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Hybrid volumetric modulated arc therapy for whole breast irradiation: a dosimetric comparison of different arc designs

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Abstract

Purpose

To find an optimal arc design for hybrid volumetric modulated arc therapy (H-VMAT), a combination of conventional 3DCRT and VMAT plans for left-sided whole breast radiation therapy.

Methods and materials

A total of 26 left-sided early-stage breast cancer patients were selected for this study. To find the superior plan, H-VMAT with three different arc designs including, two partial arcs (2A), four partial arcs (4A) and four tangential arcs (TA) were created for each study case by combining 3DCRT and VMAT with 75% 3DCRT/25% VMAT dose proportion of prescription dose.

Results

All H-VMAT plans achieved the expected target coverage. A higher conformity index and homogeneity index were achieved for 2A and 4A H-VMAT plans and significantly differ from TA H-VMAT (p < 0.003). The heart and ipsilateral lung dose parameters were comparable among all plans except heart V40Gy which was significantly less in 4A H-VMAT plan (p < 0.05). The contralateral lung, contralateral breast, spinal cord, normal tissue doses and MU were significantly less in TA H-VMAT (p < 0.03). The beam-on time was significantly less in 2A H-VMAT (p < 0.0001).

Conclusion

2A and 4A H-VMAT techniques are effective in improving the PTV dosimetric parameters as well as reducing the OAR doses. Further, 2A H-VMAT delivers less MU and beam-on time compared to 4A H-VMAT.

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Authors and Affiliations

  1. School of Advanced Sciences, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India

    Velayudham Ramasubramanian, Karunakaran Balaji & Chandrasekaran Anu Radha

  2. Department of Radiation Oncology, Gleneagles Global Hospitals, Chennai, India

    Karunakaran Balaji, Sitaraman Balaji Subramanian, Krishnamoorthi Sathiya & Moorthi Thirunavukarasu

Authors
  1. Velayudham Ramasubramanian
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  2. Karunakaran Balaji
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  3. Sitaraman Balaji Subramanian
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  4. Krishnamoorthi Sathiya
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  5. Moorthi Thirunavukarasu
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  6. Chandrasekaran Anu Radha
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Correspondence to Velayudham Ramasubramanian.

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Ramasubramanian, V., Balaji, K., Balaji Subramanian, S. et al. Hybrid volumetric modulated arc therapy for whole breast irradiation: a dosimetric comparison of different arc designs. Radiol med 124, 546–554 (2019). https://doi.org/10.1007/s11547-019-00994-1

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  • DOI: https://doi.org/10.1007/s11547-019-00994-1

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