Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) · 2026
Skin dose in post-mastectomy radiotherapy - a comparative analysis of field-in-field intensity modulated radiotherapy and volumetric modulated arc therapy.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Ali T, Pignol J P, Fishawy M Al, Salmi F Al, Mandhari Z Al, Amri I Al, Lopes A P Galerani, Af Rosenschold P Munck
Аннотация
BACKGROUND AND PURPOSE: Post-mastectomy radiotherapy (PMRT) improves both the locoregional control and survival in advanced breast cancer. While the use of bolus can enhance skin dose, many oncologists prefer not to use it because of the dramatic increase in skin toxicity. The optimal technique to ensure adequate skin dose is unknown, and this study compares the superficial dose for three techniques - field-in-field intensity modulated radiotherapy (FIF-IMRT), volumetric-modulated arc therapy (VMAT), and flattening-filter-free volumetric-modulated arc therapy (FFF-VMAT) - in patients receiving only PMRT without bolus.
METHODS: CT simulation data of 51 post-mastectomy patients treated between 2023 and 2024 were acquired. For each patient, three plans (FIF-IMRT, VMAT, FFF-VMAT) were generated using 6 MV beams with the Anisotropic Analytical Algorithm (AAA) for dose calculation. The skin target volume was defined as a 2 to 5 mm subcutaneous layer. Dosimetric endpoints included skin V90%, mean dose, Dmin1cc, and PTV_eval V90% and V105%. Statistical analysis used was the Friedman test with significance set at p < 0.001.
RESULTS: 153 plans were generated. FIF-IMRT systematically demonstrated superior skin coverage: median skin V90% was 81.6% vs. 61.5% (FFF-VMAT) and 57.0% (VMAT); median mean skin dose was 94.6% (FIF-IMRT) vs. 90.7% (FFF-VMAT) and 90.1% (VMAT). Dmin1cc was also the highest with FIF-IMRT. Differences were all statistically significant (p < 0.001). The PTV_eval dose was more homogeneous with VMAT and FFF-VMAT, and a 2.1% increase of V105% with FIF-IMRT was deemed clinically acceptable.
CONCLUSION: In the absence of a bolus, FIF-IMRT systematically provides superior and consistent coverage of the superficial dermis compared to VMAT-based techniques.
METHODS: CT simulation data of 51 post-mastectomy patients treated between 2023 and 2024 were acquired. For each patient, three plans (FIF-IMRT, VMAT, FFF-VMAT) were generated using 6 MV beams with the Anisotropic Analytical Algorithm (AAA) for dose calculation. The skin target volume was defined as a 2 to 5 mm subcutaneous layer. Dosimetric endpoints included skin V90%, mean dose, Dmin1cc, and PTV_eval V90% and V105%. Statistical analysis used was the Friedman test with significance set at p < 0.001.
RESULTS: 153 plans were generated. FIF-IMRT systematically demonstrated superior skin coverage: median skin V90% was 81.6% vs. 61.5% (FFF-VMAT) and 57.0% (VMAT); median mean skin dose was 94.6% (FIF-IMRT) vs. 90.7% (FFF-VMAT) and 90.1% (VMAT). Dmin1cc was also the highest with FIF-IMRT. Differences were all statistically significant (p < 0.001). The PTV_eval dose was more homogeneous with VMAT and FFF-VMAT, and a 2.1% increase of V105% with FIF-IMRT was deemed clinically acceptable.
CONCLUSION: In the absence of a bolus, FIF-IMRT systematically provides superior and consistent coverage of the superficial dermis compared to VMAT-based techniques.