A Dosimetric Comparison of Radiotherapy Techniques in the Treatment of Carcinoma of Breast


Objectives of present study are a) to compare the planning and delivery aspects of five different techniques, planned by a) forward, inverse planning and electronic tissue compensation methods; and b) to evaluate and verify the accuracy of the planning system using phantom to estimate the skin dose for target and contraletral breast from five techniques. In-vivo skin dosimetry is planned with TL detectors. Five different radiotherapy techniques for treatment of carcinoma breast were studied using archived computed tomography (CT) scans of 25 breast conserving surgery patients (leftsided whole breast), planned for 50 Gy in 25 fractions. Linear accelerator (Clinac 2300 CD) photon beams were used and thermoluminescent detectors (TLD) [LiF:Mg, Ti] estimated dose on humanoid phantom. Dose coverage (95%) (to PTV) and hot spot (105%) covering volumes did not show differences (p > 0.05) in all 5 plans; Electronic compensator plans are better than others. IP-IMRT plan showed the worst Homogeneity Index (HI) (p < 0.05) and needed more monitor units (MU) (437 ± 84), than other techniques. The mean doses to ipsi-lateral lung, contra-lateral breast (CB) and heart OARs (V20 ipsi.lung, CB, V30 Heart,) are the least with IP-IMRT. IP-IMRT and E-COMP plans resulted in significantly lower mean dose to the superficial skin (Dmean, V40skin, 45skin, 50skin) (p < 0.05). The mean doses estimated by TLDs were comparable or higher in 3D-CRT (D) and 3D-CRT (P) for PTV and CB; less for IP-IMRT and E-COMP compared to TPS. IP-IMRT and E-COMP techniques provide good target coverage, low doses to OARs, the least doses to the skin of PTV and contra-lateral breast and less hot spots; E-COMP showed better homogeneity, fewer MUs, and the least dose in non-target zones.

Share and Cite:

Z. Al-Rahbi, R. Ravichandran, J. Binukumar, C. Davis, N. Satyapal and Z. Al-Mandhari, "A Dosimetric Comparison of Radiotherapy Techniques in the Treatment of Carcinoma of Breast," Journal of Cancer Therapy, Vol. 4 No. 11A, 2013, pp. 10-17. doi: 10.4236/jct.2013.411A002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] U. Veronesi, E. Marubini, L. Marian, V. Galimberti, A. Luini, P. Veronesi, et al., “Radiotherapy after Breast Conserving Surgery in Breast Cancer: Long Term Result of Randomized Trial,” Annals of Oncology, Vol. 12, No. 7, 2001, pp. 997-1003. http://dx.doi.org/10.1023/A:1011136326943
[2] A. Recht, “Breast Cancer: Stages T1 and T2,” In: L. L. Gunderson and J. E. Tepper, Eds., 2nd Edition, Clinical Radiation Oncology, Churchill Livingstone, Elsevier Publications, 2007, pp. 1475-1495.
[3] E. P. Saibishkumar, M. A. Mackenzie, D. Severin, A. Mihai, J. Hanson, H. Daly, G. Fallone, M. B. Parliament and B. Abdulkarim, “Skin-Sparing Radiation Using Intensity-Modulated Radiotherapy after Conservative Surgery in Early-Stage Breast Cancer: A Planning Study,” International Journal of Radiation Oncology Biological Physics, Vol. 70, No. 2, 2008, pp. 485-491. http://dx.doi.org/10. 1016/j.ijrobp.2007.06.049
[4] J. Caudell, F. Jennifer, D. L. Santos, K. S. Keene, J. B. Fiveash, W. Wang and J. D. Carlisle, “A Dosimetric Comparison of Electronic Compensation, Conventional Intensity Modulated Radiotherapy, and Tomotherapy in Patients with Early-Stage Carcinoma of the Left Breast Jimmy Popple,” International Journal of Radiation Oncology Biological Physics, Vol. 68, No. 5, 2007, pp. 1505-1511. http://dx.doi.org/10.1016/j.ijrobp.2007.04.026
[5] N. Dogan and G. P. Glasgow, “Surface and Build-Up Region Dosimetry for Obliquely Incident Intensity Modulated Radiotherapy 6 MV X-Rays,” Medical Physics, Vol. 30, No. 12, 2003, pp. 3091-3096. http://dx.doi.org/10.1118/1.1625116
[6] S. H. Hsu, P. L. Roberson, Y. Chen, R. B. Marsh, L. J. Pierce and J. M. Moran, “Assessment of Skin Dose for Breast Chest Wall Radiotherapy as a Function of Bolus Material,” Physics in Medicine and Biology, Vol. 53, No. 10, 2008, pp. 2593-2606. http://dx.doi.org/10.1088/0031-9155/53/10/010
[7] S. Yokoyama, P. L. Roberson, D. W. Litzenberg, J. M. Moran and B. A. Fraass, “Surface Buildup Dose Dependence on Photon Field Delivery Technique for IMRT,” Journal of Applied Clinical Medical Physics, Vol. 5, No. 2, 2004, pp. 71-81. http://dx.doi.org/10.1120/jacmp.2020.21706
[8] M. Nakano, R. F. Hill, M. Whitaker, J. H. Kim and Z. J. Kuncic, “A Study of Surface Dosimetry for Breast Cancer Radiotherapy Treatments Using Gafchromic EBT2 Film,” Journal of Applied Clinical Medical Physics, Vol. 13, No. 3, 2012, pp. 83-96.
[9] K. Y. Quach, J. Morales, M. J. Butson, A. B. Rosenfeld and P. E. Metcalfe, “Measurement of Radiotherapy X-Ray Skin Dose on a Chest Wall Phantom,” Medical Physics, Vol. 27, No. 7, 2000, pp. 1676-1680.
[10] K. Krishnamurthy, S. S. Sivakumar, C. A. Davis, R. Ravichandran and K. ElGhamrawy, “Optimization of Dose Distribution with Multi-Leaf Collimator Using Field-inField Technique for Parallel Opposing Tangential Beams of Breast Cancers,” Journal of Medical Physics, Vol. 33, No. 2, 2008, pp. 60-63. http://dx.doi.org/10.4103/0971-6203.41194
[11] Z. S. Al-Rahbi, Z. Al Mandhari, R. Ravichandran, F. Al-Kindi, C. A. Davis, S. Bhasi, N. Satyapal and B. Rajan, “Dosimetric Comparison of Intensity Modulated Radiotherapy Isocentric Field Plans and Field in Field forward Plans in the Treatment of Breast Cancer,” Journal of Medical Physics, Vol. 38, No. 1, 2013, pp. 34-41. http://dx.doi.org/10.4103/0971-6203.106601
[12] A. Kelly, N. Hardcastle, Metcalfe, D. Cutajar, A. Quinn, K. Foo, M. Cardoso, S. Barlin and A. Rosenfeld, “Surface Dosimetry for Breast Radiotherapy in the Presence of Immobilization Cast Material,” Physics in Medicine and Biology, Vol. 56, No. 4, 2011, pp. 1001-1013. http://dx.doi.org/10.1088/0031-9155/56/4/008
[13] A. K. Bhatnagar, D. E. Heron, M. Deutch, E. Brandner, W. U. Andrew and S. Kalnicki, “Does Breast Size Affect the Scatter Dose to Ipsilateral Lung, Heart or Contralateral Breast in Primary Irradiation Using Intensity Modulated Radiotherapy (IMRT),” American Journal of Clinical Oncology, Vol. 29, No. 1, 2006, pp. 80-84. http://dx.doi.org/10.1097/01.coc.0000198743.80991.15

Copyright © 2021 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.