Dosimetric comparison of two irradiation modes after radical mastectomy for breast cancer

doi:10.11958/20252154

Abstract

Abstract:

Objective To compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) in the irradiation of chest wall and upper and lower clavicle regions after radical mastectomy for breast cancer. Methods A total of 100 patients who were scheduled to receive radiotherapy after radical mastectomy were included and selected as research subjects. Patients were divided into the VMAT group and the IMRT group by random number table method, with 50 cases in each group. The target dose parameters, exposure dose of organs at risk, monitor unit (MU) and treatment time were compared between the two groups. Results There were no statistical differences in V₉₅ and V₁₁₀ between the VMAT group and the IMRT group (P>0.05). The D_2% in the VMAT group was lower than that of the IMRT group, while D_98% and D_50% were higher in the VMAT group than those in the IMRT group (P<0.05). Target area uniformity and target area conformity were better in the VMAT group than those in the IMRT group (P<0.05). There were no significant differences in mean cardiac dose (D_mean) and ipsilateral lung V₅ and V₁₀ between the VMAT group and the IMRT group (P>0.05). The heart V₂₀ and V₃₀, contralateral lung D_mean, maximum spinal cord dose (D_max), contralateral breast D_mean, ipsilateral lung D_mean, V₂₀, V₃₀ and mean MU were lower in the VMAT group than those in the IMRT group, and the treatment time was shorter than that in the IMRT group (P<0.05). Conclusion In the irradiation treatment of chest wall and upper and lower clavicle regions after radical mastectomy, VMAT demonstrates superior dosimetric characteristics and higher treatment efficiency compared with IMRT, particularly in terms of target area uniformity, target area conformity and exposure doses to organs at risk.

Key words: breast neoplasms, radiotherapy, intensity-modulated, radiotherapy dosage, volumetric modulated arc therapy, intensity modulated radiation therapy

CLC Number:

R737.9，R816.42

Figures/Tables 4

References 14

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组别	年龄/岁	病变侧		肿瘤T分期
组别	年龄/岁	左侧	右侧	T3	T4
IMRT组	52.56±9.83	23（46.0）	27（54.0）	23（46.0）	27（54.0）
VMAT组	51.52±11.20	21（42.0）	29（58.0）	22（44.0）	28（56.0）
χ²或t	0.494	0.162		0.040

组别	年龄/岁	病变侧		肿瘤T分期
组别	年龄/岁	左侧	右侧	T3	T4
IMRT组	52.56±9.83	23（46.0）	27（54.0）	23（46.0）	27（54.0）
VMAT组	51.52±11.20	21（42.0）	29（58.0）	22（44.0）	28（56.0）
χ²或t	0.494	0.162		0.040

组别	D_2%/Gy	D_98%/Gy	D_50%/Gy	V₉₅/%
IMRT组	55.23±1.07	45.93±0.96	51.29±0.96	97.97±0.90
VMAT组	54.60±0.85	47.13±1.06	52.22±0.87	98.13±1.01
t	3.268^＊＊	5.959^＊＊	5.079^＊＊	0.828
组别	V₁₁₀/%	HI		CI
IMRT组	1.47±0.47	0.18±0.03		0.79±0.06
VMAT组	1.61±0.44	0.14±0.02		0.85±0.05
t	1.525	7.263^＊＊		5.844^＊＊

组别	D_2%/Gy	D_98%/Gy	D_50%/Gy	V₉₅/%
IMRT组	55.23±1.07	45.93±0.96	51.29±0.96	97.97±0.90
VMAT组	54.60±0.85	47.13±1.06	52.22±0.87	98.13±1.01
t	3.268^＊＊	5.959^＊＊	5.079^＊＊	0.828
组别	V₁₁₀/%	HI		CI
IMRT组	1.47±0.47	0.18±0.03		0.79±0.06
VMAT组	1.61±0.44	0.14±0.02		0.85±0.05
t	1.525	7.263^＊＊		5.844^＊＊

组别		心脏
组别		D_mean/Gy		V₃₀/%		V₂₀/%
IMRT组		7.88±1.74		9.70±2.44		15.52±4.22
VMAT组		7.28±1.35		7.75±1.92		13.04±3.28
t		1.918		4.439^＊＊		3.285^＊＊
组别		对侧肺 D_mean/Gy		脊髓 D_max/Gy		对侧乳腺 D_mean/Gy
IMRT组		3.42±0.84		27.69±4.98		2.93±0.86
VMAT组		2.95±0.62		25.35±3.15		1.81±0.47
t		3.182^＊＊		2.803^＊＊		8.088^＊＊
组别	同侧肺
组别	D_mean/Gy		V₃₀/%	V₂₀/%	V₁₀/%	V₅/%
IMRT组	13.80±1.16		18.08±1.57	23.73±1.87	33.90±23.04	45.10±5.27
VMAT组	12.64±0.88		15.55±1.20	20.55±1.55	33.76±2.12	45.09±3.58
t	5.624^＊＊		9.046^＊＊	9.228^＊＊	0.275	0.020