Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI)

作者：Qiu Jian Jian; Chang Zheng; Horton Janet K; Wu Qing Rong Jackie; Yoo Sua; Yin Fang Fang^*

来源：Medical Dosimetry, 2014, 39(2): 152-158.

DOI：10.1016/j.meddos.2013.12.001

• Volumetric-modulated arc therapy (V-MAT)
• IMRT
• Intensity-modulated arc therapy
• Accelerated partial-breast irradiation (APBI)

The purpose is to dosimetrically compare the following 3 delivery techniques: 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated arc therapy (IMRT), and volumetric-modulated arc therapy (V-MAT) in the treatment of accelerated partial-breast irradiation (APBI). Overall, 16 patients with T1/2N0 breast cancer were treated with 3D-CRT (multiple, noncoplanar photon fields) on the RTOG 0413 partial-breast trial. These cases were subsequently replanned using static gantry IMRT and V-MAT technology to understand dosimetric differences among these 3 techniques. Several dosimetric parameters were used in plan quality evaluation, including dose conformity index (Cl) and dose-volume histogram analysis of normal tissue coverage. Quality assurance studies including gamma analysis were performed to compare the measured and calculated dose distributions. The IMRT and V-MAT plans gave more conformal target dose distributions than the 3D-CRT plans (p < 0.05 in Cl). The volume of ipsilateral breast receiving 5 and 10 Gy was significantly less using the V-MAT technique than with either 3D-CRT or IMRT (p < 0.05). The maximum lung dose and the ipsilateral lung volume receiving 10 (V-10) or 20 Gy (V-20) were significantly less with both V-MAT and IMRT (p < 0.05). The IMRT technique was superior to 3D-CRT and V-MAT of low dose distributions in ipsilateral lung (p < 0.05 in V-5 and D-5). The total mean monitor units (MUs) for V-MAT (621.0 +/- 111.9) were 12.2% less than those for 3D-CRT (707.3 +/- 130.9) and 46.5% less than those for IMRT (1161.4 +/- 315.6) (p < 0.05). The average machine delivery time was 1.5 0.2 minutes for the V-MAT plans, 7.0 +/- 1.6 minutes for the 3D-CRT plans, and 11.5 +/- 1.9 minutes for the IMRT plans, demonstrating much less delivery time for V-MAT. Based on this preliminary study, V-MAT and IMRT techniques offer improved dose conformity as compared with 3D-CRT techniques without increasing dose to the ipsilateral lung. In terms of MU and delivery time, V-MAT is significantly more efficient for APBI than for conventional 3D-CRT and static-beam IMRT.

• 出版日期2014
• 单位复旦大学