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Dosimetric comparison between interstitial brachytherapy and volumetric-modulated arc therapy for tumor bed boost in breast cancer
Journal of Contemporary Brachytherapy ( IF 1.1 ) Pub Date : 2021-05-14 , DOI: 10.5114/jcb.2021.106141 Kannan Periasamy 1, 2 , Gunaseelan Karunanithi 2 , Shamsudheen Cholayil 3 , Kadambari Dharanipragada 4 , Vijayprabhu Neelakanadan 2
Journal of Contemporary Brachytherapy ( IF 1.1 ) Pub Date : 2021-05-14 , DOI: 10.5114/jcb.2021.106141 Kannan Periasamy 1, 2 , Gunaseelan Karunanithi 2 , Shamsudheen Cholayil 3 , Kadambari Dharanipragada 4 , Vijayprabhu Neelakanadan 2
Affiliation
Introduction
To dosimetrically compare high-dose-rate interstitial brachytherapy (HDR-BT) with volumetric-modulated arc therapy (VMAT) for tumor bed boost, following breast conservative treatment.
Material and methods
50 patients with early-stage breast cancer who underwent breast conservation surgery, followed by either HDR-BT (n = 25) of 15 Gy in 6 fractions over a period of 3 days, or VMAT dose of 16 Gy in 8 fractions (n = 25) for tumor bed boost, were retrospectively reviewed. All patients received whole breast irradiation of 46 Gy in 23 fractions. Dosimetric parameters for organs at risk (OARs), including ipsilateral and contralateral lungs, heart, contralateral breast, skin, and ribs, were evaluated with the help of dose-volume histograms (DVH).
Results
Heart sparing was similar in both modalities (left-sided breast irradiation, HDR-BT D2cc 20.5% vs. VMAT 30.2%, p-value = 0.243; right-sided breast irradiation, D2cc 6.5% vs. 4.4%, p-value = 0.165). Left-sided cases received higher dose to heart compared to right-sided patients. Interstitial brachytherapy resulted in significantly less dose to contralateral breast (D2cc 4.3% vs. 9.6%, p-value < 0.0001), ipsilateral lung (D2cc 27.6% vs. 73.2%, p-value < 0.0001), contralateral lung (D2cc 4.2% vs. 14.5%, p-value < 0.0001), ribs (D2cc 24.1% vs. 41.2%, p-value < 0.0001), and skin (D2cc 77.3% vs. 95%, p-value < 0.0001).
Conclusions
HDR-BT-based tumor bed boost irradiation results in significantly lower doses to most organs at risk with similar heart sparing compared to VMAT.
中文翻译：
间质近距离放射治疗和容积调制弧光治疗乳腺癌肿瘤床的剂量学比较
引言
在乳房保守治疗后，要定量比较高剂量率间质近距离放射疗法（HDR-BT）与体积调制弧光疗法（VMAT）的肿瘤床增强作用。
材料和方法对
50例早期乳腺癌患者进行了保乳手术，然后在3天内分6步进行HDR-BT（n = 25）15 Gy，或按8步进行VMAT剂量16 Gy （n = 25）进行肿瘤床增强治疗，进行回顾性回顾。所有患者均接受了23次46 Gy的全乳照射。借助剂量-体积直方图（DVH）评估了高危器官（OAR）的剂量学参数，包括同侧和对侧肺，心脏，对侧乳房，皮肤和肋骨。
结果
两种方式的心脏保护相似（左侧乳房照射，HDR-BT D2cc 20.5％vs. VMAT 30.2％，p值= 0.243；右侧乳房照射，D2cc 6.5％vs. 4.4％，p值= 0.165）。与右侧患者相比，左侧患者对心脏的剂量更高。间质性近距离放疗导致对侧乳房的剂量显着减少（D2cc 4.3％对9.6％，p值<0.0001），同侧肺（D2cc 27.6％对73.2％，p值<0.0001），对侧肺部（D2cc 4.2％ vs. 14.5％，p值<0.0001），肋骨（D2cc 24.1％vs.41.2％，p值<0.0001）和皮肤（D2cc 77.3％vs.95％，p值<0.0001）。
结论
与VMAT相比，基于HDR-BT的肿瘤床增强放疗可以使大多数处于危险状态的器官的剂量显着降低，且具有相似的心脏保护功能。
更新日期：2021-05-26
To dosimetrically compare high-dose-rate interstitial brachytherapy (HDR-BT) with volumetric-modulated arc therapy (VMAT) for tumor bed boost, following breast conservative treatment.
