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Experimental determination of breast skin dose using volumetric modulated arc therapy and field-in-field treatment techniques

Published online by Cambridge University Press:  03 October 2022

Ana María Cardona-Maya ,
José Alejandro Rojas-López Open the ORCID record for José Alejandro Rojas-López [Opens in a new window] ,
Alejandro Germanier ,
Patricia Murina  and
Daniel Venencia
Ana María Cardona-Maya
Affiliation:
Instituto Zunino, Córdoba, Argentina
José Alejandro Rojas-López*
Affiliation:
Instituto Zunino, Córdoba, Argentina Facultad de Matemática, Astronomía, Física y Computación, Universidad Nacional de Córdoba, Córdoba, Argentina
Alejandro Germanier
Affiliation:
Unidad Estudios Físicos, CEPROCOR, Ministerio de Ciencia y Tecnología, Córdoba, Argentina
Patricia Murina
Affiliation:
Instituto Zunino, Córdoba, Argentina
Daniel Venencia
Affiliation:
Instituto Zunino, Córdoba, Argentina
*
Author for correspondence: José Alejandro Rojas-López, Instituto Zunino, 423 Bispo Oro, Córdoba 5000, Argentina. E-mail: alexrojas@ciencias.unam.mx
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Abstract

Introduction:

The use of volumetric modulated arc therapy (VMAT) on the breast has several dosimetric advantages but its impact on skin dose should be evaluated and compared to well-established treatment techniques using tangential fields. The aim of this work is to contrast the skin dose for VMAT and field-in-field (FIF) and to estimate the magnitude of the skin dose involved.

Method:

The skin dose was measured, without build-up, using thermoluminescent dosimeter (TLD) and optically stimulated luminescence dosimeter (OSLD) in breast radiotherapy by an in-house anthropomorphic phantom. Two different treatment techniques were used: FIF and VMAT, based on the planning strategy proposed by Nicolini et al. The dose levels were 4300 cGy, 4600 cGy and 5600 cGy in 20 fractions. In vivo dosimetry with TLD for VMAT was performed for different breast sizes in the same locations as phantom measurements.

Results:

The ipsilateral phantom breast skin dose using both treatment techniques was equivalent. TLD measured doses by the VMAT technique were up to 5% higher than OSLD, although they agree if we consider the geometry uncertainty of the TLD. In accordance with in vivo dosimetry, the mean dose of the ipsilateral breast skin was 62 ± 6% (51%, 75%) relative to the prescribed dose, regardless of the breast size for the volumes considered with this small population (n = 9) as shown by Mann–Whitney U-test (Z = 1·9, 95% confidence). The uncertainty expected in this region due to geometry (volume) changes is up to 9% higher for volumes from 225·9 cc to 968·8 cc. According to the treatment techniques and in vivo dosimetry, the contralateral breast skin dose was 1·0% in FIF and 2·5% in VMAT concerning the prescribed dose.

Conclusion:

There is no difference in skin dosimetry between VMAT and FIF techniques on the ipsilateral breast. It provides useful support for the use of VMAT as a planning technique for breast irradiation. The work describes the importance of quantifying potential differences in skin dosimetry.

Keywords

breast skin dosefield-in-fieldOSLDTLDVMAT
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e59
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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