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Hybrid planning techniques for hypofractionated whole-breast irradiation using flattening filter-free beams

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Abstract

Objective

The aim of this study was to assess the feasibility of flattening filter-free (FFF) photon beams in hybrid intensity-modulated radiation therapy (H-IMRT) and hybrid volumetric modulated arc therapy (H-VMAT) for left-sided whole-breast radiation therapy with a boost volume (RT) using a hypofractionated dose regimen.

Patients and methods

RT plans of 25 patients with left-sided early-stage breast cancer were created with H‑IMRT and H‑VMAT techniques under breath-hold conditions using 6‑MV FFF beams. In hybrid techniques, three-dimensional conformal radiotherapy (3DCRT) plans were kept as base-dose plans for the VMAT and IMRT plans. In addition, H‑IMRT in step-and-shoot mode was also calculated to assess its achievability with FFF beams.

Results

All hybrid plans achieved the expected target coverage. H‑VMAT showed better coverage and homogeneity index results for the boost target (p < 0.002), while H‑IMRT presented better results for the whole-breast target (p < 0.001). Mean doses to normal tissues were comparable between both plans, while H‑IMRT reduced the low-dose levels to heart and ipsilateral lung (p < 0.05). H‑VMAT revealed significantly better results with regard to monitor units (MU) and treatment time (p < 0.001).

Conclusion

The 6‑MV FFF beam technique is feasible for large-field 3DCRT-based hybrid planning in whole-breast and boost planning target volume irradiation. For breath-hold patients, the H‑VMAT plan is superior to H‑IMRT for hypofractionated dose regimens, with reduced MU and treatment delivery time.

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Authors and Affiliations

  1. Department of Radiation Oncology, Gleneagles Global Hospitals, Chennai, Tamil Nadu, India

    Karunakaran Balaji M.Sc., Sitaraman Balaji Subramanian DNB, Krishnamoorthi Sathiya DNB & Moorthi Thirunavukarasu M.Sc.

  2. School of Advanced Sciences, Vellore Institute of Technology, Vellore, India

    Karunakaran Balaji M.Sc., Chandrasekaran Anu Radha Ph.D. & Velayudham Ramasubramanian Ph.D.

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  1. Karunakaran Balaji M.Sc.
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  2. Sitaraman Balaji Subramanian DNB
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  3. Krishnamoorthi Sathiya DNB
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  4. Moorthi Thirunavukarasu M.Sc.
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  5. Chandrasekaran Anu Radha Ph.D.
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  6. Velayudham Ramasubramanian Ph.D.
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Correspondence to Karunakaran Balaji M.Sc..

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Conflict of interest

K. Balaji, S. Balaji Subramanian, K. Sathiya, M. Thirunavukarasu, C. Anu Radha, and V. Ramasubramanian declare that they have no competing interests.

Ethical standards

The institutional scientific and ethics board has approved this study. This article does not contain any studies with human participants performed by any of the authors. Informed consent was waivered by the ethics board of the institute as this is a retrospective study with no human involved. For this type of study, formal consent is not required.

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Balaji, K., Balaji Subramanian, S., Sathiya, K. et al. Hybrid planning techniques for hypofractionated whole-breast irradiation using flattening filter-free beams. Strahlenther Onkol 196, 376–385 (2020). https://doi.org/10.1007/s00066-019-01555-1

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