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Improvement of helical tomotherapy treatment plan efficiency with block techniques for left-sided post-mastectomy radiation therapy

Published online by Cambridge University Press:  16 January 2023

Arisara Chirawattana ,
Imjai Chitapanarux  and
Wannapha Nobnop Open the ORCID record for Wannapha Nobnop [Opens in a new window]
Arisara Chirawattana
Affiliation:
Faculty of Medicine, Medical Physics Program, Radiation Oncology Division, Department of Radiology, ChiangMai University, ChiangMai, Thailand
Imjai Chitapanarux
Affiliation:
Faculty of Medicine, Radiation Oncology Division, Department of Radiology, ChiangMai University, ChiangMai, Thailand
Wannapha Nobnop*
Affiliation:
Faculty of Medicine, Radiation Oncology Division, Department of Radiology, ChiangMai University, ChiangMai, Thailand
*
Author for correspondence: Dr Wannapha Nobnop, Faculty of Medicine, Chiangmai University, ChiangMai, 50200, Thailand. E-mail: wannapha.n@cmu.ac.th
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Abstract

Purpose:

To limit the entrance dose to normal tissue and achieve the appropriate treatment time (TT) by using three different virtual structures with directional blocks for left-sided post-mastectomy radiation therapy (PMRT) with regional nodal irradiation (RNI).

Methods and materials:

Ten breast cancer patients who received PMRT by helical tomotherapy were enrolled. Three virtual structures were created for each patient: Organ-based, L-shaped (LB) and C-shaped (CB). The dose to the target and organ at risk (OARs), TT, the volume which received dose 5 Gy (V5Gy), integral dose (ID) and block structure contouring workload (BSCW) of the three virtual block techniques were evaluated. The performance scores were used to explore the suitable technique.

Results:

The CB plans showed a significantly better V5Gy, ID and contralateral breast-sparing. However, the CB plans revealed the longest TT and BSCW (p < 0·001). Contrary to the LB, the LB plans showed a significantly reduced TT and BSCW and provided the balance of plan efficiency with the highest score.

Conclusion:

The LB technique is considered to be the suitable technique for left-sided PMRT with RNI and provided the advantage of TT, V5Gy, ID and BSCW while maintaining acceptable criteria for the target and OARs.

Keywords

directional blockhelical tomotherapyintegral dosepost-mastectomytreatment timevirtual block structure
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e68
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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