Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment

Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment Shi Dong, Honghua Lin, Enyi Qiu, Hao zhang, Wenqi Jin, Yajing Xu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4242199/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This study aimed to compare dosimetry of the target region and organ at risk (OAR) according to two different radiation plans for patients after breast-conserving surgery (BCS), hypofractionated whole breast irradiation (HFWBI) combined with an additional sequential boost (SEQ) versus simultaneous integrated boost (SIB), and further explore better radiotherapy after breast-conserving surgery. Methods We included 56 patients with early-stage left-sided breast cancer. Hybrid volumetric modulated arc therapy (H-VMAT) plus sentinel lymph node biopsy was given to all participants. The following SIB and SEQ treatments were planned for each patient. The radiation doses delivered to OAR and dose-volume histogram were analyzed. The comparison of the max dose (Dmax), the mean dose (Dmean), the min dose (Dmin), and the volume of each organ that received x Gy (Vx) was accomplished. Results The V5, V10, and V20 of the heart and the ipsilateral lung were lower in the SIB plan than SEQ, while among patients receiving the SIB plan, the V5 and V10 of the right and the left ventricle were lower. The Dmean for the heart, left anterior descending (LAD), right ventricle, left ventricle and the ipsilateral lung was lower for the SIB plan (heart: 5.24 ± 0.75 Gy vs. 6.92 ± 0.92Gy, p < 0.001; lad: 9.27 ± 1.07Gy vs. 11.86 ± 1.40Gy, p < 0.001; right ventricle 6.39 ± 1.54Gy vs. 8.39 ± 1.88Gy, left ventricle 6.10 ± 1.33Gy vs. 8.54 ± 1.80Gy, p < 0.001; lung: 9.28 ± 1.07Gy vs. 11.86 ± 1.41Gy, p < 0.001). Conclusions Regarding the dosimetry among the heart, LAD, ventricle, and left lung, SIB radiotherapy achieved better results, suggesting that the SIB plan might be more suitable for postoperative radiotherapy after BCS for early-stage breast cancer patients. We also witnessed that large daily radiation doses could be safe and effective when combined with the radiobiology of breast cancer. breast cancer hypofractionated whole breast irradiation sequential boost simultaneous integrated boost Figures Figure 1 Background The techniques and regimens of whole-breast radiotherapy are always being revolutionized [ 1 ]. In China, the previous mainstream treatment was conventional fractionation WBI (CFWBI), but since the 1990s, HFWBI has been slowly gaining popularity [ 2 ]. HFWBI has also been demonstrated to be superior in clinical trials and real-world cases. Not only has HFWBI shown the same therapeutic effect as CFWBI in trials, but also its radiation-induced reaction is lower [ 3 , 4 ]. Additionally, it can provide patients shorter radiotherapy cycle and enhance their convenience[ 5 ]. An additional boost in the whole breast irradiation (WBI) treatment plan is considered an essential option for most post-BCS patients [ 6 ], which could enhance the local control of recurrence, especially those with poor prognostic factors [ 7 , 8 ]. SEQ and SIB are the most used boosting choices for TB, however, SIB exhibited better tolerance owing to shorter treatment times, better dose distribution, and greater patient convenience [ 9 , 10 ]. But currently, studies comparing the dosimetry of SEQ and SIB are lacking [ 11 – 13 ]. We have recruited patients who intended to receive radiotherapy after surgery for early-stage left-sided breast cancer and treated them with two radiotherapy plans, SEQ and SIB. We completed the comparative analysis of the differences in dosimetric parameters of the two plans, dose distribution to the target areas, and protection of normal tissues so as to evaluate a more optimal choice of clinical radiotherapy technique. Methods Patient selection This comparative study enrolled pT1-2 pN0-1 breast cancer patients of any age and histologic subtype. Participants who had received any neoadjuvant chemotherapy prior to BCS and those with a prior history of breast augmentation were excluded. RT planning data of 56 patients with early-stage left-sided breast cancer were analyzed. All participants had at least 3 surgical clips fixed to the central bottom and lateral edges of the surgical cavity to mark the tumor bed (TB) boundaries. Following BCS and sentinel lymph node biopsy, all patients underwent H-VMAT between January 2021 and March 2022. CT simulation scans were performed in the supine position with free breathing for all patients. Moreover, no seroma was observed in the operative cavity during simulation scanning. Informed consent was obtained from all patients and/or their legal guardians, and the study was approved by the institutional research ethics board of the Wenzhou Central Hospital Ethics Committee (approval number: 202402231026000561941) and was performed under relevant guidelines/regulations. Target Volume Delineation The clinical target volume (CTV) and planning target volume (PTV) were outlined for each patient according to the breast cancer radiotherapy target area, to be specific, CTVtb and PTVtb were delineated as the volume extending 5mm and 15mm beyond the clips marking the TB respectively. The CTV of the whole breast (WB) covers the glandular breast tissue of the ipsilateral breast, referred to as the CTVwb. In addition, the CTVwb was confined to the glandular-pectoral muscle wall interface and 5 mm from the skin surface, which included the CTVtb. The PTV of WB is a 5-mm outward expansion