|Table of Contents|

Application of volumetric modulated arc therapy based on inner edge tangential arc for left breast cancer patients after breast-conserving surgery

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 08
Page:
1480-1485
Research Field:
Publishing date:

Info

Title:
Application of volumetric modulated arc therapy based on inner edge tangential arc for left breast cancer patients after breast-conserving surgery
Author(s):
PU Qin; ZHAO Biao; YUAN Meifang; LIN Ling; LI Jing; YANG Yi
Department of Radiation Oncology，Peking University Cancer Hospital Yunnan，The Third Affiliated Hospital of Kunming Medical University，Yunnan Cancer Hospital，Yunnan Kunming 650118，China.
Keywords:
inner edge tangential arc; VMAT; left breast cancer; breast-conserving surgery; dosimetry
PACS:
R737.9
DOI:
10.3969/j.issn.1672-4992.2024.08.020
Abstract:
Objective:To investigate the dosimetric difference between VMAT based on inneredge tangential arc and conventional tangential arc after breast-conserving surgery for left breast cancer,explore the greater benefit of VMAT technique after breast-conserving surgery for breast cancer,and provide more references and data support for the design of VMAT plan after breast-conserving surgery for breast cancer.Methods:30 patients with left breast cancer who received intensity-modulated radiotherapy after left breast-conserving surgery were selected,the conventional tangential arc (CTA) and inner edge tangential arc (IETA) VMAT plans were designed for each.Data such as conformity index (CI),homogeneity index (HI),the number of machine unit and dose of endangered organs of the two groups of plans were collected and analyzed.Results:The target area conformity index (CI) was 0.86±0.02（CTA group）and 0.87±0.02（IETA group）,the difference was statistically significant(P＜0.05),and there were no significant differences in D98,D50,D2,homogeneity index (HI),and the number of machine unit(P＞0.05).The V5,V10,V20,V30,V40,and Dmean of left lung,V5,Dmean of right lung,and V5,V10,V20,Dmean of heart in IETA group were lower than those in the CTA group,the difference was statistically significant(P＜0.05).The V5,V20 of left lung in CTA group and IETA group were 37.18±7.18 vs 34.32±6.43,11.00±2.40 vs 9.65±2.17.The Dmean of right lung and heart in CTA group and IETA group were 302.26±42.78 vs 273.50±26.62,479.30±60.08 vs 442.39±140.92,these parameters of the IETA group were lower than that of the CTA group.There was little difference in the Dmean of right breast between the two groups (P＞0.05).Conclusion:Both plans satisfied the clinical requirements,IETA group can not only improve CI,but also significantly reduce the dose of left lung,right lung,heart and spinal cord.Therefore,it is recommended to use the inner edge tangential arc of VMAT after left breast cancer-conserving surgery to obtain greater benefits in the target area and organs at risk.

References:

