J Breast Cancer.  2015 Mar;18(1):57-62. 10.4048/jbc.2015.18.1.57.

A Dosimetric Comparative Analysis of TomoDirect and Three-Dimensional Conformal Radiotherapy in Early Breast Cancer

• Chung MJ
• Kim SH
• Lee JH
• Suh YJ

• KMID: 2286338
• DOI: http://doi.org/10.4048/jbc.2015.18.1.57

Abstract

PURPOSE
The purpose of this study is to compare dosimetric parameters of intensity-modulated mode of TomoDirect and three-dimensional conformal radiotherapy (3D-CRT) in patients with early breast cancer.
METHODS
TomoDirect and 3D-CRT planning were carried out for 26 patients with early breast cancer who had received breast-conserving surgery. A total of 50.4 Gy in 28 fractions were prescribed to the planning target volume. The organs at risk (OAR) such as lung and heart were contoured. Planning target volume (PTV) dose coverage, radiation conformity index (RCI), radical dose homogeneity index (rDHI), and irradiation dose of organs at risk were compared between TomoDirect and 3D-CRT planning.
RESULTS
The mean PTV dose (51.65+/-0.37 Gy) and V47.8 (100%) in TomoDirect were significantly higher than the mean PTV dose (50.88+/-0.65 Gy) and V47.8 (89.23%+/-0.06%) in 3D-CRT (all, p<0.001). The RCI value in TomoDirect was significantly better than that in 3D-CRT (1.00 vs. 1.13, p<0.001). However, the rDHI value in TomoDirect was not significantly better than that in 3D-CRT (0.72 vs. 0.67, p=0.056). The mean lung dose and V10, V20, V30, and V40 values of ipsilateral lung in TomoDirect were significantly lower than those in 3D-CRT (all, p<0.05). There is no significant difference in the V10, V20, V30, and V40 values of heart between TomoDirect and 3D-CRT. And the mean dose for heart in TomoDirect was marginally lower than that in 3D-CRT (1.05 Gy vs. 1.62 Gy, p=0.085). The mean dose for left anterior descending coronary artery in left breast cancer was significantly lower in TomoDirect than in 3D-CRT (7.2 Gy vs. 12.1 Gy, p<0.001).
CONCLUSION
Compared to 3D-CRT, TomoDirect could result in favorable target coverage while reducing the irradiation dose of the ipsilateral lung for patients with early breast cancer.

Keyword

Breast; Neoplasms; Radiometry; Radiotherapy

MeSH Terms

Breast
Breast Neoplasms*
Coronary Vessels
Heart
Humans
Lung
Mastectomy, Segmental
Organs at Risk
Radiometry
Radiotherapy
Radiotherapy, Conformal*

Figure

• 

  Figure 1 Dose distribution for TomoDirect plan (A) and three-dimensional conformal radiotherapy plan (B). Red contour means the planning target volume which contains lumpectomy site with clips and normal breast tissue.

• 

  Figure 2 Dose-volume histogram of the planning target volume in TomoDirect and three-dimensional conformal radiotherapy (3D-CRT) planning. The mean value of V47.8 was significantly higher in TomoDirect than in 3D-CRT (100% vs. 89.2%, *p<0.001). VnGy=percentage of the volume receiving radiation ≥n Gy.

• 

  Figure 3 Dose volume histogram of the ipsilateral lung (A) and heart (B) in TomoDirect and three-dimensional conformal radiotherapy (3D-CRT) planning. The mean±SD values of V10, V20, V30, and V40 of ipsilateral lung were significantly lower in TomoDirect than in 3D-CRT. VnGy=percentage of the volume receiving radiation ≥n Gy. *p<0.05.

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