Material and methods
50 patients with early-stage breast cancer who underwent breast conservation surgery, followed by either HDR-BT (n = 25) of 15 Gy in 6 fractions over a period of 3 days, or VMAT dose of 16 Gy in 8 fractions (n = 25) for tumor bed boost, were retrospectively reviewed. All patients received whole breast irradiation of 46 Gy in 23 fractions. Dosimetric parameters for organs at risk (OARs), including ipsilateral and contralateral lungs, heart, contralateral breast, skin, and ribs, were evaluated with the help of dose-volume histograms (DVH).
Results
Heart sparing was similar in both modalities (left-sided breast irradiation, HDR-BT D2cc 20.5% vs. VMAT 30.2%, p-value = 0.243; right-sided breast irradiation, D2cc 6.5% vs. 4.4%, p-value = 0.165). Left-sided cases received higher dose to heart compared to right-sided patients. Interstitial brachytherapy resulted in significantly less dose to contralateral breast (D2cc 4.3% vs. 9.6%, p-value < 0.0001), ipsilateral lung (D2cc 27.6% vs. 73.2%, p-value < 0.0001), contralateral lung (D2cc 4.2% vs. 14.5%, p-value < 0.0001), ribs (D2cc 24.1% vs. 41.2%, p-value < 0.0001), and skin (D2cc 77.3% vs. 95%, p-value < 0.0001).
Conclusions
HDR-BT-based tumor bed boost irradiation results in significantly lower doses to most organs at risk with similar heart sparing compared to VMAT.
中文翻译：
间质近距离放射治疗和容积调制弧光治疗乳腺癌肿瘤床的剂量学比较
引言
在乳房保守治疗后，要定量比较高剂量率间质近距离放射疗法（HDR-BT）与体积调制弧光疗法（VMAT）的肿瘤床增强作用。
材料和方法对
50例早期乳腺癌患者进行了保乳手术，然后在3天内分6步进行HDR-BT（n = 25）15 Gy，或按8步进行VMAT剂量16 Gy （n = 25）进行肿瘤床增强治疗，进行回顾性回顾。所有患者均接受了23次46 Gy的全乳照射。借助剂量-体积直方图（DVH）评估了高危器官（OAR）的剂量学参数，包括同侧和对侧肺，心脏，对侧乳房，皮肤和肋骨。
结果
两种方式的心脏保护相似（左侧乳房照射，HDR-BT D2cc 20.5％vs. VMAT 30.2％，p值= 0.243；右侧乳房照射，D2cc 6.5％vs. 4.4％，p值= 0.165）。与右侧患者相比，左侧患者对心脏的剂量更高。间质性近距离放疗导致对侧乳房的剂量显着减少（D2cc 4.3％对9.6％，p值<0.0001），同侧肺（D2cc 27.6％对73.2％，p值<0.0001），对侧肺部（D2cc 4.2％ vs. 14.5％，p值<0.0001），肋骨（D2cc 24.1％vs.41.2％，p值<0.0001）和皮肤（D2cc 77.3％vs.95％，p值<0.0001）。
结论
与VMAT相比，基于HDR-BT的肿瘤床增强放疗可以使大多数处于危险状态的器官的剂量显着降低，且具有相似的心脏保护功能。
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