Application of tangent-arc technology for deep inspiration breath-hold radiotherapy in left-sided breast cancer

Objective: To explore the advantages of dosimetry and the treatment efficiency of tangent-arc technology in deep inspiration breath-hold radiotherapy for breast cancer. Methods: Forty patients with left-sided breast cancer who were treated in our hospital from May 2020 to June 2021 were randomly selected and divided into two groups. The first group's plan was a continuous semi-arc that started at 145 degrees ( +/- 5 degrees) and stopped at 325 degrees ( +/- 5 degrees). The other group's plan, defined as the tangentarc plan, had two arcs: the first arc started at 145 degrees ( +/- 5 degrees) and stopped at 85 degrees ( +/- 5 degrees), and the second arc started at 25 degrees ( +/- 5 degrees) and stopped at 325 degrees ( +/- 5 degrees). We compared the target dose, dose in organs at risk (OARs), and treatment time between the two groups. Results: The target dose was similar between the continuous semiarc and tangent-arc groups. The V5 of the right lung was significantly different between the two groups (Dif 5.52, 95% confidence interval 1.92-9.13, t=3.10, P=0.004), with the patients in the continuous semi-arc and tangent-arc groups having lung V-5 values of (9.16 +/- 1.62)%, and (3.64 +/- 0.73)%, respectively. The maximum dose to the spinal cord was (1835.88 +/- 222.17) cGy in the continuous semi-arc group and (599.42 +/- 153.91) cGy in the tangent-arc group, yielding a significant difference between the two groups (Dif 1236.46, 95% confidence interval 689.32-1783.6, t=4.57, P<0.001). The treatment times was (311.70 +/- 60.45) s for patients in the continuous semi-arc group and (254.66 +/- 40.73) s for patients in the tangent-arc group, and there was a significant difference in the mean number of treatment times between the two groups (Dif 57.04, 95% confidence interval 24.05-90.03, t=3.5, P=0.001). Conclusion: Both the continuous semi-arc and tangent-arc plans met the clinical prescription dose requirements. The OARs received less radiation with the tangent-arc plan than the continuous semi-arc plan, especially for the lung measured as V5) and the spinal cord (measured as the maximum dose). Tangentarc plan took significantly less time than the continuous semi-arc, which can greatly improve treatment efficiency. Therefore, tangent-arc plans are superior continuous semi-arc plans for all cases.