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• W2004235052 abstract "Purpose/Objective(s): The purpose of the current study is to compare standard tangential and volumetric modulated arc (VMAT) plans for synchronous bilateral breast patients in terms of target coverage and doses to organs at risk (OARs). Materials/Methods: For 10 bilateral breast patients we created separate left and right tangential plans and a single VMAT plan encompassing both breasts as target volume. Patients were prescribed to 50 Gy in 2 Gy fractions. Breast PTV was contracted 3 mm inside the body contour. Lungs, heart, and spine were contoured. For 3D plans each breast was planned independently, aiming to achieve adequate coverage. Where a significant portion of the heart was in the left breast fields, we used a multileaf collimator to block the heart. The hotspot was kept below 107%. A plan sum of the independent plans was generated to ensure no dose overlaps, and for comparison with the VMAT plan. VMAT plans were normalized to 95% dose covering 95% PTV volume, with maximum dose below 107%. OAR optimization objectives were based on QUANTEC data: Both lungs: mean lung dose (MLD) <20 Gy, V20<30%,V5<70%; Heart: V25<10%, Maximal dose ALARA; Spine: maximal dose < 50 Gy. The conformity index (CI) was calculated for all plans. We used the MannWhitney Rank-Sum test to determine statistical significance between 3D and VMAT plans. Results: PTV coverage was similar for 3D and VMAT plans. However, CI for VMATwas 0.91 0.04, and for 3D plans 0.56 0.07. This difference was statistically significant (p < 0.001). All lung metrics were also significantly different (p < 0.001), in favor of 3D plans: MLD was 14.2 2.9 (RA) vs 5.74 0.8 (3D), V20 was 22.4 10.7 (RA) vs 9.1 1.7 (3D), V5 was 86.5 7.5 (RA) vs 20.3 3.2 (3D). Other statistically significant parameters (p < 0.001) were: D2%, the measure used for maximal heart dose: 22.5 6.5 (RA) vs 5.4 2.5 (3D), and D2% for the spinal cord: 14.4 2.9 (RA) vs 0.5 0.3 (3D). Conclusions: Conformity in the VMAT plans was much better than in 3D plans. In addition, VMAT requires a single isocenter setup, which is much simpler than the standard setup, where treatment is given sequentially to each breast, necessitating separate setups for each breast. Thus, treatment time is shorter, and treatment is easier on the patients. However, 3D plans are overwhelmingly superior to VMAT in terms of doses to OARs. These advantages, in our clinic, outweigh the drawbacks of a more complex setup. Thus, the breast is a unique site, where organs at risk are better spared by a conventional, “simple” tangential plan rather than a more sophisticated VMAT plan. Author Disclosure: D. Levin: None. E. Shekel: None. D. Epstein: None. Y. Tova: None. S. Zalmanov-Faermann: None. R. Pfeffer: None." @default.
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• W2004235052 date "2013-10-01" @default.
• W2004235052 modified "2023-09-27" @default.
• W2004235052 title "Efficient VMAT Treatment Plan Optimization Using Non-Uniformly Distributed Control Points" @default.
• W2004235052 doi "https://doi.org/10.1016/j.ijrobp.2013.06.1989" @default.
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