Enhancing jawless VMAT plan quality for hypofractionated left breast cancer with the avoidance structure tool
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Radiation Physics and Chemistry
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Introduction: The Avoidance Structure (AvS) tool shields a structure by maintaining the multileaf collimator
leaves over the structure's projection in the beam's eye view. In this work, we tested the dosimetric impact of
using part of the outlines of the heart and lungs as avoidance structure when creating knowledge-based left
breast volumetric modulated arc therapy treatment plans.
Methods: Dose-volume histogram estimates were calculated using a RapidPlan model for 30 patients who
received whole breast radiation therapy in five fractions. Then, two sets of plans were generated for a Halcyon v2
linear accelerator by alternating the use of the AvS tool. Dose metrics for both procedures were compared.
Results: Coverage on the target volume remained similar regardless of the use of AvS. The mean absorbed dose
received by the heart, as well as the relative volumes receiving 1.5, 3.5 and 7.8 Gy, decreased with effect sizes
(ESZ) 0.98, 1.43, and 0.63 respectively. Homolateral lung volumes receiving 1.5 and 3.5 Gy were also lowered
using AvS. However, the dose received by 0.03 cc of the contralateral breast increased with an ESZ of 0.52.
Conclusions: Except for the contralateral breast, the AvS tool improved DVH metrics for organs at risk without
compromising target coverage or worsening hotspots.
Como referenciar
CASTELO, J.H.M.; MENEZES, D.C.T.; MENEZES, D.C.T.; ROSA, L.A.R. da; BONIFACIO, D.A.B. Enhancing jawless VMAT plan quality for hypofractionated left breast cancer with the avoidance structure tool. Radiation Physics and Chemistry, v. 243, p. 1-5, 2025. DOI: 10.1016/j.radphyschem.2025.113464. Disponível em: https://repositorio.ipen.br/handle/123456789/49848. Acesso em: 04 May 2026.
Esta referência é gerada automaticamente de acordo com as normas do estilo IPEN/SP (ABNT NBR 6023) e recomenda-se uma verificação final e ajustes caso necessário.