Comparison of breast simultaneous integrated boost (SIB) radiotherapy techniques

Purpose: To dosimetrically evaluate different breast SIB techniques with respect to target coverage and organs at risk (OARs) doses. Methods: Four IMRT techniques were compared in 12 patients. Three techniques employ tangential whole breast irradiation with either two coplanar fields (T-2F), or four non-coplanar fields (T-NC), or one Volumetric Modulated Arc Therapy (T-VMAT) for the boost volume. The fourth technique is a fully-modulated VMAT technique (f-VMAT). Dosimetric parameters were compared for the boost and breast target volumes as well as OARs. Delivery efficiency was analysed based on number of monitor units (MUs) and estimated delivery time. Results: T-VMAT and f-VMAT ranked highest with respect to integral assessment of boost and breast treatment quality measures. T-VMAT significantly outperformed f-VMAT with respect to ipsi-lateral lung and left-sided patients' heart volumes >= 5 Gy (35 % +/- 5 % vs. 52 % +/- 6 % and 11 % +/- 5 % vs. 22 % +/- 6 %, respectively). f-VMAT significantly outperformed T-VMAT with respect to ipsi-lateral lung volume >= 20 Gy (13 % +/- 2 % vs. 15 % +/- 3 %) and heart volume >= 30 Gy in left breast cancer (0 % +/- 0 % vs. 1 % +/- 1 %). T-VMAT and f-VMAT needed 442 +/- 58 and 1016 +/- 152 MUs, respectively. Conclusions: The hybrid T-VMAT is considered the technique of choice due to its balance of quality, efficiency and dose to OARs.