Optimum Treatment Planning Technique Evaluation for Synchronous Bilateral Breast Cancer with Left Side Supraclavicular Lymph Nodes

Introduction: Bilateral breast cancer cases are classified as complex in radiotherapy treatment, especially those with the left side mastectomy and right-side lumpectomy with left side supraclavicular lymph nodes patients. The purpose of this study is to find the optimum treatment planning technique among the three available techniques: ۳Dimentional conformal Radiotherapy (۳D-CRT), Intensity modulated radiation therapy (IMRT), and Volumetric Modulated Arc Therapu (VMAT). Material and Methods: Ten Bilateral breast cancer included in this study with left-side mastectomy and right-side lumpectomy with left-side supraclavicular lymph nodes. The patients are delineated by oncologists and prepared for radiation planning by MONACO ۵.۱ treatment planning system (TPS) with an X-ray photon beam of ۶ MV or ۱۰ MV energy using ‎ELEKTA’s Agility linear accelerator. The prescribed dose is set at ۴۰۰۵ cCy per ۱۵ fractions. Statistically with anova test among each other. Results: The treatment with ۳D-CRT, IMRT, and VMAT show a significant difference in the results. VMAT gives high dose distribution for the left mastectomy breast and its regional supraclavicular lymph nodes, while the IMRT gives a higher value for the right side breast with lumpectomy. The good homogeneity index is acquired with IMRT, while VMAT gives a better conformity index. The ۳D-CRT planning technique lowers the dose to the heart and lunges better than the other techniques. Conclusion: depending on the patient health and stage, the optimum treatment planning is applied. VMAT and IMRT give effective results than the ۳D-CRT.  

Keywords:

Synchronous Bilateral Breast Cancer Supraclavicular IMRT VMAT ۳D , CRT