Treatment Planning With Unflattened as Compared to Flattened Beams for Bilateral Carcinoma of the Breast

Aim: To evaluate the plan quality of 6MV unflattened (UFB) and flattened beam (FB) photon energy using AAA dose calculation algorithms for volumetric arc therapy. Materials and Methods: Plans were generated for bilateral carcinoma of breast and the dose prescribed was 50.4Gy in 28 fractions. Two different plans were made for each patient using 6MV FB and 6MV UFB. Dose calculations were performed on an AAA dose calculation algorithm. Plans were generated on Eclipse TPS and were capable of being delivered with a true beam STx linear accelerator. The homogeneity index (HI), conformity index (CI), normal tissue integral dose (NTID), and effect of low dose volume on normal tissue and monitor units (MU) were noted. Results: All the plans were clinically acceptable. The HI and CI of 6MV UF rapid arc (RA) plans were higher than with the 6MV FB plan (1.16±0.05 and 0.12±0.00 respectively). There was no appreciable difference observed in Organ at risk (OAR) doses. The mean NTID and low dose volume were significantly low with 6MV RA UFB as compared to FB. 6MV RA UFB required a 35% higher MU than with the 6MV RA plan (p<0.05). Conclusion: RA plans generated with UFB on Eclipse TPS achieved target volume coverage and preserved OAR’s essentially similar to 6MV RA FB plans. However RA plans generated in Varian Eclipse of UFB were superior with respect to mean NTID and low dose volumes in normal tissue.