Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital
This article aims to identify, through a literature review, the best intensity-modulated technique (IMRT)/volumetric-modulated arc therapy (VMAT) for the breast/chest wall (Br/CW) as a function of the treatment planning system (TPS) and present the institutional dosimetric data for the same. A PubMe...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Medical Physics |
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| Online Access: | http://www.jmp.org.in/article.asp?issn=0971-6203;year=2023;volume=48;issue=3;spage=221;epage=229;aulast=Sarkar |
| _version_ | 1797645551692414976 |
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| author | Biplab Sarkar Anirudh Pradhan |
| author_facet | Biplab Sarkar Anirudh Pradhan |
| author_sort | Biplab Sarkar |
| collection | DOAJ |
| description | This article aims to identify, through a literature review, the best intensity-modulated technique (IMRT)/volumetric-modulated arc therapy (VMAT) for the breast/chest wall (Br/CW) as a function of the treatment planning system (TPS) and present the institutional dosimetric data for the same. A PubMed search was conducted following intensity-modulated irradiation techniques (IMRT) presented in the study: field-in-field (FiF), tangential IMRT (t-IMRT), multi-field IMRT, tangential VMAT (t-VMAT), half-arc VMAT (HA-VMAT), and large arc VMAT (LA-VMAT). The literature with at least one arm VMAT is included in this study. A total of 370 articles were identified between 2010 and 2022, out of which 19 articles were found to be unique. These articles were classified in terms of the TPS used: Eclipse (9), Monaco (6), RayStation (2), Pinnacle (1), and one unidentified TPS. Based on the literature review, dosimetric attributes, and second cancer risk analysis (SCRA), t-IMRT was found to be the most preferable technique in Eclipse, Pinnacle, and RayStation TPS. However, for Monaco TPS, t-VMAT (approximately 30° tangential arc) offers better dose coverage with lower organ-at-risk (OAR) doses. In terms of OAR doses and SCRA, LA-VMAT (≥210°) and HA-VMAT (180°) are avoidable techniques in any TPS, and FiF should be preferred over these two techniques. In our present institution, which uses the Eclipse TPS, data for 300 patients treated with t-IMRT were collected. The data included beam angle, monitor unit [MU], target coverage (D95% and V105% [cc]), and analysis of the maximum (%), and mean dose (%) of the OAR. t-IMRT utilizes two medial and three lateral tangential beams placed at a spread of approximately 10° and 20°, respectively. The results showed a D95% of 96.3 ± 1.2% and a V105% of 4.9 ± 7.0 cc. The mean doses to the heart and ipsilateral lung were 10.1 ± 20.9% and 11.4 ± 10.2%, respectively. The mean MU was 1282.7 ± 453.4. Based on the findings, the most preferred intensity-modulated technique for Eclipse, Pinnacle, and RayStation is t-IMRT, while for Monaco, it is t-VMAT. The data from the Eclipse planning system demonstrate a satisfactory dosimetric outcome for t-IMRT. However, the use of VMAT techniques employing an arc angle between 180° and 210° or higher is strongly discouraged. |
| first_indexed | 2024-03-11T14:48:31Z |
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| id | doaj.art-24005a2e1e8d4d5ea613a89a026c2d56 |
| institution | Directory Open Access Journal |
| issn | 0971-6203 1998-3913 |
| language | English |
| last_indexed | 2024-03-11T14:48:31Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
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| series | Journal of Medical Physics |
| spelling | doaj.art-24005a2e1e8d4d5ea613a89a026c2d562023-10-30T10:15:29ZengWolters Kluwer Medknow PublicationsJournal of Medical Physics0971-62031998-39132023-01-0148322122910.4103/jmp.jmp_51_23Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospitalBiplab SarkarAnirudh PradhanThis article aims to identify, through a literature review, the best intensity-modulated technique (IMRT)/volumetric-modulated arc therapy (VMAT) for the breast/chest wall (Br/CW) as a function of the treatment planning system (TPS) and present the institutional dosimetric data for the same. A PubMed search was conducted following intensity-modulated irradiation techniques (IMRT) presented in the study: field-in-field (FiF), tangential IMRT (t-IMRT), multi-field IMRT, tangential VMAT (t-VMAT), half-arc VMAT (HA-VMAT), and large arc VMAT (LA-VMAT). The literature with at least one arm VMAT is included in this study. A total of 370 articles were identified between 2010 and 2022, out of which 19 articles were found to be unique. These articles were classified in terms of the TPS used: Eclipse (9), Monaco (6), RayStation (2), Pinnacle (1), and one unidentified TPS. Based on the literature review, dosimetric attributes, and second cancer risk analysis (SCRA), t-IMRT was found to be the most preferable technique in Eclipse, Pinnacle, and RayStation TPS. However, for Monaco TPS, t-VMAT (approximately 30° tangential arc) offers better dose coverage with lower organ-at-risk (OAR) doses. In terms of OAR doses and SCRA, LA-VMAT (≥210°) and HA-VMAT (180°) are avoidable techniques in any TPS, and FiF should be preferred over these two techniques. In our present institution, which uses the Eclipse TPS, data for 300 patients treated with t-IMRT were collected. The data included beam angle, monitor unit [MU], target coverage (D95% and V105% [cc]), and analysis of the maximum (%), and mean dose (%) of the OAR. t-IMRT utilizes two medial and three lateral tangential beams placed at a spread of approximately 10° and 20°, respectively. The results showed a D95% of 96.3 ± 1.2% and a V105% of 4.9 ± 7.0 cc. The mean doses to the heart and ipsilateral lung were 10.1 ± 20.9% and 11.4 ± 10.2%, respectively. The mean MU was 1282.7 ± 453.4. Based on the findings, the most preferred intensity-modulated technique for Eclipse, Pinnacle, and RayStation is t-IMRT, while for Monaco, it is t-VMAT. The data from the Eclipse planning system demonstrate a satisfactory dosimetric outcome for t-IMRT. However, the use of VMAT techniques employing an arc angle between 180° and 210° or higher is strongly discouraged.http://www.jmp.org.in/article.asp?issn=0971-6203;year=2023;volume=48;issue=3;spage=221;epage=229;aulast=Sarkarbreastintensity-modulated techniqueradiotherapyvolumetric-modulated arc therapy |
| spellingShingle | Biplab Sarkar Anirudh Pradhan Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital Journal of Medical Physics breast intensity-modulated technique radiotherapy volumetric-modulated arc therapy |
| title | Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital |
| title_full | Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital |
| title_fullStr | Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital |
| title_full_unstemmed | Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital |
| title_short | Planning system-dependent recommendations of intensity-modulated technique for breast radiotherapy: A literature review-based adaptation and institutional dosimetric experience from a large-volume tertiary cancer care hospital |
| title_sort | planning system dependent recommendations of intensity modulated technique for breast radiotherapy a literature review based adaptation and institutional dosimetric experience from a large volume tertiary cancer care hospital |
| topic | breast intensity-modulated technique radiotherapy volumetric-modulated arc therapy |
| url | http://www.jmp.org.in/article.asp?issn=0971-6203;year=2023;volume=48;issue=3;spage=221;epage=229;aulast=Sarkar |
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