Dosimetric comparison of helical tomotherapy,volumetric-modulated arc therapy,intensity-modulated radiotherapy,and field-in-field technique for synchronous bilateral breast cancer |
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| Institution: | 2. Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan;3. Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan;4. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan;5. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;2. Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan;2. School of Medicine, China Medical University, Taichung, Taiwan;3. Oncology Treatment Center, Sijhih Cathay General Hospital, New Taipei, Taiwan;4. Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan;2. Department of Health Technology & Informatics, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR;1. Department of Radiation Oncology, MedStar RadAmerica, Baltimore, MD, 21237, USA;2. Department of Radiation Oncology, Fairview Range Medical Center, Hibbing, MN, 55746, USA;3. Department of Radiation Oncology, Advocate Lutheran General Hospital, Park Ridge, IL, 60068;4. Medical Dosimetry Program, University of Wisconsin – La Crosse, La Crosse, WI 54601, USA;2. Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan |
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| Abstract: | Purpose: To compare the dosimetric characteristics of helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), intensity-modulated radiotherapy (IMRT), and tangential field-in-field technique (FIF) for the treatment of synchronous bilateral breast cancer (SBBC). Methods and Materials: Ten patients with early-stage unilateral breast cancer were selected for simulating the patients with SBBC in this retrospective analysis. Treatment plans with HT, VMAT, IMRT, and FIF were generated for each patient with a total dose of 50.4 Gy in 28 fractions to the target. Plan quality, namely conformity index (CI), homogeneity index (HI), dose-volume statistics of organs at risk (OARs), and beam-on time (BOT), were evaluated. Results: HT plans showed a lower mean heart dose (3.53 ± 0.31Gy) compared with the other plans (VMAT = 5.6 ± 1.36 Gy, IMRT = 3.80 ± 0.76 Gy, and FIF = 4.84 ± 2.13 Gy). Moreover, HT plans showed a significantly lower mean lung dose (p < 0.01) compared with the other plans: mean right lung doses were 6.81 ± 0.67, 10.32 ± 1.04, 9.07 ± 1.21, and 10.03 ± 1.22 Gy and mean left lung doses were 6.33 ± 0.87, 8.82 ± 0.91, 7.84 ± 1.07, and 8.64 ± 0.99 Gy for HT, VMAT, IMRT, and FIF plans, respectively. The mean dose to the left anterior descending artery was significantly lower in HT plans (p < 0.01) than in the other plans: HT = 19.41 ± 0.51 Gy, VMAT = 25.77 ± 7.23 Gy, IMRT = 27.87 ± 6.48 Gy, and FIF = 30.95 ± 10.17 Gy. FIF plans showed a worse CI and HI compared with the other plans. VMAT plans showed shorter BOT (average, 3.9 ± 0.2 minutes) than did HT (average, 11.0 ± 3.0 minutes), IMRT (average, 6.1 ± 0.5 minutes), and FIF (average, 4.6 ± 0.7 minutes) plans. Conclusions: In a dosimetric comparison for SBBC, HT provided the most favorable dose sparing of OARs. However, HT with longer BOT may increase patient discomfort and treatment uncertainty. VMAT enabled shorter BOT with acceptable doses to OARs and had a better CI than did FIF and IMRT. |
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