Figure 1, illustrates the generated DVHs for the 3D-CRT and IMRT inverse plans.
Table 1, indicates the mean (± SD) dose to PTV and also imposed radiation dose to the OARs among the studied methods. Table 2, gives a comparison between tumor control and OARs complications probabilities for the patients. PTV coverage of 9FIMRT and hypofractionated IMRT (95%) was higher than the 6 fields (94%) and 3D-CRT (92%).
Table 1
The imposed radiation dose to OARs among 3D-CRT, 6 and 9fields IMRT inverse plans and hypofractionated IMRT.
| 3D-CRT (with/without internal mammary fields) | 6fiels IMRT inverse planning ( with/without internal mammary fields) | 9fields IMRT inverse planning (with/without internal mammary fields) | Hypofractionated IMRT (with/without internal mammary fields) | 3D-CRT vs 6FIMRT (p value) | 3D-CRT vs 9FIMRT (p value) | 3D-CRT vs Hypofractionated IMRT (p value) | 6F vs 9F IMRT (p value) | 6F vs Hypofractionated IMRT (p value) | 9F vs Hypofractionated IMRT (p value) |
PTV Coverage (%) | 92 | 94 | 95 | 95 | | | | | | |
Ipsilateral lung | | | | | | | | | | |
Mean Dose | 12.62 ± 0.56/ 12.21 ± 0.43 | 8.32 ± 1.03/ 8.04 ± 0.87 | 10.57 ± 1.01 / 9.91 ± 0.74 | 10.23 ± 1.00 / 9.81 ± 0.78 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Maximum Dose | 58.77/54.46 | 31.58 /27.29 | 37.64 / 32.46 | 36.25 / 31.73 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Minimum Dose | 42.21/ 41.08 | 29.37/ 27.34 | 34.86/31.46 | 33.67/31.62 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
V20Gy (%) | 10.08 ± 1.07 /12.23 ± 1.93 | 7.43 ± 1.14/ 9.46 ± 1.26 | 8.15 ± 1.38 / 10.48 ± 1.41 | 8.07 ± 1.23 / 10.31 ± 1.22 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Heart | | | | | | | | | | |
Mean Dose | 4.95 ± 0.86 /2.26 ± 0.72 | 2.53 ± 1.18 /2.36 ± 0.69 | 3.62 ± 1.18 / 4.51 ± 0.84 | 3.37 ± 1.07 / 4.26 ± 0.84 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Maximum Dose | 55.04 /48.02 | 44.24/ 41.78 | 47.56/43.61 | 47.32/43.16 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Minimum Dose | 0.22 /0.19 | 0.20/ 0.18 | 0.20/ 0.19 | 0.20/ 0.17 | > 0.005 | > 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
V25Gy (%) | 18.51 ± 2.14 / 21.43 ± 1.87 | 13.76 ± 1.04/ 22.07 ± 1.27 | 14.29 ± 1.37 / 22.98 ± 0.28 | 14.03 ± 1.16 / 21.47 ± 0.23 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
LAD | | | | | | | | | | |
Mean Dose | 6.79 ± 1.25 /4.12 ± 0.87 | 3.14 ± 1.37 / 3.93 ± 0.95 | 5.46 ± 1.83 /4.38 ± 1.04 | 5.24 ± 1.15 /4.24 ± 0.97 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Maximum Dose | 56.21/ 52.14 | 45.23/ 49.61 | 47.65/50.19 | 46.17/50.02 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Minimum Dose | 1.26/ 1.15 | 0.76/ 0.50 | 1.08/0.98 | 1.01/0.89 | > 0.005 | > 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
V25Gy (%) | 19.27 ± 1.38 / 22.56 ± 2.37 | 15.75 ± 1.24 / 17.63 ± 2.41 | 17.27 ± 0.64 / 18.56 ± 1.51 | 16.97 ± 0.32 / 18.23 ± 1.27 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
RCA | | | | | | | | | | |
Mean Dose | 1.17 ± 0.06 /0.73 ± 0.18 | 0.71 ± 0.23/ 0.58 ± 0.27 | 0.92 ± 0.14/ 0.89 ± 0.11 | 0.89 ± 0.10/ 0.82 ± 0.11 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Maximum Dose | 43.18 / 35.63 | 38.64 / 37.69 | 40.94 / 39.77 | 40.05 / 39.21 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
Minimum Dose | 0.15/ 0.11 | 0.10/0.10 | 0.11/ 0.11 | 0.09/ 0.08 | < 0.005 | < 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
V25Gy (%) | 13.42 ± 1.59 / 16.74 ± 1.32 | 10.53 ± 1.24 / 14.36 ± 1.57 | 10.79 ± 1.64 / 14.98 ± 1.06 | 10.34 ± 1.16 / 14.24 ± 1.11 | > 0.005 | > 0.005 | < 0.005 | > 0.005 | > 0.005 | > 0.005 |
MHD | | | | | | | | | | |
Mean (Range) | 1.26 (0.9–1.43) | 1.26 (0.9–1.43) | 1.26 (0.9–1.43) | 1.26 (0.9–1.43) | | | | | | |
Table 2
The TCP and NTCP values among the studied modalities.
