Does deep inspiration breath hold reduce plan complexity? Multicentric experience of left breast cancer radiotherapy with volumetric modulated arc therapy

•A multicenter comparison between FB and DIBH VMAT breast plans was conducted.•VMAT-DIBH plans allow to significantly reduce OARs doses and to improve target coverage.•The cardiac-sparing benefits of the DIBH plans were achieved with a lower plan complexity than FB.•A new global score index accounti...

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Veröffentlicht in:Physica medica 2019-03, Vol.59, p.79-85
Hauptverfasser: Russo, Serenella, Esposito, Marco, Hernandez, Victor, Saez, Jordi, Rossi, Francesca, Paoletti, Lisa, Pini, Silvia, Bastiani, Paolo, Reggiori, Giacomo, Nicolini, Giorgia, Vanetti, Eugenio, Tomatis, Stefano, Scorsetti, Marta, Mancosu, Pietro
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Sprache:eng
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Zusammenfassung:•A multicenter comparison between FB and DIBH VMAT breast plans was conducted.•VMAT-DIBH plans allow to significantly reduce OARs doses and to improve target coverage.•The cardiac-sparing benefits of the DIBH plans were achieved with a lower plan complexity than FB.•A new global score index accounting for both plan quality and dosimetric parameters was defined.•All plans verifications produced satisfactory QA results. Volumetric modulated arc therapy (VMAT) for left breast treatments allows heart sparing without compromising PTV coverage. However, this technique may require highly complex plans. Deep Inspiration Breath Hold (DIBH) procedure increases the heart-to-breast distance, facilitating the dose sparing of the heart. The aim of the present work was to investigate if the cardiac-sparing benefits of the DIBH technique were achieved with lower plan modulation and complexity than Free Breathing (FB) treatments. Ten left side breast cases were considered by two centers with different treatment planning systems (TPS) and Linacs. VMAT plans were elaborated in FB and DIBH according to the same protocol. Plan complexity was evaluated by scoring several complexity indices. A new global score index accounting for both plan quality and dosimetric parameters was defined. Pre-treatment QA was performed for all VMAT plans using EPID and Epiqa software. DIBH-VMAT plans were associated with significant PTV coverage improvement and mean heart dose reduction (p 
ISSN:1120-1797
1724-191X
DOI:10.1016/j.ejmp.2019.02.018