Impact of GBBS algorithm on post-mastectomy scar boost irradiation of breast using catheter flap

PURPOSE: Post-mastectomy radiation therapy significantly reduces locoregional recurrence rates, which can be achieved with external beam radiotherapy delivered to chest wall, followed by scar irradiation either by electron or high-dose-rate (HDR) mould brachytherapy. The present study evaluates dosimetric advantage of Acuros(®) BV, a TG-186 MBDCA, over TG-43 formalism using (192)Ir source for HDR brachytherapy in chest wall scar boost using catheter flap. MATERIAL AND METHODS: A total of 25 patients, free of cardiac and pulmonary co-morbidities, who met the inclusion criteria were involved in the study. Catheter flap made of silicon with 20 channels was used to deliver a total dose of 7.5 Gy/3 fx by HDR surface mould brachytherapy to delineated scar volume. Plan was optimized with iterative method to obtain desired results with TG-43 formalism, followed by Acuros(®) BV (GBBS algorithm) without altering dwell positions or time. The two algorithm plans were analyzed qualitatively and quantitatively with dose-volume histograms. RESULTS: The mean D(98%) CTV-HDR_evl coverage decreased by 1.16% compared to TG-43, and near-maximum dose decreased by 8.18% (p = 0.000), mean D(max) dose to CTV-HDR_evl, and mean D(mean) dose was lesser by 6.25% (p = 0.000) and 10.82% (p = 0.000), respectively, compared to TG-43. Heart D(2%) showed significant results, whereas D(median) (cGy) revealed very significant difference. A 5 mm thick skin contour showed statistically significant results (p = 0.000) for V(150%) and V(200%). CONCLUSIONS: The presented data showed how Acuros(®) BV, algorithm-based calculation in scar boost irradiation of breast, accounting for a mass density of the medium and scatter condition, considered actual dose prediction in a medium.