of the CTVwb, i.e., the PTVwb. The delineation work was done by the same radiation oncologist with over 5 years of experience following the Radiation Therapy Oncology Group (RTOG) guidelines for adjuvant radiotherapy in early breast cancer. CT simulation Patients underwent three-dimensional computed tomography (3D-CT) simulation in the supine position using a 16-slice CT scanner (GE Discovery RT590, America) during free breathing. The patients were lying supine with arms crossed overhead, secured with a vacuum pad and body membrane fixation. The patients extended their left upper limbs at more than 90 degrees with lead wires marking the midline of the body and axillary fossa, surgical scars, and drainage ports. The CT images were generated in 3 mm slices from the cricothyroid membrane to 5 cm below the diaphragm. The CT dataset was exported to the uRT-TPOIS treatment planning system (uRT-TPOIS software, United Imaging Healthcare (UIH) Co, Ltd. Shanghai, China) [ 14 ] for target and OAR delineation and to formulate treatment plans. Treatment Planning All treatment plans were designed by the same physiologist to ensure consistency in treatment design and minimize errors. We employed the uRT-TPOIS software (United Imaging Healthcare (UIH) Co. Ltd. (Shanghai, China) for design work and the H-VMAT [ 18 ] technique to develop the radiotherapy plans, which included the use of the ut -linac 506c linear accelerator. For the individualized treatment regimens, the H-VMAT technology was predominant, with each program consisting of a Three-dimensional conformal therapy (3D-CRT) plan and a VMAT plan. Then all the planning parameters such as gantry and wedge filter angles, collimator position, and field weightings were individually optimized. The weighting between 3D-CRT and VMAT was 25/75, where 3D-CRT was used as the base scenario for VMAT optimization. The supplementary dose consisted of individual VMAT fields with identical isocenter positions. The range of their rotation angles corresponded to the tangent angle of the base plane. The collimator rotation angle was set to 0° and the maximum dose rate was set to 400 MU/min. A standard optimization scheme for the inverse planning process of VMAT was used and adapted individually. Finally, two radiotherapy plans were developed for each patient, the SIB and SEQ H-VMAT plans. The PTV prescription dose for WB was 42.5 Gy which was delivered in 16 fractions. At the same time, the PTVtb was 49.6 Gy, (total of 16 fractions). The PTV prescription dose of the SEQ H-VMAT plan for WB was 42.5 Gy, a total of 16 fractions, followed by 4 fractions consecutive increase doses in PTV for TB, with 2.66 Gy for each fraction [ 15 ]. According to the prescription dose requirements and organ-endangering dose limitations, at least 95% of PTVs are required to reach the prescribed dose, optimizing the irradiation dose for the whole heart, atrium, ventricle, coronary artery, heart valve, lung, spinal cord, and contralateral breast. Dosimetric evaluation The assessment of PTV was done by the conformal index (CI) and homogeneity index (HI). The data of V100% indicates the PTV coverage percent is the same as the prescribed dose line we designed. CI is calculated using the following formula: The Ref. isodose volume of the PTV provides the data of the absolute volume of the PTV covered by the prescribed dose while the absolute volume covered by the prescribed dose was reflected by Ref. isodose volume [ 16 ]. HI can be described as: HI = (D2 − D98) / D5 Doses covering 2% and 98% of the PTV are presented by D2 and D98 [ 17 ]. Dmax, Dmean, and Dmin represent the max dose, the mean dose, and the min dose respectively in the evaluation of the whole heart, atrium, ventricle, coronary artery, heart valve, lung, spinal cord, and contralateral breast. Moreover, the volumes that received ≥ 5 Gy, 10 Gy, 15 Gy, 20 Gy, 30 Gy and 40 Gy (V5, V10, V15, V 20, V30 and V40, respectively) were recorded. The monitor unit (MU) was adopted as the tool for treatment plan verification. Statistical methods SPSS 27.0 software (IBM Corporation, Armonk, NY, USA) finished the statistical analysis of this study. We used paired-sample t-tests, means, and standard deviations to deal with normally distributed data; Wilcoxon signed rank test, medians and ranges were for non-normally distributed data. The comparison of dosimetric parameters of the target OARs was performed by Wilcoxon signed-rank test and paired-sample t-tests depending on different tissue structures. P < 0.05 was the threshold for statistical significance. Results 1. Patient characteristics 56 individuals diagnosed with early-stage breast cancer who underwent HFWBI post-BCS within the timeframe of January 2021- March 2022 were enrolled in our study. The median age of the participants ranged from 30 to 60, with a median of 46 years old. All cases involved stage I or II breast cancer (T1N0M0-T2N0M0) on the left side, adhering to the 7th edition of the American Joint Committee on Cancer guidelines. Surgical interventions included lumpectomy coupled with either sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND) were adopted to ensure tumor-free margins. Detailed demographic specifics are delineated in Table 1 , and the images of the dose distribution of a typical patient receiving the WBI-SEQ and WBI-SIB plans are shown in Fig. 1 . Figure 1 . Dose distribution of a representative case using the sequential boost technique (A) versus the simultaneous integrated boost technique (B) Table 1 Patient and tumor characteristics (n = 56) Characteristic Classification Numbers of Patients (%) Age Median(range) 59(39–79) Histology Invasive ductal carcinoma 56(100) Histologic grade I II III 15(26.0) 16(28.0) 25(46.0) Tumor location Left inner quadrant Left outer quadrant 36(64.0) 20(36.0) T classification T1 T2 40(71) 16(29) Hormone receptor status ER-or PR-positive ER-and PR-negative 36(64.0) 20(36.0) HER2/neu + receptor Positive Negative 10(18.0) 46(82.0) 2. Dosimetric Evaluation of Target Regions in SEB HFWBI vs. SIB HFWBI Plans Dosimetric parameters, encompassing D2, D98, and V100% for the PTVtb and V100% for PTVwb (refer to Table 2 ), displayed notably higher values in the SEQ HFWBI plan vis-a-vis the SIB HFWBI plan utilizing H-VMAT (all P < 0.05). The CI values, indicative of target area conformity, exhibited similarity between the SEQ-HFWBI and SIB-HFWBI plans (p = 0.276), denoting high conformity in both strategies (the SEQ-HFWBI PTVtb 1.00 ± 0.001, the SIB-HFWBI PTVtb 1.00 ± 0.008, P = 0.276, the SEQ-HFWBI PTVwb 0.98 ± 0.008, the SIB-HFWBI PTVwb0.98 ± 0.009, P = 0.27 see Table 3 for details). Nonetheless, discrepancies were noted in the HI values, reflecting dose uniformity within the target region (the SEQ-HFWBI PTVtb 0.18 ± 0.61, the SIB-HFWBI PTVtb 0.11 ± 0.95, < 0.001; the SEQ-HFWBI PTVwb-tb 0.46 ± 0.12, the SIB-HFWBI PTVwb 0.33 ± 0.84, < 0.001, see Table 3 for details). Table 2 Dosimetric evaluation of the targets for the SEQ-HFWBI and SIB-HFWBI plans parameters SEQ-HFWBI SIB-HFWBI Z-value P-value PTVtb D2(Gy) 64.82(61.38–68.93) 58.57(56.90-61.51) -6.338 < 0.001 D98(Gy) 57.32(55.83–60.83) 49.29(48.88–49.68) -6.469 < 0.001 Dmean(Gy) 61.59(58.34–65.27) 54.31(53.18–55.39) -6.314 < 0.001 V100% 49.03(36.75–62.55) 48.91(36.00-62.28) -1.992 0.046 PTVwb V100% 893.44(724.17-1150.70) 893.44(724.17-1052.08) -2.232 0.026 PTVwb-tb D2(Gy) 63.95(60.76–66.39) 56.81(53.80-58.18) -6.485 < 0.001 D98(Gy) 40.78(40.00-41.33) 40.78(40.28–41.23) -0.188 0.851 V100% 813.88(654.70-1069.43) 796.60(635.50–1052.00) -6.509 < 0.001 Table 3 Comparison of the CI and HI for the targets between SEQ-HFWBI and SIB-HFWBI plans SEQ-HFWBI SIB-HFWBI T-value P-value PTVtb CI 1.00 ± 0.001 1.00 ± 0.008 1.101 0.276 HI 0.18 ± 0.95 0.11 ± 0.61 4.838 < 0.001 PTVwb CI 0.98 ± 0.008 0.98 ± 0.009 .436 0.664 PTVwb-tb HI 0.46 ± 0.12 0.33 ± 0.84 -8.887 < 0.001 3. Comparative Dosimetric Analysis of OARs in SEQ HFWBI vs. SIB HFWBI Plans Regarding OARs, the SIB-HFWBI plan showcased considerably lower average dose parameters (Dmean, V5, V10, V15, V20, V30, V40) for the ipsilateral lung compared to the SEQ-HFWBI plan (all P < 0.05, see Table 4 ). Conversely, when individuals with left-sided breast cancer subjecting to the SEQ, they manifested elevated dose parameters for the heart, atrium, ventricle, coronary artery, and heart valve (comprising Dmax, Dmean, V5, V10, V20, V30, V40) in contrast to the SIB-HFWBI plan in the same position(P < 0.05, refer to Table 5 – 6 ). No significant distinctions were observed in dose parameters (Dmax, Dmean, Dmean, V5, V10, V20, V30, and V40) towards the contralateral breast between both protocols. Additionally, the SIB configuration necessitated fewer MUs than the SEB setup, with statistically significant variations (refer to Table 4 ). Table 4 Dosimetric evaluation of the IPSL and Contralateral breast cancer patients between the SEQ-HFWBI and SIB-HFWBI plans parameters SEQ-HFWBI SIB-HFWBI P-value Ipsilateral lung V5(%) 57.01 ± 7.46 43.95 ± 4.76 < 0.001 V10(%) 32.70 ± 2.94 26.35 ± 3.34 < 0.001 v15(%) 25.18 ± 3.28 19.74 ± 4.12 < 0.001 V20(%) 20.08 ± 3.67 15.36 ± 3.72 < 0.001 V30(%) 12.90 ± 3.24 8.86 ± 2.65 < 0.001 V40(%) 6.41 ± 2.53 3.13 ± 1.74 < 0.001 Dmean (Gy) 11.86 ± 1.41 9.28 ± 1.07 < 0.001 Contralateral breast V5(%) 24.06 ± 15.37 23.93 ± 11.46 0.946 V10(%) 7.31 ± 6.04 6.95 ± 5.84 0.444 V20(%) 1.70 ± 4.31 1.27 ± 1.83 0.334 V30(%) 0.62 ± 3.49 0.67 ± 3.27 0.484 V40(%) 0.39 ± 2.85 0.39 ± 2.69 0.951 Dmean (Gy) 401.19 ± 129.14 399.27 ± 161.39 0.914 Mu 1056.18 ± 103.95 878.56 ± 179.50 < 0.001 Table 5 Dosimetric evaluation of the heart between the SEQ-HFWBI and SIB-HFWBI plans parameters SEQ-HFWBI SIB-HFWBI P-value Heart Dmax(Gy) 47.22 ± 5.56 43.43 ± 5.12 < 0.001 Dmin(Gy) 1.43 ± 0.33 1.10 ± 0.23 < 0.001 Dmean(Gy) 6.92 ± 0.92 5.24 ± 0.75 < 0.001 V5(%) 45.88 ± 11.14 29.00 ± 8.34 < 0.001 V10(%) 15.20 ± 3.19 9.52 ± 3.31 < 0.001 V20(%) 6.27 ± 1.75 3.76 ± 1.25 < 0.001 V30(%) 2.33(1.61.-3.48) 1.40(0.83–1.91) < 0.001 V40(%) 0.36(0.07–0.99) 0.11(0.00-0.42) < 0.001 LAD Dmax(Gy) 57.30 ± 3.98 49.63 ± 2.79 < 0.001 Dmin(Gy) 1.01 ± 0.45 0.79 ± 0.33 < 0.001 Dmean(Gy) 11.86 ± 1.40 9.27 ± 1.07 < 0.001 V5(%) 57.01 ± 7.46 43.95 ± 4.76 < 0.001 V10(%) 32.70 ± 2.94 26.35 ± 3.34 < 0.001 V20(%) 20.08 ± 3.67 15.36 ± 3.72 < 0.001 V30(%) 12.90 ± 3.24 8.86 ± 2.65 < 0.001 V40(%) 6.40 ± 2.53 3.13 ± 1.74 < 0.001 Right atrium Dmax(Gy) 8.51 ± 2.56 7.35 ± 2.71 < 0.001 Dmin(Gy) 1.85 ± 0.57 1.28 ± 0.32 < 0.001 Dmean(Gy) 3.71 ± 0.92 3.08 ± 0.97 < 0.001 V5(%) 11.0(3.05–28.54) 5.83(0.82–17.41) 0.001 Left atrium Dmax(Gy) 9.80 ± 6.38 7.13 ± 5.36 < 0.001 Dmin(Gy) 1.76 ± 0.53 1.23 ± 0.37 < 0.001 Dmean(Gy) 3.16 ± 0.86 2.30 ± 0.64 < 0.001 V5(%) 1.97(0.49–7.91) 0.07(0.00-0.86) < 0.001 Right ventricle Dmax(Gy) 37.76 ± 8.14 33.50 ± 8.63 < 0.001 Dmin(Gy) 2.49 ± 0.67 1.93 ± 0.53 < 0.001 Dmean(Gy) 8.39 ± 1.88 6.39 ± 1.54 < 0.001 V5(%) 71.76 ± 16.25 50.69 ± 21.02 < 0.001 V10(%) 23.94 ± 12.44 12.00 ± 8.01 < 0.001 V20(%) 3.61(1.58–8.73) 1.49(0.29–4.18) < 0.001 V30(%) 0.59(0.04–2.70) 0.12(0.00-0.74) < 0.001 Table 6 Dosimetric evaluation of the heart between the SEQ-HFWBI