Comparison of volumetric modulated arc therapy and intensity-modulated radiotherapy for left-sided whole-breast irradiation using automated planning

Background Published treatment technique comparisons for postoperative left-sided whole breast irradiation (WBI) with deep-inspiration breath-hold (DIBH) are scarce, small, and inconclusive. In this study, fully automated multi-criterial plan optimization, generating a single high-quality, Pareto-op...

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Bibliographic Details
Published in:Strahlentherapie und Onkologie 2022-03, Vol.198 (3), p.236-246
Main Authors: Redapi, L., Rossi, L., Marrazzo, L., Penninkhof, J. J., Pallotta, S., Heijmen, B.
Format: Article
Language:English
Subjects:
Automation
Breast
Breast cancer
Dosimetry
Homogeneity
Humans
Irradiation
Lungs
Medicine
Medicine & Public Health
Oncology
Optimization
Organs at Risk - radiation effects
Original
Original Article
Parameter estimation
Radiation therapy
Radiometry
Radiotherapy
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted - methods
Radiotherapy, Intensity-Modulated - methods
Unilateral Breast Neoplasms - radiotherapy
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Summary:Background Published treatment technique comparisons for postoperative left-sided whole breast irradiation (WBI) with deep-inspiration breath-hold (DIBH) are scarce, small, and inconclusive. In this study, fully automated multi-criterial plan optimization, generating a single high-quality, Pareto-optimal plan per patient and treatment technique, was used to compare for a large patient cohort 1) intensity modulated radiotherapy (IMRT) with two tangential fields and 2) volumetric modulated arc therapy (VMAT) with two small tangential subarcs. Materials and methods Forty-eight randomly selected patients recently treated with DIBH and 16 × 2.66 Gy were included. The optimizer was configured for the clinical planning protocol. Comparisons between IMRT and VMAT included dosimetric plan parameters, estimated excess relative risks (ERR) for toxicities, delivery times, MUs, and deliverability accuracy at a linac. Results The automatically generated IMRT and VMAT plans applied in this study were similar or higher in quality than the manually generated clinical plans. For equal PTVin V95% (98.4 ± 0.9%), VMAT had significant advantages compared to IMRT regarding breast dose homogeneity and doses in heart and ipsilateral lung, at the cost of some minor deteriorations for contralateral breast (few cases with larger deteriorations) and lung. Conformality improved from 1.38 to 1.18 ( p  
ISSN:0179-7158
1439-099X
DOI:10.1007/s00066-021-01817-x