The Feasibility of Hybrid IMRT treatment planning for Left sided Chest wall Irradiation: A Comparative Treatment Planning Study

Document Type : Original Paper


1 Department of Physics, Institute of Applied Science and Humanities, GLA University, Mathura -281406 (U.P.), India.

2 Department of Radiotherapy, Alexis Multispeciality Hospital, Nagpur-440030 (Maharashtra) , India.

3 Department of Mathematics, Institute of Applied Science and Humanities, GLA University, Mathura -281406 (U.P.), India

4 Chief Medical Physicist, Apollo Gleneagles Hospitals, Kolkata, India

5 Department of Radiation Oncology, Gandhi Medical College , Bhopal-462001 (M.P.), India



Introduction: Due to the limited target volume and irregular body surface, irradiating the chest wall (CW) and lymphatic nodes is more challenging. IMRT and VMAT (volumetric modulated arc therapy) are two treatment delivery techniques that help to improve dose coverage and homogeneity while reducing irradiation to the heart and ipsilateral (I/L) lung. The use of a hybrid treatment planning approach for the ca-breast will impact the treatment plan. The hybrid planning system must be reviewed and compared to alternative treatment options for ca-breast cancer.

Methods & Materials: For 10 patients undergoing left-sided breast chest wall irradiation, the 3 distinct planning techniques (FiF [Field-in-field], IMRT, and Hybrid IMRT) were evaluated. A prescription dose of 40 Gy in 15 fractions was used for the planned target volume (PTV). To compare plans, dose-volume histograms (DVHs) were assessed for PTV and organs at risk.

Result: D95% of PTV was 37.10 ± 0.48 Gy in FiF, but considerably raised to 39.32 ± 0.34 Gy and 38.39 ± 0.29 Gy in IMRT (p=0.01) and Hybrid IMRT (p=0.01).When compared to IMRT (0.981 ± 0.014) and Hybrid IMRT (0.970 ± 0.013) FiF plans have the lowest CI value of 0.931 ± 0.026. IMRT plans (0.087 ± 0.021) were found to be more homogeneous than other 2 planning techniques (0.111 ± 0.013 [FiF, p=0.016], 0.107 ± 0.021[hybrid IMRT, p=0.056]).

Conclusion: Hybrid IMRT treatment plans for the ca-breast are recommended because they provide superior and similar PTV dose coverage and OAR sparing compared to FiF and IMRT plans. Hybrid IMRT plans feature lower MU and BOT, as well as a smaller low dose volume in comparison to IMRT.


Main Subjects

Articles in Press, Accepted Manuscript
Available Online from 08 May 2022
  • Receive Date: 03 October 2021
  • Revise Date: 05 February 2022
  • Accept Date: 08 May 2022
  • First Publish Date: 08 May 2022