Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region

Abstract Introduction Until late 2018, standard of practice at the Northern Sydney Cancer Centre (NSCC) for breast and nodal treatment was a conformal mono‐isocentric technique. A planning study comparing an existing mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning techniqu...

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Main Authors: Leigh Ambrose, Cameron Stanton, Lorraine Lewis, Gillian Lamoury, Marita Morgia, Susan Carroll, Regina Bromley, John Atyeo
Format: Article
Language:English
Published: Wiley 2022-03-01
Series:Journal of Medical Radiation Sciences
Subjects:
Online Access:https://doi.org/10.1002/jmrs.473
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author Leigh Ambrose
Cameron Stanton
Lorraine Lewis
Gillian Lamoury
Marita Morgia
Susan Carroll
Regina Bromley
John Atyeo
author_facet Leigh Ambrose
Cameron Stanton
Lorraine Lewis
Gillian Lamoury
Marita Morgia
Susan Carroll
Regina Bromley
John Atyeo
author_sort Leigh Ambrose
collection DOAJ
description Abstract Introduction Until late 2018, standard of practice at the Northern Sydney Cancer Centre (NSCC) for breast and nodal treatment was a conformal mono‐isocentric technique. A planning study comparing an existing mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to a hybrid intensity‐modulated radiotherapy (hIMRT) approach for the whole breast and supraclavicular fossa (SCF) region was undertaken with the aim to improve plan quality by improving dose conformity/homogeneity across target volumes and reducing hotspots outside the target. Methods A cohort of 17 patients was retrospectively planned using the proposed hIMRT technique, keeping the same planning constraints as the original treated breast and SCF 3D‐CRT plan and normalising the 3D‐CRT plans to achieve minimum breast/SCF target coverage to compare organs at risk (OARs). Normal tissue index (NTI) and homogeneity index (HI) were compared for plan quality as well as for evaluating OARs. Results The hIMRT technique showed statistically significant improvements in NTI and HI, as well as improvement in maximum brachial plexus and thyroid doses. There was a negligible increase in maximum oesophagus dose which could be improved if used in optimisation. Other OAR doses in the irradiated region were comparable to the 3D‐CRT plans, however maximum doses were reduced overall. Conclusion The hIMRT planning technique maintained clinically acceptable doses to OARs and reduced normal tissue dose while maintaining equivalent dose coverage to breast and SCF planning target volumes with improved conformity and homogeneity. The reduction in maximum doses promotes a favourable toxicity profile, with potential benefit of improved long‐term cosmesis.
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spelling doaj.art-c6dfea1b2b744704956892cccfade0f32022-12-21T16:43:14ZengWileyJournal of Medical Radiation Sciences2051-38952051-39092022-03-01691758410.1002/jmrs.473Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) regionLeigh Ambrose0Cameron Stanton1Lorraine Lewis2Gillian Lamoury3Marita Morgia4Susan Carroll5Regina Bromley6John Atyeo7Department of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaDepartment of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaDepartment of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaDepartment of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaDepartment of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaDepartment of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaDepartment of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaDepartment of Radiation Oncology Northern Sydney Cancer Centre Royal North Shore Hospital St Leonards NSW AustraliaAbstract Introduction Until late 2018, standard of practice at the Northern Sydney Cancer Centre (NSCC) for breast and nodal treatment was a conformal mono‐isocentric technique. A planning study comparing an existing mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to a hybrid intensity‐modulated radiotherapy (hIMRT) approach for the whole breast and supraclavicular fossa (SCF) region was undertaken with the aim to improve plan quality by improving dose conformity/homogeneity across target volumes and reducing hotspots outside the target. Methods A cohort of 17 patients was retrospectively planned using the proposed hIMRT technique, keeping the same planning constraints as the original treated breast and SCF 3D‐CRT plan and normalising the 3D‐CRT plans to achieve minimum breast/SCF target coverage to compare organs at risk (OARs). Normal tissue index (NTI) and homogeneity index (HI) were compared for plan quality as well as for evaluating OARs. Results The hIMRT technique showed statistically significant improvements in NTI and HI, as well as improvement in maximum brachial plexus and thyroid doses. There was a negligible increase in maximum oesophagus dose which could be improved if used in optimisation. Other OAR doses in the irradiated region were comparable to the 3D‐CRT plans, however maximum doses were reduced overall. Conclusion The hIMRT planning technique maintained clinically acceptable doses to OARs and reduced normal tissue dose while maintaining equivalent dose coverage to breast and SCF planning target volumes with improved conformity and homogeneity. The reduction in maximum doses promotes a favourable toxicity profile, with potential benefit of improved long‐term cosmesis.https://doi.org/10.1002/jmrs.473Breast radiotherapyconformal radiotherapyintensity‐modulated radiotherapyorgans at riskplanning techniques
spellingShingle Leigh Ambrose
Cameron Stanton
Lorraine Lewis
Gillian Lamoury
Marita Morgia
Susan Carroll
Regina Bromley
John Atyeo
Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region
Journal of Medical Radiation Sciences
Breast radiotherapy
conformal radiotherapy
intensity‐modulated radiotherapy
organs at risk
planning techniques
title Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region
title_full Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region
title_fullStr Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region
title_full_unstemmed Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region
title_short Potential gains: Comparison of a mono‐isocentric three‐dimensional conformal radiotherapy (3D‐CRT) planning technique to hybrid intensity‐modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region
title_sort potential gains comparison of a mono isocentric three dimensional conformal radiotherapy 3d crt planning technique to hybrid intensity modulated radiotherapy himrt to the whole breast and supraclavicular fossa scf region
topic Breast radiotherapy
conformal radiotherapy
intensity‐modulated radiotherapy
organs at risk
planning techniques
url https://doi.org/10.1002/jmrs.473
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