CyberKnife versus multicatheter interstitial brachytherapy for accelerated partial breast irradiation: a dosimetrical assessment with focus on organs at risk

András Herein; Gábor Stelczer; Csilla Pesznyák; Georgina Fröhlich; Viktor Smanykó; Norbert Mészáros; Csaba Polgár; Zoltán Takácsi-Nagy; Tibor Major

doi:10.5603/RPOR.a2022.0011

CyberKnife versus multicatheter interstitial brachytherapy for accelerated partial breast irradiation: a dosimetrical assessment with focus on organs at risk

Rep Pract Oncol Radiother. 2022 Mar 22;27(1):152-160. doi: 10.5603/RPOR.a2022.0011. eCollection 2022.

Authors

András Herein^{1

2}, Gábor Stelczer^{1

2}, Csilla Pesznyák^{1

2}, Georgina Fröhlich^{1

3}, Viktor Smanykó¹, Norbert Mészáros^{1

4}, Csaba Polgár^{1

4}, Zoltán Takácsi-Nagy^{1

4}, Tibor Major^{1

4}

Affiliations

¹ National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.
² Budapest University of Technology and Economic, Institute of Nuclear Techniques, Budapest, Hungary.
³ Eötvös Loránd University, Faculty of Science, Budapest, Hungary.
⁴ Semmelweis University, Department of Oncology, Budapest, Hungary.

Abstract

Background: The purpose of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation with special focus on dose to organs at risk (OARs).

Materials and methods: Treatment plans of thirty-one patients treated with MIBT were selected and additional CK plans were created on the same CT images. The OARs included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left sided cases. The fractionation was identical (4 × 6.25 Gy). Dose-volume parameters were calculated for both techniques and compared.

Results: The D90 of the PTV for MIBT and CK were similar (102.4% vs. 103.6%, p = 0.0654), but in COIN the MIBT achieved lower value (0.75 vs. 0.91, p < 0.001). Regarding the V100 parameter of non-target breast CK performed slightly better than MIBT (V100: 1.1% vs. 1.6%), but for V90, V50 and V25 MIBT resulted in less dose. Every examined parameter of ipsilateral lung, skin, ribs and contralateral lung was significantly smaller for MIBT than for CK. Protection of the heart was slightly better with MIBT, but only the difference of D2cm³ was statistically significant (17.3% vs. 20.4%, p = 0.0311). There were no significant differences among the dose-volume parameters of the contralateral breast.

Conclusion: The target volume can be properly irradiated by both techniques with high conformity and similar dose to the OARs. MIBT provides more advantageous plans than CK, except for dose conformity and the dosimetry of the heart and contralateral breast. More studies are needed to analyze whether these dosimetrical findings have clinical significance.

Keywords: APBI; CyberKnife; dosimetrical comparison; multicatheter interstitial brachytherapy.