and SIB-HFWBI plans parameters SEQ-HFWBI SIB-HFWBI P-value Left ventricle Dmax (Gy) 45.37 ± 5.27 41.42 ± 6.59 < 0.001 Dmin (Gy) 2.22 ± 0.68 1.55 ± 0.36 < 0.001 Dmean (Gy) 8.54 ± 1.80 6.10 ± 1.33 < 0.001 V5(%) 55.54 ± 18.28 30.40 ± 9.22 < 0.001 V10(%) 21.81 ± 6.76 13.31 ± 5.37 < 0.001 V20(%) 10.03 ± 3.91 5.80 ± 3.38 < 0.001 V30(%) 4.16 ± 2.39 2.21 ± 1.81 < 0.001 V40(%) 0.44(0.04–1.68) 0.05(0.00-0.60) < 0.001 Pulmonary artery Dmax (Gy) 18.66 ± 8.97 14.00 ± 7.31 < 0.001 Dmin (Gy) 2.18 ± 0.80 1.53 ± 0.50 < 0.001 Dmean (Gy) 5.71 ± 1.80 4.23 ± 1.30 < 0.001 V5(%) 47.72 ± 25.24 26.26 ± 20.77 < 0.001 V10(%) 6.55(0.47–13.21) 0.53(0.00-3.53) < 0.001 Superior vena cave Dmax (Gy) 4.67 ± 1.61 3.91 ± 1.68 < 0.001 Dmin (Gy) 2.62 ± 0.97 1.99 ± 0.89 < 0.001 Dmean (Gy) 3.75 ± 1.24 2.86 ± 1.30 < 0.001 Ascending aorta Dmax (Gy) 8.21 ± 2.75 6.55 ± 2.45 < 0.001 Dmin (Gy) 2.66 ± 0.66 1.87 ± 0.55 < 0.001 Dmean (Gy) 4.48 ± 1.13 3.56 ± 1.22 < 0.001 V5(%) 23.79(5.80-47.21) 2.68(0.00-28.50) < 0.001 Aortic valve Dmax (Gy) 5.45 ± 1.47 4.25 ± 1.33 < 0.001 Dmin (Gy) 3.28 ± 0.92 2.39 ± 0.78 < 0.001 Dmean (Gy) 4.17 ± 1.11 3.17 ± 1..03 < 0.001 Pulmonary valve Dmax (Gy) 12.08 ± 5.29 8.33 ± 3.36 < 0.001 Dmin (Gy) 4.77 ± 1.47 3.29 ± 0.85 < 0.001 Dmean (Gy) 6.79 ± 2.13 4.71 ± 1.27 < 0.001 V5(%) 63.60 ± 27.35 43.70 ± 30.88 < 0.001 Mitral valve Dmax (Gy) 3.84 ± 1.26 2.80 ± 0.85 < 0.001 Dmin (Gy) 2.85 ± 0.87 1.98 ± 0.54 < 0.001 Dmean (Gy) 3.34 ± 1.04 2.38 ± 0.69 < 0.001 Discussion WBI following early-stage breast cancer surgery plays a crucial role in reducing the risk of local recurrence of invasive breast cancer, thereby extending overall survival. Additional irradiation further enhances the local control rate [ 18 ]. Currently, the CFWBI regimen typically involves daily doses of 1.8-2.0 Gy, with a total WBI dose of 50 Gy and an additional 10–16 Gy sequentially to the TB, spanning a treatment period of 5–7 weeks. However, due to its prolonged duration, high cost, and potential intolerance, this approach may face resistance [ 19 , 20 ]. Despite the widespread acceptance of CFWBI, approximately 15–20% of BCS patients opt out of radiotherapy due to its lengthy course [ 21 ]. In contrast, adjuvant hypofractionated radiotherapy post-breast-conserving surgery presents several advantages, including reduced treatment duration [ 21 ], minimized normal tissue exposure, lowered treatment costs [ 22 ], and improved patient compliance [ 23 ]. Research has indicated that early-stage breast cancer patients undergoing adjuvant hypofractionated radiotherapy achieve comparable tumor local control rates and incidence of adverse effects as those receiving conventional fractionated radiotherapy [ 24 ]. Consequently, HFWBI has rapidly replaced conventional radiotherapy globally, emerging as a recommended standard treatment modality. Regarding the TB boost in HFWBI, its inclusion is pivotal in the standard HFWBI setup [ 25 – 27 ]. However, existing studies lack consensus on the optimal parameters for the TB boost post-HFWBI, including the ideal dose, fractionation schedule, delivery method, and timing. Notably, a Canadian multicenter trial demonstrated the equivalence of HFWBI (42.5 Gy in 16 fractions) to CFWBI (50 Gy in 25 fractions) for early-stage breast cancer patients, albeit without a TB boost. In contrast, the UK START Trial A administered a boost of 10 Gy to the TB in five fractions following HFWBI sequentially [ 26 , 27 ]. Recent investigations have delved into the regimen for the TB boost in the context of HFWBI. For instance, Gupta et al. conducted a phase 2 randomized trial of HFWBI with a 5-year follow-up, delivering a whole breast dose of 36.63 Gy in 11 fractions followed by a TB boost of 13.32 Gy in 4 fractions. The outcomes at the 5-year mark revealed a locoregional control rate of 97.7%, an excellent breast cosmesis rate of 95%, and relatively low rates of acute and late toxicities [ 28 ]. The comparison between sequential and simultaneous integrated boosts in HFWBI is a topic of interest in radiotherapy research. A phase III randomized study by Paelinck et al. revealed differences in toxicity outcomes between the two approaches. Initially, grade 2/3 dermatitis was more frequent in the sequential integrated boost (SEB) arm, while edema incidence was lower in the SIB arm [ 29 ]. However, recent data showed no significant differences in physician-assessed two-year toxicity and photographic analysis between the SIB and SEB treatments [ 30 ]. As a pioneering study utilizing H-VMAT when comparing dosimetric parameters between SEQ-HFWBI and SIB-HFWBI, we found the CI value for both plans was close to 1, aligning with the ideal value as suggested by previous studies. Additionally, the HI analysis indicated that the SIB plans exhibited better dose homogeneity for the tumor bed (PTVtb) and the whole breast excluding the tumor bed (PTVwb-tb) compared to the SEQ plans, consistent with findings from Yu et al. [ 17 ]. Besides, radiation pneumonitis (RP) is a significant nonfatal complication in breast cancer radiotherapy. Dose-volume histogram (DVH) analysis plays a crucial role in understanding the relationship between OAR irradiation doses, volumes, and RP occurrence. Optimal optimization of DVH parameters, such as V5, V10, V15, V20, V30, and Mean lung dose (MLD), is essential in preventing RP. Studies have highlighted the importance of minimizing low-dose lung volumes (e.g., V5) to reduce RP risk. Studies by Kharofa and Pinnix have shown that specific thresholds of V5 are associated with RP occurrence in lung cancer and