Margin expansion for treatment field of volumetric modulated arc therapy for breast cancer
Guo Chenlei, Xu Yingjie, Dai Jianrong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,China
Abstract：Objective We developed a method to expand margin of beam aperture for VMAT treatment planning of breast cancer and evaluated its effectiveness in clinic. Methods An expanded VMAT (E-VMAT) plan for breast cancer using Pinnacle3 9.10 planning system was made. A small tissue-equivalent bolus was added at the middle of the breast surface as part of the target and the VMAT plan was generated with beam aperture automatically expanded. Then the tissue-equivalent bolus was removed and the final dose distribution was calculated. Ten patients with breast cancer undergoing breast conserving surgery were tested. The dosimetrical metrics and delivery efficiency were compared between the E-VMAT plans and the routine VMAT plans. Results On the BEV view, it was observed that in E-VMAT plans the collimator and MLC leaf positions was extended outside the skin along the anterior-posterior direction of the thorax. There were no significant differences in conformity index and homogeneity index of target volume between the two types of plans and the planned delivery efficiency was consistent (P>0.05). Conclusions The method established in this study can automatically generate expansion of VMAT beam apertures and prevent missing of target volume due to respiratory motion and/or setup error of the patient. The method does not require programming skill and available for different treatment planning systems.
Guo Chenlei,Xu Yingjie,Dai Jianrong. Margin expansion for treatment field of volumetric modulated arc therapy for breast cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(9): 845-849.
[1] Bedi C,Kron T,Willis D,et al. Comparison of radiotherapy treatment plans for left-sided breast cancer patients based on three-and four-dimensional computed tomography imaging[J].Clin Oncol (R Coll Radiol),2011,23(9):601-607.DOI:10.1016/j.clon.2011.04.004. [2] Wang W,Bin LJ,Hu HG,et al. Evaluation of dosimetric variance in whole breast forward-planned intensity-modulated radiotherapy based on 4DCT and 3DCT[J].J Radiat Res,2013,54(4):755-761.DOI:10.1093/jrr/rrs143. [3] Hong L,Hunt M,Chui C,et al. Intensity-modulated tangential beam irradiation of the intact breast[J].Phys Contrib,1999,44(5):1155-1164.DOI:10.1016/s0360-3016(99)00132-7. [4] Evans PM,Donovan EM,Partridge M,et al. The delivery of intensity modulated radiotherapy to the breast using multiple static fields[J].Radiother Oncolo,2000,57(1):79-89.DOI:10.1016/s0167-8140(00)00263-2. [5] Morrow NV,Stepaniak C,White J,et al. Intra-and interfractional variations for prone breast irradiation:an indication for image-guided radiotherapy[J].Int J Radiat Oncol Biol Phys,2007,69(3):910-917.DOI:10.1016/j.ijrobp.2007.06.056. [6] Listed N.The ICRU Report 83:prescribing, recording, and reporting photon-beam intensity-modulated radiation therapy (IMRT)[J].J ICRU,2010,10(1):NP.3-NP.DOI:10.1093/jicru/ndq002. [7] 田源,马攀,门阔,等.基于VMAT的乳腺癌保乳术后全乳混合调强技术的建立与评价[J].中华放射肿瘤学杂志,2016,25(7):728-732.DOI:10.3760/cma.j.issn.1004-4221.2016.07.014. Tian Y,Ma P,Men K,et al. Development and evaluation of whole breast irradiation with volumetric modulated arc therapy-based hybrid intensity-modulated radiotherapy after breast conserving surgery for breast cancer[J].Chin J Radiat Oncol,2016,25(7):728-732.DOI:10.3760/cma.j.issn.1004-4221.2016.07.014. [8] Mayo C S,Urie M M,Fitzgerald T J.Hybrid IMRT plans—concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time[J].Int J Radiat Oncol Biol Phys,2005,61(3):922-932.DOI:10.1016/j.ijrobp.2004.10.033. [9] 马攀,章众,陈辛元,等.乳腺锁骨上淋巴区调强放疗的计划设计方法.中华医学会放射肿瘤治疗学分会六届二次暨中国抗癌协会肿瘤放疗专业委员会二届二次学术会议[C],济南,2009.济南:中华医学会放射肿瘤治疗学分会,2009:491-492. Ma P,Zhang Z,Chen XY,et al. Planned method for intensity-modulated radiotherapy in the supraclavicular lymphatic region of the breast.The Second Session of the Second Session of the Radiation Oncology Therapy Branch of the Chinese Medical Association and the Second Session of the China Anti-Cancer Association Cancer Radiotherapy Professional Committee[C],Ji′nan,2009.Ji'nan:Chines medical association branch of radiation oncology society,2009:491-492. [10] 王华芳,杨国姿,杨旭,等.早期乳腺癌保乳术后4种放疗技术的剂量参数比较[J].