Radiotherapy for breast cancer: an analysis of the hybrid volumetric archotherapy technique
DOI:
https://doi.org/10.32635/2176-9745.RBC.2024v70n3.4711Keywords:
Radiotherapy, Conformal, Radiotherapy, Intensity-Modulated, Breast Neoplasms/radiotherapyAbstract
Introduction: Radiotherapy is one of the treatment strategies for breast cancer. With advances in radiotherapy treatment modalities, such as intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT), it has become possible to deliver radiation doses while reducing treatment margins and improving radiation conformation to the target volume. Objective: To quantitatively analyze a hybrid radiotherapy technique for breast cancer treatment that combines VMAT technology with conventional 3D-CRT, called hybrid volumetric arc therapy (H-VMAT). Method: CT images of an anthropomorphic simulator object were acquired to develop the plan. Five hybrid treatment plans were developed: H-VMAT 90% 3D-CRT and 10% VMAT, H-VMAT 80% 3D-CRT and 20% VMAT, H-VMAT 70% 3D-CRT and 30% VMAT, H-VMAT 60% 3D-CRT and 40% VMAT, H-VMAT 50% 3D-CRT and 50% VMAT. Results: The hybrid plan with the best dosimetric results was H-VMAT 80% 3D-CRT and 20% VMAT, with excellent coverage of the target volume and doses to organs at risk within the limits, especially the contralateral breast. Conclusion: Hybrid techniques can be used to meet the target volume dose conformity and homogeneity indexes established by international protocols, and reduce the dose to organs at risk at the same time.
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Instituto Nacional de Câncer. Estimativa 2023 incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2022. [acesso 2023 dez 20]. Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2023.pdf
Waks AG, Winer EP. Breast cancer treatment: a review. JAMA. 2019;321(3):288-300. doi: https://doi.org/10.1001/jama.2018.19323
Bradley JA, Mendenhall NP. Novel radiotherapy techniques for breast cancer. Annu Rev Med. 2018;69(1):277-88. doi: https://doi.org/10.1146/annurev-med-042716-103422
Conselho Nacional de Saúde (BR). Resolução n° 510, de 7 de abril de 2016. Dispõe sobre as normas aplicáveis a pesquisas em Ciências Humanas e Sociais cujos procedimentos metodológicos envolvam a utilização de dados diretamente obtidos com os participantes ou de informações identificáveis ou que possam acarretar riscos maiores do que os existentes na vida cotidiana, na forma definida nesta Resolução [Internet]. Diário Oficial da União, Brasília, DF. 2016 maio 24 [acesso 2024 jan 25]; Seção I:44. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/cns/2016/res0510_07_04_2016.html
Eclipse Treatment Planning System [Internet]. Versão 15.6. Palo Alto: Varian Medical Systems; 2023. [acesso 2024 jan 25]. Disponível em: https://www.varian.com/pt-br/products/radiotherapy/treatment-planning/eclipse
Vicini FA, Winter K, Freedman GM, et al. NRG RTOG 1005: a phase III trial of hypo fractionated whole breast irradiation with concurrent boost vs. conventional whole breast irradiation plus sequential boost following lumpectomy for high risk early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2022;114(Sup3):S1. doi: https://doi.org/10.1016/j.ijrobp.2022.07.2320
Hodapp N. Der ICRU-Report 83: prescribing, recording, and reporting intensity-modulated photon-beam therapy (IMRT). Strahlenther Onkol. 2012;188(1):97-100. doi: https://doi.org/10.1007/s00066-011-0015-x
Lopes JS, Leidens M, Razera RAZ, et al. Avaliação da homogeneidade e conformidade de dose em planejamentos de IMRT de próstata em radioterapia. Rev Bras Fis Med. 2016;9(3):34-7. doi: https://doi.org/10.29384/rbfm.2015.v9.n3.p34-37
Freedman GM, White JR, Arthur DW, et al. Accelerated fractionation with a concurrent boost for early stage breast cancer. Radiother Oncol. 2013;106(1):15-20. doi: https://doi.org/10.1016/j.radonc.2012.12.001
Jöst V, Kretschmer M, Sabatino M, et al. Heart dose reduction in breast cancer treatment with simultaneous integrated boost. Strahlenther Onkol. 2015;191(9):734-41. doi: https://doi.org/10.1007/s00066-015-0874-7
Bahrainy M, Kretschmer M, Jöst V, et al. Treatment of breast cancer with simultaneous integrated boost in hybrid plan technique. Strahlenther Onkol. 2016;192(5):333-41. doi: https://doi.org/10.1007/s00066-016-0960-5
Beaton L, Bergman A, Nichol A, et al. Cardiac death after breast radiotherapy and the QUANTEC cardiac guidelines. Clin Transl Radiat Oncol. 2019;19:39-45. doi: https://doi.org/10.1016/j.ctro.2019.08.001
Dumane VA, Lo YC, Green S. Combination of volumetric-modulated arc therapy (VMAT) and partially wide tangents (PWT) for improved organ sparing in a left-si. Appl Rad Oncol. 2018;7(2):31-38.
Ramasubramanian V, Balaji K, Balaji SS, et al. Hybrid volumetric modulated arc therapy for whole breast irradiation: a dosimetric comparison of different arc designs. La radiologia medica. 2019;124(6):546-54.
Liu H, Chen X, He Z, et al. Evaluation of 3D-CRT, IMRT and VMAT radiotherapy plans for left breast cancer based on clinical dosimetric study. Comput med imaging graph. 2016;54:1-5. doi: https://doi.org/10.1016/j.compmedimag.2016.10.001
Jensen CA, Roa AMA, Johansen M, et al. Robustness of VMAT and 3DCRT plans toward setup errors in radiation therapy of locally advanced left-sided breast cancer with DIBH. Phys Med. 2018;45:12-8. doi: https://doi.org/10.1016/j.ejmp.2017.11.019
Brownlee Z, Garg R, Listo M, et al. Late complications of radiation therapy for breast cancer: evolution in techniques and risk over time. Gland Surg. 2018;7(4):371-8. doi: https://doi.org/10.21037%2Fgs.2018.01.05
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