mediastinal lymphoma patients, respectively [ 31 ]. It has been observed that even low doses of radiation to a large lung volume can increase the risk of acute lung toxicity. Therefore, it is preferable to irradiate a smaller lung volume with higher doses rather than a larger volume with lower doses to reduce the risk of RP. V20 has been identified as an important risk factor for RP occurrence in breast cancer patients [ 32 , 33 ]. In our study, we found that the SIB plan significantly reduced V5, V10, V15, V30, and V40 compared to the SEQ plan, indicating its superiority in reducing low-dose exposure to normal lung tissue. This aligns with the findings from Kim et al. [ 15 ]. Additionally, we observed a decrease in Dmean for the left lung in the SIB plan compared to the SEQ plan, consistent with previous research. The advantages of SIB include the delivery of a higher biologically effective dose to the target volume, shorter overall treatment time, and more homogeneous and conformal dose distributions. Moreover, the impact of radiotherapy on cardiac function in breast cancer patients is a growing concern, with studies showing an increased risk of cardiovascular complications post-radiotherapy, particularly after 20 years, with a positive association with radiation dose [ 34 ]. Studies in China have highlighted the relationship between radiotherapy dose and cardiomyocyte damage, emphasizing the non-homogeneous dose distribution in the heart, particularly in the LAD territory [ 35 , 36 ]. Damage to the LAD, a major coronary artery, can lead to serious ischemic heart disease, underscoring the importance of monitoring cardiac doses and protecting cardiac substructures during radiotherapy. To be specific, based on the anatomy of the LAD, its distal segments can easily be included in the radiation fields. As a major coronary artery, it plays a pivotal role in myocardial perfusion, and any radiation-induced damage to this artery can lead to significant cardiac complications, including ischemic heart disease [ 37 ]. Recent studies have underscored the importance of protecting the LAD and left ventricle during radiotherapy for left breast cancer, as these structures are often exposed to high radiation doses [ 38 ]. It has also been found that the left ventricle and LAD of left-sided breast cancer patients are the most dose-exposed cardiac substructures, which are closely associated with long-term cardiac damage, and that Dmean higher than 20 Gy in the LAD increases the risk of developing late coronary stenosis by 5-fold [ 38 ], so the irradiation dose to cardiac substructures has come under scrutiny. Advanced radiotherapy techniques, such as VMAT and SIB technique, have been instrumental in optimizing dose distribution and reducing radiation exposure to the heart [ 39 , 40 ]. The finding in our study supports that the WBI-SIB group significantly reduced Dmax, Dmean, Dmin, and V5-V40 (%) in the whole heart compared with WBI-SEQ (P < 0.001), and secondly, for all sub-structures of the heart, these data were different degrees of decreases, especially in the LAD, atria, and ventricles. We also observed a difference between atrial and ventricular doses received, with Dmax, Dmean, Dmin, and V5 all decreasing in the former and all statistically significant. Whereas V10-V40 also decreased but the difference was not statistically significant due to the lower doses received. Few studies have reported dose data for cardiac substructures. The results of this study suggest that SIB has a dosimetric advantage over SEQ in terms of the amount of cardiac substructures subjected to the dose, which significantly reduces the irradiated dose to various cardiac substructures, and is expected to reduce the risk of long-term adverse cardiac events in the later stages. Moreover, our study identified the LAD and left ventricle as the most exposed cardiac substructures during left breast cancer radiotherapy, consistent with findings by Naimi Z [ 37 ]. The discrepancy between the decrease in Dmean for the whole heart and the LAD/left ventricle underscores the importance of considering these structures independently to effectively protect the heart [ 37 ]. Limiting the Dmean of the whole heart alone may not sufficiently shield the LAD, nor comprehensively assess the dose and damage to cardiac substructures. Due to its limited predictive value, the mean heart dose (MHD) may not reliably reflect the dose to cardiac subvolumes (including the LAD). For optimal cardiac sparing in radiotherapy, we recommend treating the left ventricle and LAD as independent dose–limiting organs to comprehensively protect the heart. Finally, the SIB plan significantly reduces the MU, potentially reducing machine inefficiency. Conclusion The potential benefits of the SIB plan include reduced doses of OARs, improved dose conformity, and a shortened overall treatment duration, thereby enhancing patient convenience. The plan also underscores the importance of continued monitoring and assessment to ensure the efficacy and safety of radiation therapy in the management of breast cancer. Long-term follow-up data are essential to evaluate whether the dosimetric advantages of the WBI-SIB plan could translate into improved clinical outcomes and reduce late cardiac toxicities. Abbreviations OAR: Organ at risk; BCS: Breast-conserving surgery; HFWBI: Hypofractionated whole breast irradiation; SEQ: Sequential boost; SIB: Simultaneous integrated boost; TB: Tumor bed; H-VMAT: Hybrid volumetric modulated arc therapy; Dmax: Max dose; Dmean: Mean dose; Dmin: Min dose; LAD: Left anterior descending; CFWBI: Conventional fractionation WBI; WBI: Whole breast irradiation; CTV: Clinical target volume; PTV: Planning target volume; WB: Whole breast; RTOG: Radiation Therapy Oncology Group; 3D-CT: Three-dimensional computed tomography; 3D-CRT: Three-dimensional conformal therapy; CI: Conformal index; HI: Homogeneity index; MU: Monitor unit; SLND: Sentinel lymph node dissection; ALND: Axillary lymph node dissection; RP: Radiation pneumonitis; DVH: Dose-volume histogram; MLD: Mean lung dose. Declarations Ethics approval and consent to participate This study was approved by the institutional research ethics board of the Wenzhou Central Hospital Ethics Committee (approval number: 202402231026000561941). Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no conflicts of interest. Funding None Authors' contributions Conception and design: SD and RZH; methodology: SD; software: HHL; validation: EYQ; formal analysis: HZ; investigation: YJX; resources: WQJ; data: WQJ; Manuscript writing: All authors; final approval of manuscript: All authors. Acknowledgments Not applicable. References National Comprehensive Cancer Network. Breast Cancer(Version 3.2023). Fowler JF. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol. 1989;62(740):679–94. 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Prognostic Factors for Local Control in Breast Cancer After Long-term Follow-up in the EORTC Boost vs No Boost Trial: A Randomized Clinical Trial. JAMA Oncol. 2017;3(1):42–8. Whelan T, MacKenzie R, Julian J, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94(15):1143–50. Alford SL, Prassas GN, Vogelesang CR, et al. Adjuvant breast radiotherapy using a simultaneous integrated boost: clinical and dosimetric perspectives. J Med Imaging Radiat Oncol. 2013;57(2):222–9. Bantema-Joppe EJ, Schilstra C, de Bock GH, et al. Simultaneous integrated boost irradiation after breast-conserving surgery: physician-rated toxicity and cosmetic outcome at 30 months' follow-up. Int J Radiat Oncol Biol Phys. 2012;83(4):e471–7. Van Parijs H, Reynders T, Heuninckx K, et al. Breast conserving treatment for breast cancer: dosimetric comparison of sequential versus simultaneous integrated photon boost. 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Correlation between target motion and the dosimetric variance of breast and organ at risk during whole breast radiotherapy using 4DCT. Radiation oncology (London, England). 2013;8:111. Yu T, Li Y, Sun T, et al. A comparative study on hypofractionated whole-breast irradiation with sequential or simultaneous integrated boost on different positions after breast-conserving surgery. Sci Rep. 2021;11(1):18017. Bartelink H, Horiot JC, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881 – 10882 trial. J Clin oncology: official J Am Soc Clin Oncol. 2007;25(22):3259–65. Morrow M, White J, Moughan J, et al. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin oncology: official J Am Soc Clin Oncol. 2001;19(8):2254–62. Polednak AP. Trends in, and predictors of, breast-conserving surgery and radiotherapy for breast cancer in Connecticut, 1988–1997. Int J Radiat Oncol Biol Phys. 2002;53(1):157–63. Lee HH, Hou MF, Chuang HY, et al. Intensity modulated radiotherapy with simultaneous integrated boost vs. conventional radiotherapy with sequential boost for breast cancer - A preliminary result. Breast. 2015;24(5):656–60. Chen GP, Liu F, White J et al. A planning comparison of 7 irradiation options allowed in RTOG 1005 for early-stage breast cancer. Medical dosimetry: official journal of the American Association of Medical Dosimetrists. 2015 Spring;40(1):21–5. McDonald MW, Godette KD, Whitaker DJ, et al. Three-year outcomes of breast intensity-modulated radiation therapy with simultaneous integrated boost. Int J Radiat Oncol Biol Phys. 2010;77(2):523–30. Hickey BE, James ML, Lehman M, et al. Fraction size in radiation therapy for breast conservation in early breast cancer. Cochrane Database Syst Rev. 2016;7(7):Cd003860. Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20. Bentzen SM, Agrawal RK, Aird EG, et al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008;9(4):331–41. Bentzen SM, Agrawal RK, Aird EG, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet (London England). 2008;371(9618):1098–107. Gupta A, Khan AJ, Yegya-Raman N, et al. 5-Year Results of a Prospective Phase 2 Trial Evaluating 3-Week Hypofractionated Whole Breast Radiation Therapy Inclusive of a Sequential Boost. Int J Radiat Oncol Biol Phys. 2019;105(2):267–74. Paelinck L, Gulyban A, Lakosi F, et al. Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial. Radiotherapy oncology: J Eur Soc Therapeutic Radiol Oncol. 2017;122(1):30–6. Van Hulle H, Desaunois E, Vakaet V, et al. Two-year toxicity of simultaneous integrated boost in hypofractionated prone breast cancer irradiation: Comparison with sequential boost in a randomized trial. Radiotherapy oncology: J Eur Soc Therapeutic Radiol Oncol. 2021;158:62–6. Kharofa J, Cohen EP, Tomic R, et al. Decreased Risk of Radiation Pneumonitis With Incidental Concurrent Use of Angiotensin-Converting Enzyme Inhibitors and Thoracic Radiation Therapy. Int J Radiation Oncology*Biology*Physics. 2012;84(1):238–43. Wen G, Tan Y-T, Lan X-W, et al. New Clinical Features and Dosimetric Predictor Identification for Symptomatic Radiation Pneumonitis after Tangential Irradiation in Breast Cancer Patients. J Cancer. 2017;8(18):3795–802. Shi S, Zeng Z, Ye L, et al. Risk Factors Associated With Symptomatic Radiation Pneumonitis After Stereotactic Body Radiation Therapy for Stage I Non–Small Cell Lung Cancer. Technol Cancer Res Treat. 