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Automated hybrid volumetric modulated arc therapy (HVMAT) for whole-breast irradiation with simultaneous integrated boost to lumpectomy area

A treatment planning study

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Abstract

Purpose

To develop an automated treatment planning approach for whole breast irradiation with simultaneous integrated boost using an automated hybrid VMAT class solution (HVMAT).

Materials and methods

Twenty-five consecutive patients with left breast cancer received 50 Gy (2 Gy/fraction) to the whole breast and an additional simultaneous 10 Gy (2.4 Gy/fraction) to the tumor cavity. Ipsilateral lung, heart, and contralateral breast were contoured as main organs-at-risk. HVMAT plans were inversely optimized by combining two open fields with a VMAT semi-arc beam. Open fields were setup to include the whole breast with a 2 cm flash region and to carry 80% of beams weight. HVMAT plans were compared with three tangential techniques: conventional wedged-field tangential plans (SWF), field-in-field forward planned tangential plans (FiF), and hybrid-IMRT plans (HMRT). Dosimetric differences among the plans were evaluated using Kruskal–Wallis one-way analysis of variance. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array.

Results

No significant differences were found among the four techniques for both targets coverage. HVMAT plans showed consistently better PTVs dose contrast, conformity, and homogeneity (p < 0.001 for all metrics) and statistically significant reduction of high-dose breast irradiation. V55 and V60 decreased by 30.4, 26.1, and 20.8% (p < 0.05) and 12.3, 9.9, and 6.0% (p < 0.05) for SWF, FIF, and HMRT, respectively. Pretreatment dose verification reported a gamma pass-rate greater than the acceptance threshold of 95% for all HVMAT plans. In addition, HVMAT reduced the time for full planning optimization to about 20 min.

Conclusions

HVMAT plans resulted in superior target dose conformity and homogeneity compared to other tangential techniques. Due to fast planning time HVMAT can be applied for all patients, minimizing the impact on human or departmental resources.

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Funding

The authors received no specific financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Largo Gemelli 1, 86100, Campobasso, Italy

    Savino Cilla,  Carmela Romano &  Vittoria E. Morabito

  2. Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy

    Gabriella Macchia,  Mariangela Boccardi, Livia P. De Vivo M.Sc. &  Francesco Deodato

  3. Radiation Oncology Department, IRCCS Azienda Ospedaliero—Universitaria di Bologna, Bologna, Italy

    Milly Buwenge &  Alessio G. Morganti

  4. Medical Physics Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, Bologna, Italy

    Lidia Strigari

  5. Radiation Oncology Department, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy

    Luca Indovina &  Vincenzo Valentini

  6. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy

    Vincenzo Valentini &  Francesco Deodato

  7. DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy

    Alessio G. Morganti

Authors
  1. Savino Cilla
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  2. Carmela Romano
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  3. Gabriella Macchia
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  4. Mariangela Boccardi
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  5. Livia P. De Vivo M.Sc.
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  6. Vittoria E. Morabito
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  7. Milly Buwenge
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  9. Luca Indovina
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  10. Vincenzo Valentini
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  11. Francesco Deodato
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  12. Alessio G. Morganti
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Contributions

Concept: SC. Design: SC. Conduct: SC, CR, GM, FD, LS, LI Supervision: MB, LI, VV, AGM. Data acquisition: VEM, CR, LPDV. Statistical analysis: SC, MB. Critical review: VV, AGM. Manuscript drafting, editing: all authors. Revision and final approval: all authors.

Corresponding author

Correspondence to Savino Cilla.

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Conflict of interest

S. Cilla, C. Romano, G. Macchia, M. Boccardi, L.P. De Vivo, V.E. Morabito, M. Buwenge, L. Strigari, L. Indovina, V. Valentini, F. Deodato and A.G. Morganti declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. The study received approval at the Gemelli Molise Hospital Institutional Review Board. Informed consent: not applicable; patients signed informed consent to the treatment procedure, but the study was retrospective.

Additional information

The two authors Francesco Deodato and Alessio G. Morganti share the seniorship.

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Cilla, S., Romano, C., Macchia, G. et al. Automated hybrid volumetric modulated arc therapy (HVMAT) for whole-breast irradiation with simultaneous integrated boost to lumpectomy area. Strahlenther Onkol 198, 254–267 (2022). https://doi.org/10.1007/s00066-021-01873-3

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