Dosimetric and radiobiological evaluations as well as technical aspects of left breast treatment employing DIBH with SGRT in radiotherapy with IMRT step and shoot, IMRT Dynamic MLC and VMAT
Abstract
Abstract Background Treatment of the left breast using deep inspiration breath hold (DIBH), combined with surface guided radiotherapy (SGRT), has emerged as the standard for reducing the dose to the heart, the left anterior descending coronary artery (LAD), and the ipsilateral lung. Since this treatment is administered during breath hold (BH) phases, it is beneficial to limit the duration of delivery to improve patient comfort. Furthermore, the SGRT signal can be disrupted when the gantry passes in front of the left SGRT camera during the delivery with volumetric modulated arc therapy (VMAT), which complicates the treatment process. In contrast, using a simpler treatment plan with two tangential beams with intensity modulated radiation therapy (IMRT) helps avoid this difficulty. For image guided radiotherapy (IGRT) as well, monitoring becomes more complex with the addition of the imaging panel and the X‐ray tube for the SGRT signal. Purpose This study compares dosimetric and radiobiological differences between two methods in IMRT step and shoot (SS‐IMRT) or dynamic multileaf collimator (DMLC‐IMRT) using two tangential beams and VMAT with two arcs. Methods Twenty left breasts were planned using SS‐IMRT, DMLC‐IMRT and VMAT. The comparison is based on dosimetric criteria at target (D95%, homogeneity index (HI), conformity index (CI)) and doses to organs at risk (OARs). Radiobiological parameters (tumor control probability (TCP), normal tissue complication probability (NTCP) and…
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