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 Table of Contents    
LETTERS TO EDITOR
Year : 2017  |  Volume : 42  |  Issue : 2  |  Page : 100
 

Response to the comments on “The feasibility study of a hybrid coplanar arc technique versus hybrid intensity-modulated radiotherapy in treatment of early-stage left-sided breast cancer with simultaneous-integrated boost. J Med Phys 2017;42:1-8”


1 Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
2 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA

Date of Web Publication16-Jun-2017

Correspondence Address:
Ben-Hua Xu
Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmp.JMP_56_17

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How to cite this article:
Chen YG, Li AC, Li WY, Huang MY, Li XB, Chen MQ, Zhang M, Xu BH. Response to the comments on “The feasibility study of a hybrid coplanar arc technique versus hybrid intensity-modulated radiotherapy in treatment of early-stage left-sided breast cancer with simultaneous-integrated boost. J Med Phys 2017;42:1-8”. J Med Phys 2017;42:100

How to cite this URL:
Chen YG, Li AC, Li WY, Huang MY, Li XB, Chen MQ, Zhang M, Xu BH. Response to the comments on “The feasibility study of a hybrid coplanar arc technique versus hybrid intensity-modulated radiotherapy in treatment of early-stage left-sided breast cancer with simultaneous-integrated boost. J Med Phys 2017;42:1-8”. J Med Phys [serial online] 2017 [cited 2019 Nov 17];42:100. Available from: http://www.jmp.org.in/text.asp?2017/42/2/100/208272


We highly appreciate your comments. It is well known that there are considerable target position uncertainties during breast radiotherapy. These uncertainties result from respiratory motions, tissue and organ deformation, daily patient setup, and other causes. Respiratory gating and breath control can reduce the target position uncertainties. However, these techniques are not thoroughly implemented at each hospital, including the authors' institutions. In our manuscript,[1] we proposed hybrid plans (three-dimensional conformal radiotherapy [3DCRT] + intensity-modulated radiation therapy [IMRT] or 3DCRT + volumetric modulated arc therapy [VMAT]) solely for simultaneous integrated boost treatment delivery. As indicated in the manuscript, “The rationale of using two coplanar 90° arcs in the hybrid VMAT technology is as follows: (1) In the VMAT plan, two arcs are needed to optimize dose distribution when dealing with a complex target; (2) the target is an arc that was nearly 90° along the chest wall, and the 90° arc in tangential direction enters the target without irradiating much of the lung.” In the left breast irradiation, the target dose inhomogeneity and doses to the organs at risk (OAR), especially the heart, ipsilateral lung, and contralateral breast, are the major limitations of 3DCRT.[2] IMRT is capable of improving dose homogeneity and conformity and sparing normal tissues.[3],[4],[5] Some oncologists illustrate that VMAT has better protection for the adjacent organs than IMRT.[6],[7],[8] In our study, the contribution of IMRT/VMAT is only 30% of the prescribed dose, and 3DCRT delivers 70% of dose in the hybrid plan. For this reason, the hybrid plans of 3DCRT + VMAT result in higher doses to OARs than pure VMAT plans. The 3DCRT portals take into account target position uncertainties; meanwhile, target dose uniformity and normal tissue doses are addressed by the IMRT/VMAT fields. As shown in the manuscript, the hybrid VMAT plans have some dosimetric advantages over previously proposed 3DCRT + IMRT plans. Where respiratory gating or breath control is not implemented, the hybrid plans may be considered for patients who underwent breast-conserving surgery.

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Chen YG, Li AC, Li WY, Huang MY, Li XB, Chen MQ, et al. The feasibility study of a hybrid coplanar arc technique versus hybrid intensity-modulated radiotherapy in treatment of early-stage left-sided breast cancer with simultaneous-integrated boost. J Med Phys 2017;42:1-8.  Back to cited text no. 1
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2.
Buchholz TA, Gurgoze E, Bice WS, Prestidge BR. Dosimetric analysis of intact breast irradiation in off-axis planes. Int J Radiat Oncol Biol Phys 1997;39:261-7.  Back to cited text no. 2
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3.
Kestin LL, Sharpe MB, Frazier RC, Vicini FA, Yan D, Matter RC, et al. Intensity modulation to improve dose uniformity with tangential breast radiotherapy: Initial clinical experience. Int J Radiat Oncol Biol Phys 2000;48:1559-68.  Back to cited text no. 3
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4.
Dogan N, Cuttino L, Lloyd R, Bump EA, Arthur DW. Optimized dose coverage of regional lymph nodes in breast cancer: The role of intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2007;68:1238-50.  Back to cited text no. 4
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5.
Beckham WA, Popescu CC, Patenaude VV, Wai ES, Olivotto IA. Is multibeam IMRT better than standard treatment for patients with left-sided breast cancer? Int J Radiat Oncol Biol Phys 2007;69:918-24.  Back to cited text no. 5
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6.
Zhao LR, Zhou YB, Sun JG. Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation. Oncol Lett 2016;11:3389-94.  Back to cited text no. 6
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7.
Popescu CC, Olivotto IA, Beckham WA, Ansbacher W, Zavgorodni S, Shaffer R, et al. 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 2010;76:287-95.  Back to cited text no. 7
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8.
Nicolini G, Clivio A, Fogliata A, Vanetti E, Cozzi L. Simultaneous integrated boost radiotherapy for bilateral breast: A treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapy. Radiat Oncol 2009;4:27.  Back to cited text no. 8
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