Dosimetric Comparison of Various Treatment Technique for Radical Mastectomy Breast Cancer Radiotherapy: Exploring a Hybrid Treatment Approach in Nepal
Abstract
Background: Radiotherapy is integral to breast cancer treatment and is a crucial adjuvant therapy a combination of surgery and chemotherapy in Nepal. The study was designed to assess the impact of h-IMRT on tumor response and in improving overall survival and the best different radiotherapy techniques, including Field in Field (FiF), Intensity modulated Radiotherapy (IMRT), and hybrid-Intensity Modulated Radiotherapy (h-IMRT).
Methods: Twenty-five left-sided breast cancer patients were included for plan evaluation in terms of Planning target volume (PTV) coverage and organ at risk (OAR) irradiation. Patients who underwent modified radical mastectomy (MRM) were planned in Eclipse 13.6 TPS for 40.05 Gy in 15 fractions, using FiF, IMRT, and h-IMRT separately. The PTV included the left chest wall, axillary nodes, and supraclavicular nodes.
Results: The Dmean within the PTV was lowest in IMRT and increased by 1.52% in the h-IMRT plan. The study showed that the lowest Dmean for the heart was in the h-IMRT plan, while it increased by 45% in the FiF plan. The V20 and V10 of the heart are good indicators of heart risk and were minimal in the h-IMRT plan compared to FiF and IMRT. The lung volume receiving a dose equal to or greater than 20 Gy (V20) was also minimal in the h-IMRT plan compared to IMRT and FiF.
Conclusion: The h-IMRT treatment plan for left-sided breast cancer provides better PTV dose coverage and OAR sparing compared to FiF and IMRT plans. The h-IMRT plan also features a reduced Monitor Unit (MU).
Full text article
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018;68(6):394–424. https://doi.org/10.3322/caac.21492
Forouzanfar MH, Foreman KJ, Delossantos AM, Lozano R, Lopez AD, Murray CJL, et al. Breast and cervical cancer in 187 countries between 1980 and 2010: a systematic analysis. The Lancet. 2011 Oct 22;378(9801):1461–84. DOI: 10.1016/S0140-6736(11)61351-2
Kwong DLW, McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. The Lancet [Internet]. 2014. http://dx.doi.org/10.1016/ S0140-6736(14)60488-8
Balaji K, Subramanian B, Yadav P, Radha CA, Ramasubramanian V. Radiation therapy for breast cancer: Literature review. Medical Dosimetry. 2016;41(3):253–7. https://doi.org/10.1016/j.meddos.2016.06.005
Schubert LK, Gondi V, Sengbusch E, Westerly DC, Soisson ET, Paliwal BR, et al. Dosimetric comparison of left-sided whole breast irradiation with 3DCRT, forward-planned IMRT, inverse-planned IMRT, helical tomotherapy, and topotherapy. Radiotherapy and Oncology. 2011;100(2):241–6. https://doi.org/10.1016/j.radonc.2011.01.004
Yavas G, Yavas C, Acar H. Dosimetric comparison of whole breast radiotherapy using field in field and conformal radiotherapy techniques in early stage breast cancer. International Journal of Radiation Research. 2012;10(3/4):131-138. http://ijrr.com/article-1-979-en.html
Lee JW, Hong S, Choi KS, Kim YL, Park BM, Chung JB, et al. Performance evaluation of field-in-field technique for tangential breast irradiation. Japanese journal of clinical oncology. 2008;38(2):158–63. https://doi.org/10.1093/jjco/hym167
Barnett GC, Wilkinson JS, Moody AM, Wilson CB, Twyman N, Wishart GC, et al. Randomized Controlled Trial of Forward-Planned Intensity Modulated Radiotherapy for Early Breast Cancer: Interim Results at 2 Years. International Journal of Radiation Oncology*Biology*Physics. 2012 Feb 1;82(2):715–23. https://doi.org/10.1016/j.ijrobp.2010.10.068
Selvaraj RN, Beriwal S, Pourarian RJ, Lalonde RJ, Chen A, Mehta K, et al. Clinical implementation of tangential field intensity modulated radiation therapy (IMRT) using sliding window technique and dosimetric comparison with 3D conformal therapy (3DCRT) in breast cancer. Medical Dosimetry. 2007;32(4):299–304. https://doi.org/10.1016/j.meddos.2007.03.001
Mayo CS, Urie MM, Fitzgerald TJ. Hybrid IMRT plans—concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time. International Journal of Radiation Oncology* Biology* Physics. 2005;61(3):922–32. https://doi.org/10.1016/j.ijrobp.2004.10.033
Farace P, Zucca S, Solla I, Fadda G, Durzu S, Porru S, et al. Planning hybrid intensity modulated radiation therapy for whole-breast irradiation. International Journal of Radiation Oncology* Biology* Physics. 2012;84(1):e115–22. https://doi.org/10.1016/j.ijrobp.2012.02.025
Shiau AC, Hsieh CH, Tien HJ, Yeh HP, Lin CT, Shueng PW, et al. Left-Sided Whole Breast Irradiation with Hybrid-IMRT and Helical Tomotherapy Dosimetric Comparison. BioMed Research International. 2014;2014:1–7 https://doi.org/10.1155/2014/741326
Prescribing R. Reporting intensity-modulated photon-beam therapy (IMRT)(ICRU Report 83) ICRU Report 83. J ICRU. 2010;10.
