title: Combined modulated electron and photon beams planned by a Monte-Carlo-based optimization procedure for accelerated partial breast irradiation.
abstract: The purpose of this study was to present a Monte-Carlo (MC)-based optimization procedure to improve conventional treatment plans for accelerated partial breast irradiation (APBI) using modulated electron beams alone or combined with modulated photon beams, to be delivered by a single collimation device, i.e. a photon multi-leaf collimator (xMLC) already installed in a standard hospital. Five left-sided breast cases were retrospectively planned using modulated photon and/or electron beams with an in-house treatment planning system (TPS), called CARMEN, and based on MC simulations. For comparison, the same cases were also planned by a PINNACLE TPS using conventional inverse intensity modulated radiation therapy (IMRT). Normal tissue complication probability for pericarditis, pneumonitis and breast fibrosis was calculated. CARMEN plans showed similar acceptable planning target volume (PTV) coverage as conventional IMRT plans with 90% of PTV volume covered by the prescribed dose (D(p)). Heart and ipsilateral lung receiving 5% D(p) and 15% D(p), respectively, was 3.2-3.6 times lower for CARMEN plans. Ipsilateral breast receiving 50% D(p) and 100% D(p) was an average of 1.4-1.7 times lower for CARMEN plans. Skin and whole body low-dose volume was also reduced. Modulated photon and/or electron beams planned by the CARMEN TPS improve APBI treatments by increasing normal tissue sparing maintaining the same PTV coverage achieved by other techniques. The use of the xMLC, already installed in the linac, to collimate photon and electron beams favors the clinical implementation of APBI with the highest efficiency.
authors.affiliation: Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, Sevilla, Spain.
authors.forename: Bianey Atriana
authors.initials: BA
authors.lastname: Palma
authors.forename: Ana Ureba
authors.initials: AU
authors.lastname: Sánchez
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Salguero
authors.forename: Rafael
authors.initials: R
authors.lastname: Arráns
authors.forename: Carlos Míguez
authors.initials: CM
authors.lastname: Sánchez
authors.forename: Amadeo Walls
authors.initials: AW
authors.lastname: Zurita
authors.forename: María Isabel Romero
authors.initials: MI
authors.lastname: Hermida
authors.forename: Antonio
authors.initials: A
authors.lastname: Leal
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D004583:Electrons; D005260:Female; D005373:Film Dosimetry / Q000379:methods; D006801:Humans; D009010:Monte Carlo Method; D019047:Phantoms, Imaging; D017785:Photons; D011874:Radiometry / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012867:Skin / Q000528:radiation effects; D012984:Software