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Lee, Kim, Kim, Lee, Park, and Huh: Dosimetric Plan Comparison of Accelerated Partial Breast Irradiation (APBI) Using CyberKnife
Original Article

Progress in Medical Physics 2018;29(2):73-80.

Published online: 20 June 2018

DOI: https://doi.org/10.14316/pmp.2018.29.2.73

Dosimetric Plan Comparison of Accelerated Partial Breast Irradiation (APBI) Using CyberKnife

Chang Yeol Lee∗, Woo Chul Kim∗, Hun Jeong Kim∗, Jeongshim Lee∗, Seungwoo Park†, Hyun Do Huh∗

∗Department of Radiation Oncology, College of Medicine, Inha University, Incheon, Korea

†Research Institute of Radiological and Medical Sciences, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

Corresponding author Hyun Do Huh (hyundohuh@gmail.com) Tel: 82-32-890-3073 Fax: 82-32-890-3082

Received 14 June 2018       Revised 23 June 2018       Accepted 23 June 2018

Copyright © 2018 Korean Society of Medical Physics

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Accelerated partial breast irradiation (APBI) is a new treatment delivery technique that decreases overall treatment time by using higher fractional doses than conventional fractionation. Here, a quantitative analysis study of CyberKnife-based APBI was performed on 10 patients with left-sided breast cancer who had already finished conventional treatment at the Inha University Hospital. Dosimetric parameters for four kinds of treatment plans (3D-CRT, IMRT, VMAT, and CyberKnife) were analyzed and compared with constraints in the NSABP B39/RTOG 0413 protocol and a published CyberKnife-based APBI study. For the 10 patients recruited in this study, all the dosimetric parameters, including target coverage and doses to normal structures, met the NSABP B39/RTOG 0413 protocol. Compared with other treatment plans, a more conformal dose to the target and better dose sparing of critical structures were observed in CyberKnife plans. Accelerated partial breast irradiation via CyberKnife is a suitable treatment delivery technique for partial breast irradiation and offers improvements over external beam APBI techniques.

Keywords: APBI, Cyberknife, Treatment planning

References

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Fig. 1.
Mean DVH data for ipsilateral breast (a), contralateral breast (b), ipsilateral lung (c), contralateral lung (d), heart (e), cheat wall (f).
pmp-29-73f1.tif
Table 1.
Patient and tumor characteristics for the ten patients with ten treated tumors.
Characteristic Value
Age (years)
Mean 60
Range 50∼78
Tumor type
DCIS 0
IDC 10
Tumor stage
Tis 0
T1a 1
T1b 2
T1c 3
T2 4
GTV (cm3)
Mean 6.4
Range 3.5∼11.2
PTV (cm3)
Mean 37.7
Range 21.3∼65.1
Tumor laterality
Right 0
Left 10
Quadrant
UOQ 6
UIQ 3
Central 1
LOQ 0
LIQ 0

IDC, invasive ductal carcinoma; DCIS, ductal carcinoma in situ; UOQ, upper outer quadrant; UIQ, upper inner quadrant; LIQ, lower inner quadrant.

Table 2.
Constraints given by the NSABP B39/RTOG 0413 protocol for patients treated with CyberKnife SAPBI.
Structure Constraint
Ipsilateral breast V30 Gy<35%
  V15 Gy<60%
Contralateral breast Dmax<1 Gy
Ipsilateral lung V9 Gy<15%
Contralateral lung V1.5 Gy<15%
Heart (left breast) V1.5 Gy<40%
Heart (right breast) V1.5 Gy<5%
Thyroid Dmax<1 Gy
Skin Dmax<36 Gy
Chest wall Dmax<36 Gy

SAPBI, stereotactic accelerated partial breast irradiation; NSABP, National Surgical Adjuvant Breast and Bowel Project; RTOG, Radiation Therapy Oncology Group.

