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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Dosimetric Comparison of Sequential Boost versus Simultaneous Integrated Boost Intensity-modulated Delivery

Mukesh Kumar Zope1, Deepali Patil1, Rohit Verma2

  • 1Department of Medical Physics, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

Journal of Medical Physics
|July 9, 2026
PubMed
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Sequential boost (SB) and simultaneous integrated boost (SIB) offer comparable breast radiotherapy outcomes. SIB improves treatment efficiency and heart sparing, while SB enhances lung sparing, guiding individualized technique selection.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Breast-conserving surgery (BCS) is a standard treatment for breast cancer.
  • Radiotherapy plays a crucial role in reducing local recurrence after BCS.
  • Intensity-modulated techniques offer precise dose delivery for breast radiotherapy.

Purpose of the Study:

  • To compare the dosimetric characteristics of sequential boost (SB) and simultaneous integrated boost (SIB) techniques.
  • To evaluate SB and SIB in left-sided breast cancer patients undergoing BCS.
  • To assess target coverage, dose homogeneity, and organ-at-risk sparing for both techniques.

Main Methods:

  • Retrospective analysis of 27 left-sided breast cancer patients post-BCS.
  • Generation of SB and SIB treatment plans using Eclipse Treatment Planning System.
Keywords:
Breast cancerdosimetrysequential boostsimultaneous integrated boostvolumetric-modulated arc therapy

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  • Comparison of dosimetric parameters including target coverage, homogeneity, conformity, and OAR doses.

    • Main Results:

    • Both SB and SIB achieved adequate target coverage with comparable whole breast mean doses.
    • SIB demonstrated superior dose homogeneity and significantly reduced treatment time and monitor units.
    • SIB offered better sparing of the left anterior descending artery and spinal cord, while SB provided superior ipsilateral lung sparing.

    Conclusions:

    • SIB enhances treatment efficiency and coronary artery sparing, whereas SB excels in V95% coverage and lung sparing.
    • Both techniques are viable options for breast radiotherapy post-BCS.
    • Individualized selection based on patient factors and institutional priorities is recommended.