Comparison of radiotherapy techniques for left-sided early-stage breast cancer radiotherapy : a systematic literature review on planning dose analysis

Abstract

Adjuvant radiotherapy improves local cancer control and the overall survival of women with breast cancer. However, it is unclear what the ideal radiotherapy (RT) planning technique is for these patients. The aim was to perform a synopsis of the literature comparing RT techniques to treat early-stage left breast tumours. A PRISMA guideline was used on this systematic review and registered in PROSPERO (CRD420251168901). For all the investigations, the Open-field technique (OF) showed worse results for the Planning Target Volume (PTV), lung and heart. Field-in-Field stood out in low doses and mean doses in OARs. IMRT distinguished itself in Homogeneity Index. VMAT provides higher Conformity Index results and thus an advantage in high and mean doses of OARs. Hybrid-IMRT and Hybrid-VMAT combine the advantages of two techniques; however, few studies have included them in their research. There is not a clear “gold-standard” technique, and the results depend heavily on many factors which affect the quality of the plans and the priorities of the departments. However, OF is no longer recommended. An international framework should be developed to allow for a standardisation of the plans, improving inter-departmental comparisons. And each department should perform their own comparison between the techniques available to them.