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Original ArticleOpen Access
Dosimetric Study of Inverse-Planed Intensity Modulated, Forward-Planned Intensity Modulated and Conventional Tangential Techniques in Breast Conserving Radiotherapy
Rongsriyam K 
,
Rojpornpradit P ,
Lertbutsayanukul C ,
Sanghangthum T ,
Oonsiri S
,
Rojpornpradit P ,
Lertbutsayanukul C ,
Sanghangthum T ,
Oonsiri S Objective: The authors present the result of a dosimetric comparison of inverse-planed intensity modulated,
forward-planned intensity modulated, and conventional tangential technique in breast conserving radiotherapy.
Method and Material: The breasts (Right side: Left side = 1:1), heart, and lungs of 28 patients were contoured
on all the computed tomography (CT)-slice. Three different treatment plans were created: (1) inverse IMRT
(iIMRT), (2) forward IMRT (fIMRT), and (3) conventional tangential technique (CVT). The total prescribed
dose for all plans was 50 Gy/ 25 fractions. All treatment plans were normalized at 95% of the prescribed dose
covered the entire PTV and used inhomogeneity corrections.
Results: For the entire group, the mean breast volume was 517 cc. The V105% for iIMRT, fIMRT and conventional
plans was 1.12%, 2.36% and 16.81%, which iIMRT better than fIMRT and CVT (p < 0.001) and fIMRT
better than CVT (p < 0.05). The Dmax for the iIMRT plan received 105.03%, which was significantly less than
those from the fIMRT (106.6%, p < 0.001) and the conventional (110.68%, p < 0.001) plan. The PT V coverage
(V95-105%) for the iIMRT, fIMRT and conventional was 96%, 91% and 87%, which iIMRT better than fIMRT and
CVT (p < 0.05) and fIMRT better than CVT (p < 0.05).The PTV CI for the iIMRT technique was 0.704, which
was significantly more conformity than those from the fIMRT (0.639, p < 0.001) and the conventional (0.539,
p < 0.001) techniques. The PTV CI of fIMRT is significantly better than CVT (p < 0.005). Mean ipsilateral lung
dose was 642.7 cGy, 747.6 cGy and 882.25 cGy for iIMRT, fIMRT and CVT, respectively (p < 0.05) The V20 Gy
reduced from 14.87% for conventional plan to 12.82% for the fIMRT plan, while 0.88% was obtained for the
iIMRT plan (P<0.05). The heart V30 Gy value was 3.124%, 4.65%, and 5.84% for iIMRT, fIMRT and conventional
plans, respectively (p < 0.05). The mean dose of contralateral breast was 55.86 cGy, 60.33 cGy, 68.57
cGy for iIMRT, fIMRT and conventional plans, respectively (p < 0.05 both). The mean contralateral lung dose
was 57.8 cGy, 43.87 cGy, and 32.28 cGy for iIMRT, fIMRT and conventional plans, respectively (p < 0.005
both).
Conclusion: The iIMRT technique provides significantly improved PTV Dmax, PTV V105%, PTV V110%, target
volume coverage, dose homogeneity and dose conformity throughout the target volume of breast and reduced
doses to all critical structures, compared to the fIMRT and conventional techniques. In view of fIMRT technique,
it significantly improved the dose distribution and reduced dose to OARs compared to conventional technique,
although not better than iIMRT technique.
Keywords: Breast conserving radiotherapy, Dosimetric study, IMRT
forward-planned intensity modulated, and conventional tangential technique in breast conserving radiotherapy.
Method and Material: The breasts (Right side: Left side = 1:1), heart, and lungs of 28 patients were contoured
on all the computed tomography (CT)-slice. Three different treatment plans were created: (1) inverse IMRT
(iIMRT), (2) forward IMRT (fIMRT), and (3) conventional tangential technique (CVT). The total prescribed
dose for all plans was 50 Gy/ 25 fractions. All treatment plans were normalized at 95% of the prescribed dose
covered the entire PTV and used inhomogeneity corrections.
Results: For the entire group, the mean breast volume was 517 cc. The V105% for iIMRT, fIMRT and conventional
plans was 1.12%, 2.36% and 16.81%, which iIMRT better than fIMRT and CVT (p < 0.001) and fIMRT
better than CVT (p < 0.05). The Dmax for the iIMRT plan received 105.03%, which was significantly less than
those from the fIMRT (106.6%, p < 0.001) and the conventional (110.68%, p < 0.001) plan. The PT V coverage
(V95-105%) for the iIMRT, fIMRT and conventional was 96%, 91% and 87%, which iIMRT better than fIMRT and
CVT (p < 0.05) and fIMRT better than CVT (p < 0.05).The PTV CI for the iIMRT technique was 0.704, which
was significantly more conformity than those from the fIMRT (0.639, p < 0.001) and the conventional (0.539,
p < 0.001) techniques. The PTV CI of fIMRT is significantly better than CVT (p < 0.005). Mean ipsilateral lung
dose was 642.7 cGy, 747.6 cGy and 882.25 cGy for iIMRT, fIMRT and CVT, respectively (p < 0.05) The V20 Gy
reduced from 14.87% for conventional plan to 12.82% for the fIMRT plan, while 0.88% was obtained for the
iIMRT plan (P<0.05). The heart V30 Gy value was 3.124%, 4.65%, and 5.84% for iIMRT, fIMRT and conventional
plans, respectively (p < 0.05). The mean dose of contralateral breast was 55.86 cGy, 60.33 cGy, 68.57
cGy for iIMRT, fIMRT and conventional plans, respectively (p < 0.05 both). The mean contralateral lung dose
was 57.8 cGy, 43.87 cGy, and 32.28 cGy for iIMRT, fIMRT and conventional plans, respectively (p < 0.005
both).
Conclusion: The iIMRT technique provides significantly improved PTV Dmax, PTV V105%, PTV V110%, target
volume coverage, dose homogeneity and dose conformity throughout the target volume of breast and reduced
doses to all critical structures, compared to the fIMRT and conventional techniques. In view of fIMRT technique,
it significantly improved the dose distribution and reduced dose to OARs compared to conventional technique,
although not better than iIMRT technique.
Keywords: Breast conserving radiotherapy, Dosimetric study, IMRT
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