Dosimetric Impact of Respiratory Motion During Breast Intensity-modulated Radiation Therapy Using Four-dimensional Dose Calculations

We investigated the differences in dosimetric uncertainty between the conventional tangential field technique and intensity-modulated radiation therapy using these 3D dose distributions

YOUNG EUN CHOI; KIHOON SUNG; KAP SANG DONG; HYUN JU KIM; YOUNG-KHI LIM

2021

Scholarcy highlights

  • Breast cancer is a heterogeneous disease with different molecular subtypes
  • Such techniques applied to breast intensity-modulated radiation therapy cannot promise to minimize respiration-induced organ movement and target deformation, which may result in significant dose blurring and differences between the planned and delivered dose distributions
  • *p<0.05, based on the Wilcoxon signed-rank test using the EE plan as a reference. conventional tangential field, Conventional tangential field; IMRT, intensity-modulated radiation therapy; EE, end-expiration; EI, end-inspiration; DI, deep-inspiration; PTV, planning target volume; conformation number, conformity number; HI, homogeneity index; Vx, relative organ volume receiving more than a threshold dose
  • reference dose distribution, Reference dose distribution; IMRT, intensity-modulated radiation therapy; EE, end-expiration; EI, end-inspiration; PTV, planning target volume; CN, conformity number; CI, Radiation Therapy Oncology Group conformity index; CVF, lesion coverage factor; HI, homogeneity index; Vx, relative organ volume receiving more than a threshold dose
  • This study showed that the actual dose distribution of breast IMRT delivered to the patient, which is closer to the ground truth, could be simulated by 4D dose calculations with deformable image registration
  • While significant reductions of the target coverage were observed in the tumor bed, only minor differences in the PTV were observed throughout the five respiratory patterns
  • Special considerations such as breathing-adapted techniques and robust optimization, should be given to the implication of breast intensity-modulated radiation therapy with the tumor bed simultaneous-integrated boost technique

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