title: Dosimetric evaluation of conventional radiotherapy, 3-D conformal radiotherapy and direct machine parameter optimisation intensity-modulated radiotherapy for breast cancer after conservative surgery.
abstract: BACKGROUND
  The use of conservative surgery combined with whole-breast irradiation (WBI) has been established as a valid alternative to mastectomy for the management of early-stage breast cancer. The aim of this study was to compare dosimetric parameters of the planning target volume(PTV) and organs at risk (OARs) between conventional radiation therapy (CR), 3-D conformal radiation therapy (3DCRT), and direct machine parameter optimisation intensity-modulated radiation therapy (DMPO-IMRT) after breast-conserving surgery.
  
  
  METHODS
  Computed tomography (CT) scans from 20 patients (13 left-sided and 7 right-sided) previously treated with T1N0 or ductal carcinoma were selected for this dosimetric planning study. We designed CR, 3DCRT and DMPO-IMRT plans for each patient. The prescribed dose was 50 Gy/2 Gy/25 f, 95% of PTV received the prescription dose. Doses were computed with a commercially available treatment planning system using convolution/superimposition (CS) algorithm. Plans were compared according to dose-volume histogram (DVH) analysis in terms of PTV homogeneity and conformity indices (HI and CI) as well as OARs dose and volume parameters.
  
  
  RESULTS
  Both the HI and CI of the PTV showed statistically significant difference between CR, 3DCRT and DMPO-IMRT with those of DMPO-IMRT were best (P < 0.05). Compared with CR, 3DCRT showed smaller exposed volumes of ipsilateral lung, contralateral breast and heart while DMPO-IMRT indicated larger exposed volumes of ipsilateral lung (except for V20 and V30), contralateral breast and heart. In addition, DMPO-IMRT demonstrated an increase of exposed volume of ipsilateral lung (except for V30), contralateral breast and heart compared with 3DCRT.
  
  
  CONCLUSIONS
  In WBI of breast cancer after conservative surgery, 3DCRT and DMPO-IMRT improved the homogeneity and conformity of the PTV compared with CR. Meanwhile, 3DCRT reduced the irradiated volumes of OARs at all dose levels listed in our study while DMPO-IMRT reduced the irradiated volumes of OARs in high-dose areas but increased the irradiated volumes of OARs in low-dose areas.
authors.affiliation: Radiation Oncology Department, the Military General Hospital of Beijing PLA, Dongcheng, Beijing, China. radiozfli@163.com
authors.forename: Fuli
authors.initials: F
authors.lastname: Zhang
authors.forename: Mingmin
authors.initials: M
authors.lastname: Zheng
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D016896:Treatment Outcome