a hybrid conformal planning technique with solitary dynamic portal for postmastectomy radiotherapy with regional nodes

Purpose: This study focuses on incorporation of a solitary dynamic portal (SDP) in conformal planning for postmastectomy radiotherapy (PMRT) with nodal regions with an intention to overcome the treatment planning limitations imposed by conventional techniques. Materials and Methods: Twenty-four patients who underwent surgical mastectomy followed by PMRT were included in this study. Initially, a treatment plan comprising tangential beams fitted to beam's-eye-view (BEV) of chest wall (CW) and a direct anterior field fitted to BEV of nodal region, both sharing a single isocenter was generated using Eclipse treatment planning system. Multiple field-in-fields with optimum beam weights (5% per field) were added primarily from the medial tangent, fitted to BEV of entire target volume, and finally converted into a dynamic portal. Dosimetric analysis for the treatment plans and fluence verification for the dynamic portals were performed. Results and Discussion: Conformal plans with SDP showed excellent dose coverage (V95%>95%), higher degree of tumor dose conformity (≤1.25) and homogeneity (≤0.12) without compromising the organ at risk sparing for PMRT with nodal region. Treatment plans with SDP considerably reduced the lower isodose spread to the ipsilateral lung, heart, and healthy tissue without affecting the dose homogeneity. Further, gamma evaluation showed more than 96% pixel pass rate for standard 3%/3 mm dose difference and distance-to-agreement criteria. Moreover, this plan offers less probability of “geometrical miss” at the highly irregular CW with regional nodal radiotherapy. Conclusion: Hybrid conformal plans with SDP would facilitate improved dose distribution and reduced uncertainty in delivery and promises to be a suitable treatment option for complex postmastectomy CW with regional nodal irradiation.