Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation

Zhao,Li‑Rong; Zhou,Yi‑Bing; Sun,Jian‑Guo

doi:10.3892/ol.2016.4376

Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation

Authors:
- Li‑Rong Zhao
- Yi‑Bing Zhou
- Jian‑Guo Sun
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Affiliations: Cancer Institute of the People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
Published online on: March 23, 2016 https://doi.org/10.3892/ol.2016.4376
Pages: 3389-3394

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Abstract

The aim of the present study was to investigate volumetric-modulated arc therapy (VMAT) with single arc (1ARC) and dual arc (2ARC), and intensity-modulated radiation therapy (IMRT), and to evaluate the quality and delivery efficiency of post-mastectomy regional irradiation. A total of 24 female patients who required post-mastectomy regional irradiation were enrolled into the current study, and 1ARC, 2ARC and IMRT plans were designed for each individual patient. The quality of these plans was evaluated by calculating the homogeneity index (HI), conformity index (CI) and specific volume dose to the ipsilateral lung, double lungs, contralateral breast, heart and spinal cord. For the delivery efficiency of these plans, the total treatment time (TTT) and the number of monitor units (MUs) were evaluated. The 1ARC and 2ARC VMAT plans exhibited significantly better HIs and CIs than IMRT. For dose‑volume histogram analysis, 1ARC and 2ARC VMAT spared a more specific volume dose to the ipsilateral lung, double lungs, contralateral breast, heart and spinal cord than IMRT (P<0.05). A lower MU per 2.0‑Gy fraction was required for 1ARC (539 MU) and 2ARC (608 MU) than for IMRT (1,051 MU). Thus, TTT was correspondingly reduced in 1ARC and 2ARC compared to IMRT (P<0.05). There was no signiﬁcant dose‑volume difference in all the organs at risk (OARs) between the 1ARC and 2ARC plans (P>0.05), and 2ARC VMAT displayed a better HI and CI than 1ARC VMAT (P<0.05). By contrast, 1ARC VMAT was superior to 2ARC VAMT with regard to MU and TTT (P<0.05). The 1ARC and 2ARC VMAT plans demonstrated significantly better dose distribution in a shorter treatment time than IMRT for post‑mastectomy regional irradiation, and spared the majority of OARs without compromising target coverage. The results of the present study suggest that 2ARC VMAT may be an alternative to 1ARC in order to obtain a more optimal HI and CI.

