TY - JOUR
T1 - Comparison of treatment planning techniques in treatment of carcinoma of left breast
T2 - Second cancer perspective
AU - Sakthivel, Vasanthan
AU - Kadirampatti Mani, Ganesh
AU - Mani, Sunil
AU - Boopathy, Raghavendiran
N1 - Publisher Copyright:
© 2016 Elsevier Ltd
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Aim To compare the secondary cancer risk (SCR) between different planning techniques for treatment of Ca. Left-Breast patient. Materials and methods Five treatment plans; 3DCRT tangential fields with physical wedge (PW), enhanced dynamic wedges (EDW), electronic compensator (EC), IMRT tangential fields (ITF) and Volumetric modulated arc (VMAT) plan (partial arcs) with 6 MV photon beams were generated for a carcinoma of Left breast patient of age 40 to a prescription dose of 50Gy in 25 fractions. The SCR was estimated using the organ equivalent dose (OED) concept with a linear-exponential, a plateau, and a linear dose-response model for OARs. Also, the low dose-bath volume (5Gy) was calculated for all the plans. Results For contra lateral breast the SCR relative to PW were (linear, plateau, linear-exponential) (−26.0%, −35.0%, −39.0%) for VMAT, (−50.0%,−50.0%,−51.0%) for ITF, (−48.0%, −49.0%,−49.0%) for EC and (−33.0%, −24%, −25.0%) for EDW respectively. The relative SCR (plateau) for heart and left lung were (−66.0% & −73.0%) for VMAT, (−20.0% & −6.0%) for ITF, (−24.0% & −18.0%) for EC and ( −17.0% & −14.0%)for EDW. In contrast, for skin the relative SCR (linear - exponential) were 78.0%, −8.0%, −13.0% and −10.0% for VMAT, ITF, EC and EDW respectively. The 5Gy low dose volume relative to PW for VMAT was 201.45%, whereas the same for ITF, EC and EDW were 17.0%, −7.33% and −4.3%. Conclusion Compared to all plans, VMAT plan showed high conformity for CTV and superior heart and left lung sparing. But SCR for skin and the low dose bath volume were significantly high in VMAT. ITF plan showed relatively better sparing for contra lateral breast and heart. EC plan shows moderately good sparing for OARs while scoring least SCR value for skin next to EDW. EDW and PW plans were similar but later had high SCR for contra lateral-breast. Planning techniques like ITF and VMAT can be strongly considered for left breast, provided better skin sparing techniques and less dose spillage can be achieved.
AB - Aim To compare the secondary cancer risk (SCR) between different planning techniques for treatment of Ca. Left-Breast patient. Materials and methods Five treatment plans; 3DCRT tangential fields with physical wedge (PW), enhanced dynamic wedges (EDW), electronic compensator (EC), IMRT tangential fields (ITF) and Volumetric modulated arc (VMAT) plan (partial arcs) with 6 MV photon beams were generated for a carcinoma of Left breast patient of age 40 to a prescription dose of 50Gy in 25 fractions. The SCR was estimated using the organ equivalent dose (OED) concept with a linear-exponential, a plateau, and a linear dose-response model for OARs. Also, the low dose-bath volume (5Gy) was calculated for all the plans. Results For contra lateral breast the SCR relative to PW were (linear, plateau, linear-exponential) (−26.0%, −35.0%, −39.0%) for VMAT, (−50.0%,−50.0%,−51.0%) for ITF, (−48.0%, −49.0%,−49.0%) for EC and (−33.0%, −24%, −25.0%) for EDW respectively. The relative SCR (plateau) for heart and left lung were (−66.0% & −73.0%) for VMAT, (−20.0% & −6.0%) for ITF, (−24.0% & −18.0%) for EC and ( −17.0% & −14.0%)for EDW. In contrast, for skin the relative SCR (linear - exponential) were 78.0%, −8.0%, −13.0% and −10.0% for VMAT, ITF, EC and EDW respectively. The 5Gy low dose volume relative to PW for VMAT was 201.45%, whereas the same for ITF, EC and EDW were 17.0%, −7.33% and −4.3%. Conclusion Compared to all plans, VMAT plan showed high conformity for CTV and superior heart and left lung sparing. But SCR for skin and the low dose bath volume were significantly high in VMAT. ITF plan showed relatively better sparing for contra lateral breast and heart. EC plan shows moderately good sparing for OARs while scoring least SCR value for skin next to EDW. EDW and PW plans were similar but later had high SCR for contra lateral-breast. Planning techniques like ITF and VMAT can be strongly considered for left breast, provided better skin sparing techniques and less dose spillage can be achieved.
KW - Breast cancer
KW - Electronic compensator
KW - Second cancer
KW - Secondary cancer risk
KW - Treatment planning
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U2 - 10.1016/j.radphyschem.2016.11.009
DO - 10.1016/j.radphyschem.2016.11.009
M3 - Article
AN - SCOPUS:85000995823
SN - 0969-806X
VL - 132
SP - 41
EP - 45
JO - Radiation Physics and Chemistry
JF - Radiation Physics and Chemistry
ER -