ORIGINAL RESEARCH article
Front. Oncol.
Sec. Radiation Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1610980
This article is part of the Research TopicInnovative Approaches in Precision Radiation OncologyView all 12 articles
Application of the Monaco-Serial Biological Function for Cardiac Dose Constraints in DIBH-IMRT Treatment Planning for Left-Sided Breast Cancer
Provisionally accepted
- 1Hangzhou Cancer Hospital, Hangzhou, Zhejiang Province, China
- 2Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
- 3Lishui City People's Hospital, Lishui, China
- 4Zhejiang Hospital, Hangzhou, China
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The Serial function in the Monaco treatment planning system is essential for cardiac dose optimization in left breast cancer radiotherapy; however, its optimal K-value for deep-inspiration breath-hold intensity-modulated radiotherapy (DIBH-IMRT) has not been established. This study aims to determine the evidence-based K-value configuration for clinical implementation. Methods: 41 left breast cancer patients undergoing DIBH-IMRT were retrospectively analyzed. Plans were stratified by Monaco-Serial K-values: Group A (K=1), B (2≤K≤4), and C (K>4). Dosimetric parameters (heart, LAD, Lung-L) and dose-volume reduction rates (Groups B/C vs A) were compared. Correlations between K-values and DIBH-induced anatomical changes ( Lung-L volume increment rate, Lung-L/Heart volume ratio, and Heart-Breast Distance increment) were assessed. Results: All plans satisfied target coverage. Group B achieved optimal cardiac protection: mean heart dose (273.9±91.0 cGy), max heart dose (2676.2±1380.7 cGy), and LAD doses (mean: 411.3 cGy; max: 1483.3±736.3 cGy) significantly decreased versus Group A. Lung-L V500cGy in Group B increased marginally but within clinical tolerance. Correlation analysis confirmed that Group B achieved balanced control of mean/maximum heart doses, aligning with the expected effects of anatomical variations induced by the DIBH technique. Conclusions: Adjusting Monaco-Serial K-value to 2≤K≤4 provides optimal dose constraints for the heart and substructures while ensuring target coverage, making it the optimal parameter setting for left breast cancer DIBH-IMRT.
Keywords: breast cancer, Radiotherapy planning, biological optimization, monte carlo, Equivalent biological dose
Received: 13 Apr 2025; Accepted: 15 May 2025.
Copyright: © 2025 Hu, Zhou, Jiang and Lai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jianjun Lai, Zhejiang Hospital, Hangzhou, China
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