［1］SUNG H,FERLAY J,SIEGEL RL,et al.Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries［J］.CA:A Cancer Journal for Clinicians,2021,71(3):209-249.
［2］周昌明,莫淼,袁晶,等.以医院登记为基础的20万例恶性肿瘤患者生存报告［J］.中国癌症杂志,2020,30(01):11-24. ZHOU CM,MO M,YUAN J,et al.Survival report of 200 000 malignant tumor patients based on hospital registration［J］.Chinese Journal of Cancer,2020,30(01):11-24.
［3］中国医师协会放射肿瘤治疗医师分会.乳腺癌放射治疗指南(中国医师协会2020版) ［J］.中华放射肿瘤学杂志,2021,30(4):321-342. Radiation Oncology Therapy Physicians Branch of Chinese Physicians Association.Guidelines for radiation therapy of breast cancer (Chinese Physicians Association 2020 Edition)［J］.Chinese Journal of Radiation Oncology,2021,30(4):321-342.
［4］XIAO HH,LIU LL,LI WY,et al.TLD calibration and absorbed dose measurement in a radiation-induced liver injury model under a linear accelerator［J］.Nuclear Science and Techniques,2023,34(04):71-80.
［5］MANSOURI S,NAIM A,GLARAIA L,et al.Dosimetric evaluation of 3-D conformal and intensity-modulated radiotherapy for breast cancer after conservative surgery［J］.Asian Pac J Cancer Prev,2015,11:4727-4732.
［6］LIU H,CHEN X,HE Z,et al.Evaluation of 3D-CRT,IMRT and VMAT radiotherapy plans for left breast cancer based on clinical dosimetric study［J］.Computerized Medical Imaging and Graphics,2016,54(12):1-5.
［7］钟胜河,胡洪波,黎建绪.早期乳腺癌保乳术后动态与静态调强放疗技术的剂量学对比分析［J］.广西医学,2020,42(11):1377-1380,1393. ZHONG SH,HU HB,LI JX.Comparative dosimetric analysis of dynamic and static intensity-modulated radiotherapy techniques after breast-conserving surgery for early breast cancer［J］.Guangxi Medicine,2020,42(11):1377-1380,1393.
［8］刘礼东,李军烽,钟美佐，等.CRT+IMRT混合调强与IMRT技术在乳腺癌放疗计划的剂量学比较研究［J］.重庆医学,2023,52(09):1281-1286. LIU LD,LI JF,ZHONG MZ,et al.Comparative dosimetric study of CRT+IMRT hybrid intensity modulation and IMRT technology in breast cancer radiotherapy planning［J］.Chongqing Medicine,2023,52(09):1281-1286.
［9］高瀚,钱普东,明学中,等.不同体位固定方式在乳腺癌放疗中的应用［J］.中华放射医学与防护杂志,2022,42(1):12-17. GAO H,QIAN PD,MING XZ,et al.Application of different body immobilization modes in radiotherapy of breast cancer［J］.Chinese Journal of Radiation Medicine and Protection,2022,42(1):12-17.
［10］YUAN Y,CHANG XB,HU LJ,et al.Effect of isocenter deviation on volume modulated arc therapy plan results and gamma passing rate in the treatment of cervical cancer［J］.Translational Cancer Research,2021,10(10):4403-4412.
［11］杨海芳,刘建平,王志武，等.多等中心调强计划在双侧乳腺癌放射治疗中的应用［J］.中华肿瘤防治杂志,2020,27(19):1548-1553. YANG HF,LIU JP,WANG ZW,et al.Application of multi-isocenter intensity tuning plan in bilateral breast cancer radiotherapy［J］.Chinese Journal of Tumor Control,2020,27(19):1548-1553.
［12］国家癌症中心/国家肿瘤质控中心.乳腺癌术后放疗靶区勾画和计划设计指南［J］.中华放射肿瘤学杂志,2022,31(10):863-878. National Cancer Center/National Center for Cancer Quality Control.Guidelines for target delineation and planning design of postoperative radiotherapy for breast cancer［J］.Chinese Journal of Radiation Oncology,2022,31(10):863-878.
［13］BALISKI MHJ.Intraoperative ultrasound is associated with low re-excision rates following breast conserving surgery for non-palpable invasive breast cancers［J］.The American Journal of Surgery,2021,221(6):1164-1166.
