴结照射的全乳腺照射:顺序增强的3D-CRT和同时集成增强的双部分弧VMAT的剂量比较","authors":"Avinash Poojari, Shantanu Sapru, Rohini Khurana, Madhup Rastogi, Rahat Hadi, Ajeet Kumar Gandhi, Surendra Mishra, Anoop Srivastava, Avinav Bharati","doi":"10.1002/pro6.1203","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare volumetric modulated arc therapy (VMAT) with simultaneous tumor bed boost (dpSIB-VMAT) to the whole breast and regional nodal irradiation (RNI) against standard three-dimensional conformal radiotherapy plus RNI with sequential tumor bed boost (3D-CRT-seqB).</p><p><strong>Methods: </strong>Thirty patients who underwent breast cancer surgery (BCS) with axillary lymph node dissection (ALND) were enrolled. Two plans were generated for each case: (1) dpSIB-VMAT, and (2) 3D-CRT-seqB plans. Planning target volume (PTV)-Breast and PTV-Nodes were prescribed at a dose of 50 Gy in 25 fractions in both plans. PTV-Boost was prescribed at a dose of 60 Gy in 25 fractions simultaneously in the dpSIB-VMAT plans, whereas it was planned sequentially in the 3D-CRT-seqB plans at 10 Gy in 5 fractions. Dosimetric parameters were compared between the two plans.</p><p><strong>Results: </strong>Both plans achieved the target coverage. D<sub>mean</sub> of the heart was lower with dpSIB-VMAT in left-sided cases (7.17 ± 0.66 Gy vs. 10.12 ± 2.91 Gy; <i>t</i> = 4.02; <i>p</i> = 0.001). Ipsilateral mean lung dose (15.87 ± 1.40 Gy vs. 19.82 ± 3.20 Gy; <i>t</i> = 6.30; <i>p</i><0.001) was significantly lower but mean doses of the contralateral breast (4.30 ± 1.76 Gy vs. 1.48 ± 0.76 Gy; <i>t</i> = -7.84; <i>p</i><0.001), contralateral lung (3.86 ± 1.21 Gy vs. 0.96 ± 0.25 Gy; <i>t</i> = -13.13; <i>p</i><0.001) and esophagus (13.11 ± 2.63 Gy vs. 10.32 ± 3.56 Gy; <i>t</i> = -6.65; <i>p</i><0.001) were relatively higher with dpSIB-VMAT.</p><p><strong>Conclusion: </strong>Dosimetrically, dpSIB-VMAT reduced doses to the ipsilateral lung and heart (in left breast but not right breast cases) compared to 3D-CRT-seqB plans for adequate target coverage.</p>","PeriodicalId":32406,"journal":{"name":"Precision Radiation Oncology","volume":"7 1","pages":"118-127"},"PeriodicalIF":0.0000,"publicationDate":"2023-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934988/pdf/","citationCount":"0","resultStr":"{\"title\":\"Whole-breast irradiation with lumpectomy cavity boost and regional nodal irradiation: Dosimetric comparison of 3D-CRT using sequential boost and dual partial-arc VMAT using simultaneous integrated boost.\",\"authors\":\"Avinash Poojari, Shantanu Sapru, Rohini Khurana, Madhup Rastogi, Rahat Hadi, Ajeet Kumar Gandhi, Surendra Mishra, Anoop Srivastava, Avinav Bharati\",\"doi\":\"10.1002/pro6.1203\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare volumetric modulated arc therapy (VMAT) with simultaneous tumor bed boost (dpSIB-VMAT) to the whole breast and regional nodal irradiation (RNI) against standard three-dimensional conformal radiotherapy plus RNI with sequential tumor bed boost (3D-CRT-seqB).</p><p><strong>Methods: </strong>Thirty patients who underwent breast cancer surgery (BCS) with axillary lymph node dissection (ALND) were enrolled. Two plans were generated for each case: (1) dpSIB-VMAT, and (2) 3D-CRT-seqB plans. Planning target volume (PTV)-Breast and PTV-Nodes were prescribed at a dose of 50 Gy in 25 fractions in both plans. PTV-Boost was prescribed at a dose of 60 Gy in 25 fractions simultaneously in the dpSIB-VMAT plans, whereas it was planned sequentially in the 3D-CRT-seqB plans at 10 Gy in 5 fractions. Dosimetric parameters were compared between the two plans.