Abstract
The present study aimed to compare 4 techniques in the planning of locoregional irradiation
including internal mammary nodal region for left-sided breast cancer. Ten patients
with left-sided breast cancer undergoing breast conservation surgery were enrolled.
For each patient, 4 treatment plans were performed: a helical tomotherapy (HT) plan,
a volumetric modulated arc therapy (VMAT) plan, a static intensity modulated radiation
therapy (IMRT) plan, and a hybrid IMRT plan, designed to encompass the whole breast,
internal mammary, and supraclavicular nodal regions. The prescribed dose of radiation
was 50 Gy in 25 fractions. The dosimetric parameters of the target and organs at risk,
as well as the dose delivery time, were evaluated and compared using an independent-samples
t-test. The HT and VMAT plans had the best conformity and homogeneity. For the HT,
VMAT, IMRT, and hybrid IMRT plans, the mean conformity index (CI) and homogeneity
index (HI) were 0.83, 0.82, 0.8, and 0.77 (p < 0.001); and 1.07, 1.11, 1.14, and 1.14 (p < 0.001), respectively. The corresponding V55 values were 0.3%, 11.4%, 27.02%, and 23.29% (p < 0.001). The Dmean and V20 of the left lung obtained using the HT plan were significantly lower than those of
VMAT, IMRT, and hybrid IMRT plans (p = 0.002, p = 0.004). There were no significant differences in D max of LAD descending coronary
artery, or the Dmean of the heart among the 4 types of plans. The HT and VMAT plans had a lower dose to
other organ at risk (OARs) compared with the IMRT and hybrid IMRT plans. The mean
delivery times were 1042 ± 33 seconds, 136 ± 12 seconds, 450 ± 65 seconds, and 451
± 70 seconds for the HT, VMAT, IMRT, and hybrid IMRT plans, respectively (p < 0.001). For whole breast plus supraclavicular and internal mammary nodal irradiation
in left-sided breast cancer, the VMAT technique is recommended considering both the
dose distribution and the delivery time. Under circumstances in which dose distribution
is a priority, the HT technique is a valid option.
Keywords
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Article info
Publication history
Published online: October 24, 2018
Accepted:
September 24,
2018
Received in revised form:
August 30,
2018
Received:
December 5,
2017
Identification
Copyright
© 2018 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
