[Home ] [Archive]    
:: Main :: About :: Current Issue :: Archive :: Search :: Submit :: Contact ::
Main Menu
Home::
IJRR Information::
For Authors::
For Reviewers::
Subscription::
News & Events::
Web Mail::
::
Search in website

Advanced Search
..
Receive site information
Enter your Email in the following box to receive the site news and information.
..
ISSN
Hard Copy 2322-3243
Online 2345-4229
..
Online Submission
Now you can send your articles to IJRR office using the article submission system.
..

AWT IMAGE

AWT IMAGE

:: Volume 24, Issue 2 (4-2026) ::
Int J Radiat Res 2026, 24(2): 301-307 Back to browse issues page
Dosimetric comparison of IMRT and VMAT treatment plans for breast cancer with 1-2 sentinel lymph node metastasis
K. Yao , M. Wang , C. Shi , H. Wu , J. Liu , H. Yue , R. Wang , Y. Du
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Beijing 100142, China , ruoxi.wang@pku.edu.cn
Abstract:   (729 Views)
Background: To compare the dosimetry of Intensity-Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) techniques for breast cancer patients with 1-2 sentinel lymph node metastases. Materials and Methods: A total of 90 breast cancer patients (left:33, right:57) receiving post-operative radiotherapy were retrospectively included. IMRT and VMAT treatment plans were designed for each patient with same prescriptions and dose-volume constraints. Key dose-volume histogram (DVH) metrics in target volumes and organs-at-risks (OARs) were analyzed and compared in groups. Results: Compared with IMRT, VMAT showed superior target coverage and dose conformity, particularly for planning target volume (PTV) and axillary levels 1-2 lymph nodes in both left- and right-sided cancers. For left-sided cases, VMAT significantly reduced mean dose (Dmean) to the heart and left coronary artery (p<0.001), with a 33% decrease in V40% for left coronary artery. For right-sided cases, VMAT showed a modest Dmean increase to these structures due to dose spillage, though all values remained within clinical constraints. Compared with IMRT, VMAT demonstrated superior dose sparing for the ipsilateral lung and humeral head. While both techniques achieved comparable dose coverage for axillary level 3 lymph nodes (p > 0.05), VMAT required significantly fewer monitor units (MU) (p < 0.001). Conclusion: The dosimetric analysis demonstrates VMAT's superiority over IMRT in breast cancer patients with 1-2 sentinel lymph node metastases, offering improved target coverage, enhanced organ sparing, and greater delivery efficiency.
Keywords: Breast Cancer, Sentinel Irradiation, Lymph Node Metastasis, Dosimetry, Radiotherapy.
Full-Text [PDF 1186 kb]   (298 Downloads)    
Type of Study: Original Research | Subject: Radiation Biology
References
1. 1. Fakhri N, Chad MA, Lahkim M, Houari A, Dehbi H, Belmouden A, et al. (2022) Risk factors for breast cancer in women: an update review. Med Oncol, 39(12): 197. [DOI:10.1007/s12032-022-01804-x]
2. Bartels SAL, Donker M, Poncet C, Sauve N, Straver ME, van de Velde CJH, et al. (2023) Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer: 10-year results of the randomized controlled EORTC 10981-22023 AMAROS Trial. J Clin Oncol, 41(12): 2159-65. [DOI:10.1200/JCO.22.01565]
3. Garcia-Etienne CA, Ferrari A, Della Valle A, Lucioni M, Ferraris E, Di Giulio G, et al. (2020) Management of the axilla in patients with breast cancer and positive sentinel lymph node biopsy: An evidence-based update in a European breast center. Eur J Surg Oncol, 46(1): 15-23. [DOI:10.1016/j.ejso.2019.08.013]
4. Jimenez-Gomez M, Loro-Perez J, Vega-Benitez V, Hernandez-Hernandez JR, Aguirre NA (2023) Axillary management in patients with breast cancer and positive axilla at diagnosis. Experience in a Spanish university hospital with a 5-year follow-up. J Cancer Res Ther, 19(2): 183-90. [DOI:10.4103/jcrt.jcrt_263_22]
5. Ling DC, Iarrobino NA, Champ CE, Soran A, Beriwal S (2020) Regional recurrence rates with or without complete axillary dissection for breast cancer patients with node-positive disease on sentinel lymph node biopsy after neoadjuvant chemotherapy. Adv Radiat Oncol, 5(2): 163-70. [DOI:10.1016/j.adro.2019.09.006]
