Dosimetric Evaluation of Ezfluence In Breast Radiotherapy Using the Monaco Treatment Planning System
Abstract
Purpose
To assess the dosimetric impact and planning efficiency of EZFluence integrated into the Monaco treatment planning system compared with conventional planning in breast-conserving radiotherapy.
Methods
Fifty previously treated breast cancer patients (25 left-sided and 25 right-sided) were retrospectively replanned using the Monaco treatment planning system with the integrated EZFluence module. The original clinically approved and delivered treatment plans served as the reference for comparison. For each patient, conventional and EZFluence-based plans were generated using same target volumes and dose prescriptions. Dosimetric evaluation included planning target volume (PTV) coverage, homogeneity index (HI), conformity index (CI), and maximum PTV dose (hot spot). Organs at risk (OARs) evaluated were the heart, ipsilateral lung, contralateral lung, contralateral breast, and esophagus. All plans were assessed according to established RTOG planning objectives and acceptance criteria. Monitor units (MU) and planning time were also recorded to evaluate planning efficiency.
Results
EZFluence-based plans demonstrated a modest but consistent improvement in target coverage, with PTV coverage exceeding 97% for both conventional and EZFluence plans, and an increase of 3.0% reduction for the ipsilateral lung, and <2.0% reductions for the contralateral lung, contralateral breast, and esophagus. Although the EZFluence plans required an increase of 6.0% in MU, planning time was reduced by approximately three times.
Conclusion
The use of Monaco with EZFluence improves efficiency in breast radiotherapy planning while maintaining RTOG compliance. The plan quality is improved with increased target coverage, reduced hot spots, and better sparing of OARs.