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Radiation Oncology
Published in: Radiation Oncology 1/2017

Open Access 01-12-2017 | Review

Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer

Authors: Luca Cozzi, Frank Lohr, Antonella Fogliata, Davide Franceschini, Fiorenza De Rose, A R Filippi, Gabriele Guidi, Valentina Vanoni, Marta Scorsetti

Published in: Radiation Oncology | Issue 1/2017

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Abstract

Background

The aim of this review is the critical appraisal of the current use of volumetric modulated arc therapy for the radiation therapy management of breast cancer. Both clinical and treatment planning studies were investigated.

Material and methods

A Pubmed/MEDLINE search of the National Library of Medicine was performed to identify VMAT and breast related articles. After a first order rejection of the irrelevant findings, the remaining articles were grouped according to two main categories: clinical vs. planning studies and to some sub-categories (pointing to significant technical features). Main areas of application, dosimetric and clinical findings as well as areas of innovations were defined.

Results

A total of 131 articles were identified and of these, 67 passed a first order selection. Six studies reported clinical results while 61 treatment dealed with treatment planning investigations. Among the innovation lines, the use of high intensity photon beams (flattening filter free), altered fractionation schemes (simultaneous integrated boost, accelerated partial breast irradiation, single fraction), prone positioning and modification of standard VMAT (use of dynamic trajectories or hybrid VMAT methods) resulted among the main relevant fields of interest. Approximately 10% of the publications reported upon respiratory gating in conjunction with VMAT.

Conclusions

The role of VMAT in the radiation treatment of breast cancer seems to be consolidated in the in-silico arena while still limited evidence and only one phase II trial appeared in literature from the clinical viewpoint. More clinical reports are needed to fully proove the expected dosimetric benefits demonstrated in the planning investigations.
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Metadata
Title
Critical appraisal of the role of volumetric modulated arc therapy in the radiation therapy management of breast cancer
Authors
Luca Cozzi
Frank Lohr
Antonella Fogliata
Davide Franceschini
Fiorenza De Rose
A R Filippi
Gabriele Guidi
Valentina Vanoni
Marta Scorsetti
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2017
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-017-0935-4

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