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A Retrospective Dosimetric Analysis of the New ESTRO-ACROP Target Volume Delineation Guidelines for Postmastectomy Volumetric Modulated Arc Therapy After Implant-Based Immediate Breast Reconstruction

 Kyung Hwan Chang  ;  Jee Suk Chang  ;  Kwangwoo Park  ;  Seung Yeun Chung  ;  Se Young Kim  ;  Ryeong Hwang Park  ;  Min Cheol Han  ;  Jihun Kim  ;  Hojin Kim  ;  Ho Lee  ;  Dong Wook Kim  ;  Yong Bae Kim  ;  Jin Sung Kim  ;  Chae-Seon Hong 
 FRONTIERS IN ONCOLOGY, Vol.10 : 578921, 2020-10 
Journal Title
Issue Date
ESTRO-ACROP guideline ; VMAT ; breast cancer ; immediate breast reconstruction ; postmastectomy radiotherapy (PMRT)
Purpose: The European Society of Radiation & Oncology and Advisory Committee on Radiation Oncology Practice (ESTRO-ACROP) presented new guidelines for clinical target volume (CTV) delineation in post-mastectomy radiation therapy (PMRT) after implant-based immediate breast reconstruction (IBR-i). This study evaluated the dosimetric characteristics, dosimetric accuracy, and delivery accuracy of these guidelines in volumetric modulated arc therapy (VMAT). Methods and Materials: This retrospective study included 15 patients with left breast cancer who underwent mastectomy with tissue expander placement followed by PMRT. An experienced radiation oncologist delineated the CTV twice on the same image datasets based on the ESTRO-ACROP (EA-TVD) and conventional target volume delineation (C-TVD) guidelines. All VMAT plans, which used a double partial arc, were generated using six MV photons. Clinically relevant dose-volume parameters for organs at risk were compared. Dosimetric accuracy of the treatment plans and delivery accuracy were assessed. Results: Target volume of EA-TVD was significantly smaller than that of C-TVD. Although no statistically significant difference was noted in the target coverage between the two VMAT plans, EA-TVD VMAT significantly reduced the mean heart dose (3.99 ± 1.02 vs. 5.84 ± 1.78 Gy, p = 0.000), the maximum left anterior descending coronary artery (LAD) dose (9.43 ± 3.04 vs. 13.97 ± 6.04 Gy, p = 0.026), and the mean LAD dose (4.52 ± 1.31 vs. 6.35 ± 2.79 Gy, p = 0.028) compared with C-TVD VMAT. No significant difference was observed with respect to the total monitor units, plan complexity, and delivery quality assurance. Conclusions: This is the first study to show significant dose reduction for the normal heart and LAD tissue offered by the EA-TVD, while maintaining dosimetric and delivery accuracy, in PMRT after IBR-i in VMAT for left-sided breast cancer patients.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Wook(김동욱) ORCID logo https://orcid.org/0000-0002-5819-9783
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Kim, Jihun(김지훈) ORCID logo https://orcid.org/0000-0003-4856-6305
Kim, Jinsung(김진성) ORCID logo https://orcid.org/0000-0003-1415-6471
Kim, Hojin(김호진) ORCID logo https://orcid.org/0000-0002-4652-8682
Park, Kwang Woo(박광우) ORCID logo https://orcid.org/0000-0002-9843-7985
Lee, Ho(이호) ORCID logo https://orcid.org/0000-0001-5773-6893
Chang, Kyung Hwan(장경환)
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Chung, Seung Yeun(정승연) ORCID logo https://orcid.org/0000-0002-3877-6950
Han, Min Cheol(한민철)
Hong, Chae-Seon(홍채선) ORCID logo https://orcid.org/0000-0001-9120-6132
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