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Which simultaneous-integrated boost (SIB) intensity-modulated radiotherapy (IMRT) technique is dosimetrically superior in the treatment of breast cancer; volumetric-modulated arc therapy (VMAT) or fixed field (ff) IMRT?

Published online by Cambridge University Press:  11 April 2017

Steven B. D. Murphy  and
Heather Drury-Smith
Steven B. D. Murphy*
Affiliation:
GenesisCare Southampton, Spire Hospital, Chalybeate Close, Southampton, UK
Heather Drury-Smith
Affiliation:
Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
*
Correspondence to: Steven B. D. Murphy, GenesisCare Southampton, Spire Hospital, Southampton, Hampshire, SO16 6UY, UK. Tel: 02380 764961. E-mail: [email protected]
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Abstract

Background and purpose

To determine which concomitant boost technique is dosimetrically superior in the treatment of breast cancer; volumetric-modulated arc therapy (VMAT) or fixed field intensity-modulated radiotherapy (ff-IMRT).

Materials and methods

In total, 30 breast patients were re-planned with both VMAT and fixed field concomitant boost intensity-modulated radiotherapy techniques. A hybrid technique was used delivering 80% of the dose through tangential beams and 20% through an integrated boost. A two-tailed t-test sample for means was used to compare the dosimetric differences between the techniques.

Results

Maximum dose was statistically lower for VMAT; 103·2 versus 103·7% for ff-IMRT along with statistically lower V2 Gy doses to the contralateral lung (0·7 versus 1·6%) and heart for both left- (19·0%/22·6%), and right- (5·5%/8·8%) sided patients, respectively. ff-IMRT boasted significantly lower ipsilateral lung V20, V18 and V10 Gy (7·9/8·6/13·1 versus 8·1/8·8/13·4%) than VMAT, respectively. No differences were found with minimum coverage, mean dose and V5 Gy to all organs at risk (OARs).

Conclusion

VMAT and ff-IMRT techniques demonstrate excellent target coverage and OAR sparing facilitated by the hybrid planning technique and deep inspiration breath hold. There is no obvious dosimetrically superior option between the two techniques. Reduced treatment times with VMAT make it more desirable to implement clinically.

Keywords

breast cancerdosimetryIMRTsimultaneous-integrated boostVMAT
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 3 , September 2017 , pp. 272 - 279
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Copyright
© Cambridge University Press 2017 