| 3D-CRT (with/ without internal mammary fields) | | 6F IMRT inverse planning (with/without internal mammary fields) | | 9F IMRT inverse planning (with/without internal mammary fields) | | Hypofractionated IMRT (with/without internal mammary fields) | |
| MATLAB | R environment | MATLAB | R environment | MATLAB | R environment | MATLAB | R environment |
TCP (%) | | | | | | | | |
Chest Wall | 87/86 | 86/85 | 91/90 | 91/90 | 92/90 | 92/90 | 92/90 | 92/90 |
Axilla | 90/90 | 91/91 | 92/92 | 92/92 | 92/92 | 93/92 | 92/92 | 93/92 |
Supra- Clavicu Lar Nodes | 94/94 | 94/94 | 94/94 | 94/94 | 94/94 | 94/94 | 94/94 | 94/93 |
Internal Mammary Nodes | 93/86 | 93/85 | 95/89 | 96/90 | 96/91 | 96/90 | 96/91 | 96/90 |
NTCP (%) | | | | | | | | |
Ipsilateral Lung | 8/6 | 8/6 | 5/4 | 5/4 | 6/5 | 6/5 | 6/5 | 6/5 |
Heart | 4/3 | 5/3 | 2/1 | 2/1 | 3/2 | 2/1 | 3/2 | 2/1 |
LAD | 6/5 | 6/5 | 3/2 | 3/2 | 4/3 | 4/3 | 4/3 | 4/3 |
RCA | 1/0.7 | 2/1.5 | 0.8/0.4 | 0.7/0.5 | 2/1.3 | 2/1.4 | 2/1.3 | 2/1.4 |
The mean (± SD) imposed radiation dose (with/ without internal mammary fields) to Ipsilateral lung, heart, LAD and RCA was 12.62 ± 0.56/ 12.21 ± 0.43, 4.95 ± 0.86 /2.26 ± 0.72, 6.79 ± 1.25 /4.12 ± 0.87and 1.17 ± 0.06 /0.73 ± 0.18 for the 3D-CRT, respectively (Table 1). In addition, the V20Gy for Ipsilateral lung, and V25Gy for heart, LAD and RCA (with/ without internal mammary fields) was 10.08 ± 1.07 /12.23 ± 1.93, 18.51 ± 2.14 / 21.43 ± 1.87, 19.27 ± 1.38 / 22.56 ± 2.37 and 13.42 ± 1.59 / 16.74 ± 1.32 percent for 3D-CRT, respectively. Table 2 illustrates, the TCP models which were gained using MATLAB program for the target volume including the chest wall surface, three levels of axilla, supraclavicular and internal mammary lymph nodes (with/ without internal mammary fields) were 87 /86, 90/90, 94/94 and 93/86 percent, respectively. However, the TCP values of R software were 86/85, 91/91, 94/94 and 93/85 percent, respectively for the stated target volumes. The NTCP (with/ without internal mammary fields) of Ipsilateral lung, heart, LAD and RCA was 8/6, 4/3, 6/5 and 1/0.7 percent, respectively using MATLAB program. But, the NTCP of the organs which were generated from R software were 8/6, 5/3, 6/5 and 2/1.5 percent, respectively (Table 2).