2016;16(3):316–20. Rutqvist LE, Lax I, Fornander T, et al. Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys. 1992;22(5):887–96. Dai Xiaoping GJ. Serum cardiac troponin T measurement and cardiac injury in patients undergoing postoperative radiotherapy for breast cancer. J Oncol. 2005;11(04):292–3. Kang Changchun WX. Analysis of Serum Troponin T Measurement and Cardiac Injury in Patients Undergoing Postoperative Radiotherapy for Breast Cancer. China Med Guide. 2020;18(10):127–8. Naimi Z, Moujahed R, Neji H, et al. Cardiac substructures exposure in left-sided breast cancer radiotherapy: Is the mean heart dose a reliable predictor of cardiac toxicity? Cancer/Radiothérapie. 2021;25(3):229–36. Taylor C, McGale P, Brønnum D, et al. Cardiac Structure Injury After Radiotherapy for Breast Cancer: Cross-Sectional Study With Individual Patient Data. J Clin oncology: official J Am Soc Clin Oncol. 2018;36(22):2288–96. Duma MN, Baumann R, Budach W, et al. Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol. 2019;195(10):861–71. Virén T, Heikkilä J, Myllyoja K, et al. Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiation Oncol (London England). 2015;10:79. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4242199","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":289620107,"identity":"59248541-5670-457d-b218-b5bcc2dfcd96","order_by":0,"name":"Shi Dong","email":"","orcid":"","institution":"Wenzhou Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shi","middleName":"","lastName":"Dong","suffix":""},{"id":289620108,"identity":"a7542eb0-7466-46af-a915-a2f9f446a87a","order_by":1,"name":"Honghua Lin","email":"","orcid":"","institution":"Wenzhou Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Honghua","middleName":"","lastName":"Lin","suffix":""},{"id":289620109,"identity":"43cb51e8-5769-44f1-824b-30f6d43566f8","order_by":2,"name":"Enyi Qiu","email":"","orcid":"","institution":"Wenzhou Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Enyi","middleName":"","lastName":"Qiu","suffix":""},{"id":289620111,"identity":"89e08442-cb20-496f-b844-e81ac0129bac","order_by":3,"name":"Hao zhang","email":"","orcid":"","institution":"Wenzhou Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"zhang","suffix":""},{"id":289620113,"identity":"98ae2885-7499-4743-b614-568e43011ca3","order_by":4,"name":"Wenqi Jin","email":"","orcid":"","institution":"Wenzhou Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenqi","middleName":"","lastName":"Jin","suffix":""},{"id":289620114,"identity":"6d76e2da-c9c7-498e-8cd0-cfcf9a838ce1","order_by":5,"name":"Yajing Xu","email":"","orcid":"","institution":"Wenzhou Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yajing","middleName":"","lastName":"Xu","suffix":""},{"id":289620115,"identity":"dbda045b-d545-4213-b3d4-78efdf340222","order_by":6,"name":"Ruozhen Han","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACAwYGxgcfKmqY7dubDz5IqKghSguz4Ywzx9gNeI4lGzw4c4woLWzSvG3M/AYSPmaSD1uYCWsxlz7+2HAGG5u0uQRbWkViAxsDf3t3Al4tln0JiQ8+8MgYW85uPnYjcYcMg8SZsxvwO+wMw2HDGRJsyQx3jqXdSDzDxmAgkUtIC2ObNI8Bc33DjRyzgsQ2ZmK0MLNJ8yQwMxsAtTAQqYUNGMgHjjFL9hxLlkg4c4yHCL+wP3zw8V8NMz9788GPPypq5Pjbe/FrwQA8pCkfBaNgFIyCUYAVAABckkv8bNvv8AAAAABJRU5ErkJggg==","orcid":"","institution":"Wenzhou Central Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ruozhen","middleName":"","lastName":"Han","suffix":""}],"badges":[],"createdAt":"2024-04-09 13:18:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4242199/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4242199/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54992212,"identity":"a21c77ca-8f03-48d3-b349-5bb7f18b951a","added_by":"auto","created_at":"2024-04-19 17:24:31","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71643,"visible":true,"origin":"","legend":"\u003cp\u003eDose distribution of a representative case using the sequential boost technique (A) versus the simultaneous integrated boost technique (B)\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4242199/v1/deab16f49f0f313e9981a69e.jpg"},{"id":56781423,"identity":"b17c2d1d-1a2c-47a0-b13e-a30fc03466ae","added_by":"auto","created_at":"2024-05-20 11:36:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":907081,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4242199/v1/d65a06ee-11a9-427c-afcd-38a8e1d7b553.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment","fulltext":[{"header":"Background","content":"\u003cp\u003eThe techniques and regimens of whole-breast radiotherapy are always being revolutionized [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In China, the previous mainstream treatment was conventional fractionation WBI (CFWBI), but since the 1990s, HFWBI has been slowly gaining popularity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. HFWBI has also been demonstrated to be superior in clinical trials and real-world cases. Not only has HFWBI shown the same therapeutic effect as CFWBI in trials, but also its radiation-induced reaction is lower [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, it can provide patients shorter radiotherapy cycle and enhance their convenience[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn additional boost in the whole breast irradiation (WBI) treatment plan is considered an essential option for most post-BCS patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], which could enhance the local control of recurrence, especially those with poor prognostic