Table 3.
Dosimetric parmeters from plans based on the NSABP B39/RTOG 0413 protocol.
Structure and dosimetric parameters NSABP B39/ RTOG 0413 Protocol Min (%) Max (%) Mean (%) Std (%)
Ipsilateral breast V30 Gy<35% 2 22 10 6.6
  V15 Gy<60% 5 48 24 12.9
Contralateral breast Dmax<1 Gy 1 Gy 8 Gy 3 Gy 3.1 Gy
Ipsilateral lung V9 Gy<15% 0 9 3 2.6
Contralateral lung V1.5 Gy<15% 0 20 9 5.7
Heart (left breast) V1.5 Gy<40% 4 36 23 10.6
Thyroid Dmax<1 Gy 0 Gy 1.5 Gy 1 Gy 0.2 Gy
Skin Dmax<36 Gy 29 Gy 34 Gy 31 Gy 1.5 Gy
Chest wall Dmax<36 Gy 23 Gy 35 Gy 31 Gy 3.2 Gy
Coverage of PTV >90% 95 97.6 96.5 0.7
CI   1.1 1.35 1.2 0.1
Table 4.
Comparison of our dosimetric parameters to other CyberKnife studies.
Structure and dosimetric parameters CyberKnife (mean, range) Olusola et al (mean, range) Sndra et al (mean, range)
Ipsilateral breast 10%, 2–22% 14%, 3–26% 11%, 8–13%
  24%, 5–48% 31%, 8–58% 23%, 16–30%
Contralateral breast 3 Gy, 1–8 Gy 3 Gy, 0–11 Gy 1 Gy, 1–2 Gy
Ipsilateral lung 3%, 0–9% 3%, 0–17% 5%, 0–10%
Contralateral lung 9%, 0–20% 8%, 0–21% 6%, 2–10%
Heart (left breast) 23%, 4–36% 31%, 7–43% 40%, 25–54%
Heart (right breast) NA 18%, 0–37% NA
Thyroid <1 Gy, 0–1.5 Gy <1 Gy, 0–1.4 Gy <1 Gy, 0–1 Gy
Skin 31 Gy, 29–34 Gy 32 Gy, 28–36 Gy 33 Gy
Chest wall 31 Gy, 23–35 Gy 26 Gy, 13–33 Gy 30 Gy
Table 5.
Comparison of our dosimetric parameters to 3D-CRT, IMRT, and VMAT plan.
Structure and dosimetric parameters Constraint CyberKnife (mean, range)
Ipsilateral breast V30 Gy<35% 10%, 2–22%
  V15 Gy<60% 24%, 5–48%
Contralateral breast Dmax<1 Gy 3 Gy, 1–8 Gy
Ipsilateral lung V9 Gy<15% 3%, 0–9%
Contralateral lung V1.5 Gy<15% 9%, 0–20%
Heart (left breast) V1.5 Gy<40% 23%, 4–36%
Thyroid Dmax<1 Gy <1 Gy, 0–1.5 Gy
Skin Dmax<36 Gy 31 Gy, 29–34 Gy
Chest wall Dmax<36 Gy 31 Gy, 23–35 Gy
CI   1.2
MU   12138
Structure and dosimetric parameters 3DCRT (mean, range) IMRT (mean, range) VMAT (mean, range)
Ipsilateral breast 16%, 4–33% 12%, 5–24% 12%, 2–25%
  33%, 9–67% 33%, 8–59% 25%, 5–57%
Contralateral breast 3 Gy, 0–12 Gy 5 Gy, 3–13 Gy 2 Gy, 2–5 Gy
Ipsilateral lung 8%, 1–12% 2%, 0–9% 6%, 0–14%
Contralateral lung 26%, 17–36% 10%, 0–23% 13%, 1–41%
Heart (left breast) 58%, 32–94% 29%, 11–65% 43%, 28–59%
Thyroid <1 Gy, 0–0.1 Gy <1 Gy, 0–0.1 Gy <1 Gy, 0–0.1 Gy
Skin 30 Gy, 27–32 Gy 31 Gy, 29–33 Gy 31 Gy, 26–36 Gy
Chest wall 31 Gy, 21–36 Gy 30 Gy, 10–33 Gy 32 Gy, 19–38 Gy
CI 1.8 1.3 1.3
MU 749 1285 2433
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