Dosimetric Evaluation of IMRT and VMAT Techniques with DIBH for WBI

Overview

This study compares dosimetric outcomes of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) for right-sided whole-breast irradiation (WBI) under deep inspiration breath-hold (DIBH) and free-breathing (FB) conditions. Results indicate that DIBH significantly reduces radiation exposure to organs-at-risk compared to FB, enhancing the therapeutic ratio.

Background

Whole-breast irradiation (WBI) following breast-conserving surgery is a standard treatment for early-stage breast cancer. Minimizing radiation exposure to organs-at-risk (OARs) is crucial for improving patient outcomes. While DIBH is commonly used for left-sided breast cancer to protect the heart, its application for right-sided WBI has not been thoroughly evaluated, despite potential benefits.

Data Highlights

No numerical data available in the provided source.

Key Findings

• DIBH significantly reduces radiation doses to the heart, liver, and lungs compared to FB in right-sided breast cancer.
• IMRT techniques may struggle with dose homogeneity in complex anatomy, while VMAT offers improved target coverage.
• VMAT has shown better sparing of the ipsilateral lung and liver compared to tangential IMRT.
• There is a critical gap in literature regarding WBI without regional nodal irradiation for right-sided breast cancer.
• Patient immobilization and respiratory motion monitoring are essential for effective DIBH implementation.

Clinical Implications

The findings support the use of DIBH in right-sided WBI to enhance dosimetric outcomes and reduce radiation exposure to critical organs. Clinicians should consider DIBH as a viable option for patients undergoing right-sided breast radiotherapy, particularly in cases with inferiorly located targets.

Conclusion

DIBH offers significant dosimetric advantages for right-sided whole-breast irradiation, warranting its consideration in clinical practice. Further studies are needed to solidify its role in routine treatment protocols.

References

1. The ASCO Post, 2020 -- Partial-Breast Irradiation Favored Over Whole-Breast in Early Breast Cancer
2. The ASCO Post, 2020 -- Long-Term Outcomes With Accelerated Partial-Breast vs Whole-Breast Irradiation in Patients With Early Breast Cancer
3. The ASCO Post, 2012 -- Prone Position during Radiation Therapy for Breast Cancer Is Associated with Reduced Irradiation to Lung and Heart
4. Scientific summary - One versus three weeks hypofractionated whole breast radiotherapy for early breast cancer treatment: the FAST-Forward phase III RCT - NCBI Bookshelf
5. Deep inspirational breath hold (DIBH) for right breast irradiation: Improved sparing of liver and lung tissue - ScienceDirect
6. Dosimetric comparison of IMRT and VMAT with deep inspiration breath hold or free breathing for right-sided whole breast irradiation - PMC
7. Journal of Neuro-Oncology — Assessing the Precision of Contouring and Dosimetric Effects in Contemporary MRI-Guided Adaptive Radiation Therapy for Brain Metastases: A Retrospective Analysis
8. Scientific summary - One versus three weeks hypofractionated whole breast radiotherapy for early breast cancer treatment: the FAST-Forward phase III RCT - NCBI Bookshelf
9. Deep inspirational breast hold (DIBH) for right breast irradiation: Improved sparing of liver and lung tissue - ScienceDirect
10. Dosimetric comparison of IMRT and VMAT with deep inspiration breath hold or free breathing for right-sided whole breast irradiation - PMC