Tangential volumetric modulated arc therapy reduces cardiac and contralateral low-dose exposure compared with continuous volumetric modulated arc therapy in postoperative breast radiotherapy
- 1Department of Radiotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, 30625, Germany
- 2Corresponding author.
Abstract
Background and purpose: Tangential volumetric modulated arc therapy may combine rotational conformality with tangential beam geometry. We compared tangential with continuous-arc volumetric modulated arc therapy for postoperative breast radiotherapy with deliberately matched target coverage, focusing on cardiac and contralateral low-dose exposure. Material and methods: Fifty-four patients were included in this paired planning study. For each patient, the clinically delivered tangential plan and a matched continuous-arc plan were evaluated. Target coverage was matched by clinical-target-volume D95% and planning-target-volume D2%. Dose-volume endpoints, low-dose area-under-the-curve metrics, delta dose-volume histograms, subgroup interactions, and mechanistic organ-equivalent-dose surrogates were evaluated. Results: Target coverage and homogeneity were comparable, while conformity was higher with tangential planning ( p = 0.006). Tangential planning reduced mean heart dose from 1.34 to 1.17 Gy ( p < 0.001), contralateral lung mean dose from 0.94 to 0.57 Gy, and contralateral breast mean dose from 1.16 to 0.76 Gy (both p < 0.001). Mechanistic organ-equivalent-dose surrogates were reduced by 37.0% for the contralateral lung and 32.7% for the contralateral breast. Exploratory interaction analyses did not identify statistically significant interactions by laterality, deep-inspiration breath hold, simultaneous integrated boost, or regional nodal irradiation. Conclusions: In a clinically heterogeneous paired cohort that included boost irradiation, regional nodal irradiation, and deep-inspiration breath hold, tangential volumetric modulated arc therapy reduced cardiac and contralateral low-dose exposure while preserving target coverage.
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BibTeX
@article{knochelmann2026tangential,
title = {{Tangential volumetric modulated arc therapy reduces cardiac and contralateral low-dose exposure compared with continuous volumetric modulated arc therapy in postoperative breast radiotherapy}},
author = {Anne Caroline Knöchelmann and Mirko Fischer and Kathrin Burchardt and Daniela Meinecke and Jan-Niklas Becker},
journal = {Physics and Imaging in Radiation Oncology},
year = {2026},
month = nov,
doi = {10.1016/j.phro.2026.101115},
url = {https://doi.org/10.1016/j.phro.2026.101115},
note = {CC BY},
}
RIS
TY - JOUR
TI - Tangential volumetric modulated arc therapy reduces cardiac and contralateral low-dose exposure compared with continuous volumetric modulated arc therapy in postoperative breast radiotherapy
AU - Anne Caroline Knöchelmann
AU - Mirko Fischer
AU - Kathrin Burchardt
AU - Daniela Meinecke
AU - Jan-Niklas Becker
PY - 2026
DA - 2026/11/05
JO - Physics and Imaging in Radiation Oncology
DO - 10.1016/j.phro.2026.101115
UR - https://doi.org/10.1016/j.phro.2026.101115
AB - Background and purpose: Tangential volumetric modulated arc therapy may combine rotational conformality with tangential beam geometry. We compared tangential with continuous-arc volumetric modulated arc therapy for postoperative breast radiotherapy with deliberately matched target coverage, focusing on cardiac and contralateral low-dose exposure. Material and methods: Fifty-four patients were included in this paired planning study. For each patient, the clinically delivered tangential plan and a matched continuous-arc plan were evaluated. Target coverage was matched by clinical-target-volume D95% and planning-target-volume D2%. Dose-volume endpoints, low-dose area-under-the-curve metrics, delta dose-volume histograms, subgroup interactions, and mechanistic organ-equivalent-dose surrogates were evaluated. Results: Target coverage and homogeneity were comparable, while conformity was higher with tangential planning ( p = 0.006). Tangential planning reduced mean heart dose from 1.34 to 1.17 Gy ( p < 0.001), contralateral lung mean dose from 0.94 to 0.57 Gy, and contralateral breast mean dose from 1.16 to 0.76 Gy (both p < 0.001). Mechanistic organ-equivalent-dose surrogates were reduced by 37.0% for the contralateral lung and 32.7% for the contralateral breast. Exploratory interaction analyses did not identify statistically significant interactions by laterality, deep-inspiration breath hold, simultaneous integrated boost, or regional nodal irradiation. Conclusions: In a clinically heterogeneous paired cohort that included boost irradiation, regional nodal irradiation, and deep-inspiration breath hold, tangential volumetric modulated arc therapy reduced cardiac and contralateral low-dose exposure while preserving target coverage.
SN - 2405-6316
ER -