Top

Strahlentherapie und Onkologie

Published in:

01-05-2013 | Original article

Node-positive left-sided breast cancer: does VMAT improve treatment plan quality with respect to IMRT?

Authors: M. Pasler, D. Georg, S. Bartelt, J. Lutterbach

Published in: Strahlentherapie und Onkologie | Issue 5/2013

Abstract

Purpose

The aim of the present work was to explore plan quality and dosimetric accuracy of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for lymph node-positive left-sided breast cancer.

Methods

VMAT and IMRT plans were generated with the Pinnacle³ V9.0 treatment planning system for 10 lymph node-positive left-sided breast cancer patients. VMAT plans were created using a single arc and IMRT was performed with 4 beams using 6, 10, and 15 MV photon energy, respectively. Plans were evaluated both manually and automatically using ArtiView™. Dosimetric plan verification was performed with a 2D ionization chamber array placed in a full scatter phantom.

Results

Photon energy had no significant influence on plan quality for both VMAT and IMRT. Large variability in low doses to the heart was found due to patient anatomy (range V_5 Gy 26.5–95 %). Slightly more normal tissue dose was found for VMAT (e.g., V_Tissue30% = 22 %) than in IMRT (V_Tissue30% = 18 %). The manual and ArtiView™ plan evaluation coincided very accurately for most dose metrics (difference < 1 %). In VMAT, 96.7 % of detector points passed the 3 %/3 mm gamma criterion; marginally better accuracy was found in IMRT (98.3 %).

Conclusion

VMAT for node-positive left-sided breast cancer retains target homogeneity and coverage when compared to IMRT and allows maximum doses to organs at risk to be reduced. ArtiView™ enables fast and accurate plan evaluation.

Available only for authorised users

Abo-Madyan Y, Polednik M, Rahn A et al (2008) Improving dose homogeneity in large breasts by IMRT: efficacy and dosimetric accuracy of different techniques. Strahlenther Onkol 184:86–92PubMedCrossRef

Cotrutz C, Xing L (2003) Segment-based dose optimisation using a genetic algorithm. Phys Med Biol 48:2987–2998PubMedCrossRef

Dogan N, Cuttino L, Lloyd R et al (2007) Optimized dose coverage of regional lymph nodes in breast cancer- the role of intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 68:1238–1250PubMedCrossRef

Donovan E, Bleakley N, Denholm E et al (2007) Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol 82:254–264PubMedCrossRef

Dörr W, Herrmann T (2002) Second primary tumors after radiotherapy for malignancies. Treatment-related parameters. Strahlenther Onkol 178:357–362PubMedCrossRef

Eppinga E, Lagerwaard F, Verbakel W et al (2010) Volumetric modulated arc therapy for advanced pancreatic cancer. Strahlenther Onkol 186:382–387PubMedCrossRef

Evans PM, Donovan EM, Partridge M et al (2000) The delivery of intensity modulated radiotherapy to the breast using multiple static fields. Radiother Oncol 57:79–88PubMedCrossRef

Fogliata A, Clivio A, Nicolini G et al (2007) A treatment planning study using non-coplanar static fields and coplanar arcs for whole breast radiotherapy of patients with concave geometry. Radiother Oncol 85:346–354PubMedCrossRef

Freedman GM, Li T, Nicolaou N et al (2009) Breast intensity-modulated radiation therapy reduces time spent with acute dermatitis for women of all breast sizes during radiation. Int J Radiat Oncol Biol Phys 74:689–694PubMedCrossRef

10.

Georg D, Nyholm T, Olofsson J et al (2007) Clinical evaluation of monitor unit software and the application of action levels. Radiother Oncol 85:306–315PubMedCrossRef

11.

Georg D, Knöös T, McClean B (2011) Current status and future perspective of flattening filter free photon beams. Med Phys 38:1280–1293PubMedCrossRef

12.

Goddu SM, Chaudhari S, Mamalui-Hunter M et al (2009) Helical tomotherapy planning for left-sided breast cancer patients with positive lymph nodes: comparison to conventional multiport breast technique. Int J Radiat Oncol Biol Phys 73:1243–1251PubMedCrossRef

13.

International Commission on Radiation Units and Measurements (ICRU). ICRU Report No. 83: Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT)

14.

Jagsi R, Moran J, Marsh R et al (2010) Evaluation of four techniques using intensity-modulated radiation therapy for comprehensive locoregional irradiation of breast cancer. Int J Radiat Oncol Biol Phys 78:1594–1603PubMedCrossRef

15.

Lind PA, Wennberg B, Gagliardi G, Fornander T (2001) Pulmonary complications following different radiotherapy techniques for breast cancer, and the association to irradiated lung volume and dose. Breast Cancer Res Treat 68:199–210PubMedCrossRef

16.

Lohr F, Heggemann F, Papavassiliu T et al (2009) Is cardiotoxicity still an issue after breast-conserving surgery and could it be reduced by multifield IMRT? Strahlenther Onkol 185:222–230PubMedCrossRef

17.

