VMAT techniques for lymph node-positive left sided breast cancer

Pasler, Marlies; Lutterbach, Johannes; Björnsgard, M.; Reichmann, U.; Bartelt, Susanne; Georg, Dietmar

doi:10.1016/j.zemedi.2014.03.008

Cited by 29 publications

(28 citation statements)

References 26 publications

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“…From this summary, the present study is the only one where the mean doses of all OARs were lowered using the AvS. Pasler et al 27 improved with tangential setting all the structures except the I lung ; Jeulink et al 25 did not improve the contralateral structures; Virén et al 26 were deteriorating the ipsilateral structures, especially the heart. This variability in dose distribution for similar concepts for planning is proof that it is difficult to find the best trade-offs for OAR sparing.…”

Section: 10mentioning

confidence: 61%

“…95% and V 107% , 3 cm 3 ); on the contrary, none of the three studies mentioned previously 25,26,27 applied so stringent rules to the target dose homogeneity as part of the trade-off balance.…”

Section: 10mentioning

confidence: 95%

“…They used Elekta VMAT; the dose prescribed to the breast was 50 Gy in 25 fractions, no nodal regions, no simultaneous boost and no DIBH. Finally, a German-Austrian group (Pasler et al 27 ) compared one partial arc with two small tangential arcs. Nodal regions and internal mammary chain were included, simultaneous boost with 50.4 and 60.2 Gy doses in 28 fractions were planned with the Pinnacle planning system for an Elekta linear accelerator and no DIBH.…”

Section: 10mentioning

confidence: 99%

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Dosimetric trade-offs in breast treatment with VMAT technique

Fogliata

Seppälä

Reggiori

et al. 2017

The British Journal of Radiology

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Objective: Breast planning with volumetric modulated arc therapy (VMAT) has been explored, especially for leftsided breast treatments, with the primary intent of lowering the heart dose and improving target dose homogeneity. As a trade-off, larger healthy tissue volumes would receive low dose levels, with the potential risk of increasing late toxicities and secondary cancer induction, although no clinical data are available today to confirm the risk level. The scope of this work is to explore the dosimetric trade-offs using two different VMAT plans. Methods: Two planning strategies for dual-partial-arc VMAT, RA_avoid and RA_full, with and without avoidance sectors, were explored in a cohort of 20 patients, for whole left breast irradiation for 40.05 Gy to the mean target dose in 15 fractions. Common dose objectives included a stringent dose homogeneity, mean dose to the heart ,5 Gy, ipsilateral lung (I lung ) ,8 Gy, contralateral lung (C lung ) ,2 Gy and contralateral breast (C breast ) ,3 Gy.Results: RA_full showed a better dose conformity, lower high-dose spillage in the healthy tissue and lower skin dose. RA_avoid presented a reduction of the mean doses for all critical structures: 51% to the heart, 12% to the I lung , 81% to the C lung and 73% to the C breast . All differences were significant with p , 0.0001. Conclusion: The adaptation of VMAT options to planning objectives reduced significantly the healthy tissue dose levels at the price of some high-dose spillage. Evaluation of the trade-offs for application to the different critical structures should drive in improving the usage of the VMAT technique for breast cancer treatment. Advances in knowledge: Different planning strategies in the same VMAT technique could give significant variations in dose distributions. The choice of the trade-offs would affect the possible future late toxicity and secondary cancer induction risk. INTRODUCTIONRadiotherapy treatment is an integral part of the standard of care of patients with breast cancer after breast-conserving surgery. Different fractionation schemes have been applied, from the conventional 50 Gy in 25 fractions to hypofractionated regimes like 40.05 Gy delivered in 15 fractions, as proposed by the START (UK Standardisation of Breast Radiotherapy) Trial B.

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Section: 10mentioning

confidence: 61%

Section: 10mentioning

confidence: 95%

Section: 10mentioning

confidence: 99%

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Dosimetric trade-offs in breast treatment with VMAT technique

Fogliata

Seppälä

Reggiori

et al. 2017

The British Journal of Radiology

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“…The VMAT plans were realized with two arcs covering gantry angles from 180° to 60° clockwise (cw) and counter-clockwise (ccw). For the tVMAT two partial arcs were used ranging from 60° to 5° and from 255° to 200° gantry angle ccw similar to the technique described by Pasler et al [4]. All plans were optimized in Monaco 5.0 using identical constraints.…”

Section: Methodsmentioning

confidence: 99%

Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study

et al. 2016

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BackgroundThe aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer.MethodsAn Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05.ResultsSignificantly best target coverage and homogeneity was achieved using VMAT FFF with V95% = (98.7 ± 0.8) % and HI = (8.2 ± 0.9) % for the SIB and V95% = (98.3 ± 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a Dmean of (0.7 ± 0.1) Gy for the contralateral lung, (1.0 ± 0.2) Gy for the contralateral breast and (1.4 ± 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 ± 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 ± 0:07) min.ConclusionBalancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.

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“…Recent publications propose several delivery methods that use modern intensity-modulated treatment techniques (IMRT, VMAT, RapidArc) or a combination of them as well [5][6][7][8]. However, multiple-field IMRT or full-arc VMAT plans seem to increase the dose in the contralateral breast and in the lungs compared to the standard tangential-field plan and thus, they are associated with a higher second cancer risk [8].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a new hybrid VMAT simultaneous integrated boost technique for breast radiotherapy

Vaegler

Scheibner²,

Hartwig

et al. 2017

Current Directions in Biomedical Engineering

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Abstract:In this survey we propose a new hybrid simultaneous integrated boost (SIB) delivery method for breast radiotherapy that was implemented in our department of Radiation Oncology. This technique encompasses nonmodulated tangential fields as well as VMAT-arcs and combines the robustness and the dose confinement properties of tangential opposed fields with the benefits of a complex VMAT-technique. The results of the dosimetric evaluation indicate that the proposed technique enables a balanced mix between dose coverage, homogeneity and conformity versus the exposure of the organs-at-risks. More precisely, the proposed technique is on par with other recently published SIB techniques for breast radiotherapy.

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VMAT techniques for lymph node-positive left sided breast cancer

Cited by 29 publications

References 26 publications

Dosimetric trade-offs in breast treatment with VMAT technique

Dosimetric trade-offs in breast treatment with VMAT technique

Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study

Evaluation of a new hybrid VMAT simultaneous integrated boost technique for breast radiotherapy

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