Clinical implementation of a hybrid solitary dynamic portal radiotherapy for left-sided post-mastectomy chest-wall and regional nodal irradiation using Monaco TPS.
[BACKGROUND] A hybrid solitary dynamic portal radiotherapy (h-SDPRT) technique for complex chest-wall and regional nodal irradiation was clinically implemented on the Monaco treatment planning system
APA
Rafic KM, Akhtaruzzaman M, et al. (2025). Clinical implementation of a hybrid solitary dynamic portal radiotherapy for left-sided post-mastectomy chest-wall and regional nodal irradiation using Monaco TPS.. Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology, 30(6), 758-766. https://doi.org/10.5603/rpor.109516
MLA
Rafic KM, et al.. "Clinical implementation of a hybrid solitary dynamic portal radiotherapy for left-sided post-mastectomy chest-wall and regional nodal irradiation using Monaco TPS.." Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology, vol. 30, no. 6, 2025, pp. 758-766.
PMID
41498076
Abstract
[BACKGROUND] A hybrid solitary dynamic portal radiotherapy (h-SDPRT) technique for complex chest-wall and regional nodal irradiation was clinically implemented on the Monaco treatment planning system (TPS) by effectively adapting the Eclipse-based h-SDPRT method with minimal amendments to align with Monaco-specific technical constraints while maintaining consistent and reproducible dosimetric outcomes.
[MATERIALS AND METHODS] This technique was evaluated on ten left-sided post-mastectomy radiotherapy (PMRT) patients, delivering 80-85% of the prescribed dose through asymmetric static open field apertures with the Elekta Agility multileaf collimator (MLC), and the remaining 15-20% via a unidirectional solitary dynamic field with differential blocks, composed of 10-15 MLC control points (4-5% of the dose per segment).
[RESULTS] The h-SDPRT plans demonstrated excellent dose coverage to the chest-wall target (D ≥ 96.3 ± 0.2%) and regional nodes (D ≥ 96.4 ± 0.8%), optimal conformity (1.5 ± 0.1), and superior homogeneity (0.104 ± 0.01), while effectively sparing critical organs-at-risk (OAR) viz., ipsilateral lung (V ≤ 26.7 ± 2.0% and D: 14.3 ± 5.7 Gy) and heart (V ≤ 6.4 ± 3.8% and D: 6.1 ± 1.6 Gy), with complete sparing of contralateral lung (V ≤ 0.1 ± 0.2% and D: 1.3 ± 0.3 Gy) and breast (V ≤ 1.5 ± 1.0% and D: 1.6 ± 0.2 Gy). Gamma evaluation (γ) showed > 95% pixels passing the standard 3% dose difference and 3 mm distance-to-agreement γ criteria, with results closely aligning with Eclipse TPS data.
[CONCLUSIONS] The h-SDPRT technique minimizes the risk of "geometrical miss" and reduces delivery uncertainties associated with irregular or thin chest-wall with comprehensive nodal irradiation. By combining dominant static portals with simplified unidirectional dynamic field sequencing strategy, this approach provides a feasible and effective solution for PMRT.
[MATERIALS AND METHODS] This technique was evaluated on ten left-sided post-mastectomy radiotherapy (PMRT) patients, delivering 80-85% of the prescribed dose through asymmetric static open field apertures with the Elekta Agility multileaf collimator (MLC), and the remaining 15-20% via a unidirectional solitary dynamic field with differential blocks, composed of 10-15 MLC control points (4-5% of the dose per segment).
[RESULTS] The h-SDPRT plans demonstrated excellent dose coverage to the chest-wall target (D ≥ 96.3 ± 0.2%) and regional nodes (D ≥ 96.4 ± 0.8%), optimal conformity (1.5 ± 0.1), and superior homogeneity (0.104 ± 0.01), while effectively sparing critical organs-at-risk (OAR) viz., ipsilateral lung (V ≤ 26.7 ± 2.0% and D: 14.3 ± 5.7 Gy) and heart (V ≤ 6.4 ± 3.8% and D: 6.1 ± 1.6 Gy), with complete sparing of contralateral lung (V ≤ 0.1 ± 0.2% and D: 1.3 ± 0.3 Gy) and breast (V ≤ 1.5 ± 1.0% and D: 1.6 ± 0.2 Gy). Gamma evaluation (γ) showed > 95% pixels passing the standard 3% dose difference and 3 mm distance-to-agreement γ criteria, with results closely aligning with Eclipse TPS data.
[CONCLUSIONS] The h-SDPRT technique minimizes the risk of "geometrical miss" and reduces delivery uncertainties associated with irregular or thin chest-wall with comprehensive nodal irradiation. By combining dominant static portals with simplified unidirectional dynamic field sequencing strategy, this approach provides a feasible and effective solution for PMRT.