Optimum Treatment Planning Technique Evaluation for Synchronous Bilateral Breast Cancer with Left Side Supraclavicular Lymph Nodes

Introduction: Bilateral breast cancer cases are classified as complex in radiotherapy treatment, especially those with the left side mastectomy and right-side lumpectomy with left side supraclavicular lymph nodes patients. The purpose of this study is to find the optimum treatment planning technique among the three available techniques: 3Dimentional conformal Radiotherapy (3D-CRT), Intensity modulated radiation therapy (IMRT), and Volumetric Modulated Arc Therapu (VMAT). Material and Methods: Ten Bilateral breast cancer included in this study with left-side mastectomy and right-side lumpectomy with left-side supraclavicular lymph nodes. The patients are delineated by oncologists and prepared for radiation planning by MONACO 5.1 treatment planning system (TPS) with an X-ray photon beam of 6 MV or 10 MV energy using ‎ELEKTA‏’‏s Agility linear accelerator. The prescribed dose is set at 4005 cCy per 15 fractions. Statistically with anova test among each other. Results: The treatment with 3D-CRT, IMRT, and VMAT show a significant difference in the results. VMAT gives high dose distribution for the left mastectomy breast and its regional supraclavicular lymph nodes, while the IMRT gives a higher value for the right side breast with lumpectomy. The good homogeneity index is acquired with IMRT, while VMAT gives a better conformity index. The 3D-CRT planning technique lowers the dose to the heart and lunges better than the other techniques. Conclusion: depending on the patient health and stage, the optimum treatment planning is applied. VMAT and IMRT give effective results than the 3D-CRT.