Dosimetric comparison of three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy for free-breathing whole-breast irradiation: A planning study.

Background: Currently, recommended heart dose constraints are difficult to meet in whole-breast irradiation (WBI) for left-sided breast cancer patients, who cannot be treated with the deep inspiration breath hold. We performed a radiotherapy planning study to establish if the use of intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) allows for better sparing of the heart and its subvolumes than the three-dimensional conformal radiation therapy (3D-CRT), and how these attempts affect the dose delivered to the other organs. Methods: A total of 17 left-sided and 10 right-sided consecutive patients treated with free-breathing WBI were retrospectively included. The 3D-CRT, IMRT, and VMAT plans were generated. Several dose-volume parameters and plan quality indices were compared, separately for the left- and right-sided plans. Results: All the techniques fulfilled the planning objectives. In the left-sided plans, there was no heart or left ventricle dose reduction with IMRT, nor with VMAT; the maximum dose in the left anterior descending coronary artery was reduced with VMAT (P = 0.005); V5 for the contralateral breast, contralateral lung, and total-body increased markedly in VMAT, and for the ipsilateral lung (V5IL) also in IMRT, compared with 3D-CRT (P < 0.001). In the right-sided plans, the V5 values, except for V5IL, did not differ between the three techniques. Conclusions: IMRT and VMAT had a limited heart-sparing benefit in the left-sided free-breathing WBI, at the cost of increased low-dose volumes, measured by V5. The low-dose volumes are not increased by IMRT or VMAT in the right-sided WBI, where heart sparing is not a problem, but the attempts to reduce cardiac doses in the left-sided WBI increase them.

Angiosarcoma of the scalp: a case report.

PURPOSE: The aim of this paper is to report the treatment of angiosarcoma of the scalp. High-dose-rate (HDR) brachytherapy with an individual mold applicator is presented. CASE DESCRIPTION: A case of a 75-year-old male will be presented with multicentric lesions over the scalp in the temple and crown region. Biopsy diagnosis was angiosarcoma of the scalp, nonoperable. The patient was qualified for chemotherapy combined with radiotherapy. DISCUSSION: Angiosarcoma of the scalp is a very aggressive tumor. The main aim of the treatment of angiosarcoma is local control of the tumor. Most cases are treated with wide excision surgery. The use of surgery with adjuvant radiotherapy or chemotherapy is recommended in some cases. Chemotherapy and radiotherapy are suggested in the recurrent or extensive lesions with regional or distant metastasis. Radiation therapy can be realized with external beam therapy or brachytherapy. High-dose-rate brachytherapy is an effective, adequate, well tolerated by patients treatment method. In every case, an individual approach is needed. CONCLUSIONS: The HDR brachytherapy technique is useful and practicable. The advantages of brachytherapy are: targeted dose distribution, low integral dose, and short time of treatment. The mold HDR brachytherapy treatment using an individual applicator was an appropriate tool for the presented patient.