Individually selected teletherapy technique for accelerated partial breast irradiation.

Area of Science:

• Radiation Oncology
• Medical Physics
• Oncology

Background:

• Accelerated partial breast irradiation (APBI) aims to optimize dose distribution for breast cancer patients.
• Protecting organs at risk and predicting the most advantageous radiotherapy technique are crucial for personalized treatment.
• Individualizing APBI requires careful consideration of various treatment planning techniques.

Purpose of the Study:

• To individualize accelerated partial breast irradiation (APBI) by optimizing dose distribution.
• To protect organs at risk during APBI.
• To predict the most advantageous radiotherapy technique for APBI based on patient-specific factors.

Main Methods:

• 138 breast cancer patients receiving postoperative APBI were analyzed.
• APBI plans were generated using 3D-conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT).
• A novel plan quality index (PQI) was used for plan comparison, with additional electron beam considerations for superficial tumors.

Main Results:

• IMRT demonstrated superior homogeneity, VMAT offered the best conformity, and 3D-CRT resulted in the lowest lung and heart exposure.
• VMAT achieved the highest PQI in 32.61% of cases, while IMRT and 3D-CRT were superior in specific scenarios, particularly for large planning target volumes (PTV) where 3D-CRT was most favorable.
• IMRT showed advantages over VMAT for superficial tumors or those in medial/upper quadrants. Electron beam addition improved 3D-CRT PQI but not IMRT or VMAT.

Conclusions:

• Individually selected teletherapy techniques provide superior results in approximately half of all cases.
• The optimal APBI technique can be predicted based on planning target volume (PTV) size and tumor localization.
• Personalized selection of radiotherapy techniques is essential for maximizing treatment efficacy and minimizing toxicity in APBI.