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Dosimetric comparison of volumetric-modulated arc therapy and helical tomotherapy for adjuvant treatment of bilateral breast cancer

Published online by Cambridge University Press:  06 October 2020

Reena Phurailatpam Open the ORCID record for Reena Phurailatpam [Opens in a new window] ,
Tabassum Wadasadawala ,
Kamalnayan Chauhan ,
Subhajit Panda  and
Rajiv Sarin
Reena Phurailatpam*
Affiliation:
Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
Tabassum Wadasadawala
Affiliation:
Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
Kamalnayan Chauhan
Affiliation:
Department of Radiation Oncology, Hinduja Hospital, Mumbai, India
Subhajit Panda
Affiliation:
Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
Rajiv Sarin
Affiliation:
Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
*
Author for correspondence: R. Phurailatpam, Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India. E-mail: reena.ph@gmail.com
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Abstract

Purpose:

Dosimetric comparison between volumetric-modulated arc therapy (VMAT) and helical tomotherapy (HT) in the treatment of bilateral breast cancer (BBC).

Materials and methods:

Ten patients treated on HT were selected retrospectively. Dose prescription was 50 Gy in 25 fractions to breast/chest wall and supraclavicular fossa (SCF) while tumour bed was simultaneously boosted to 61 Gy in 25 fractions. VMAT plans were made with four mono-isocentric partial arcs. The monitoring unit (MU) and treatment time were used to quantify the treatment efficiency. Target volumes were compared for homogeneity index (HI), conformity index (CI) while organs at risk (OARs) were compared for relevant dose volumes and integral doses (IDs).

Result:

For targets, no significant difference is observed between VMAT and HT in CI but VMAT could give better HI. The mean lung dose, V20 and V5 is 10·6 Gy versus 8·4 Gy (p-value 0·03), 12% versus 11·5% (p-value 0·5) and 78·1% versus 43·4% (p-value 0·005), respectively. The mean heart dose, V30 and V5 is 4·9 Gy versus 4·7 Gy (p-value 0·88), 0·5% versus 1·5% (p-value 0·18) and 26·2% versus 22·8% (p-value 0·4). Integral dose (ID) for the whole body and heart are comparable: 289 Gy kg versus 299 Gy kg (p-value 0·24) and 2·9 Gy kg versus 2·8 Gy kg (p-value 0·80). ID for lungs was significantly higher with VMAT: 7·9 Gy kg versus 6·3 Gy kg (p-value 0·03). There is a 53% reduction in treatment time and 78% in MU with VMAT against HT.

Conclusion:

VMAT can generate clinically acceptable plans comparable to HT for BBC. HT shows better control over low dose spillage in lungs compared to VMAT thereby increasing ID to lungs. VMAT shows better homogeneity and efficient treatment delivery than HT.

Keywords

bilateral breast cancerhelical tomotherapyvolumetric-modulated arc therapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 1 , March 2022 , pp. 36 - 44
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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