ArticleJournal of applied clinical medical physics2026
Dosimetric and radiobiological evaluations as well as technical aspects of left breast treatment employing DIBH with SGRT in radiotherapy with IMRT step and shoot, IMRT Dynamic MLC and VMAT.
Article in Journal of applied clinical medical physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTreatment of the left breast using deep inspiration breath hold (DIBH), combined with surface guided radiotherapy (SGRT), has emerged as the standard for reducing the dose to the heart, the left anterior descending coronary artery (LAD), and the ipsilateral lung. Since this treatment is administered during breath hold (BH) phases, it is beneficial to limit the duration of delivery to improve patient comfort. Furthermore, the SGRT signal can be disrupted when the gantry passes in front of the left SGRT camera during the delivery with volumetric modulated arc therapy (VMAT), which complicates the treatment process. In contrast, using a simpler treatment plan with two tangential beams with intensity modulated radiation therapy (IMRT) helps avoid this difficulty. For image guided radiotherapy (IGRT) as well, monitoring becomes more complex with the addition of the imaging panel and the X-ray tube for the SGRT signal. PURPOSE: This study compares dosimetric and radiobiological differences between two methods in IMRT step and shoot (SS-IMRT) or dynamic multileaf collimator (DMLC-IMRT) using two tangential beams and VMAT with two arcs.
methodsTwenty left breasts were planned using SS-IMRT, DMLC-IMRT and VMAT. The comparison is based on dosimetric criteria at target (D
resultsThe results are listed for SS-IMRT, DMLC-IMRT and VMAT, respectively. For the PTV: D95% 37.5 Gy, 38.3 Gy, 38.4 Gy (p < 0.05 DMLC-IMRT & VMAT vs SS-IMRT); CI 0.74, 0.76, 0.83 (p < 0.05); HI 0.15, 0.11, 0.11 (p > 0.05). TCP: 91.2%, 92.2% and 92.9% (p < 0.05). For OARs; heart: D
conclusionsIn most cases, choosing DMLC-IMRT will result in a plan similar to VMAT and superior to SS-IMRT. Compared to SS-IMRT, DMLC-IMRT delivers a slightly higher dose to contralateral OARs, with a slight increase in the risk of radiation-induced cancer, but lower than VMAT. The main advantage is that it eliminates camera occlusion issues, which can lead to erroneous SGRT signals during treatment and IGRT verification. DMLC-IMRT reduces treatment time by an average of 42% compared to VMAT, which will remain the solution for the most complex morphologies.
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