Evaluation of volumetric modulated arc therapy for postmastectomy treatment.

PURPOSE: To examine the feasibility of volumetric modulated arc therapy (VMAT) for post mastectomy radiotherapy (PMRT).

METHODS AND MATERIALS: Fifteen PMRT patients previously treated at our clinic with helical tomotherapy (HT) were identified for the study. Planning target volumes (PTV) included the chest wall and regional lymph nodes. A systematic approach to constructing VMAT that met the clinical goals was devised. VMAT plans were then constructed for each patient and compared with HT plans with which they had been treated. The resulting plans were compared on the basis of PTV coverage; dose homogeneity index (DHI) and conformity index (CI); dose to organs at risk (OAR); tumor control probability (TCP), normal tissue complication probability (NTCP) and secondary cancer complication probability (SCCP); and treatment delivery time. Differences were tested for significance using the paired Student's t-test.

RESULTS: Both modalities produced clinically acceptable PMRT plans. VMAT plans showed better CI (p<0.01) and better OAR sparing at low doses than HT plans, particularly at doses less than 5 Gy. On the other hand, HT plans showed better DHI (p<0.01) and showed better OAR sparing at higher doses. Both modalities achieved nearly 100% tumor control probability and approximately 1% NTCP in the lungs and heart. VMAT showed lower SCCP than HT (p<0.01), though both plans showed higher SCCP values than conventional mixed beam (electron-photon) plans reported by our group previously. VMAT plans required 66.2% less time to deliver than HT.

CONCLUSIONS: Both VMAT and HT provide acceptable treatment plans for PMRT. Both techniques are currently utilized at our institution.