Efficacy, safety, and feasibility of volumetric modulated arc therapy for synchronous bilateral breast cancer management

Quesada, Stanislas; Fenoglietto, P.; Gourgou, Sophie; Lemanski, C.; Draghici, Roxana; Aillères, N.; Prunaretty, J.; Azria, D.; Bourgier, C.

doi:10.3389/fonc.2022.967479

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…Breast radiotherapy plays an important role for treating breast cancer patients. It is indicated for locally advanced breast cancer after mastectomy and compulsory for those after breast-conserving surgery so as to reduce cancer recurrence and related death [1]. Volumetric modulated arc therapy (VMAT) has emerged as a promising treatment option for this cancer [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…It is indicated for locally advanced breast cancer after mastectomy and compulsory for those after breast-conserving surgery so as to reduce cancer recurrence and related death [1]. Volumetric modulated arc therapy (VMAT) has emerged as a promising treatment option for this cancer [1][2][3][4][5][6][7]. Compared with conventional conformal techniques, VMAT is capable of achieving superior conformity and homogeneity of target dose and reducing treatment time [4][5][6]8].…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study of Plan Robustness for Breast Radiotherapy: Volumetric Modulated Arc Therapy Plans with Robust Optimization versus Manual Flash Approach

Chan,

Ng,

Hung

et al. 2023

Diagnostics

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A previous study investigated robustness of manual flash (MF) and robust optimized (RO) volumetric modulated arc therapy plans for breast radiotherapy based on five patients in 2020 and indicated that the RO was more robust than the MF, although the MF is still current standard practice. The purpose of this study was to compare their plan robustness in terms of dose variation to clinical target volume (CTV) and organs at risk (OARs) based on a larger sample size. This was a retrospective study involving 34 female patients. Their plan robustness was evaluated based on measured volume/dose difference between nominal and worst scenarios (ΔV/ΔD) for each CTV and OARs parameter, with a smaller difference representing greater robustness. Paired sample t-test was used to compare their robustness values. All parameters (except CTV ΔD98%) of the RO approach had smaller ΔV/ΔD values than those of the MF. Also, the RO approach had statistically significantly smaller ΔV/ΔD values (p < 0.001–0.012) for all CTV parameters except the CTV ΔV95% and ΔD98% and heart ΔDmean. This study’s results confirm that the RO approach was more robust than the MF in general. Although both techniques were able to generate clinically acceptable plans for breast radiotherapy, the RO could potentially improve workflow efficiency due to its simpler planning process.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Study of Plan Robustness for Breast Radiotherapy: Volumetric Modulated Arc Therapy Plans with Robust Optimization versus Manual Flash Approach

Chan,

Ng,

Hung

et al. 2023

Diagnostics

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Evaluation of Ethos intelligent optimization engine for left locally advanced breast cancer

Prunaretty,

Lopez,

Cabaillé

et al. 2024

Front. Oncol.

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PurposeTo evaluate the feasibility to use a standard Ethos planning template to treat left-sided breast cancer with regional lymph nodes.Material/MethodsThe tuning cohort of 5 patients was used to create a planning template. The validation cohort included 15 patients treated for a locally advanced left breast cancer randomly enrolled. The Ethos planning template was tuned using standard 3 partial arc VMAT and two collimator rotation configurations: 45/285/345° and 30/60/330°. Re-planning was performed automatically using the template without editing. The study was conducted with a schedule of 42.3 Gy in 18 fractions to the breast/chestwall, internal mammary chain (IMC) and regional lymph nodes (“Nodes”). The PTV was defined as a 3D extension of the CTV with a margin of 7 mm, excluding the 5mm below the skin. The manual treatment plans were performed using Eclipse treatment planning system with AAA and PO algorithms (v15.6) and a manual arc VMAT configuration and imported in Ethos TPS (v1.1) for a dose calculation with Ethos Acuros algorithm. The automated plans were compared with the manual plans using PTV and CTV coverage, homogeneity and conformity indices (HI and CN) and doses to organs at risk (OAR) via DVH metrics. For each plan, the patient quality assurance (QA) were performed using Mobius3D and gamma index. Finally, two breast radiation oncologists performed a blinded assessment of the clinical acceptability of each of the three plans (manual and automated) for each patient.ResultsThe manual and automated plans provided suitable treatment planning as regards dose constraints. The dosimetric comparison showed the CTV_breast D99% were significantly improved with both automated plans (p< 0,002) while PTV coverage was comparable. The doses to the organs at risk were equivalent for the three plans. Concerning treatment delivery, the Ethos-45° and Ethos-30° plans led to an increase in MUs compared to the manual plans, without affecting the beam on time. The average gamma index pass rates remained consistently above 98% regardless of the type of plan utilized. In the blinded evaluation, clinicians 1 and 2 assessed 13 out of 15 plans for Ethos 45° and 11 out of 15 plans for Ethos 30° as clinically acceptable.ConclusionUsing a standard planning template for locally advanced breast cancer, the Ethos TPS provided automated plans that were clinically acceptable and comparable in quality to manually generated plans. Automated plans also dramatically reduce workflow and operator variability.

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Efficacy, safety, and feasibility of volumetric modulated arc therapy for synchronous bilateral breast cancer management

Cited by 2 publications

References 19 publications

Comparative Study of Plan Robustness for Breast Radiotherapy: Volumetric Modulated Arc Therapy Plans with Robust Optimization versus Manual Flash Approach

Comparative Study of Plan Robustness for Breast Radiotherapy: Volumetric Modulated Arc Therapy Plans with Robust Optimization versus Manual Flash Approach

Evaluation of Ethos intelligent optimization engine for left locally advanced breast cancer

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