Highlights
- •ViTAT mimics the dose distribution of tangential fields (TF) plans.
- •Using 20° sectors of four arcs is needed to mimic the delivery of TF.
- •Better PTV homogeneity and lower dose to contralateral OARs are obtained.
- •Mean dose to ipsilateral OARs are unchanged; body integral dose reduced.
- •ViTAT may translate KB-models based on TF data into efficient automatic planning.
Abstract
Purpose
To test the performances of a volumetric arc technique named ViTAT (Virtual Tangential-fields
Arc Therapy) mimicking tangential field irradiation for whole breast radiotherapy.
Methods
ViTAT plans consisted in 4 arcs whose starting/ending position were established based
on gantry angle distribution of clinical plans for right and left-breast. The arcs
were completely blocked excluding the first and last 20°. Different virtual bolus
densities and thicknesses were preliminarily evaluated to obtain the best plan performances.
For 40 patients with tumor laterality equally divided between right and left sides,
ViTAT plans were optimized considering the clinical DVHs for OARs (resulting from
tangential field manual planning) to constrain them: ViTAT plans were compared with
the clinical tangential-fields in terms of DVH parameters for both PTV and OARs.
Results
Distal angle values were suggested in the ranges [220°,240°] for the right-breast
and [115°,135°] for the left-breast cases; medial angles were [60°,40°] for the right
side and [295°,315°] for the left side, limiting the risk of collision. The optimal
virtual bolus had −500 HU density and 1.5 cm thickness. ViTAT plans generated dose
distributions very similar to the tangential-field plans, with significantly improved
PTV homogeneity. The mean doses of ipsilateral OARs were comparable between the two
techniques with minor increase of the low-dose spread in the range 2–15 Gy (few %
volume); contralateral OARs were slightly better spared with ViTAT.
Conclusion
ViTAT dose distributions were similar to tangential-fields. ViTAT should allow automatic
plan optimization by developing knowledge-based DVH prediction models of patients
treated with tangential-fields.
Keywords
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Article info
Publication history
Published online: August 28, 2020
Accepted:
August 9,
2020
Received in revised form:
August 7,
2020
Received:
April 17,
2020
Identification
Copyright
© 2020 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
