Original Article

The Composite Planning Technique in Left Sided Breast Cancer Radiotherapy: A Dosimetric Study


  • Naveen Kumawat
  • Anil Kumar Shrotriya
  • Malhotra Singh Heigrujam
  • Satendra Kumar
  • Manoj Kumar Semwal
  • Anil Kumar Bansal
  • Ram Kishan Munjal
  • Deepak Kumar Mittal
  • Charu Garg
  • Anil Kumar Anand

Received Date: 05.01.2020 Accepted Date: 09.02.2020 Eur J Breast Health 2020;16(2):137-145


The aim of this retrospective study is to reduce the dose of heart, both lung and opposite breast and left anterior descending artery (LAD) and avoid long term complication and radiation induced secondary malignancies in radiotherapy left breast/chest wall without losing homogeneity and conformity of the Planning Target Volume (PTV), contoured using Radiotherapy Oncology Group (RTOG 1005) guideline.

Materials and Methods:

The treatment plans were generated retrospectively by TFIF, VMAT and Composite techniques for 30 patients. Dose- Volume Histograms (DVHs) were evaluated for PTV and organs at risk (OAR’s) and analyzed in two groups BCS and MRM using Wilcoxon signed rank test.


The homogeneity index (HI) was improved in Composite technique by 32.72% and 21.81% of VMAT, 50.66% and 49.41% of TFIF in BCS and MRM group respectively. The Conformity Index (CI) for composite plan was statistically same as VMAT and superior by 27.94% and 41.37% of TFIF in BCS and MRM group respectively. The low dose volume V5Gy and V10Gy of the heart were improved in Composite plan by 47.9% and 26.1% of VMAT respectively in BCS group and in MRM group, improved by 21.2% and 45.6% of VMAT. The V5Gy and V10Gy of ipsilateral lung were improved in Composite plan by 16% and 13.7% of VMAT respectively in BCS and 8.4% and 3% of VMAT respectively in MRM group.


The Composite plan consisting of VMAT and TFIF plan with an optimum selection of fractions can achieve lower low dose exposure to the OAR’s without compromising coverage compared to VMAT.

Keywords: BCS, composite plan, breast, dosimetric comparison, MRM