Plan quality assessment of modern radiotherapy delivery techniques in left-sided breast cancer: an analysis stratified by target delineation guidelines

Abstract

Objective: This study compares planning techniques stratified by consensus delineation guidelines in patients undergoing whole-breast radiotherapy based on an objective plan quality assessment scale. Methods: 10 patients with left-sided breast cancer were randomly selected, and target delineation for intact breast was performed using Tangent (RTOG 0413), ESTRO, and RTOG guidelines. Consensus Plan Quality Metric (PQM) scoring was defined and communicated to the physicist before commencing treatment planning. Field-in-field IMRT (FiF), inverse IMRT (IMRT) and volumetric modulated arc therapy (VMAT) plans were created for each delineation. Statistical analyses utilised a two-way repeated measures analysis of variance, after applying a Bonferroni correction. Results: Total PQM score of plans for Tangent and ESTRO were comparable for FiF and IMRT techniques (FiF vs IMRT for Tangent, p = 0.637; FiF vs IMRT for ESTRO, p = 0.304), and were also significantly higher compared to VMAT. Total PQM score of plans for RTOG revealed that IMRT planning achieved a significantly higher score compared to both FiF and VMAT (IMRT vs FiF, p < 0.001; IMRT vs VMAT, p < 0.001). Conclusions: Total PQM scores were equivalent for FiF and IMRT for both Tangent and ESTRO delineations, whereas IMRT was best suited for RTOG delineation. Advances in knowledge: FiF and IMRT planning techniques are best suited for ESTRO or Tangent delineations. IMRT also yields better results with RTOG delineation.

Application research on reducing radiation-induced lung injury with a trigger operator based on overlap volume histogram (OVH) in breast cancer postoperative radiotherapy

“…The design of a radiotherapy plan is a critical aspect of radiotherapy, as the quality of the plan determines both the effectiveness of the treatment and the extent of side effects. As a result, many researchers have focused their efforts on improving the quality of radiotherapy plans 11 , 12 . Among these efforts, one of the most significant contribution has been the advancement in delivery technology.…”

Variation of heart and lung radiation doses according to setup uncertainty in left breast cancer

“…Although excluded from the evaluation of this study, the dose distribution of CTV would be essential as much as OARs. The sub-fields of field-in-field technique are manually reconstructed taking account of the dose clouds in each tangential field and the broad deviation of dose distribution for CTV could be developed according to characteristics of breast contour and physician’s principle [ 27 ]. Therefore, the dose distribution of CTV related to the extent of caudal and deep set-up error could not show the uniform pattern on a case by case basis.…”

Systematic Quantitative Evaluation of Plan-IQ for Intensity-Modulated Radiation Therapy After Modified Radical Mastectomy

“…Many researchers have studied the application of Plan-IQ in RT planning design and pointed out that it further protects OAR, which was also con rmed in our study (13)(14)(15)20). Some researchers have used PQM on the dosimetric parameters of the entire RT plan to quantitatively evaluate the change in the RT plan quality from a macroscopic perspective (21)(22)(23)(24)(25). However, no study has separated the PQM score into PTV and OAR parts to evaluate IMRT planning after modi ed radical mastectomy.…”