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A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer

BACKGROUND: To compare the dosimetric, normal tissue complication probability (NTCP), secondary cancer complication probabilities (SCCP), and excess absolute risk (EAR) differences of volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for left-sided breast cance...

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Autores principales: Zhang, Yun, Huang, Yuling, Ding, Shenggou, Yuan, Xingxing, Shu, Yuxian, Liang, Jinhui, Mao, Qingfeng, Jiang, Chunling, Li, Jingao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422660/
https://www.ncbi.nlm.nih.gov/pubmed/34488817
http://dx.doi.org/10.1186/s13014-021-01895-2
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author Zhang, Yun
Huang, Yuling
Ding, Shenggou
Yuan, Xingxing
Shu, Yuxian
Liang, Jinhui
Mao, Qingfeng
Jiang, Chunling
Li, Jingao
author_facet Zhang, Yun
Huang, Yuling
Ding, Shenggou
Yuan, Xingxing
Shu, Yuxian
Liang, Jinhui
Mao, Qingfeng
Jiang, Chunling
Li, Jingao
author_sort Zhang, Yun
collection PubMed
description BACKGROUND: To compare the dosimetric, normal tissue complication probability (NTCP), secondary cancer complication probabilities (SCCP), and excess absolute risk (EAR) differences of volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for left-sided breast cancer after mastectomy. METHODS AND MATERIALS: Thirty patients with left-sided breast cancer treated with post-mastectomy radiation therapy (PMRT) were randomly enrolled in this study. Both IMRT and VMAT treatment plans were created for each patient. Planning target volume (PTV) doses for the chest wall and internal mammary nodes, PTV1, and PTV of the supraclavicular nodes, PTV2, of 50 Gy were prescribed in 25 fractions. The plans were evaluated based on PTV1 and PTV2 coverage, homogeneity index (HI), conformity index, conformity number (CN), dose to organs at risk, NTCP, SCCP, EAR, number of monitors units, and beam delivery time. RESULTS: VMAT resulted in more homogeneous chest wall coverage than did IMRT. The percent volume of PTV1 that received the prescribed dose of VMRT and IMRT was 95.9 ± 1.2% and 94.5 ± 1.6%, respectively (p < 0.001). The HI was 0.11 ± 0.01 for VMAT and 0.12 ± 0.02 for IMRT, respectively (p = 0.001). The VMAT plan had better conformity (CN: 0.84 ± 0.02 vs. 0.78 ± 0.04, p < 0.001) in PTV compared with IMRT. As opposed to IMRT plans, VMAT delivered a lower mean dose to the ipsilateral lung (11.5 Gy vs 12.6 Gy) and heart (5.2 Gy vs 6.0 Gy) and significantly reduced the V(5), V(10), V(20,) V(30,) and V(40) of the ipsilateral lung and heart; only the differences in V(5) of the ipsilateral lung did not reach statistical significance (p = 0.409). Although the volume of the ipsilateral lung and heart encompassed by the 2.5 Gy isodose line (V(2.5)) was increased by 6.7% and 7.7% (p < 0.001, p = 0.002), the NTCP was decreased by 0.8% and 0.6%, and SCCP and EAR were decreased by 1.9% and 0.1% for the ipsilateral lung. No significant differences were observed in the contralateral lung/breast V(2.5), V(5,) V(10), V(20), mean dose, SCCP, and EAR. Finally, VMAT reduced the number of monitor units by 31.5% and the treatment time by 71.4%, as compared with IMRT. CONCLUSIONS: Compared with IMRT, VMAT is the optimal technique for PMRT patients with left-sided breast cancer due to better target coverage, a lower dose delivered, NTCP, SCCP, and EAR to the ipsilateral lung and heart, similar doses delivered to the contralateral lung and breast, fewer monitor units and a shorter delivery time.
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spelling pubmed-84226602021-09-09 A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer Zhang, Yun Huang, Yuling Ding, Shenggou Yuan, Xingxing Shu, Yuxian Liang, Jinhui Mao, Qingfeng Jiang, Chunling Li, Jingao Radiat Oncol Research BACKGROUND: To compare the dosimetric, normal tissue complication probability (NTCP), secondary cancer complication probabilities (SCCP), and excess absolute risk (EAR) differences of volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for left-sided breast cancer after mastectomy. METHODS AND MATERIALS: Thirty patients with left-sided breast cancer treated with post-mastectomy radiation therapy (PMRT) were randomly enrolled in this study. Both IMRT and VMAT treatment plans were created for each patient. Planning target volume (PTV) doses for the chest wall and internal mammary nodes, PTV1, and PTV of the supraclavicular nodes, PTV2, of 50 Gy were prescribed in 25 fractions. The plans were evaluated based on PTV1 and PTV2 coverage, homogeneity index (HI), conformity index, conformity number (CN), dose to organs at risk, NTCP, SCCP, EAR, number of monitors units, and beam delivery time. RESULTS: VMAT resulted in more homogeneous chest wall coverage than did IMRT. The percent volume of PTV1 that received the prescribed dose of VMRT and IMRT was 95.9 ± 1.2% and 94.5 ± 1.6%, respectively (p < 0.001). The HI was 0.11 ± 0.01 for VMAT and 0.12 ± 0.02 for IMRT, respectively (p = 0.001). The VMAT plan had better conformity (CN: 0.84 ± 0.02 vs. 0.78 ± 0.04, p < 0.001) in PTV compared with IMRT. As opposed to IMRT plans, VMAT delivered a lower mean dose to the ipsilateral lung (11.5 Gy vs 12.6 Gy) and heart (5.2 Gy vs 6.0 Gy) and significantly reduced the V(5), V(10), V(20,) V(30,) and V(40) of the ipsilateral lung and heart; only the differences in V(5) of the ipsilateral lung did not reach statistical significance (p = 0.409). Although the volume of the ipsilateral lung and heart encompassed by the 2.5 Gy isodose line (V(2.5)) was increased by 6.7% and 7.7% (p < 0.001, p = 0.002), the NTCP was decreased by 0.8% and 0.6%, and SCCP and EAR were decreased by 1.9% and 0.1% for the ipsilateral lung. No significant differences were observed in the contralateral lung/breast V(2.5), V(5,) V(10), V(20), mean dose, SCCP, and EAR. Finally, VMAT reduced the number of monitor units by 31.5% and the treatment time by 71.4%, as compared with IMRT. CONCLUSIONS: Compared with IMRT, VMAT is the optimal technique for PMRT patients with left-sided breast cancer due to better target coverage, a lower dose delivered, NTCP, SCCP, and EAR to the ipsilateral lung and heart, similar doses delivered to the contralateral lung and breast, fewer monitor units and a shorter delivery time. BioMed Central 2021-09-06 /pmc/articles/PMC8422660/ /pubmed/34488817 http://dx.doi.org/10.1186/s13014-021-01895-2 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Zhang, Yun
Huang, Yuling
Ding, Shenggou
Yuan, Xingxing
Shu, Yuxian
Liang, Jinhui
Mao, Qingfeng
Jiang, Chunling
Li, Jingao
A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer
title A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer
title_full A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer
title_fullStr A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer
title_full_unstemmed A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer
title_short A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer
title_sort dosimetric and radiobiological evaluation of vmat following mastectomy for patients with left-sided breast cancer
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422660/
https://www.ncbi.nlm.nih.gov/pubmed/34488817
http://dx.doi.org/10.1186/s13014-021-01895-2
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