Iranian Journal of Medical Physics

Iranian Journal of Medical Physics

Dosimetric Comparison of Tangential Volumetric Arc Therapy and Half Beam Volumetric Modulated Arc Therapy Planning Technique for Carcinoma of the Breast

Document Type : Original Paper

Authors
Shreekripa Rao 1
Alpha Benny 2
Srinidhi Gururajarao Chandraguthi 3
Rechal NISHA Dsouza 4
1 Radiotherapy and Oncology Assistant Professor in Medical Physics School of Allied Health Sciences Kasturba Medical College Manipal Academy of Higher Education Manipal 576104
2 Department of Radiotherapy and Oncology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
3 Radiotherapy and Oncology Senior Grade Lecturer Medical Physics Kasturba Medical College Manipal Academy of Higher Education Manipal India
4 ASSISTANT PROFESSOR, MEDICAL RADIATION PHYSICS PROGRAM, MANIPAL COLLEGE OF HEALTH PROFESSIONS(MCHP), MANIPAL ACADEMY OF HIGHER EDUCATION(MAHE), MANIPAL-576104, KARNATAKA, INDIA
10.22038/ijmp.2024.69049.2219
Abstract
Introduction: This study aims to compare tangential volumetric modulated arc therapy with half beam volumetric modulated arc therapy in the treatment of cancer in the left and right breasts.
Material and Methods: Twenty patients (10 with left and 10 with right breast cancer) were planned with Tangential Volumetric Modulated Arc Therapy (tVMAT) and Half Beam Volumetric Modulated Arc Therapy (HVMAT) techniques for prescribed dose of 42.56Gy over 16 fractions with 6MV photon. The tVMAT technique limit the radiation to non-target areas. Dosimetric evaluations were performed for planning target volume (PTV), ipsilateral lung, heart, and contralateral breast with analysis via Repeated Measures ANOVA with a significance level of 5%.
Results: tVMAT achieved superior target coverage and dose homogeneity compared to HVMAT. For left breast cancer, HVMAT reduced ipsilateral lung doses but increased contralateral breast doses. Heart doses remained similar in both techniques. For right breast cancer, tVMAT provided higher target coverage and reduced doses across critical parameters.
Conclusion: tVMAT demonstrates strong potential as an advanced radiotherapy technique for breast cancer, improving dose control to the ipsilateral lung and heart while minimizing dose spread to the contralateral side, making it a promising alternative to conventional VMAT for enhanced precision in breast cancer treatment.
Keywords
VMAT
Breast Cancer
Radiation Dose
Planning
Radiotherapy
Subjects

  1.  

