Alsaihaty Zainab, Abdel-Rahman Wamied, Balaji Karunakaran, Alkhaldi Mashaal, Alghufaili Abdulraouf, Alghadban Shama, El Lathy Hala, Manan Hanani Abdul, Sabarudin Akmal, Yahya Noorazrul
Diagnostic Imaging and Radiotherapy, CODTIS, Faculty of Health Sciences, The National University of Malaysia, Jalan Raja Muda Aziz, 50300 Kuala Lumpur, Malaysia; Department of Radiation Oncology, King Fahd Specialist Hospital, 31444 Dammam, Saudi Arabia.
Department of Radiation Oncology, King Fahd Specialist Hospital, 31444 Dammam, Saudi Arabia.
Cancer Radiother. 2025 Feb;29(1):104589. doi: 10.1016/j.canrad.2025.104589. Epub 2025 Feb 27.
Breast radiation treatment has been linked to complications such as pneumonitis and cardiac toxicity, necessitating dose optimization. This study aims to determine the optimal integration plan of volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) in a deep inspiration breath-hold regimen.
CT imaging data from twenty patients with breast or chest wall cancer, either right or left-sided, and with supraclavicular and internal mammary chain lymph nodes were retrieved. The CT data planned with a hybrid VMAT of three different weighting proportions: 30 % using 3DCRT and 70 % using VMAT, 50 % using 3DCRT and 50 % using VMAT, and 70% using 3DCRT and 30 % using VMAT and compared with full 3DCRT and full VMAT plan (classic and five arc design).
The homogeneity and conformity indices were better in the hybrid VMAT plans than in plans using VMAT or 3DCRT alone (P<0.005). Results of all hybrid VMAT plans showed a considerable drop of volumes receiving more than 4Gy, 8Gy or 16Gy in the ipsilateral lung compared to the full VMAT plan (P<0.001). There was a noticeable decrease in the mean dose to the heart and the dose in 5% of the contralateral breast in the plan using 70 % 3DCRT and 30 % VMAT compared to full VMAT (P<0.001). The plan using 70 % 3DCRT and 30% VMAT achieved a balance between the target and surrounding areas, compared to using only 3DCRT or VMAT.
A hybrid plan using 70 % 3DCRT contribution achieved a balanced outcome for breast or chest wall irradiation, considering both planning target volume and organs at risk. Utilizing our VMAT arc design, incorporating one shortened arc can significantly reduce doses to organs at risk further. It is important to consider the patient's anatomy when making this decision.
乳房放射治疗与诸如肺炎和心脏毒性等并发症相关，因此需要优化剂量。本研究旨在确定在深吸气屏气方案中容积调强弧形放疗（VMAT）和三维适形放疗（3DCRT）的最佳整合方案。
检索了20例患有乳房或胸壁癌（左右侧均可）且伴有锁骨上和内乳链淋巴结的患者的CT成像数据。使用三种不同加权比例的混合VMAT规划CT数据：30%使用3DCRT和70%使用VMAT、50%使用3DCRT和50%使用VMAT、70%使用3DCRT和30%使用VMAT，并与全3DCRT和全VMAT计划（经典和五弧设计）进行比较。
混合VMAT计划中的均匀性和适形性指数优于单独使用VMAT或3DCRT的计划（P<0.005）。与全VMAT计划相比，所有混合VMAT计划的结果显示同侧肺中接受超过4Gy、8Gy或16Gy照射的体积显著下降（P<0.001）。与全VMAT相比，在使用70% 3DCRT和30% VMAT的计划中，心脏的平均剂量以及对侧乳房5%的剂量有明显降低（P<0.001）。与仅使用3DCRT或VMAT相比，使用70% 3DCRT和30% VMAT的计划在靶区和周围区域之间实现了平衡。
考虑到计划靶区体积和危及器官，使用70% 3DCRT的混合计划在乳房或胸壁照射方面取得了平衡的结果。利用我们的VMAT弧形设计，纳入一个缩短的弧可以进一步显著降低对危及器官的剂量。做出这一决定时考虑患者的解剖结构很重要。
