Radiotherapy to the Left Breast with 3DCRT, IMRT or VMAT: International Medical Center Experience

Abstract

Radiation therapy after conservative breast surgery is an integral part of the treatment of early breast cancer. The aim of radiotherapy is to achieve the best coverage of the Planning Target Volume (PTV), while reducing the dose to the Organs at Risk (OAR). Such goals are not always achievable with the conformal three dimensions plans (3DCRT). Recently, radiation oncologist uses Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast. In this study, we compared 3DCRT, IMRT and VMAT for left breast cancer patients in terms of PTV coverage, OAR. We also revised the different dose distribution in 1) different breast volume categories, 2) nodal irradiation versus breast only, and 3) boost versus no boost. Results: The routinely reported dose constrains for the ipsilateral lung and for the heart were not significantly different on comparing the three techniques. While for the contralateral lung, the difference in mean dose was in favor of 3DCRT. In large breast volume, 3DCRT provided a lower Max dose to the contralateral lung and the lowest mean dose to the contralateral breast when compared to IMRT p < 0. 046. In case of no nodal irradiation, the contralateral breast mean dose was lower in 3DCRT in comparison to IMRT and VMAT p < 0.037. When boost dose was given, 3DCRT plans had produced a lower Max dose to the contralateral lung p < 0.017. Conclusion: The three techniques (3DCRT, IMRT, and VMAT) can meet the clinical dosimetry demands of radiotherapy for left breast cancer after conservative surgery, as long as the routinely OARs only (heart and ipsilateral lung) are reported. Our study showed that 3CDRT can provide a lower dose to the contralateral organs (breast and lung), specially, in case of large breast volumes, no nodal irradiation and when a boost is given.

Organ-sparing techniques and dose-volume constrains used in breast cancer radiation therapy – Results from European and Latin American surveys

“…However, these percentages are not equivalent with those reported by our study, since the German results reflect the proportion of departments using a certain technique as preferred option, and our question allowed multiple answers mentioning all the implemented techniques in the department where the participant was working. Data regarding the superiority of one technique or the other is heterogeneous and he results can be dependent on patient’s anatomy, study sample size and planning optimization [35] , [36] . However, most of the results show that both inverse-planning methods significantly decrease OAR’ D mean and high-dose volumes but not the low-dose volumes [19] , [37] , [38] , [39] .…”