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Trajectory modulated arc therapy using quasi-continuous couch motion layered on top of volumetric modulated arc therapy in left breast and chest wall irradiation: a feasibility study

Published online by Cambridge University Press:  23 January 2017

Biplab Sarkar  and
Anirudh Pradhan
Biplab Sarkar*
Affiliation:
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, HaryanaIndia Department of Physics, GLA University Mathura, Uttar Pradesh, India
Anirudh Pradhan
Affiliation:
Dean (Research and Development) GLA University Mathura, Uttar Pradesh, India
*
Correspondence to: Biplab Sarkar, Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana 122002, India. Tel: +919560128094; E-mail: biplabphy@gmail.com
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Abstract

Aim

To investigate the dosimetric advantage of quasi-continuous couch motion-enabled trajectory modulated arc radiotherapy therapy (TMAT) over the coplanar tangential partial arcs volumetric modulated arc radiotherapy (VMAT) for treating left breast and chest wall patients.

Method

Treatment plans of 43 patients who received radiotherapy for left breast (17) or for left chest wall (26) using coplanar partial tangential arcs VMAT (reference plan) were considered for this study. For each patient, in addition to the treatment plan, a TMAT plan was also generated using quasi-continuous couch rotation. The TMAT plan consisted of original two 30° tangential arc beams and two supplementary beams having a couch rotation of ±10°, ±20° and ±30°, respectively. The difference in PTV volume coverage (PTV V95%) between TMAT plan and VMAT plan was calculated for all the cases and normalised to the plan’s prescription dose. Similarly, differences in PTV_V105% and several dose-volume parameters related to organs at risk (OAR) were also computed and tabulated.

Result

TMAT shows an increment in the PTV dose coverage V95% with respect to reference plan by 4·7±2·5% when averaged overall prescription dose levels. Mean PTV dose (averaged overall prescription levels) for reference and TMAT plan was 4638·6±423·8 and 4793·5±447·2 cGy, respectively, and statistically insignificant (p=0·06). However mean PTV_V105% values for TMAT and for reference plans were 6·7±4·8 and 7·2±5·2%, respectively, and were not statistically different (p=0·85). Mean heart dose in TMAT was less than in VMAT plans, but not significantly. As regarding D1% to heart, TMAT plan was again found to be better with a mean difference of 137·1 cGy over VMAT plan. Other parameters evaluated were: mean dose and D1% to contralateral breast, and V20 Gy and V5 Gy for lung.

Conclusion

TMAT plans were found to be better than VMAT plans in terms of PTV coverage and D1% for heart. For evaluated dose parameters apart from PTV coverage and D1% to the heart, no significant differences were observed. Thus, TMAT plans yielded better dose distribution in terms of PTV dose coverage, hot spots and OAR doses.

Keywords

breast radiotherapycouch rotationTMATtrajectory modulated arc therapyVMAT
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 2 , June 2017 , pp. 133 - 140
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Copyright
© Cambridge University Press 2017 

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References

1. Forman, D, Ferlay, J, Stewart, B W, Wild, C P. The global and regional burden of cancer. World Cancer Report 2014; 16–53.Google Scholar
2. Overgaard, M, Hansen, P S, Overgaard, J et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med 1997; 337 (14): 949–955.CrossRefGoogle ScholarPubMed
3. Early Breast Cancer Trialists’ Collaborative Group. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet 2011; 378 (9804): 1707–1716.Google Scholar
4. Darby, S C, Ewertz, M, McGale, P et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013; 368 (11): 987–998.Google Scholar
5. Henson, K E, McGale, P, Taylor, C, Darby, S C. Radiation-related mortality from heart disease and lung cancer more than 20 years after radiotherapy for breast cancer. Br J Cancer 2013; 108 (1): 179–182.Google Scholar
6. Munshi, A, Pai, R H, Phurailatpam, R et al. Do all patients of breast carcinoma need 3-dimensional CT-based planning? A dosimetric study comparing different breast sizes. Med Dosim 2009; 34 (2): 140–144.Google Scholar
7. Aznar, M C, Korreman, S S, Pedersen, A N, Persson, G F, Josipovic, M, Specht, L. Evaluation of dose to cardiac structures during breast irradiation. Br J Radiol 2011; 84 (1004): 743–746.CrossRefGoogle ScholarPubMed
8. Azizova, T V, Muirhead, C R, Druzhinina, M B et al. Cardiovascular diseases in the cohort of workers first employed at Mayak PA in 1948–1958. Radiat Res 2010; 174 (2): 155–168.Google Scholar
9. Zhao, H, He, M, Cheng, G et al. A comparative dosimetric study of left sided breast cancer after breast-conserving surgery treated with VMAT and IMRT. Radiat Oncol 2015; 10 (1): 1.CrossRefGoogle ScholarPubMed
10. Virén, T, Heikkilä, J, Myllyoja, K, Koskela, K, Lahtinen, T, Seppälä, J. Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiat Oncol 2015; 10 (1): 1.Google Scholar
11. Liang, J, Atwood, T, von Eyben, R et al. Trajectory modulated arc therapy: a fully dynamic delivery with synchronized couch and gantry motion significantly improves dosimetric indices correlated with poor cosmesis in accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2015; 92 (5): 1148–1156.CrossRefGoogle ScholarPubMed
12. Shaitelman, S F, Kim, L H, Yan, D, Martinez, A A, Vicini, F A, Grills, I S. Continuous arc rotation of the couch therapy for the delivery of accelerated partial breast irradiation: a treatment planning analysis. Int J Radiat Oncol Biol Phys 2011; 80 (3): 771–778.Google Scholar
13. Popescu, C C, Beckham, W A, Patenaude, V V, Olivotto, I A, Vlachaki, M T. Simultaneous couch and gantry dynamic arc rotation (CG-Darc) in the treatment of breast cancer with accelerated partial breast irradiation (APBI): a feasibility study. J Appl Clin Med Phys 2013; 14 (1): 4035.Google Scholar
14. Dong, P, Lee, P, Ruan, D et al. 4π non-coplanar liver SBRT: a novel delivery technique. Int J Radiat Oncol Biol Phys 2013; 85 (5): 1360–1366.CrossRefGoogle ScholarPubMed
15. Dong, P, Lee, P, Ruan, D et al. 4π noncoplanar stereotactic body radiation therapy for centrally located or larger lung tumors. Int J Radiat Oncol Biol Phys 2013; 86 (3): 407–413.Google Scholar
16. Yang, Y, Zhang, P, Happersett, L et al. Choreographing couch and collimator in volumetric modulated arc therapy. Int J Radiat Oncol Biol Phys 2011; 80 (4): 1238–1247.Google Scholar
17. Smyth, G, Bamber, J C, Evans, P M, Bedford, J L. Trajectory optimization for dynamic couch rotation during volumetric modulated arc radiotherapy. Phys Med Biol 2013; 58 (22): 8163.Google Scholar