Dose comparison between hybrid volumetric modulated arc therapy, volumetric modulated arc therapy, and three-dimensional conformal radiotherapy for breast/chest wall irradiation, including regional lymph node irradiation using deep inspiration breath-hold technique

Alsaihaty Z 1 , Abdel-Rahman W 2 , Balaji K 3 , Alkhaldi M 2 , Alghufaili A 2 , Alghadban S 2 Show all authors , El Lathy H 2 , Manan HA 4 , Sabarudin A 5 , Yahya N 6

Affiliations 

  • 1 Diagnostic Imaging and Radiotherapy, CODTIS, Faculty of Health Sciences, The National University of Malaysia, Jalan Raja Muda Aziz, 50300 Kuala Lumpur, Malaysia; Department of Radiation Oncology, King Fahd Specialist Hospital, 31444 Dammam, Saudi Arabia
  • 2 Department of Radiation Oncology, King Fahd Specialist Hospital, 31444 Dammam, Saudi Arabia
  • 3 Department of Radiation Oncology, Gleneagles Global Hospitals, Chennai 600100, India
  • 4 Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, 56000 Kuala Lumpur, Malaysia
  • 5 Diagnostic Imaging and Radiotherapy, CODTIS, Faculty of Health Sciences, The National University of Malaysia, Jalan Raja Muda Aziz, 50300 Kuala Lumpur, Malaysia
  • 6 Diagnostic Imaging and Radiotherapy, CODTIS, Faculty of Health Sciences, The National University of Malaysia, Jalan Raja Muda Aziz, 50300 Kuala Lumpur, Malaysia. Electronic address: azrulyahya@ukm.edu.my
Cancer Radiother, 2025 Feb 27;29(1):104589.
PMID: 40020437 DOI: 10.1016/j.canrad.2025.104589

Abstract

PURPOSE: Breast radiation treatment has been linked to complications such as pneumonitis and cardiac toxicity, necessitating dose optimization. This study aims to determine the optimal integration plan of volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) in a deep inspiration breath-hold regimen.

MATERIALS AND METHODS: CT imaging data from twenty patients with breast or chest wall cancer, either right or left-sided, and with supraclavicular and internal mammary chain lymph nodes were retrieved. The CT data planned with a hybrid VMAT of three different weighting proportions: 30 % using 3DCRT and 70 % using VMAT, 50 % using 3DCRT and 50 % using VMAT, and 70% using 3DCRT and 30 % using VMAT and compared with full 3DCRT and full VMAT plan (classic and five arc design).

RESULTS: The homogeneity and conformity indices were better in the hybrid VMAT plans than in plans using VMAT or 3DCRT alone (P<0.005). Results of all hybrid VMAT plans showed a considerable drop of volumes receiving more than 4Gy, 8Gy or 16Gy in the ipsilateral lung compared to the full VMAT plan (P<0.001). There was a noticeable decrease in the mean dose to the heart and the dose in 5% of the contralateral breast in the plan using 70 % 3DCRT and 30 % VMAT compared to full VMAT (P<0.001). The plan using 70 % 3DCRT and 30% VMAT achieved a balance between the target and surrounding areas, compared to using only 3DCRT or VMAT.

CONCLUSION: A hybrid plan using 70 % 3DCRT contribution achieved a balanced outcome for breast or chest wall irradiation, considering both planning target volume and organs at risk. Utilizing our VMAT arc design, incorporating one shortened arc can significantly reduce doses to organs at risk further. It is important to consider the patient's anatomy when making this decision.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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