Hypofractionated Hybrid Radiotherapy Techniques for Synchronous Bilateral Breast Cancer.

Objective: This study intends at a dosimetric comparison of four different hybrid plans which is a combination of different radiation therapy techniques, for synchronous bilateral breast cancer (SBBC) irradiation using a hypofractionated dose regimen.

Methods: Four different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT, IMRT+VMAT, and VMAT+IMRT were planned using computed tomography (CT) images of fifteen SBBC patients.  All hybrid plans were generated using a hypofractionated dose prescription of 40.5 Gy in 15 fractions. 70% of the dose was planned with a base-dose component and the remaining 30% of the dose was planned with a hybrid component. The plans were evaluated based on the PTV and organs at risk (OARs) dosimetric parameter results and computed a plan quality score for each plan.

Results: The results for PTV parameters have shown that the 3DCRT+VMAT and 3DCRT+IMRT plans were better than other plans. The 3DCRT±IMRT plan was provided better results for OARs, while IMRT±VMAT and VMAT+IMRT plans were increased the low dose volumes to the heart and lungs. The 3DCRT+VMAT plan was required less monitor units and treatment time compared to other plans.

Conclusions: The overall plan quality score that integrated the dosimetric parameters of PTV and OARs indicated that the 3DCRT+VMAT hybrid plan is superior for SBBC treatment.