［14］徐晓帆,薛玉,王璐,等.术中放疗与术后放疗在早期乳腺癌保乳手术中的应用比较［J］.医学研究生学报,2021,34(9):947-952. XU XF,XUE Y,WANG L,et al.Comparison of intraoperative radiotherapy and postoperative radiotherapy in breast conserving surgery for early breast cancer ［J］.Journal of Postgraduate Medical Science,2021,34(9):947-952.
［15］ZHANG Y,HHUANG Y,DING S,et al.A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer［J］.Radiation Oncology,2021,16(1):171.
［16］刘涛,郝大为,拾锦,等.乳腺癌保乳术后行IMRT与VMAT的早期不良反应及美容效果研究［J］.现代医药卫生,2020,36(18):2902-2904,2909. LIU T,HAO DW,SHI J,et al.Study on early adverse reactions and cosmetic effects of IMRT and VMAT after breast cancer breast-conserving surgery［J］.Modern Medicine and Health,2020,36(18):2902-2904,2909.
［17］王晓明,宋燕薇,李娜娜.侧胸壁肿瘤等中心点选择对放射治疗剂量的影响［J］.全科医学临床与教育,2020,18(10):881-884. WANG XM,SONG YW,LI NN.Influence of isocenter selection of lateral chest wall tumors on radiation therapy dose［J］.Clinical and Education in Family Medicine,2020,18(10):881-884.
［18］TIMMEREN JEV,EHRBAR S,CHAMBERLAIN M,et al.Single-isocenter versus multiple-isocenters for multiple lung metastases:Evaluation of lung dose［J］.Radiotherapy and Oncology,2022,166（03）:189-194.
［19］柳文琦,曾旺元.等中心点对右侧乳腺癌术后胸壁加内乳和锁骨上淋巴结放疗计划的影响［J］.医药界,2020，9（18）：100. LIU WQ,ZENG WY.Effect of isocenter on radiotherapy planning for chest wall plus internal breast and supraclavicular lymph nodes after right-sided breast cancer surgery［J］.Medicine,2020,9(18):100.
［20］SAlTER BJ,FUSS M,SARKAR V,et al.Optimization of isocenter location for intensity modulated stereotactic treatment of small intracranial targets［J］.International Journal of Radiation Oncology Biology Physics,2009,73(2):546-555.
［21］XU LM,KANG ML,JIANG B,et al.A study of the dosimetric characteristics between different fixed-field IMRT and VMAT in early-stage primary mediastinal B-cell lymphoma［J］.Med Dosim,2018,43(1):91-99.
［22］KARPF D,SAKKA M,METZGER M,et al.Left breast irradiation with tangential intensity modulated radiotherapy (t-IMRT) versus tangential volumetric modulated arc therapy (t-VMAT):trade-offs between secondary cancer induction risk and optimal target coverage［J］.Radiat Oncol,2019,14(1):156.
［23］LAI Y,CHEN Y,WU S,et al.Modified volumetric modulated arc therapy in left sided breast cancer after radical mastectomy with flattening filter free versus flattened beams［J］.Medicine,2016,95(14):e3295.
［24］俞文方,章健,王笑娟,等.乳腺癌术后放射性肺炎合并肺部感染病原菌及Th17/Treg水平［J］.中华医院感染学杂志,2021,31(03):444-448. YU WF,ZHANG J,WANG XJ,et al.Pathogenic bacteria and Th17/Treg levels of lung infection associated with radiation pneumonia after breast cancer surgery［J］.Chinese Journal of Nosocomiology,2021,31(03):444-448.
［25］CHEN CH,HSIEH CC,CHANG CS,et al.A retrospective analysis of dose distribution and toxicity in patients with left breast cancer treated with adjuvant intensity-modulated radiotherapy:comparison with three-dimensional conformal radiotherapy［J］.Dove Press,2020,12:9137-9182.
［26］林金勇.两种放疗系统的乳腺癌保乳术后切线弧容积旋转调强放疗计划质量评估与剂量学质量控制检验［J］.医疗装备,2022,35(22):1-4. LIN JY.Quality evaluation and dosimetry quality control test of tangential arc volume rotation-modulated radiotherapy after breast cancer breast preservation with two radiotherapy systems［J］.Medical Equipment,2022,35(22):1-4.
