Sequential Volumetric Modulated Arc Therapy (VMAT) Boost in Hybrid Plan with Tangential Beams for Whole Breast Treatment: a Dosimetric Study

Author(s) :

Antonio Piras1, Luca Boldrini2, Andrea D’Aviero3, Antonella Sanfratello4, Sebastiano Menna2, Mariangela Massaccesi2, Massimiliano Spada5, Gianfranco Pernice5, Tommaso Angileri6, Antonino Daidone1

1UO Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo

2UOC Radioterapia Oncologica – Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Roma

3Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari, Italy

4Università degli Studi di Palermo, Radioterapia Oncologica, Palermo

5UO Oncologia, Fondazione Istituto G. Giglio, Cefalù, Palermo

6UO Radiologia, Villa Santa Teresa, Bagheria, Palermo

Corresponding author: Andrea D’Aviero, Email: andrea.daviero@materolbia.com


Published: Volume II, Issue 1, July 2022, 27-38, , , - DOI: https://doi.org/10.53011/JMRO.2022.01.04

Open Access

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July 1, 2022 0 Comments

Abstract

Introduction: Whole breast radiation therapy (WBRT) with a boost to the tumor bed following conservative primary surgery in women with breast cancer (BC) plays a central role in reducing local recurrences and mortality. Volumetric modulated arc therapy (VMAT) technique has been shown to allow better dose conformation with low dose levels to organs at risk (OARs), compared to static fields three-dimensional Conformal Radiotherapy (3D-CRT). The aim of this study was to evaluate the feasibility and dosimetric advantages of sequential boost (SB), administered with VMAT technique in hybrid plans with tangential beams for whole breast treatment.

Material and methods: BC patients undergoing adjuvant RT from June to October 2020 were selected. ESTRO guidelines for the Clinical Target Volume (CTV) delineation were used. Total delivered dose was 60-66 Gy; 50 Gy in 2 Gy daily fractions for whole breast and 10-16 in 2 Gy daily fractions Gy to tumor bed was 10-16 Gy in 2 Gy daily fractions.

Results: The analysis included 31 patients with BC treated with adjuvant RT following conservative surgery. Hybrid treatment plans characterized by a 3D-CRT plan using tangential mediolateral and lateromedial fields for the irradiation of the whole breast Planning Target Volume (PTV)  and a sequential VMAT plan with 2 coplanar arches for boost PTV irradiation were generated. Dosimetric analysis resulted in homogeneous target volumes coverage and OARs constraints compliance. As regarding to organs at risks (OARs), contralateral breast, ipsi- and contralateral lung and heart constraints values were analysed.

Conclusions: In the frame BC RT, this dosimetric study showed that hybrid plans performed with 3D-CRT and  VMAT techniques are feasible in terms of dosimetric outcomes.

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