6. Wu J, Lu AD, Zhang LP, Zuo YX, Jia YP (2019) Study of clinical outcome and prognosis in pediatric core binding factor-acute myeloid leukemia. Zhonghua Xue Ye Xue Za Zhi, 40(1): 52-7.
7. Reed DR, Lindsley SK, Mann GN, Austin-Seymour M, Korssjoen T, Anderson BO, et al. (2005) Axillary lymph node dose with tangential breast irradiation. Int J Radiat Oncol Biol Phys, 61(2): 358-64. [DOI:10.1016/j.ijrobp.2004.06.006]
8. Jacobson G, Bunda-Randall N, Wen S, Miller M (2017) Axillary lymph node coverage with 3-dimensional tangential field irradiation and correlation with heart and lung dose. Adv Radiat Oncol, 2(4): 630-5. [DOI:10.1016/j.adro.2017.07.005]
9. Nitsche M, Temme N, Forster M, Reible M, Hermann RM (2014) Tangential vs defined radiotherapy in early breast cancer treatment without axillary lymph node dissection: a comparative study. Strahlenther Onkol, 190(8): 715-21. [DOI:10.1007/s00066-014-0681-6]
10. Alco G, Igdem SI, Ercan T, Dincer M, Senturk R, Atilla S, et al. (2010) Coverage of axillary lymph nodes with high tangential fields in breast radiotherapy. Br J Radiol, 83(996): 1072-6. [DOI:10.1259/bjr/25788274]
11. Seppala J, Heikkila J, Myllyoja K, Koskela K (2015) Volumetric modulated arc therapy for synchronous bilateral whole breast irradiation - A case study. Rep Pract Oncol Radiother, 20(5): 398-402. [DOI:10.1016/j.rpor.2015.05.011]
12. Bi S, Zhu R, Dai Z (2022) Dosimetric and radiobiological comparison of simultaneous integrated boost radiotherapy for early stage right side breast cancer between three techniques: IMRT, hybrid IMRT and hybrid VMAT. Radiat Oncol, 17(1): 60. [DOI:10.1186/s13014-022-02009-2]
13. Rossi M, Boman E, Kapanen M (2019) Contralateral tissue sparing in lymph node-positive breast cancer radiotherapy with VMAT technique. Med Dosim, 44(2): 117-21. [DOI:10.1016/j.meddos.2018.03.005]
14. Shao WC, Yin HT, Zhang H. (2022) Assessment of vital organ dose in volumetric intensity modulated arc therapy for left and right breast cancer. Int J Radiat Res, 20(4): 761-5.
15. Arslan A, Aktas E, Eren SK, Dengiz I, Arslan SA, Güney Y (2023) Dosimetric comparison of the heart substructures with IMRT and VMAT techniques in left breast radiotherapy: The effect of deep inspiratory breath-hold. Int J Radiat Res, 21(1): 23-30.
16. Viren T, Heikkila J, Myllyoja K, Koskela K, Lahtinen T, Seppala J (2015) Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiat Oncol, 10: 79. [DOI:10.1186/s13014-015-0392-x]
17. Byrne M, Archibald-Heeren B, Hu Y, Fong A, Chong L, Teh A (2018) Comparison of semiautomated tangential VMAT with 3DCRT for breast or chest wall and regional nodes. J Appl Clin Med Phys, 19(5): 684-93. [DOI:10.1002/acm2.12442]
18. Boman E, Rossi M, Haltamo M, Skytta T, Kapanen M (2016) A new split arc VMAT technique for lymph node positive breast cancer. Phys Med, 28: s1120-1797 (16) 30954-1. [DOI:10.1016/j.ejmp.2016.10.012]
19. Offersen BV, Boersma LJ, Kirkove C, Hol S, Aznar MC, Biete Sola A, et al. (2015) ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol, 114(1): 3-10. [DOI:10.1016/j.radonc.2014.11.030]
20. Paddick I and Lippitz B (2006) A simple dose gradient measurement tool to complement the conformity index. J Neurosurg, 105 Suppl: 194-201. [DOI:10.3171/sup.2006.105.7.194]
21. Shaw E, Kline R, Gillin M, Souhami L, Hirschfeld A, Dinapoli R, et al. (1993) Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys, 27(5): 1231-9. [DOI:10.1016/0360-3016(93)90548-A]
22. Castelo M, Hu SY, Dossa F, Acuna SA, Scheer AS (2020) Comparing observation, axillary radiotherapy, and completion axillary lymph node dissection for management of axilla in breast cancer in patients with positive sentinel nodes: A systematic review. Ann Surg Oncol, 27(8): 2664-76. [DOI:10.1245/s10434-020-08225-y]
23. Gradishar WJ, Moran MS, Abraham J, Abramson V, Aft R, Agnese D, et al. (2023) NCCN Guidelines(R) Insights: Breast Cancer, Version 4.2023. J Natl Compr Canc Netw, 21(6): 594-608. [DOI:10.6004/jnccn.2023.0031]
24. Keenan LG, Lavan N, Dunne M, McArdle O (2019) Modifiable risk factors for acute skin toxicity in adjuvant breast radiotherapy: Dosimetric analysis and review of the literature. Med Dosim, 44(1): 51-5. [DOI:10.1016/j.meddos.2018.01.004]
25. Qiu J, Zhang S, Lv B, Zheng X (2021) Cardiac dose control and optimization strategy for left breast cancer radiotherapy with non-uniform VMAT technology. Technol Cancer Res Treat, 20: 15330338211053752. [DOI:10.1177/15330338211053752]
