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Research Article Open Access
Background: Women with large body habitus present unique challenges for breast cancer radiation planning. We describe volumetric modulated arc therapy (VMAT) planning and its associated challenges for loco-regional radiotherapy of left sided cancer; we also describe strategies to overcome these challenges.
Methods: We performed a dosimetric comparison of loco-regional radiotherapy using three dimensional conformal radiotherapy (3D CRT) with VMAT. Our patient was a 49 year old female patient who underwent left modified radical mastectomy for stage IIB (pT1 pN1) breast cancer. She had a chest wall separation of >40 cm. Dose prescription to planning target volumes were 50 Gy of chest wall (PTV50_ eval), 45 Gy to levels II-III axilla (PTV45) and 40 Gy to internal mammary nodes (PTV40) – all in 25 fractions. To assess chest wall motion, we used fluoroscopy and breath hold scan; we fused breath hold scan to the free breathing planning scan, and slice by slice examined the chest wall motion.
Results: In 3D CRT, 95% of PTV50_eval could be covered by 95% dose with hotspots of dose up to 115%. PTV40 could not be adequately covered because of excessive doses to the heart and lung. VMAT achieved planning objectives on target volumes and organs-at-risk. Breath hold scan revealed ≤ 5 mm chest wall motion.
Conclusion: Compared to 3D CRT in woman with large body habitus, VMAT can produce superior dosimetric plan. Chest wall motion must be carefully assessed. Breath hold scan is a useful tool in addition to fluoroscopy to assess chest wall motion, and could be incorporated in VMAT for treatment delivery.
Breast Cancer, Arc Therapy, Radiotherapy, Molecular Cancer Therapeutics, Oncology Research, Inflammatory breast cancer