Journal of contemporary brachytherapy · 2026
Dosimetric comparison of organs at risk exposure in multicatheter high-dose-rate interstitial brachytherapy vs. VMAT-based APBI for real patient treatment plans.
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Yaddanapudi Suma, Altintas Mehmet M, Kistler Andreas D, Fernandez Isabel, Möller Clemens C, Wei Changli, Peev Vasil, Flesche Jan B, Forst Anna-Lena, Li Jing, Patrakka Jaakko, Xiao Zhijie, Grahammer Florian, Schiffer Mario, Lohmüller Tobias, Reinheckel Thomas, Gu Changkyu, Huber Tobias B, Ju Wenjun, Bitzer Markus, Rastaldi Maria P, Ruiz Phillip, Tryggvason Karl, Shaw Andrey S, Faul Christian, Sever Sanja, Reiser Jochen
Аннотация
PURPOSE: To dosimetrically compare multicatheter interstitial high-dose-rate brachytherapy (MIBT) with two volumetric modulated arc therapy (VMAT) techniques, i.e., continuous (cVMAT) and tangential (tVMAT), for accelerated partial breast irradiation (APBI), specifically focusing on organs at risk (OARs) exposure.
MATERIAL AND METHODS: Treatment plans of 50 early-stage breast cancer patients treated with interstitial multicatheter HDR brachytherapy (MIBT) were analyzed. Using identical CT datasets with catheters in situ and standardized contours, MIBT, cVMAT, and tVMAT plans were generated for each patient. For VMAT plans, planning target volume (PTV) was created by adding a 5 mm margin to clinical target volume (CTV). A uniform prescription dose of 32 Gy in 8 fractions was applied across all techniques. Dosimetric parameters were evaluated for target volumes, heart (including tumor quadrant sub-group analysis for left-sided cases), ipsilateral lung, skin, ribs, and non-target breast.
RESULTS: VMAT safety margins increased target volume by 129% vs. MIBT. MIBT achieved superior sparing of non-target breast (median V50%: 15.84% vs. 27.66% tVMAT and 23.91% cVMAT, p < 0.0001), skin, and ribs (D1cc, p < 0.0001). For left-sided tumors, overall, tVMAT reduced mean heart dose vs. MIBT (0.38 Gy vs. 1.54 Gy, p < 0.0001). However, sub-group analysis revealed that this cardiac advantage was restricted to upper and outer quadrant tumors, with no significant differences for lower quadrant lesions. cVMAT delivered a high low-dose lung bath (V5%, 52.60%), which was significantly limited by tVMAT (19.26%) and MIBT (15.48%) (p < 0.0001).
CONCLUSIONS: APBI technique selection should be individualized based on anatomy and intramammary tumor bed location. MIBT optimizes sparing of healthy breast tissue, skin, and chest wall across all locations. Conversely, tVMAT provides a cardiac advantage mainly for left-sided upper/ outer quadrant tumors, and effectively minimizes low-dose lung exposure compared with continuous arc arrangements.
MATERIAL AND METHODS: Treatment plans of 50 early-stage breast cancer patients treated with interstitial multicatheter HDR brachytherapy (MIBT) were analyzed. Using identical CT datasets with catheters in situ and standardized contours, MIBT, cVMAT, and tVMAT plans were generated for each patient. For VMAT plans, planning target volume (PTV) was created by adding a 5 mm margin to clinical target volume (CTV). A uniform prescription dose of 32 Gy in 8 fractions was applied across all techniques. Dosimetric parameters were evaluated for target volumes, heart (including tumor quadrant sub-group analysis for left-sided cases), ipsilateral lung, skin, ribs, and non-target breast.
RESULTS: VMAT safety margins increased target volume by 129% vs. MIBT. MIBT achieved superior sparing of non-target breast (median V50%: 15.84% vs. 27.66% tVMAT and 23.91% cVMAT, p < 0.0001), skin, and ribs (D1cc, p < 0.0001). For left-sided tumors, overall, tVMAT reduced mean heart dose vs. MIBT (0.38 Gy vs. 1.54 Gy, p < 0.0001). However, sub-group analysis revealed that this cardiac advantage was restricted to upper and outer quadrant tumors, with no significant differences for lower quadrant lesions. cVMAT delivered a high low-dose lung bath (V5%, 52.60%), which was significantly limited by tVMAT (19.26%) and MIBT (15.48%) (p < 0.0001).
CONCLUSIONS: APBI technique selection should be individualized based on anatomy and intramammary tumor bed location. MIBT optimizes sparing of healthy breast tissue, skin, and chest wall across all locations. Conversely, tVMAT provides a cardiac advantage mainly for left-sided upper/ outer quadrant tumors, and effectively minimizes low-dose lung exposure compared with continuous arc arrangements.