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1	Hijal T, Fournier-Bidoz N, Castro-Pena P, Kirova YM, Zefkili S, Bollet MA, Dendale R, Campana F and Fourquet A: Simultaneous integrated boost in breast conserving treatment of breast cancer: A dosimetric comparison of helical tomotherapy and three-dimensional conformal radiotherapy. Radiother Oncol. 94:300–306. 2010. View Article : Google Scholar : PubMed/NCBI
2	Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, Godwin J, Gray R, Hicks C, James S, et al: Early Breast Cancer Trialists' Collaborative Group: Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomised trials. Lancet. 366:2087–2106. 2005. View Article : Google Scholar : PubMed/NCBI
3	Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH and Wolmark N: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 347:1233–1241. 2002. View Article : Google Scholar : PubMed/NCBI
4	Kong FM, Klein EE, Bradley JD, Mansur DB, Taylor ME, Perez CA, Myerson RJ and Harms WB: The impact of central lung distance, maximal heart distance, and radiation technique on the volumetric dose of the lung and heart for intact breast radiation. Int J Radiat Oncol Biol Phys. 54:963–971. 2002. View Article : Google Scholar : PubMed/NCBI
5	Kirova YM, Fournier-Bidoz N, Servois V, Laki F, Pollet GA, Salmon R, Thomas A, Dendale R, Bollet MA, Campana F, et al: How to boost the breast tumor bed? A multidisciplinary approach in eight steps. Int J Radiat Oncol Biol Phys. 72:494–500. 2008. View Article : Google Scholar : PubMed/NCBI
6	Gray JR, McCormick B, Cox L and Yahalom J: Primary breast irradiation in large-breasted or heavy women: Analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys. 21:347–354. 1991. View Article : Google Scholar : PubMed/NCBI
7	Neal AJ, Mayles WP and Yarnold JR: Invited review: Tangential breast irradiation-rationale and methods for improving dosimetry. Br J Radiol. 67:1149–1154. 1994. View Article : Google Scholar : PubMed/NCBI
8	Moody AM, Mayles WP, Bliss JM, A'Hern RP, Owen JR, Regan J, Broad B and Yarnold JR: The inﬂuence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol. 33:106–112. 1994. View Article : Google Scholar : PubMed/NCBI
9	Neal AJ, Torr M, Helyer S and Yarnold JR: Correlation of breast dose heterogeneity with breast size using 3D CT planning and dose-volume histograms. Radiother Oncol. 34:210–218. 1995. View Article : Google Scholar : PubMed/NCBI
10	Kestin LL, Sharpe MB, Frazier RC, Vicini FA, Yan D, Matter RC, Martinez AA and Wong JW: Intensity modulation to improve dose uniformity with tangential breast radiotherapy: Initial clinical experience. Int J Radiat Oncol Biol Phys. 48:1559–1568. 2000. View Article : Google Scholar : PubMed/NCBI
11	Vicini FA, Sharpe M, Kestin L, Martinez A, Mitchell CK, Wallace MF, Matter R and Wong J: Optimizing breast cancer treatment efﬁcacy with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 54:1336–1344. 2002. View Article : Google Scholar : PubMed/NCBI
12	Lo YC, Yasuda G, Fitzgerald TJ and Urie MM: Intensity modulation for breast treatment using static multi-leaf collimators. Int J Radiat Oncol Biol Phys. 46:187–194. 2000. View Article : Google Scholar : PubMed/NCBI
13	Palma DA, Verbakel WF, Otto K and Senan S: New developments in arc radiation therapy: A review. Cancer Treat Rev. 36:393–399. 2010. View Article : Google Scholar : PubMed/NCBI
14	Lee TF, Ting HM, Chao PJ and Fang FM: Dual arc volumetric-modulated arc radiotherapy (VMAT) of nasopharyngeal carcinomas: A simultaneous integrated boost treatment plan comparison with intensity-modulated radiotherapies and single arc VMAT. Clin Oncol (R Coll Radiol). 24:196–207. 2012. View Article : Google Scholar : PubMed/NCBI
15	Bertelsen A, Hansen CR, Johansen J and Brink C: Single arc volumetric modulated arc therapy of head and neck cancer. Radiother Oncol. 95:142–148. 2010. View Article : Google Scholar : PubMed/NCBI
16	Chan OS, Lee MC, Hung AW, Chang AT, Yeung RM and Lee AW: The superiority of hybrid-volumetric arc therapy (VMAT) technique over double arcs VMAT and 3D-conformal technique in the treatment of locally advanced non-small cell lung cancer - a planning study. Radiother Oncol. 101:298–302. 2011. View Article : Google Scholar : PubMed/NCBI
17	Quan EM, Li X, Li Y, Wang X, Kudchadker RJ, Johnson JL, Kuban DA, Lee AK and Zhang X: A comprehensive comparison of IMRT and VMAT plan quality for prostate cancer treatment. Int J Radiat Oncol Biol Phys. 83:1169–1178. 2012. View Article : Google Scholar : PubMed/NCBI
18	Kopp RW, Duff M, Catalfamo F, Shah D, Rajecki M and Ahmad K: VMAT vs. 7-field-IMRT: Assessing the dosimetric parameters of prostate cancer treatment with a 292-patient sample. Med Dosim. 36:365–372. 2011. View Article : Google Scholar : PubMed/NCBI
19	Guckenberger M, Richter A, Krieger T, Wilbert J, Baier K and Flentje M: Is a single arc sufﬁcient in volumetric-modulated arc therapy (VMAT) for complex-shaped target volumes? Radiother Oncol. 93:259–265. 2009. View Article : Google Scholar : PubMed/NCBI
20	Bzdusek K, Friberger H, Eriksson K, Hårdemark B, Robinson D and Kaus M: Development and evaluation of an efﬁcient approach to volumetric arc therapy planning. Med Phys. 36:2328–2339. 2009. View Article : Google Scholar : PubMed/NCBI
21	Solin LJ, Gray R, Goldstein LJ, Recht A, Baehner FL, Shak S, Badve S, Perez EA, Shulman LN, Martino S, et al: Prognostic value of biologic subtype and the 21-gene recurrence score relative to local recurrence after breast conservation treatment with radiation for early stage breast carcinoma: Results from the Eastern Cooperative Oncology Group E2197 study. Breast Cancer Res Treat. 134:683–692. 2012. View Article : Google Scholar : PubMed/NCBI
22	Zagouri F, Liakou P, Bartsch R, Peccatori FA, Tsigginou A, Dimitrakakis C, Zografos GC, Dimopoulos MA and Azim HA Jr: Discrepancies between ESMO and NCCN breast cancer guidelines: An appraisal. Breast. 24:513–523. 2015. View Article : Google Scholar : PubMed/NCBI
23	Wong EK, Truong PT, Kader HA, Nichol AM, Salter L, Petersen R, Wai ES, Weir L and Olivotto IA: Consistency in seroma contouring for partial breast radiotherapy: Impact of guidelines. Int J Radiat Oncol Biol Phys. 66:372–376. 2006. View Article : Google Scholar : PubMed/NCBI
24	Feuvret L, Noël G, Mazeron JJ and Bey P: Conformity index: A review. Int J Radiat Oncol Biol Phys. 64:333–342. 2006. View Article : Google Scholar : PubMed/NCBI
25	Ayata HB, Güden M, Ceylan C, Kücük N and Engin K: Comparison of dose distributions and organs at risk (OAR) doses in conventional tangential technique (CTT) and IMRT plans with different numbers of beam in left-sided breast cancer. Rep Pract Oncol Radiother. 16:95–102. 2011. View Article : Google Scholar : PubMed/NCBI
26	Jones R, Yang W, Read P and Sheng K: Radiation therapy of post-mastectomy patients with positive nodes using fixed beam tomotherapy. Radiother Oncol. 100:247–252. 2011. View Article : Google Scholar : PubMed/NCBI
27	Hurkmans CW, Meijer GJ, van Vliet-Vroegindeweij C, van der Sangen MJ and Cassee J: High dose simultaneously integrated breast boost using intensity modulated radiotherapy and inverse optimization. Int J Radiat Oncol Biol Phys. 66:923–930. 2006. View Article : Google Scholar : PubMed/NCBI
28	van der Laan HP, Dolsma WV, Maduro JH, Korevaar EW, Hollander M and Langendijk JA: Three-dimensional conformal simultaneously integrated boost technique for breast conserving radiotherapy. Int J Radiat Oncol Biol Phys. 68:1018–1023. 2007. View Article : Google Scholar : PubMed/NCBI
29	Singla R, King S, Albuquerque K, Creech S and Dogan N: Simultaneous integrated boost intensity modulated radiation therapy (SIB-IMRT) in the treatment of early stage left sided breast carcinoma. Med Dosim. 31:190–196. 2006. View Article : Google Scholar : PubMed/NCBI