    1. Waks AG, Winer EP. Breast cancer treatment: A review. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323.
    2. Bray F, Laversanne M, Weiderpass E, Soerjomataram I. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(2):100– doi:10.3322/caac.21834.
    3. Remick J, Amin NP. Postmastectomy Breast Cancer Radiation Therapy. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519034/
    4. Franceschini D, Fogliatta A, Spoto R, et al. Long term results of a phase II trial of hypofractionated adjuvant radiotherapy for early-stage breast cancer with volumetric modulated arc therapy and simultaneous integrated boost. Radiother Oncol. 2021;156:128-135. doi:10.1016/j.radonc.2021.09.006.
    5. Zeverino M, Petersson K, Kyroudi A, Jeanneret-Sozzi W, Bourhis J, Bochud F, et al. A treatment planning comparison of contemporary photon-based radiation techniques for breast cancer. Phys Imaging Radiat Oncol. 2018 Jul;7:32-8.
    6. Khan FM, Polish RA. Treatment planning in radiation therapy. 6th ed. Jan 2020.
    7. Alahmad HN, Park JY, Potter NJ, Lu B, Yan G, Liu C, Li JG. A sliding-window approach for improved VMAT dose calculation accuracy. Med Dosim. 2020;45(2):128-136. doi:10.1016/j.meddos.2019.11.001.
    8. Sakumi A, Shiraishi K, Onoe T, et al. Single-arc volumetric modulated arc therapy planning for left breast cancer and regional nodes. J Radiat Res. 2012;53(1):151-3. doi:10.1269/jrr.11159.
    9. Mahmoudi S, Kavousi N, Hassani M, Esfahani M, Nedaie HA. Assessment of radiation-induced secondary cancer risks in breast cancer patients treated with 3D conformal radiotherapy. Iran J Med Phys. 2021;18(4):278-84. doi:10.22038/ijmp.2020.47561.1758.
    10. Hunte SO, Clark CH, Zyuzikov N, Nisbet A. Volumetric modulated arc therapy (VMAT): a review of clinical outcomes-what is the clinical evidence for the most effective implementation? Br J Radiol. 2022 Aug 1;95(1136):20201289. doi: 10.1259/bjr.20201289. Epub 2022 Jul 4. PMID: 35616646; PMCID: PMC10162061.
    11. Munshi A, Sarkar B, Anbazhagan S, Giri U, Kaur H, Jassal K, et al. Short tangential arcs in VMAT-based breast and chest wall radiotherapy lead to conformity of the breast dose with lesser cardiac and lung doses: a prospective study of breast conservation and mastectomy patients. Australas Phys Eng Sci Med. 2017 May 18;40(3):729-36.
    12. Yu PC, Wu CJ, Nien HH, Lui LT, Shaw S, Tsai YL. Tangent-based volumetric modulated arc therapy for advanced left breast cancer. Radiat Oncol. 2018;13(1):236. Available from: http://dx.doi.org/10.1186/s13014-018-1167-y.
    13. Clements M, Schupp N, Tattersall M, Brown A, Larson R. Monaco treatment planning system tools and optimization processes. Med Dosim. 2018;43(2):106-17.
    14. Nithya L, Raj NA, Kumar A, Rathinamuthu S, Pandey MB. Comparative analysis of volumetric-modulated arc therapy and intensity-modulated radiotherapy for base of tongue cancer. J Med Phys. 2014 Apr;39(2):121-6. doi:10.4103/0971-6203.131288. PMID: 24872611; PMCID: PMC4035616.
    15. Zouiri S, Tantaoui M, El Hassani M, Krim M, et al. Validation of Monaco Treatment Planning System for Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT®) on ELEKTA Infinity™ Linear Accelerator. E3S Web of Conferences. 2021;297(1):01014. doi:10.1051/e3sconf/202129701014.
    16. Rembish J, Myers P, Kirby N, et al. An evaluation of pencil beam vs Monte Carlo calculations for intracranial stereotactic radiosurgery. J BUON. 2020;25(6):2731-6.
    17. Kim DW, Park KW, Kim H, Kim J. History of the photon beam dose calculation algorithm in radiation treatment planning system. Prog Med Phys. 2020;31(3):54. Available from: https://doi.org/10.14316/pmp.2020.31.3.54
    18. Madlool SA, Abdullah SS, Alabedi HH, Alazawy N, Al-Musawi MJ, Saad D, et al. Optimum treatment planning technique evaluation for synchronous bilateral breast cancer with left side supraclavicular lymph nodes. Iran J Med Phys. 2021;18:414-20. doi:10.22038/IJMP.2020.49211.1791.
    19. De Martino, F., Clemente, S., Graeff, C., Palma, G., & Cella, L. (2021). Dose Calculation Algorithms for External Radiation Therapy: An Overview for Practitioners. Applied Sciences, 11(15), 6806. https://doi.org/10.3390/app11156806
    20. Jasper K, Liu B, Olson R, Matthews Q. Evidence-based planning target volume margin reduction for modern lung stereotactic ablative radiation therapy using deformable registration. Adv Radiat Oncol. 2021;6(1):100750. doi: 10.1016/j.adro.2021.100750..
    21. Fogliata A, Seppala J, Reggiori G, Lobefalo F, Palumbo V, De Rose F, et al. Dosimetric trade-offs in breast treatment with VMAT technique. Br J Radiol. 2017;90(1070):20160701. doi:10.1259/bjr.20160701.
    22. Pasler M, Lutterbach J, Bjornsgard M, Reichmann U, Bartelt S, Georg D. VMAT techniques for lymph node-positive left sided breast cancer. Z Med Phys. 2015;25(2):104-11. doi:10.1016/j.zemedi.2014.03.008.
    23. Kuo L, Ballangrud AM, Ho AY, Mechalakos JG, Li G, Hong L. A VMAT planning technique for locally advanced breast cancer patients with expander or implant reconstructions requiring comprehensive postmastectomy radiation therapy. Med Dosim. 2018. doi:10.1016/j.meddos.2018.04.006.

     

Iranian Journal of Medical Physics
Volume 21, Issue 5 - Serial Number 5
September and October 2024
Pages 306-313

  • Receive Date 29 November 2022
  • Revise Date 11 March 2024
  • Accept Date 02 April 2024