Abstract
Postmastectomy radiotherapy (PMRT) has been shown to improve the overall survival
for invasive breast cancer patients, and many advanced radiotherapy technologies were
adopted for PMRT. The purpose of our study is to compare various advanced PMRT techniques
including fixed-beam intensity-modulated radiotherapy (IMRT), non-coplanar volumetric
modulated arc therapy (NC-VMAT), multiple arc VMAT (MA-VMAT), and tomotherapy (TOMO).
Results of standard VMAT and mixed beam therapy that were published by our group previously
were also included in the plan comparisons. Treatment plans were produced for nine
PMRT patients previously treated in our clinic. The plans were evaluated based on
planning target volume (PTV) coverage, dose homogeneity index (DHI), conformity index
(CI), dose to organs at risk (OARs), normal tissue complication probability (NTCP)
of pneumonitis, lifetime attributable risk (LAR) of second cancers, and risk of coronary
events (RCE). All techniques produced clinically acceptable PMRT plans. Overall, fixed-beam
IMRT delivered the lowest mean dose to contralateral breast (1.56 ± 0.4 Gy) and exhibited
lowest LAR (0.6 ± 0.2%) of secondary contralateral breast cancer; NC-VMAT delivered
the lowest mean dose to lungs (7.5 ± 0.8 Gy), exhibited lowest LAR (5.4 ± 2.8%) of
secondary lung cancer and lowest NTCP (2.1 ± 0.4%) of pneumonitis; mixed beam therapy
delivered the lowest mean dose to heart (7.1 ± 1.3 Gy) and exhibited lowest RCE (8.6
± 7.1%); TOMO plans provided the most optimal target coverage while delivering higher
dose to OARs than other techniques. Both NC-VMAT and MA-VMAT exhibited lower values
of all OARs evaluation metrics compare to standard VMAT. Fixed-beam IMRT, NC-VMAT,
and mixed beam therapy could be the optimal radiation technique for certain breast
cancer patients after mastectomy.
Keywords
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Article info
Publication history
Published online: May 23, 2019
Accepted:
April 30,
2019
Received in revised form:
April 23,
2019
Received:
January 4,
2019
Identification
Copyright
© 2019 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
