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Which simultaneous-integrated boost (SIB) intensity-modulated radiotherapy (IMRT) technique is dosimetrically superior in the treatment of breast cancer; volumetric-modulated arc therapy (VMAT) or fixed field (ff) IMRT?

Published online by Cambridge University Press:  11 April 2017

Steven B. D. Murphy  and
Heather Drury-Smith
Steven B. D. Murphy*
Affiliation:
GenesisCare Southampton, Spire Hospital, Chalybeate Close, Southampton, UK
Heather Drury-Smith
Affiliation:
Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
*
Correspondence to: Steven B. D. Murphy, GenesisCare Southampton, Spire Hospital, Southampton, Hampshire, SO16 6UY, UK. Tel: 02380 764961. E-mail: sbdmurphy@gmail.com
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Abstract

Background and purpose

To determine which concomitant boost technique is dosimetrically superior in the treatment of breast cancer; volumetric-modulated arc therapy (VMAT) or fixed field intensity-modulated radiotherapy (ff-IMRT).

Materials and methods

In total, 30 breast patients were re-planned with both VMAT and fixed field concomitant boost intensity-modulated radiotherapy techniques. A hybrid technique was used delivering 80% of the dose through tangential beams and 20% through an integrated boost. A two-tailed t-test sample for means was used to compare the dosimetric differences between the techniques.

Results

Maximum dose was statistically lower for VMAT; 103·2 versus 103·7% for ff-IMRT along with statistically lower V2 Gy doses to the contralateral lung (0·7 versus 1·6%) and heart for both left- (19·0%/22·6%), and right- (5·5%/8·8%) sided patients, respectively. ff-IMRT boasted significantly lower ipsilateral lung V20, V18 and V10 Gy (7·9/8·6/13·1 versus 8·1/8·8/13·4%) than VMAT, respectively. No differences were found with minimum coverage, mean dose and V5 Gy to all organs at risk (OARs).

Conclusion

VMAT and ff-IMRT techniques demonstrate excellent target coverage and OAR sparing facilitated by the hybrid planning technique and deep inspiration breath hold. There is no obvious dosimetrically superior option between the two techniques. Reduced treatment times with VMAT make it more desirable to implement clinically.

Keywords

breast cancerdosimetryIMRTsimultaneous-integrated boostVMAT
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 3 , September 2017 , pp. 272 - 279
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Copyright
© Cambridge University Press 2017 

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