Johansen S, Cozzi L, Olsen DR. A planning comparison of dose patterns in organs at risk and predicted risk for radiation induced malignancy in the contralateral breast following radiation therapy of primary breast using conventional, IMRT and Volumetric modulated arc treatment techniques. Acta Oncologica. 2009 Jan;48(4):495–503. https://doi.org/10.1080/02841860802657227
Qiao L, Xie J, Cheng J, Liang N, Deng G, Zhang J, et al. SU‐E‐P‐51: Dosimetric Comparison to Organs at Risk Sparing Using Volumetric‐Modulated Arc Therapy Versus Intensity‐Modulated Radiotherapy in Postoperative Radiotherapy of Left‐Sided Breast Cancer. Medical Physics. 2015 Jun;42(6Part5):3238–3238. https://doi.org/10.1118/1.4923985
Xie X, Ouyang S, Wang H, Yang W, Jin H, Hu B, et al. Dosimetric comparison of left-sided whole breast irradiation with 3D-CRT, IP-IMRT and hybrid IMRT. Oncology reports. 2014;31(5):2195–205. https://doi.org/10.3892/or.2014.3058
Nakamura N, Takahashi O, Kamo M, Hatanaka S, Endo H, Mizuno N, et al. Effects of geometrical uncertainties on whole breast radiotherapy: a comparison of four different techniques. Journal of Breast Cancer. 2014;17(2):157–60. https://doi.org/10.4048/jbc.2014.17.2.157
Fogliata A, De Rose F, Franceschini D, Stravato A, Seppälä J, Scorsetti M, et al. Critical appraisal of the risk of secondary cancer induction from breast radiation therapy with volumetric modulated arc therapy relative to 3D conformal therapy. International Journal of Radiation Oncology* Biology* Physics. 2018;100(3):785–93. https://doi.org/10.1016/j.ijrobp.2017.10.040
Stovall M, Smith SA, Langholz BM, Boice Jr JD, Shore RE, Andersson M, et al. Dose to the contralateral breast from radiotherapy and risk of second primary breast cancer in the WECARE study. International Journal of Radiation Oncology* Biology* Physics. 2008;72(4):1021–30. https://doi.org/10.1016/j.ijrobp.2008.02.040
Ding Z, Zeng Q, Kang K, Xu M, Xiang X, Liu C. Evaluation of plan robustness using hybrid intensity-modulated radiotherapy (IMRT) and volumetric arc modulation radiotherapy (VMAT) for left-sided breast cancer. Bioengineering. 2022;9(4):131. https://doi.org/10.3390/bioengineering9040131
Racka I, Majewska K, Winiecki J, Kiluk K. Hybrid planning techniques for early-stage left-sided breast cancer: dose distribution analysis and estimation of projected secondary cancer-relative risk. Acta Oncologica. 2023 Aug 3;62(8): 932-41. https://doi.org/10.1080/0284186X.2023.2238553
Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. International Journal of Radiation Oncology* Biology* Physics. 2003;56(1):83–8. https://doi.org/10.1016/S0360-3016(03)00073-7
Srivastava RP, Basta K, De Gersem W, De Wagter C. A comparative analysis of Acuros XB and the analytical anisotropic algorithm for volumetric modulation arc therapy. Reports of Practical oncology and Radiotherapy. 2021;26(3):481–8. DOI: 10.5603/RPOR.a2021.0050
Authors
Copyright (c) 2025 Archives of Breast Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.