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Fluence smoothing evaluation for whole-breast automatically generated treatment plans
Giulianne Rivelli R Zaratim1,2, Luis Felipe Oliveira E Silva2,3, Ricardo G Dos Reis1,3
1Department of Biomedical Engineering, University of Brasilia, Brasília, Brazil.
Journal of Applied Clinical Medical Physics
|November 29, 2024
Summary
Optimizing fluence smoothing in breast cancer intensity-modulated radiation therapy (IMRT) is key. A smoothing weight to target priority ratio of 1:1.5 to 1:1.6 balances plan complexity and dosimetric quality without compromising dose adherence.
Area of Science:
- Medical Physics
- Radiation Oncology
- Radiotherapy Planning
Background:
- Intensity-modulated radiation therapy (IMRT) is a standard treatment for breast cancer.
- Fluence smoothing is a critical step in IMRT planning to reduce dose complexity.
- Optimizing smoothing parameters is essential for maintaining dosimetric quality and treatment efficacy.
Purpose of the Study:
- To determine the optimal fluence smoothing threshold for breast cancer IMRT.
- To evaluate the impact of different smoothing weight combinations on dosimetric plan quality.
- To identify a balance between treatment plan complexity and adherence to dose constraints.
Main Methods:
- Automated treatment planning for 60 breast cancer patients using the Eclipse Scripting Application Programming Interface.
- Four-field IMRT plans were generated with four different smoothing weight sets.
- Dosimetric data, including planning target volume (PTV) coverage and organ-at-risk (OAR) constraints, were statistically analyzed.
Main Results:
- Default smoothing (40x30) provided superior median PTV coverage.
- Higher smoothing levels significantly impacted lung constraints and reduced monitor units.
- Heart and contralateral breast constraints showed minimal variation across smoothing levels, with some exceptions for right-sided patients.
- A smoothing weight to target priority ratio between 1:1.5 and 1:1.6 demonstrated favorable outcomes.
Conclusions:
- A smoothing weight to target priority ratio of 1:1.5 to 1:1.6 offers an optimal balance for breast cancer IMRT.
- This ratio ensures good dosimetric plan quality without negatively affecting dose constraint adherence.
- The findings provide guidance for refining IMRT planning parameters to improve treatment outcomes.
