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Dosimetry Comparison between Tangential—Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy: A Deep Inspiration Breath Hold (DIBH) Study for Treatment of a Left-Sided Breast Cancer Using the FAST FORWARD UK Hypo-Fractionated Protocol
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Abstract
Research background: The FAST FORWARD protocol is a hypo-fractionated treatment regimen for early breast cancer, generally involving fewer sessions with higher doses per fraction compared to traditional regimens. Application of DIBH minimize radiation exposure to the heart and lungs during treatment of left-sided breast cancer. Research objectives: The aim of the present study, was to compare the dosimetric goals properties of the restricted tangential Intensity Modulated Radiotherapy (t-IMRT), with Volumetric Modulated Arc Therapy (VMAT) techniques, using the deep inspiration breath hold (DIBH) for whole breast irradiation using the hypo-fractionated regimen. Methods: In this retrospective analysis, a total of thirty individuals diagnosed with breast cancer on the left side but without any spread to the lymph nodes were chosen. Thorough training and patient support was provided for DIBH to assist the patients successfully integrate this technique into their treatment regimen. DIBH Computed tomography (CT) data was used to generate VMAT and t-IMRT plans using Monaco planning system. The prescribed dose was 26 Gy in 5 fractions. Dose volume histograms (DVH) were examined to assess the Planning Target Volume (PTV) and the organs at risk. UK FAST FORWARD constrains parameters of the dose distributions were compared for VMAT and t-IMRT using two-tailed paired t-test. Results: The fact that there is no significant difference in the Homogeneity Index between t-IMRT and VMAT means that both techniques are similarly effective in delivering a uniform dose within the target volume. This is beneficial as it indicates both methods provide comparable dose distribution uniformity. VMAT Shows Improvement (p ＜ 0.001): VMAT has a significantly better Conformity Index compared to t-IMRT. A higher Conformity Index indicates that VMAT is better at matching the radiation dose distribution to the shape of the target volume, which can enhance dose delivery accuracy to the tumor while minimizing exposure to surrounding healthy tissues. Higher in VMAT Plans: V1.5 ＜ 30% refers to the volume heart doses. A higher value in VMAT plans suggests that VMAT is not complying with the hypo-fractionated protocol. Conclusions: The DIBH t-IMRT hypo-fractionated technique is the most effective method for achieving a radiation dose coverage to PTV. It also significantly reduce doses to the heart organ.
Lethukuthula, N. N. , Manny, M. and Mpumelelo, N. (2024). Dosimetry Comparison between Tangential—Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy: A Deep Inspiration Breath Hold (DIBH) Study for Treatment of a Left-Sided Breast Cancer Using the FAST FORWARD UK Hypo-Fractionated Protocol . Open Access Library Journal, 11, e2178. doi: http://dx.doi.org/10.4236/oalib.1112178.
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