［27］Early Breast Cancer Trialists'Collaborative Group (EBCTCG).Overview of the randomized trials of radiotherapy in ductal carcinoma in situ of the breast［J］.JNatl Cancer Inst Monogr,2010,41:162-177.
［28］DARBY SC,MCGALE P,TAYLOR CW,et al.Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer:prospective cohort study of about 300 000 women in US SEER cancer registries［J］.Lancet Oncology,2005,6(8):557-565.
［29］KOUTROUMPAKIS E,DESWAL A,YUSUF SW,et al.Radiation-induced cardiovascular disease:mechanisms,prevention,and treatment［J］.Current Oncology Reports,2022,24(5):543-553.
［30］FINAZZI T,NGUYEN VT,ZIMMERMANN F,et al.Impact of patient and treatment characteristics on heart and lung dose in adjuvant radiotherapy for left-sided breast cancer［J］.Radiation Oncology (London,England),2019,14(1):153.
［31］MUNSHI A,SARKAR B,ANBAZHAGAN S,et al.Short tangential arcs in VMAT based breast and chest wall radiotherapy lead to conformity of the breast dose with lesser cardiac and lung doses:a prospective study of breast conservation and mastectomy patients［J］.Australasian Physical & Engineering Sciences in Medicine,2017,40(3):729-736.
［32］潘香,侯宇,杨毅,等.通量平滑度对左乳癌保乳术后容积旋转调强放疗剂量学的影响［J］.现代肿瘤医学,2021,29(15):2691-2695. PAN X,HOU Y,YANG Y,et al.Effect of flux smoothness on dosimetry of volumetric rotational intensity modulated radiotherapy after breast conserving surgery for left breast cancer［J］.Modern Oncology,2021,29(15):2691-2695.
［33］BOGUE J,WAN J,LAVEY RS,et al.Dosimetric comparison of VMAT with integrated skin flash to 3D field-in-field tangents for left breast irradiation［J］.Journal of Applied Clinical Medical Physics,2019,20(2):24-29.
［34］史亚滨,黄嵘,高艳,等.左侧乳腺癌保乳术后深吸气屏气模式下Hybrid-IMRT和Hybrid-VMAT的剂量学比较［J］.中国医学物理学杂志,2022,39(08):936-940. SHI YB,HUANG R,GAO Y，et al.Dosimetry comparison of Hybrid-IMRT and Hybrid-VMAT in deep inspiratory breath holding mode after left breast cancer preservation operation［J］.Chinese Journal of Medical Physics,2022,39(08):936-940.
［35］柴林燕,周灿,蒙渡,等.深吸气屏气技术在左侧乳腺癌保乳术后动态容积旋转调强放疗中的剂量学分析［J］.现代肿瘤医学,2021,29(21):3830-3833. CHAI LY,ZHOU C,MENG D,et al.Dosimetry analysis of deep inspiratory breath holding technique in dynamic volumetric rotational intensity modulated radiotherapy after left breast conserving surgery for breast cancer［J］.Modern Oncology,2021,29(21):3830-3833.
［36］GAO X,FISHER SG,EMAMI B.Risk of second primary cancer in the contralateral breast in women treated for early-stage breast cancer:A population-based study-science direct［J］.International Journal of Radiation Oncology*Biology*Physics,2003,56(4):1038-1045.
［37］WEI TN,HUILING Y,JIAFU L,et al.The clinical outcome of postoperative radiotherapy using hybrid planning technique in left breast cancer after breast-conserving surgery［J］.Cancer Medicine,2022,12(5):5364-5371.
［38］阎艳红,高伟,郭晓慧.早期乳腺癌保乳术后行三维适形放射治疗和二维放射治疗的临床效果观察［J］.实用癌症杂志,2021,36(06):951-953. YAN YH,GAO W,GUO XH.Clinical effect of three dimensional conformal radiotherapy and two dimensional radiotherapy after breast conserving surgery for early breast cancer［J］.Journal of Applied Cancer,2021,36(06):951-953.

Memo

Memo:
National Natural Science Foundation of China(No.81760423);国家自然科学基金资助项目（编号：81760423）；云南省卫生科技计划项目（编号：2017NS192）
Last Update: 1900-01-01