Breast-conserving radiotherapy with simultaneous integrated boost; field-in-field three-dimensional conformal radiotherapy versus inverse intensity-modulated radiotherapy – A dosimetric comparison:  Do we need intensity-modulated radiotherapy?

Bindhu Joseph; Nisma Farooq; Sabari Kumar; C.R Vijay; Kurian J. Puthur; C. Ramesh; Vishwanath Lokesh

doi:10.4103/sajc.sajc_82_18

South Asian Journal of Cancer, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · South Asian J Cancer 2018; 07(03): 163-166
DOI: 10.4103/sajc.sajc_82_18

ORIGINAL ARTICLE: Breast Cancer

Breast-conserving radiotherapy with simultaneous integrated boost; field-in-field three-dimensional conformal radiotherapy versus inverse intensity-modulated radiotherapy – A dosimetric comparison: Do we need intensity-modulated radiotherapy?

Autor*innen

Bindhu Joseph

Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
Nisma Farooq

Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
Sabari Kumar

Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
C.R Vijay

Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
Kurian J. Puthur

Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
C. Ramesh

Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
Vishwanath Lokesh

Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

Abstract

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Abstract

Background and Purpose: To examine the feasibility of improving breast-conserving radiotherapy with simultaneous integrated boost (SIB) and analyzing the efficiency of forward versus inverse intensity-modulated radiotherapy (IMRT) techniques in providing the same. Materials and Methods: Three-dimensional conformal radiotherapy (3DCRT) field-in-field (FIF) plans with simultaneous and sequential boost and IMRT SIB plans were generated for the datasets of 20 patients who had undergone breast-conserving surgery. The 3 plans were compared dosimetrically for efficiency in terms of planning target volume (PTV) coverage (PTV 95%), homogeneity and conformity, dose delivered to ipsilateral/contralateral lungs (I/L: V10, V20, C/L: Vmean, V5), heart and contralateral breast (Vmean, V30 for heart and Vmean, V1, V5 for C/L breast). Results: The FIF 3DCRT plan with SIB (PLAN B) was more homogeneous than the classical technique with sequential boost (PLAN A). There were less hot spots in terms of Dmax (63.7 ± 1.3) versus Dmax (68.9 ± 1), P < 0.001 and boost V107%, B (0.3 ± 0.7) versus A (3.5 ± 5.99), P = 0.001. The IMRT SIB (PLAN C) did not provide any significant dosimetric advantage over the 3DCRT SIB technique. IMRT SIB plan C was associated with increased dose to contralateral lung in-terms of V5 (10.35 +/- 18.23) vs. (1.13 +/- 4.24), P = 0.04 and Vmean (2.12 ± 2.18) versus Vmean (0.595 ± 0.89), P = 0.008. There was 3-fold greater exposure in terms of Monitor Unit (MU) (1024.9 ± 298.32 versus 281.05 ± 20.23, P < 0.001) and treatment delivery time. Conclusions: FIF 3DCRT SIB provides a dosimetrically acceptable and technically feasible alternative to the classical 3DCRT plan with sequential boost for breast-conserving radiotherapy. It reduces treatment time by 2 weeks. IMRT SIB does not appear to have any dosimetric advantage; it is associated with significantly higher doses to contralateral lung and heart and radiation exposure in terms of MU.

Key words

Field-in-field three-dimensional conformal radiotherapy breast - intensity-modulated radiotherapy breast - simultaneous integrated boost

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Referenzen

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