Non-coplanar volumetric modulated arc therapy for locoregional radiotherapy of left-sided breast cancer including internal mammary nodes

Xu, Yuan; Ma, Pan; Hu, Zhihui; Tian, Yuan; Men, Kuo; Wang, Shulian; Xu, Yingjie; Dai, Jianrong

doi:10.2478/raon-2021-0045

Abstract

Background

Non-coplanar volumetric modulated arc therapy (ncVMAT) is proposed to reduce toxicity in heart and lungs for locoregional radiotherapy of left-sided breast cancer, including internal mammary nodes (IMN).

Patients and methods

This retrospective study included 10 patients with left-sided breast cancer who underwent locoregional radiotherapy after breast-conserving surgery. For each patient, the ncVMAT plan was designed with four partial arcs comprising two coplanar arcs and two non-coplanar arcs, with a couch rotating to 90°. The prescribed dose was normalized to cover 95% of planning target volume (PTV), with 50 Gy delivered in 25 fractions. For each ncVMAT plan, dosimetric parameters were compared with the coplanar volumetric modulated arc therapy (coV-MAT) plan.

Results

T here were improvements in conformity index, homogeneity index and V₅₅ of total target volume (PTVall) comparing ncVMAT to coVMAT (p < 0.001). Among the organs at risk, the average V₃₀, V₂₀, V₁₀, V₅, and mean dose (D_mean) of the heart decreased significantly (p < 0.001). Furthermore, ncVMAT significantly reduced the mean V₂₀, V₁₀, V₅, and D_mean of left lung and the mean V₁₀ and V₅ and D_mean of contralateral lung (p < 0.001). An improved sparing of the left anterior descending coronary artery and right breast were also observed with ncVMAT (p < 0.001).

Conclusions

Compared to coVMAT, ncVMAT provides improved conformity and homogeneity of whole P TV, better dose sparing of the heart, bilateral lungs, left anterior descending coronary artery (LAD), and right breast for locoregional radiotherapy of left-sided breast cancer with IMN, potentially reducing the risk of normal tissue damage.

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