Breast-conserving radiotherapy with simultaneous integrated boost; field-in-field three-dimensional conformal radiotherapy versus inverse intensity-modulated radiotherapy – A dosimetric comparison: Do we need intensity-modulated radiotherapy?

Abstract

Background and Purpose:To examine the feasibility of improving breast-conserving radiotherapy with simultaneous integrated boost (SIB) and analyzing the efficiency of forward versus inverse intensity-modulated radiotherapy (IMRT) techniques in providing the same.Materials and Methods:Three-dimensional conformal radiotherapy (3DCRT) field-in-field (FIF) plans with simultaneous and sequential boost and IMRT SIB plans were generated for the datasets of 20 patients who had undergone breast-conserving surgery. The 3 plans were compared dosimetrically for efficiency in terms of planning target volume (PTV) coverage (PTV 95%), homogeneity and conformity, dose delivered to ipsilateral/contralateral lungs (I/L: V10, V20, C/L: Vmean, V5), heart and contralateral breast (Vmean, V30 for heart and Vmean, V1, V5 for C/L breast).Results:The FIF 3DCRT plan with SIB (PLAN B) was more homogeneous than the classical technique with sequential boost (PLAN A). There were less hot spots in terms of Dmax (63.7 ± 1.3) versus Dmax (68.9 ± 1), P < 0.001 and boost V107%, B (0.3 ± 0.7) versus A (3.5 ± 5.99), P = 0.001. The IMRT SIB (PLAN C) did not provide any significant dosimetric advantage over the 3DCRT SIB technique. IMRT SIB plan C was associated with increased dose to contralateral lung in-terms of V5 (10.35 +/- 18.23) vs. (1.13 +/- 4.24), P = 0.04 and Vmean (2.12 ± 2.18) versus Vmean (0.595 ± 0.89), P = 0.008. There was 3-fold greater exposure in terms of Monitor Unit (MU) (1024.9 ± 298.32 versus 281.05 ± 20.23, P < 0.001) and treatment delivery time.Conclusions:FIF 3DCRT SIB provides a dosimetrically acceptable and technically feasible alternative to the classical 3DCRT plan with sequential boost for breast-conserving radiotherapy. It reduces treatment time by 2 weeks. IMRT SIB does not appear to have any dosimetric advantage; it is associated with significantly higher doses to contralateral lung and heart and radiation exposure in terms of MU.

Assessment of planning reproducibility in three-dimensional field-in-field radiotherapy technique for breast cancer: impact of surgery-simulation interval

“…With respect to the breast WBI techniques, the 3-D conformal FIF technique has been recommended as the initial treatment planning approach for WBI in the contemporary era (American Society for Radiation Oncology guideline) 21 . Although a more sophisticated beam delivery technique has been developed to allow for better dose distribution, improved homogeneity, reduced acute reactions and relative sparing of normal organs using intensity-modulated radiotherapy (IMRT), several limitations remain including an increased dose and exposure of the opposite lung and breast, which can increase the risk of second malignancies, requires more expenses, longer treatment-planning and treatment-delivery time, trained personal and devoted quality assurance, as well as ensuring availability of the IMRT facilities 10 , 22 , 23 . We also already perceived that daily cone beam CT (CBCT)-based image match and higher doses (monitor unit) generated by IMRT could hypothetically increase the risk of second malignancies 24 , 25 .…”

“…We also already perceived that daily cone beam CT (CBCT)-based image match and higher doses (monitor unit) generated by IMRT could hypothetically increase the risk of second malignancies 24 , 25 . Therefore, among various RT delivery techniques in breast WBI, which technique is constantly superior over the others and the standard of care have not been standardized and are debatable 22 , 26 .…”

Efficacy of Modified Qingre Jiedu Decoction Combined with Three-Dimensional Conformal Radiotherapy in Treating Moderate to Advanced Ovarian Carcinoma and Its Effect on Levels of Serum Carcinoembryonic Antigen and Carbohydrate Antigen 125

“…The inclusion criteria were as follows: ① the patients who met the diagnosis criteria for OC in the 4 th edition of Guidelines for the Diagnosis and Management of Ovarian Malignancies [ 7 ] and were diagnosed after histopathological diagnosis, and the clinical manifestations included lower abdominal distending pain, abdominal mass, and hesitancy in urination; ② their KPS scores were not less than 60 points, and the estimated survival was over 6 months; ③ they met the indications of 3D-CRT; and ④ the study met the World Medical Association Declaration of Helsinki (2013 ) [ 8 ] and was approved by the Ethics Committee of Changqing District People's Hospital of Jinan.…”

“…It contains peach seed, dandelion, tuckahoe, Mongolian milkvetch root, and other herbs and can exert efficacy such as promoting blood circulation and detoxication, invigorating the spleen, and replenishing qi [ 6 ]. Relevant clinical reports in recent years have shown [ 8 ] that the combination of TCM and Western medicine has significant advantages in improving the efficacy and reducing the mortality rate of patients with gynecological tumors. Currently, few reports focus on the efficacy of combining the two, and the results of the combination therapy were reported as follows.…”

Adjuvant radiation therapy in breast cancer

“…Two other studies explored the use of helical tomotherapy for treatment of the bilateral breast cancers with an SIB to the tumour bed 24 25 . However, the use of rotational or multi-field IMRT techniques can result in a higher dose to contralateral breast and lung as shown by Joseph et al 26 .…”