Dosimetric Comparison of Various Treatment Techniques for Post-Mastectomy Breast Radiotherapy: Evaluation of a Novel Hybrid IMRT Approach in Nepal Novel hybrid IMRT approach
Abstract
Background: Radiotherapy is integral to breast cancer treatment and is a crucial adjuvant therapy alongside a combination of surgery and chemotherapy in Nepal. The study was designed to assess the impact of hybrid intensity-modulated radiotherapy (h-IMRT) on tumor response, determine its role in improving overall survival, and compare different radiotherapy techniques, including field-in-field (FiF), intensity-modulated radiotherapy (IMRT), with h-IMRT.
Methods: Twenty-five left-sided breast cancer patients were included for plan evaluation in terms of planning target volume (PTV) coverage and organ at risk (OAR) irradiation. Patients who underwent modified radical mastectomy were planned in Eclipse 13.6 treatment planning system (TPS) for 40.05 Gy in 15 fractions, using FiF, IMRT, and h-IMRT separately. The PTV included the left chest wall, axillary nodes, and supraclavicular nodes.
Results: The Dmean (mean dose) within the PTV was lowest in IMRT and increased by 1.52% in the h-IMRT plan. The study showed that the lowest Dmean for the heart was in the h-IMRT plan, while it increased by 45% in the FiF plan. The V20 and V10 of the heart as good indicators of the heart risk were minimal in the h-IMRT plan compared to FiF and IMRT. The lung volume receiving a dose equal to or greater than 20 Gy (V20) was also minimal in the h-IMRT plan compared to IMRT and FiF.
Conclusion: The h-IMRT treatment plan for left-sided breast cancer provides better PTV dose coverage and OAR sparing compared to FiF and IMRT plans. The h-IMRT plan also reduces monitor unit (MU) count.
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