26. Liu ZM, Ge XL, Chen JY, Wang PP, Zhang C, Yang X, et al. (2015) Adjuvant radiotherapy after breast conserving treatment for breast cancer: a dosimetric comparison between volumetric modulated arc therapy and intensity modulated radiotherapy. Asian Pac J Cancer Prev, 16(8): 3257-65. [DOI:10.7314/APJCP.2015.16.8.3257]
27. Zhang Q, Yu XL, Hu WG, Chen JY, Wang JZ, Ye JS, et al. (2015) Dosimetric comparison for volumetric modulated arc therapy and intensity-modulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer. Radiol Oncol, 49(1): 91-8. [DOI:10.2478/raon-2014-0033]
28. Xie Y, Bourgeois D, Guo B, Zhang R (2020) Postmastectomy radiotherapy for left-sided breast cancer patients: Comparison of advanced techniques. Med Dosim, 45(1): 34-40. [DOI:10.1016/j.meddos.2019.04.005]
29. Popescu CC, Olivotto IA, Beckham WA, Ansbacher W, Zavgorodni S, Shaffer R, et al. (2010) Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for locoregional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys, 76(1): 287-95. [DOI:10.1016/j.ijrobp.2009.05.038]
30. Seo I and Jang H (2022) Increased second primary liver cancer risk in young breast cancer patients undergoing radiotherapy and chemotherapy: a nationwide population-based study. Int J Radiat Res, 20(2): 291-7. [DOI:10.52547/ijrr.20.2.6]
31. Jang H, Baek JG, Kim W, Sohn JH (2021) Assessment of intensity modulated radiation therapy in left breast cancer including regional nodes without the internal mammary node: secondary cancer risks on thyroid and stomach. Int J Radiat Res, 19(4): 921-8. [DOI:10.52547/ijrr.19.4.19]
32. Abo-Madyan Y, Aziz MH, Aly MM, Schneider F, Sperk E, Clausen S, et al. (2014) Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer. Radiother Oncol, 110(3): 471-6. [DOI:10.1016/j.radonc.2013.12.002]
33. Lee B, Lee S, Sung J, Yoon M (2014) Radiotherapy-induced secondary cancer risk for breast cancer: 3D conformal therapy versus IMRT versus VMAT. J Radiol Prot, 34(2): 325-31. [DOI:10.1088/0952-4746/34/2/325]
34. Fogliata A, De Rose F, Franceschini D, Stravato A, Seppala J, Scorsetti M, et al. (2018) Critical appraisal of the risk of secondary cancer induction from breast radiation therapy with volumetric modulated arc therapy relative to 3D conformal therapy. Int J Radiat Oncol Biol Phys, 100(3): 785-93. [DOI:10.1016/j.ijrobp.2017.10.040]
35. Yin Y, Chen J, Sun T, Ma C, Lu J, Liu T, et al. (2012) Dosimetric research on intensity-modulated arc radiotherapy planning for left breast cancer after breast-preservation surgery. Med Dosim, 37(3): 287-92. [DOI:10.1016/j.meddos.2011.11.001]
36. Tsai PF, Lin SM, Lee SH, Yeh CY, Huang YT, Lee CC, et al. (2012) The feasibility study of using multiple partial volumetric-modulated arcs therapy in early stage left-sided breast cancer patients. J Appl Clin Med Phys, 13(5): 3806. [DOI:10.1120/jacmp.v13i5.3806]
37. Liu H, Chen X, He Z, Li J. (2016) Evaluation of 3D-CRT, IMRT and VMAT radiotherapy plans for left breast cancer based on clinical dosimetric study. Comput Med Imaging Graph, 54: 1-5. [DOI:10.1016/j.compmedimag.2016.10.001]
38. Chun M, Joon An H, Kwon O, Oh DH, Park JM, Kim JI (2019) Impact of plan parameters and modulation indices on patient-specific QA results for standard and stereotactic VMAT. Phys Med, 62: 83-94. [DOI:10.1016/j.ejmp.2019.05.005]
39. Park JM, Kim JI, Park SY (2019) Modulation indices and plan delivery accuracy of volumetric modulated arc therapy. J Appl Clin Med Phys, 20(6): 12-22. [DOI:10.1002/acm2.12589]
Send email to the article author

Add your comments about this article
Your username or Email:

CAPTCHA



XML     Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Yao K, Wang M, Shi C, Wu H, Liu J, Yue H, et al . Dosimetric comparison of IMRT and VMAT treatment plans for breast cancer with 1-2 sentinel lymph node metastasis. Int J Radiat Res 2026; 24 (2) :301-307
URL: http://ijrr.com/article-1-7004-en.html


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Volume 24, Issue 2 (4-2026) Back to browse issues page
International Journal of Radiation Research
Persian site map - English site map - Created in 0.11 seconds with 50 queries by YEKTAWEB 4741