Comparison of VMAT, Field in Field, Inverse IMRT, and Helical Tomotherapy Planning in Bilateral Synchronous Breast Cancer: A Case Study

Abstract

This study aims to compare the technical feasibility and benefits of four different planning techniques, VMAT, helical tomotherapy, IMRT and Field in Field, for synchronous bilateral breast cancer patients. In this study, two patients with early bilateral breast cancer after breast conservation surgery were planned for radiotherapy. Three different treatment planning techniques were generated for each patient on the Eclipse treatment planning system, and both patients were planned on the Tomotherapy planning system. For planning target volumes (PTVs), the mean doses, values of D2, D98, conformity index and homogeneity index were reported. For the organs at risk, the analysis included the mean dose and VXGy, depending on the organs (lungs, heart). In all techniques used in this study, there was no difference in D98% tPTV, while the lowest D2% was seen in HT plans. HT was the best in conformity and homogeneity index.

Dosimetric comparison of volumetric-modulated arc therapy and helical tomotherapy for adjuvant treatment of bilateral breast cancer

“…Dağ et al, also had reported that V 5 in VMAT planning was on average 85%, whereas in HT, it was only 45•5%. 10 The average V 5 of lungs achieved by our HT plans is 43•4%. As the series reported by Kaidar-Person et al, entailed inclusion of internal mammary targets, very high heart mean doses to the tune of 20 Gy (range 13-28) have been reported with acceptable lung V 20 and V 5 .…”

“…[2][3][4][5]7 There are very few papers reporting the direct dosimetric comparisons of VMAT and HT on BBC cancers. [8][9][10] Our study reports dosimetric comparison of VMAT and HT of BBC with SIB for tumour bed and along with nodal irradiation. The cases we had used are real clinical cases already treated with HT.…”

“…1,2,4,6,7 However, there are only a few studies on dosimetric comparison between VMAT and HT in BBC. [8][9][10] Cheng et al, had conducted dosimetric comparison for BBC among different treatment modalities HT, VMAT, intensity-modulated radiation therapy (IMRT) and FIF. They had undertaken retrospective analysis on 10 patients with early-stage unilateral breast cancer for simulating the patients with BBC.…”

“…However, only two patients were studied in the dosimetric analysis. 10 Another dosimetric comparison between intensity-modulated proton therapy (IMPT) and photon-based techniques (IMRT, VMAT, HT) showed superior cardiac and lung sparing in synchronous bilateral breast radiotherapy with IMPT. 8 In this study 11 post-lumpectomy node negative patients of BBC were planned without the irradiation of the regional nodes or tumor bed boost.…”

“…The dosimetric comparisons in the above-mentioned studies did not include SIB. [8][9][10] In the current study, we have conducted dosimetric comparison on the BBC patients with SIB of 61 Gy/25 fractions for tumour bed along with 50 Gy/25 fractions to breast/chest wall and supraclavicular fossa (SCF). Here, we intend to compare HT and VMAT with respect to doses to the targets and organs at risk (OARs), dosimetric indices, IDs and treatment efficiency.…”