Low DA, Harms WB, Mutic S, Purdy JA (1998) A technique for the quantitative evaluation of dose distributions. Med Phys 25:656–661PubMedCrossRef

18.

Nicolini G, Fogliata A, Clivio A et al (2011) Planning strategies in volumetric modulated arc therapy for breast. Med Phys 38:4025–4031CrossRef

19.

Paddick I (2000) A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note. J Neurosurg 93:219–222PubMed

20.

Pasler M, Georg D, Wirtz H, Lutterbach J (2011) Effect of photon-beam energy on VMAT and IMRT treatment plan quality and dosimetric accuracy for advanced prostate cancer. Strahlenther Onkol 187:812–819PubMedCrossRef

21.

Popescu CC, Olivotto IA, Beckham WA et al (2010) Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys 76:287–295PubMedCrossRef

22.

Rabinovitch R, Ballonoff A, Newman F, Finlayson C (2008) Evaluation of breast sentinel lymph node coverage by standard radiation therapy fields. Int J Radiat Oncol Biol Phys 70:1468–1471PubMedCrossRef

23.

Sardaro A, Petruzzelli MF, D’Errico MP et al (2012) Radiation-induced cardiac damage in early left breast cancer patients: risk factors, biological mechanisms, radiobiology, and dosimetric constraints. Radiother Oncol 103:133–142PubMedCrossRef

24.

Singh AK, Lockett MA, Bradley JD (2003) Predictors of radiation-induced esophageal toxicity in patients with non-small cell lung cancer treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 55:337–341PubMedCrossRef

25.

Spruijt KH, Dahele M, Cuijpers JP et al (2012) Flattening filter free vs flattened beams for breast irradiation. Int J Radiat Oncol Biol Phys 85:506–513 PubMedCrossRef

26.

Stock M, Kroupa B, Georg D (2005) Interpretation and evaluation of the gamma index and the gamma index angle for the verification of IMRT hybrid plans. Phys Med Biol 50:399–411PubMedCrossRef

27.

Stovall M, Smith S, Langholz B et al (2008) Dose to the contralateral breast from radiotherapy and risk of second primary breast cancer in the WECARE study. Int J Radiat Oncol Biol Phys 72:1021–1030PubMedCrossRef

28.

Subramaniam S, Thirumalaiswamy S, Srinivas C et al (2012) Chest wall radiotherapy with volumetric modulated arcs and the potential role of flattening filter free photon beams. Strahlenther Onkol 188:484–491PubMedCrossRef

29.

Taylor CW, Nisbet A, McGale P, Darby SC (2007) Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Radiat Oncol Biol Phys 69:1484–1495PubMedCrossRef

30.

Thilmann C, Zabel A, Nill S et al (2002) Intensity-modulated radiotherapy of the female breast. Med Dosim 27:79–90PubMedCrossRef

31.

Thilmann C, Zabel A, Kuhn S et al (2002) Inversely planned intensity modulated radiotherapy for irradiation of a woman with breast cancer and funnel chest. Strahlenther Onkol 178:637–643PubMedCrossRef

32.

Vandecasteele K, De Neve W, De Gersem W et al (2009) Intensity-modulated arc therapy with simultaneous integrated boost in the treatment of primary irresectable cervical cancer. Strahlenther Onkol 185:799–807PubMedCrossRef

33.

Van Esch A, Clermont C, Devillers M et al (2007) On-line quality assurance of rotational radiotherapy treatment delivery by means of a 2D ion chamber array and the Octavius phantom. Med Phys 34:3825–3837CrossRef

34.

Wiezorek T, Banz N, Schwedas M et al (2005) Dosimetric quality assurance for intensity-modulated radiotherapy. Feasibility study for a filmless approach. Strahlenther Onkol 181:468–474PubMedCrossRef

35.

Wiezorek T, Schwahofer A, Schubert K (2009) The influence of different IMRT techniques on the peripheral dose: a comparison between sMLM-IMRT and helical tomotherapy. Strahlenther Onkol 185:969–702CrossRef

Title: Node-positive left-sided breast cancer: does VMAT improve treatment plan quality with respect to IMRT?
Authors: M. Pasler
D. Georg
S. Bartelt
J. Lutterbach
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Strahlentherapie und Onkologie / Issue 5/2013
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-012-0281-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Node-positive left-sided breast cancer: does VMAT improve treatment plan quality with respect to IMRT?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2013

Validation of a survival score for patients treated with whole-brain radiotherapy for brain metastases

Lebermetastasen kolorektaler Karzinome ≤ 3 cm können sicher mit Radiofrequenzablation behandelt werden

Comparison of four target volume definitions for pancreatic cancer

125I Seed implant brachytherapy for the treatment of parotid gland cancers in children and adolescents

What’s in a name?

Physical and psychosocial support requirements of 1,500 patients starting radiotherapy