Hybrid volumetric modulated arc therapy for whole breast irradiation: a dosimetric comparison of different arc designs

  • Velayudham RamasubramanianEmail author
  • Karunakaran Balaji
  • Sitaraman Balaji Subramanian
  • Krishnamoorthi Sathiya
  • Moorthi Thirunavukarasu
  • Chandrasekaran Anu Radha



To find an optimal arc design for hybrid volumetric modulated arc therapy (H-VMAT), a combination of conventional 3DCRT and VMAT plans for left-sided whole breast radiation therapy.

Methods and materials

A total of 26 left-sided early-stage breast cancer patients were selected for this study. To find the superior plan, H-VMAT with three different arc designs including, two partial arcs (2A), four partial arcs (4A) and four tangential arcs (TA) were created for each study case by combining 3DCRT and VMAT with 75% 3DCRT/25% VMAT dose proportion of prescription dose.


All H-VMAT plans achieved the expected target coverage. A higher conformity index and homogeneity index were achieved for 2A and 4A H-VMAT plans and significantly differ from TA H-VMAT (p < 0.003). The heart and ipsilateral lung dose parameters were comparable among all plans except heart V40Gy which was significantly less in 4A H-VMAT plan (p < 0.05). The contralateral lung, contralateral breast, spinal cord, normal tissue doses and MU were significantly less in TA H-VMAT (p < 0.03). The beam-on time was significantly less in 2A H-VMAT (p < 0.0001).


2A and 4A H-VMAT techniques are effective in improving the PTV dosimetric parameters as well as reducing the OAR doses. Further, 2A H-VMAT delivers less MU and beam-on time compared to 4A H-VMAT.


Breast cancer Whole breast VMAT Hybrid-VMAT 


Compliance with ethical standards

Conflict of interest

All authors who contributed to this study declare that they have no conflict of interest with respect to the manuscript.

Ethical approval

Institutional scientific and ethics board has approved this study. This article does not contain any studies with human participants performed by any of the authors.

Informed consent

The informed consent has been waived off by the ethics board of the institute considering this as a retrospective study with no human involved. For this type of study, formal consent is not required.


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.School of Advanced SciencesVellore Institute of TechnologyVelloreIndia
  2. 2.Department of Radiation OncologyGleneagles Global HospitalsChennaiIndia

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