现代肿瘤医学,2016,24(16):2549-2553.DOI:10.3969/j.issn.1672-4992.2016.16.013. Wang HF,Yang GZ,Yang X,et al. A comparison of dose parameters for early stage breast cancer after breast-conserving surgery using four different radiotherapy techniques[J].J Mod Oncol,2016,24(16):2549-2553.DOI:10.3969/j.issn.1672-4992.2016.16.013. [11] 赵金,吴文安,廖娟,等.保乳术后全乳照射VMAT与IMRT的计量学比较[J].现代肿瘤医学,2016,24(9):1427-1429.DOI:10.3969/j.issn.167204992.2016.09.027 Zhan J,Wu WA,Liao J,et al. Dosimetric comparison of volumetric-modulated arc therapy and intensity-modulated radiation therapy for breast cancer[J].J Mod Oncol, 2016,24(9):1427-1429.DOI:10.3969/j.issn.167204992.2016.09.027. [12] 张旭,李凯,李娜,等.左乳腺癌保乳术后放疗不同外照射技术所致皮肤受照剂量的比较[J].现代肿瘤医学,2016(20):3213-3216.DOI:10.3969/j.issn.1672—4992.2016.20.011. Zhang K,Li K,Li N,et al. Dosimetric comparison of skin dose for different techniques in left-side breast cancer radiotherapy after breast-conserving surgery[J].J Mod Oncol, 2016(20):3213-3216. DOI:10.3969/j.issn.1672—4992.2016.20.011. [13] 姚晖,邱健健,王芸,等.腺癌保乳术后部分乳腺三种放疗计划的剂量学比较[J].中华放射医学与防护杂志,2014,34(5):358-361.DOI:10.3760/cma.j.issn.0254-5098.2014.05.010. Yao H,Qiu JJ,Wang Y,et al. Dosimetric comparison of three techniques in treatment of accelerated partial breast irradiation[J].Chin J Radiol Med Prot, 2014,34(5):358-361.DOI:10.3760/cma.j.issn.0254-5098.2014.05.010. [14] 孙彦泽,钱建军,周钢,等.乳腺癌保乳术后瘤床同步加量两种放疗技术的比较[J].辐射研究与辐射工艺学报,2014,32(04):18-22.DOI:10.11889/j.1000-3436.2014.rrj.32.040202. Sun YZ,Qian JJ,Zhou G,et al. Comparison between the two techniques for whole breast irradiation with tumor bed boost after breast-conserving surgery[J].J Radiat Res Radiat Process, 2014,32(04):18-22.DOI:10.11889/j.1000-3436.2014.rrj.32.040202. [15] 陈慧茹,王石,吴朝霞,等.乳腺癌保乳术后全乳及锁骨上下区三种调强剂量学分析[J].中华放射肿瘤学杂志,2017,26(7):774-777.DOI:10.3760/cma.j.issn.1004-4221.2017.07.011. Chen HR,Wang S,Wu ZX,et al. Dosimetric comparison betweenthree radiotherapy regimens involving supraclavicular and infraclavicular regions in breast cancer patients after breast-conserving surgery[J].Chin J Radiat Oncol, 2017,26(7):774-777.DOI:10.3760/cma.j.issn.1004-4221.2017.07.011. [16] Zhang Q,Yu X L,Hu W G,et al. Dosimetric comparison for volumetric modulated arc therapy and intensity-modulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer[J].Radiol Oncol,2015,49(1):91-98.DOI:10.2478/raon-2014-0033. [17] Kim YJ,Kim K,Lee R,et al. Two-year follow-up of volumetric-modulated arc therapy for treating internal mammary nodes in locally advanced breast cancer[J].Anti Res,2016,36(9):4847-4851.DOI:10.21873/anticanres.11047. [18] Popescu CC,Olivotto IA,Beckham WA,et al. Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes[J].Int J Radiat Oncol Biol Phys,2010,76(1):287-295.DOI:10.1016/j.ijrobp.2009.05.038. [19] Tyran M,Mailleux H,Tallet A,et al. Volumetric-modulated arc therapy for left-sided breast cancer and all regional nodes improves target volumes coverage and reduces treatment time and doses to the heart and left coronary artery,compared with a field-in-field technique[J].J Radiat Res,2015,56(6):927-937.DOI:10.1093/jrr/rrv052. [20] 王佳浩,李夏东,邓清华,等.乳腺癌根治术后双弧VMAT与IMRT计划的剂量学比较[J].中华放射医学与防护杂志,2014,34(12):942-945.DOI:10.3760/cma.j.issn.0254-5098.2014.12.019. Wang JH,Li XD,Deng QH,et al. Dosimetric comparison of two arcs VMAT plan and IMRT plan for breast cancer post-mastectomy[J].Chin J Radiol Med Prot, 2014,34(12):942-945.DOI:10.3760/cma.j.issn.0254-5098.2014.12.019. [21] 姜庆丰,柏森,傅玉川,等.容积旋转调强技术在乳腺癌根治术后放射治疗中的应用[J].川北医学院学报,2012(02):102-108.DOI:10.3969/j.issn.1005-3697.2012.02.003. Jiang QF,Bai S,Fu YC,et al. Feasibility of volumetric modulated arc therapy applied to breast cancer radiotherapy after radical surgery[J].J North Sichuan Med Coll.2012(02):102-108.DOI:10.3969/j.issn.1005-3697.2012.02.003. [22] Haga A,Magome T,Takenaka S,et al. Independent absorbed-dose calculation using the Monte Carlo algorithm in volumetric modulated arc therapy[J].Radiat Oncol,2014,9(1):75.DOI:10.1186/1748-717X-9-75. [23] Pasquier D,Cavillon F,Lacornerie T,et al. A dosimetric comparison of tomotherapy and volumetric modulated arc therapy in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy[J].Int J Radiat Oncol Biol Phys,2013,85(2):549-554.DOI:10.1016/j.ijrobp.2012.03.046. [24] Stanley J,Dunscombe P,Lau H,et al. The effect of contouring variability on dosimetric parameters for brain metastases treated with stereotactic radiosurgery[J].Int J Radiat Oncol Biol Phys,2013,87(5):924-931.DOI:10.1016/j.ijrobp.2013.09.013.
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