Modified Volumetric Modulated Arc Therapy in Left Sided Breast Cancer After Radical Mastectomy With Flattening Filter Free Versus Flattened Beams

作者：Lai, Youqun^*; Chen, Yanyan; Wu, Sangang; Shi, Liwan; Fu, Lirong; Ha, Huiming; Lin, Qin^*

来源：Medicine, 2016, 95(14): e3295.

DOI：10.1097/MD.0000000000003295

• CHEST-WALL
• RADIOTHERAPY
• IRRADIATION
• IMRT
• TOXICITY
• IMPACT
• MOTION
• NODES

Conventional volumetric modulated arc therapy (C-VMAT) for breast cancer after radical mastectomy had its limitation that resulted in larger volumes of normal tissue receiving low doses. We explored whether there was a way to deal with this disadvantage and determined the potential benefit of flattening filter-free (FFF) beams. @@@ Twenty patients with breast cancer after radical mastectomy were subjected to 3D conformal radiotherapy (3DCRT) and VMAT treatment planning. For VMAT plans, 3 different designs were employed with RapidArc form: conventional-VMAT plan (C-VMAT), modified-VMAT plan (M-VMAT), and modified-VMAT plan using FFF beams (M-VMAT-F). Plan quality and efficiency were assessed for all plans. @@@ For each technique in homogeneity, there were no statistically significant differences. VMAT plans showed superiority compared with 3DCRT in conformity. C-VMAT plans were obviously not only superior to 3DCRT in the medium to high-dose regions (about 15-50Gy) but also resulted in larger volumes in low-dose regions (about 0-10Gy). M-VMAT plans were similar to M-VMAT-F. Both of them might significantly reduce the regions of low dose compared with C-VMAT (V5(lung): similar to 11.5%; V5(heart): similar to 23.8%, P<0.05), even less than 3DCRT in heart irradiation (V2.5(heart), 9.4%, P<0.05). For liver, contralateral breast, and lung irradiation, M-VMAT-F plans were slightly superior to M-VMAT with a reduction of similar to 0.08, 0.2, and 0.24Gy in the respective mean doses (P<0.05). @@@ C-VMAT plans showed superiority compared with 3DCRT, while also resulted in larger volumes of normal tissue receiving low doses. M-VMAT and M-VMAT-F plans might not only reduce the region in the medium to high doses but also have lower volumes in low-dose regions. M-VMAT-F plans were slightly superior compared with M-VMAT due to further contralateral organs sparing.

• 出版日期2016-4
• 单位厦门大学