PMID- 37969141
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231117
IS  - 0971-6203 (Print)
IS  - 1998-3913 (Electronic)
IS  - 0971-6203 (Linking)
VI  - 48
IP  - 3
DP  - 2023 Jul-Sep
TI  - Planning System-dependent Recommendations of Intensity-modulated Technique for 
      Breast Radiotherapy: A Literature Review-based Adaptation and Institutional 
      Dosimetric Experience from a Large-volume Tertiary Cancer Care Hospital.
PG  - 221-229
LID - 10.4103/jmp.jmp_51_23 [doi]
AB  - This article aims to identify, through a literature review, the best 
      intensity-modulated technique (IMRT)/volumetric-modulated arc therapy (VMAT) for 
      the breast/chest wall (Br/CW) as a function of the treatment planning system 
      (TPS) and present the institutional dosimetric data for the same. A PubMed search 
      was conducted following intensity-modulated irradiation techniques (IMRT) 
      presented in the study: field-in-field (FiF), tangential IMRT (t-IMRT), 
      multi-field IMRT, tangential VMAT (t-VMAT), half-arc VMAT (HA-VMAT), and large 
      arc VMAT (LA-VMAT). The literature with at least one arm VMAT is included in this 
      study. A total of 370 articles were identified between 2010 and 2022, out of 
      which 19 articles were found to be unique. These articles were classified in 
      terms of the TPS used: Eclipse (9), Monaco (6), RayStation (2), Pinnacle (1), and 
      one unidentified TPS. Based on the literature review, dosimetric attributes, and 
      second cancer risk analysis (SCRA), t-IMRT was found to be the most preferable 
      technique in Eclipse, Pinnacle, and RayStation TPS. However, for Monaco TPS, 
      t-VMAT (approximately 30 degrees  tangential arc) offers better dose coverage with lower 
      organ-at-risk (OAR) doses. In terms of OAR doses and SCRA, LA-VMAT (>/=210 degrees ) and 
      HA-VMAT (180 degrees ) are avoidable techniques in any TPS, and FiF should be preferred 
      over these two techniques. In our present institution, which uses the Eclipse 
      TPS, data for 300 patients treated with t-IMRT were collected. The data included 
      beam angle, monitor unit [MU], target coverage (D95% and V105% [cc]), and 
      analysis of the maximum (%), and mean dose (%) of the OAR. t-IMRT utilizes two 
      medial and three lateral tangential beams placed at a spread of approximately 10 degrees  
      and 20 degrees , respectively. The results showed a D95% of 96.3 +/- 1.2% and a V105% of 
      4.9 +/- 7.0 cc. The mean doses to the heart and ipsilateral lung were 10.1 +/- 20.9% 
      and 11.4 +/- 10.2%, respectively. The mean MU was 1282.7 +/- 453.4. Based on the 
      findings, the most preferred intensity-modulated technique for Eclipse, Pinnacle, 
      and RayStation is t-IMRT, while for Monaco, it is t-VMAT. The data from the 
      Eclipse planning system demonstrate a satisfactory dosimetric outcome for t-IMRT. 
      However, the use of VMAT techniques employing an arc angle between 180 degrees  and 210 degrees  
      or higher is strongly discouraged.
CI  - Copyright: (c) 2023 Journal of Medical Physics.
FAU - Sarkar, Biplab
AU  - Sarkar B
AD  - Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, West 
      Bengal, India.
AD  - Department of Physics, GLA University, Mathura, Uttar Pradesh, India.
FAU - Pradhan, Anirudh
AU  - Pradhan A
AD  - Director, Centre for Cosmology, Astrophysics and Space Science (CCASS), GLA 
      University, Mathura, Uttar Pradesh, India.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20230918
PL  - India
TA  - J Med Phys
JT  - Journal of medical physics
JID - 9441104
PMC - PMC10642598
OTO - NOTNLM
OT  - Breast
OT  - intensity-modulated technique
OT  - radiotherapy
OT  - volumetric-modulated arc therapy
COIS- There are no conflicts of interest.
EDAT- 2023/11/16 06:45
MHDA- 2023/11/16 06:46
PMCR- 2023/07/01
CRDT- 2023/11/16 04:18
PHST- 2023/04/20 00:00 [received]
PHST- 2023/06/27 00:00 [revised]
PHST- 2023/08/08 00:00 [accepted]
PHST- 2023/11/16 06:46 [medline]
PHST- 2023/11/16 06:45 [pubmed]
PHST- 2023/11/16 04:18 [entrez]
PHST- 2023/07/01 00:00 [pmc-release]
AID - JMP-48-221 [pii]
AID - 10.4103/jmp.jmp_51_23 [doi]
PST - ppublish
SO  - J Med Phys. 2023 Jul-Sep;48(3):221-229. doi: 10.4103/jmp.jmp_51_23. Epub 2023 Sep 
      18.