Abstract
To evaluate the dosimetric advantages of incorporating the deep inspiration breath
hold (DIBH) technique into left breast cancer volumetric modulated arc therapy (VMAT)
treatment under Halcyon Linac and to investigate the correlation between mean heart
dose (MHD) and distance from the heart to target volumes in left breast cancer VMAT
treatment. Fifteen Post-lumpectomy, left-sided breast patients treated between January
2017 and October 2020 were selected. Two plans were generated for each patient using
Eclipse treatment planning system (TPS) with the prescription of 50.4 Gy to planning
target volume (PTV) breast and 58.8 Gy to PTV boost in 28 fractions. For each patient,
DIBH and free breathing (FB) VMAT treatment plans under Halcyon Linac were generated.
Dosimetric parameters, monitor unit and beam-on time of both DIBH and FB groups were
compared. Three-dimensional distances from heart surface to each target volume were
measured on computed tomography images using the TPS contouring tool and their correlation
with MHD was evaluated by Pearson's correlation coefficient (r). Comparable target coverage was shown in both groups. Mean dose to heart, left anterior
descending artery, and left ventricle in Halcyon-DIBH-VMAT group were significantly
reduced by 0.49 Gy, 1.19 Gy, and 0.57 Gy, respectively, compared to Halcyon-FB-VMAT
(p < 0.001). A significant lung dose reduction was also achieved in Halcyon-DIBH-VMAT
group. There was also a strong negative correlation between MHD and distance from
heart surface to PTV boost in both FB and DIBH group (r = −0.741, p < 0.001), but not observed for distance from heart surface to PTV breast. Incorporating
DIBH into left breast cancer VMAT treatment under Halcyon Linac demonstrated significant
cardiac and lung dose reduction. It was also demonstrated that MHD had a strong negative
correlation with distance from heart surface to PTV boost but relatively independent
of distance from heart surface to PTV breast. Recognizing the distance from the heart
surface to PTV boost as the main factor in affecting MHD could potentially facilitate
clinical treatment planning workflow and decision.
Keywords
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Article info
Publication history
Published online: May 28, 2022
Accepted:
April 24,
2022
Received in revised form:
April 20,
2022
Received:
February 7,
2022
Identification
Copyright
© 2022 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
