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Results   The VMAT plans showed superior to PTV dose conformity index (CI), homogeneity index (HI), protection of the ipsilateral lung, monitor units (MUs), and maximum dose (D max ) to the contralateral breast compared with TSP and 9FIMRT plans. The TSP provided better protection for D mean  of the heart and left ventricle ( p  < 0.05). A dose for left anterior descending artery from the three techniques had no significant difference. Compared with the 9FIMRT plans, the V 5Gy  (%) and V 10Gy  (%) for the ipsilateral lung were significantly reduced with TSP and VMAT ( p  < 0.05). The V 5Gy  (%) and V 10Gy  (%) for the ipsilateral lung turned out to be similar between VMAT and TSP techniques.Conclusions   Our study indicates that VMAT should be a better choice of radiotherapy for left-sided breast cancer patients after radical mastectomy. If VMAT is unavailable, 9FIMRT can achieve better CI and HI values and be more MU-efficient compared with TSP; however, TSP can effectively reduce the low dose volume of the ipsilateral lungs and heart.

Dosimetric Comparison of Three Radiotherapy Techniques in Irradiation of Left-Sided Breast Cancer Patients after Radical Mastectomy