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References

1. Clarke, M, Collins, R, Darby, S et al. 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 2005; 366: 2087–2106.Google ScholarPubMed
2. Bartelink, H, Horiot, J-C, Poortmans, P M et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. Clin Oncol 2007; 25: 3259–3265.Google Scholar
3. Darby, S C, Ewertz, M, McGale, P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368: 987–998.CrossRefGoogle ScholarPubMed
4. Toscas, J L, Linero, D, Rubio, I et al. Boosting the tumor bed from deep-seated tumors in early stage breast cancer: a planning study between electron, photon and proton beams. Radiother Oncol 2010; 96: 192–198.Google Scholar
5. Benda, R K, Yasuda, G, Sethia, A, Gabrum, S G, Hinerman, R W, Mendenhall, N P. Breast boost: are we missing the target? Cancer 2003; 97: 905–909.Google Scholar
6. Donovan, E M, Ciurlionis, L, Fairfoul, J et al. Planning with intensity modulated radiotherapy and tomotherapy to modulate dose across breast to reflect recurrence risk (IMPORT HIGH trial). Int J Radiat Oncol Biol Phys 2011; 79: 1064–1072.Google Scholar
7. Van Parijs, H, Reynders, T, Heuninckx, K, Verellen, D, Storme, G, De Ridder, M. Breast conserving treatment for breast cancer: dosimetric comparison of sequential versus simultaneous integrated photon boost. Biomed Res Int 2014; 2014: 1–8.Google Scholar
8. Van der Laan, H P, Dolsma, W V, Schilstra, C et al. Limited benefit of inversely optimised intensity modulation in breast conserving radiotherapy with simultaneously integrated boost. Radiother Oncol 2010; 94: 307–312.Google Scholar
9. Mitera, G, Davidson, M, Cardoso, M, Rakovitch, E, Pignol, J P. Dosimetric comparison of boost techniques for adjuvant breast radiotherapy. Radiother Oncol 2009; 92: 16–17.Google Scholar
10. Keshtgar, M, Davidson, T, Pigott, K, Falzon, M, Jones, A. Current status and advances in management of early breast cancer. Int J Surg 2010; 8: 199–202.Google Scholar
11.Cancer Research UK. Breast cancer, survival. 2015. http://www.cancerresearchuk.org/our-research/our-research-by-cancer-type/our-research-on-breast-cancer. Accessed on 3rd November 2015.Google Scholar
12. Alford, S L, Prassas, G N, Vogelesang, C R, Leggett, H J, Hamilton, C S. Adjuvant breast radiotherapy using a simultaneous integrated boost: clinical and dosimetric perspectives. J Med Imaging Radiat Oncol 2013; 57: 222–229.Google Scholar
13. Wu, S, Lai, Y, He, Z et al. Dosimetric comparison of the simultaneous integrated boost in whole breast irradiation after breast conserving surgery: IMRT, IMRT plus and electron boost and VMAT. PLoS One 2015; 10: e0120811.Google Scholar
14. McDonald, M W, Godette, K D, Whitaker, D J, Davis, L W, Johnstone, A S. Three year outcomes of breast intensity modulated radiation therapy with simultaneous integrated boost. Int J Radiat Oncol Biol Phys 2010; 77: 523–530.Google Scholar
15. Scorsetti, M, Alongi, F, Fogliata, A et al. Phase II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments. Radiat Oncol 2012; 7: 145–152.Google Scholar
16. Yeh, C, Lai, P A, Liu, F H, Lai, K K, Lee, P R. VMAT radiation therapy (VMAT) versus intensity modulated radiation therapy (IMRT) for small-sized breast. Int J Radiat Oncol Biol Phys 2013; 87: S705.Google Scholar
17. Jeulink, M, Dahele, M, Meijnen, P, Slotman, B J, Verbakel, F A R. Is there a preferred IMRT technique for left-breast irradiation? J Appl Clin Med Phys 2015; 16: 197–205.Google Scholar
18. Formenti, S C, Gidea-Addeo, D, Glodberg, J D et al. Phase I-II trial of prone accelerated intensity modulated radiation therapy to the breast to optimally spare normal tissue. Clin Oncol 2007; 25: 2236–2242.Google Scholar
19. Daly, M, Moody, A M, Patterson, H et al. The UK standardisation of breast radiotherapy (START) trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 2008; 371: 1098–1107.Google Scholar
20. Coles, C E, Brunt, A M, Wheatley, D, Mukesh, M B, Yarnold, J R. Breast radiotherapy: less is more? Clin Oncol 2013; 25: 127–134.Google Scholar
21. Gregoire, V, Mackie, T R. State of the art on dose prescription, reporting and recording in intensity-modulated radiation therapy (ICRU report no. 83). Cancer Radiother 2011; 15: 555–559.Google Scholar
22. Marks, L B, Yorke, E D, Jackson, A et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010; 76: 10–19.Google Scholar
23. Mukesh, M B, Harris, E, Collette, S et al. Normal tissue complication probability (NTCP) parameters for breast fibrosis: pooled results from two randomised trials. Radiother Oncol 2013; 108: 293–298.Google Scholar
24. Smyth, L M, Knight, K A, Aarons, Y K, Wasiak, J. The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systemic review. J Med Radiat Sci 2015; 62: 66–73.CrossRefGoogle Scholar
25. Mamon, R, Chesham, H, Bee, G et al. Deep inspiration breath hold in breast radiotherapy: are significant reductions in cardiac doses observed? Radiother Oncol 2015; 115: 810–811.Google Scholar
26. Chadha, M, Woode, R, Sillanpaa, J et al. Early stage breast cancer treated with 3-week accelerated whole-breast radiation therapy and concomitant boost. Int J Radiat Oncol Biol Phys 2013; 86: 40–44.Google Scholar
27. Teh, A Y M, Walsh, L, Purdie, T G et al. Concomitant intensity modulated boost during whole breast hypofractionated radiotherapy—a feasibility and toxicity study. Radiother Oncol 2012; 102: 89–95.Google Scholar
28. Lee, T-F, Chao, P-J, Chang, L, Ting, H M, Huang, Y J. Developing multivariable normal tissue complication probability model to predict the incidence of symptomatic radiation pneumonitis among breast cancer patients. PLoS One 2015; 10: e0131736.Google Scholar