Whereas, for the 6FIMRT, the mean (± SD) imposed dose (with/ without internal mammary fields) to Ipsilateral lung, heart, LAD and RCA was 8.32 ± 1.03/ 8.04 ± 0.87, 2.53 ± 1.18 /2.36 ± 0.69, 3.14 ± 1.37 / 3.93 ± 0.95 and 0.71 ± 0.23/ 0.58 ± 0.27. respectively. Furthermore, for the Ipsilateral lung the V20Gy was 7.43 ± 1.14/ 9.46 ± 1.26 and the V25Gy for heart, LAD and RCA (with/ without internal mammary fields) was 13.76 ± 1.04/ 22.07 ± 1.27, 15.75 ± 1.24 / 17.63 ± 2.41 and 10.53 ± 1.24 / 14.36 ± 1.57 percent, respectively (Table 1). Table 2 indicates that, for 6FIMRT approach, TCP of the stated target (with/ without internal mammary fields) was 91/90, 92/92, 94/94 and 95/89 percent, respectively (MATLAB program). However, the TCP values which were obtained from R software was 91/90, 92/92, 94/94 and 96/90 percent, respectively. For the 6FIMRT, the NTCP of the Ipsilateral lung, heart, LAD and RCA was 5/4, 2/1, 3/2 and 0.8/0.4 percent, respectively for the MATLAB program. According to R environment findings, the NTCP of the Ipsilateral lung, heart, LAD and RCA was 5/4, 2/1, 3/2 and 0.7, 0.5 percent, respectively.
For the 9FIMRT, Table 1 also indicates that the mean (± SD) imposed dose (with/ without internal mammary fields) to ipsilateral lung, heart, LAD and RCA was 10.57 ± 1.01 / 9.91 ± 0.74, 3.62 ± 1.18 / 4.51 ± 0.84, 5.46 ± 1.83 /4.38 ± 1.04, 0.92 ± 0.14/ 0.89 ± 0.11, respectively. In addition, for the ipsilateral lung the V20Gy was 8.15 ± 1.38 / 10.48 ± 1.41 and the V25Gy for heart, LAD and RCA (with/ without internal mammary fields) was 14.29 ± 1.37 / 22.98 ± 0.28, 17.27 ± 0.64 / 18.56 ± 1.51 and 10.79 ± 1.64 / 14.98 ± 1.06 percent, respectively. Table 2 indicates that, TCP of the stated target volumes (with/ without internal mammary fields) for 9FIMRT method was 92/90, 92/92, 94/94 and 96/91 percent, respectively (MATLAB program). Nevertheless, the TCP values of R software was 91/90, 92/92, 94/94 and 96/90 percent, respectively. For the 9FIMRT, the NTCP of the Ipsilateral lung, heart, LAD and RCA was 6/5, 3/2, 4/3 and 2/1.3 percent for the MATLAB program, and was 6/5, 2/1, 4/3 and 2/1.4 percent for the R program.
Table 1 also shows some data about hypofractionated IMRT. As can be seen, the mean (± SD) imposed dose (with/ without internal mammary fields) to ipsilateral lung, heart, LAD and RCA was 10.23 ± 1.00 / 9.81 ± 0.78, 3.37 ± 1.07 / 4.26 ± 0.84, 5.24 ± 1.15 /4.24 ± 0.97, 0.89 ± 0.10/ 0.82 ± 0.11, respectively. Moreover, for the hypofractionated method, the V20Gy for ipsilateral lung was 8.07 ± 1.23 / 10.31 ± 1.22 and the V25Gy for heart, LAD and RCA (with/ without internal mammary fields) was 14.03 ± 1.16 / 21.47 ± 0.23, 16.97 ± 0.32 / 18.23 ± 1.27 and 10.34 ± 1.16 / 14.24 ± 1.11 percent, respectively. Table 2 illustrates the TCP of the mentioned target volumes (with/ without internal mammary fields) for the hypofractionated modality was 92/90, 92/92, 94/94 and 96/91 percent, respectively (MATLAB program). Nonetheless, the TCPs of R software was 91/90, 92/92, 94/94 and 96/90 percent, respectively. Table 2 also indicates that the NTCP of the Ipsilateral lung, heart, LAD and RCA was 6/5, 3/2, 4/3 and 2/1.3 for the MATLAB program, and was 6/5, 2/1, 4/3 and 2/1.4 for the R program (Similar to 9FIMRT).