</p><p><strong>Results: </strong>Both plans achieved the target coverage. D<sub>mean</sub> of the heart was lower with dpSIB-VMAT in left-sided cases (7.17 ± 0.66 Gy vs. 10.12 ± 2.91 Gy; <i>t</i> = 4.02; <i>p</i> = 0.001). Ipsilateral mean lung dose (15.87 ± 1.40 Gy vs. 19.82 ± 3.20 Gy; <i>t</i> = 6.30; <i>p</i><0.001) was significantly lower but mean doses of the contralateral breast (4.30 ± 1.76 Gy vs. 1.48 ± 0.76 Gy; <i>t</i> = -7.84; <i>p</i><0.001), contralateral lung (3.86 ± 1.21 Gy vs. 0.96 ± 0.25 Gy; <i>t</i> = -13.13; <i>p</i><0.001) and esophagus (13.11 ± 2.63 Gy vs. 10.32 ± 3.56 Gy; <i>t</i> = -6.65; <i>p</i><0.001) were relatively higher with dpSIB-VMAT.</p><p><strong>Conclusion: </strong>Dosimetrically, dpSIB-VMAT reduced doses to the ipsilateral lung and heart (in left breast but not right breast cases) compared to 3D-CRT-seqB plans for adequate target coverage.</p>\",\"PeriodicalId\":32406,\"journal\":{\"name\":\"Precision Radiation Oncology\",\"volume\":\"7 1\",\"pages\":\"118-127\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934988/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Precision Radiation Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/pro6.1203\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/6/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Precision Radiation Oncology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/pro6.1203","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/6/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Whole-breast irradiation with lumpectomy cavity boost and regional nodal irradiation: Dosimetric comparison of 3D-CRT using sequential boost and dual partial-arc VMAT using simultaneous integrated boost.
Objective: To compare volumetric modulated arc therapy (VMAT) with simultaneous tumor bed boost (dpSIB-VMAT) to the whole breast and regional nodal irradiation (RNI) against standard three-dimensional conformal radiotherapy plus RNI with sequential tumor bed boost (3D-CRT-seqB).
Methods: Thirty patients who underwent breast cancer surgery (BCS) with axillary lymph node dissection (ALND) were enrolled. Two plans were generated for each case: (1) dpSIB-VMAT, and (2) 3D-CRT-seqB plans. Planning target volume (PTV)-Breast and PTV-Nodes were prescribed at a dose of 50 Gy in 25 fractions in both plans. PTV-Boost was prescribed at a dose of 60 Gy in 25 fractions simultaneously in the dpSIB-VMAT plans, whereas it was planned sequentially in the 3D-CRT-seqB plans at 10 Gy in 5 fractions. Dosimetric parameters were compared between the two plans.
Results: Both plans achieved the target coverage. Dmean of the heart was lower with dpSIB-VMAT in left-sided cases (7.17 ± 0.66 Gy vs. 10.12 ± 2.91 Gy; t = 4.02; p = 0.001). Ipsilateral mean lung dose (15.87 ± 1.40 Gy vs. 19.82 ± 3.20 Gy; t = 6.30; p<0.001) was significantly lower but mean doses of the contralateral breast (4.30 ± 1.76 Gy vs. 1.48 ± 0.76 Gy; t = -7.84; p<0.001), contralateral lung (3.86 ± 1.21 Gy vs. 0.96 ± 0.25 Gy; t = -13.13; p<0.001) and esophagus (13.11 ± 2.63 Gy vs. 10.32 ± 3.56 Gy; t = -6.65; p<0.001) were relatively higher with dpSIB-VMAT.
Conclusion: Dosimetrically, dpSIB-VMAT reduced doses to the ipsilateral lung and heart (in left breast but not right breast cases) compared to 3D-CRT-seqB plans for adequate target coverage.