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Dosimetric study of three-dimensional conformal radiotherapy, electronic compensator technique, intensity-modulated radiation therapy and volumetric-modulated arc therapy in whole breast irradiation†

Published online by Cambridge University Press:  09 May 2017

Chonnipa Nantavithya ,
Kitwadee Saksornchai ,
Puntiwa Oonsiri  and
Kanjana Shotelersuk
Chonnipa Nantavithya
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Kitwadee Saksornchai
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Puntiwa Oonsiri
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Kanjana Shotelersuk*
Affiliation:
Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
*
Correspondence to: Kanjana Shotelersuk, Associate Professor, Department of Radiology, Division of Radiation Oncology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital (KCMH), 1873 Rama 4 Road, Patumwan, Bangkok 10330, Thailand. Tel: +66 256 4334; E-mail: kanjanash@yahoo.co.th
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Abstract

Background

Whole breast irradiation is an essential treatment after breast-conserving surgery (BCS). However, there are some adverse effects from inhomogeneity and dose to adjacent normal tissues.

Objective

Aim of this study was to compare dosimetry among standard technique, three-dimensional conformal radiotherapy (3D-CRT), and advanced techniques, electronic compensator (ECOMP), inverse intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).

Methods

Whole breast irradiation treatment plans of patients who had underwent BCS and whole breast irradiation were re-planned with all four techniques. Clinical target volume was contoured according to the Radiation Therapy Oncology Group atlas for breast only in patients who had negative node or ductal carcinoma in situ and breast with chest wall for patients with positive node. Planning target volume was non-uniformly expanded. Dose prescription was 50 Gy in 25 fractions with 6 MV photon energy.

Results

In total, 25 patients underwent whole breast irradiation with computed tomography simulation from November 2013 to November 2014 were included. Six patients with positive nodes were re-planned for breast with chest wall irradiation and 19 patients with negative nodes were re-planned for breast only irradiation. Primary outcome, radical dose homogeneity index (HI) of 3D-CRT, ECOMP, IMRT and VMAT were 0·865, 0·889, 0·890 and 0·866, respectively. ECOMP and IMRT showed significant higher HI than 3D-CRT (p-value<0·001). Secondary outcome, conformity index (CI) of advanced technique were significantly better than 3D-CRT. Lung V20, mean ipsilateral lung dose (MILD), mean heart dose (MHD), heart V25, heart V30 of advanced techniques were also lower than 3D-CRT. ECOMP had better mean lung dose (MLD), mean contralateral lung dose (MCLD) and mean contralateral breast dose (MCBD) when compared with 3D-CRT. Monitor units of advanced techniques were significantly higher than 3D-CRT.

Conclusions

HI of ECOMP and IMRT were significantly higher than 3D-CRT technique. All advanced techniques showed statistically better in CI. Lung V20, MILD, heart V25 and heart V30 of advanced techniques were lower than 3D-CRT. However, only ECOMP showed decreased MLD, MHD, MCLD and MCBD when compared with 3D-CRT.

Keywords

electronic compensatorintensity-modulated radiation therapythree-dimensional conformal radiotherapyvolumetric-modulated arc therapywhole breast irradiation
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 4 , December 2017 , pp. 431 - 443
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Copyright
© Cambridge University Press 2017 

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Footnotes

†

Presentation at a conference; 2015 Breast Cancer Symposium, San Francisco, CA, USA.

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