factors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. SEQ and SIB are the most used boosting choices for TB, however, SIB exhibited better tolerance owing to shorter treatment times, better dose distribution, and greater patient convenience [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. But currently, studies comparing the dosimetry of SEQ and SIB are lacking [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe have recruited patients who intended to receive radiotherapy after surgery for early-stage left-sided breast cancer and treated them with two radiotherapy plans, SEQ and SIB. We completed the comparative analysis of the differences in dosimetric parameters of the two plans, dose distribution to the target areas, and protection of normal tissues so as to evaluate a more optimal choice of clinical radiotherapy technique.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003ePatient selection\u003c/h2\u003e\n \u003cp\u003eThis comparative study enrolled pT1-2 pN0-1 breast cancer patients of any age and histologic subtype. Participants who had received any neoadjuvant chemotherapy prior to BCS and those with a prior history of breast augmentation were excluded. RT planning data of 56 patients with early-stage left-sided breast cancer were analyzed. All participants had at least 3 surgical clips fixed to the central bottom and lateral edges of the surgical cavity to mark the tumor bed (TB) boundaries. Following BCS and sentinel lymph node biopsy, all patients underwent H-VMAT between January 2021 and March 2022. CT simulation scans were performed in the supine position with free breathing for all patients. Moreover, no seroma was observed in the operative cavity during simulation scanning. Informed consent was obtained from all patients and/or their legal guardians, and the study was approved by the institutional research ethics board of the Wenzhou Central Hospital Ethics Committee (approval number: 202402231026000561941) and was performed under relevant guidelines/regulations.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eTarget Volume Delineation\u003c/h2\u003e\n \u003cp\u003eThe clinical target volume (CTV) and planning target volume (PTV) were outlined for each patient according to the breast cancer radiotherapy target area, to be specific, CTVtb and PTVtb were delineated as the volume extending 5mm and 15mm beyond the clips marking the TB respectively. The CTV of the whole breast (WB) covers the glandular breast tissue of the ipsilateral breast, referred to as the CTVwb. In addition, the CTVwb was confined to the glandular-pectoral muscle wall interface and 5 mm from the skin surface, which included the CTVtb.\u003c/p\u003e\n \u003cp\u003eThe PTV of WB is a 5-mm outward expansion of the CTVwb, i.e., the PTVwb. The delineation work was done by the same radiation oncologist with over 5 years of experience following the Radiation Therapy Oncology Group (RTOG) guidelines for adjuvant radiotherapy in early breast cancer.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eCT simulation\u003c/h2\u003e\n \u003cp\u003ePatients underwent three-dimensional computed tomography (3D-CT) simulation in the supine position using a 16-slice CT scanner (GE Discovery RT590, America) during free breathing. The patients were lying supine with arms crossed overhead, secured with a vacuum pad and body membrane fixation. The patients extended their left upper limbs at more than 90 degrees with lead wires marking the midline of the body and axillary fossa, surgical scars, and drainage ports. The CT images were generated in 3 mm slices from the cricothyroid membrane to 5 cm below the diaphragm. The CT dataset was exported to the uRT-TPOIS treatment planning system (uRT-TPOIS software, United Imaging Healthcare (UIH) Co, Ltd. Shanghai, China) [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e] for target and OAR delineation and to formulate treatment plans.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eTreatment Planning\u003c/h2\u003e\n \u003cp\u003eAll treatment plans were designed by the same physiologist to ensure consistency in treatment design and minimize errors. We employed the uRT-TPOIS software (United Imaging Healthcare (UIH) Co. Ltd. (Shanghai, China) for design work and the H-VMAT [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e] technique to develop the radiotherapy plans, which included the use of the ut -linac 506c linear accelerator. For the individualized treatment regimens, the H-VMAT technology was predominant, with each program consisting of a Three-dimensional conformal therapy (3D-CRT) plan and a VMAT plan. Then all the planning parameters such as gantry and wedge filter angles, collimator position, and field weightings were individually optimized. The weighting between 3D-CRT and VMAT was 25/75, where 3D-CRT was used as the base scenario for VMAT optimization. The supplementary dose consisted of individual VMAT fields with identical isocenter positions. The range of their rotation angles corresponded to the tangent angle of the base plane. The collimator rotation angle was set to 0° and the maximum dose rate was set to 400 MU/min. A standard optimization scheme for the inverse planning process of VMAT was used and adapted individually. Finally, two radiotherapy plans were developed for each patient, the SIB and SEQ H-VMAT plans. The PTV prescription dose for WB was 42.5 Gy which was delivered in 16 fractions. At the same time, the PTVtb was 49.6 Gy, (total of 16 fractions). The PTV prescription dose of the SEQ H-VMAT plan for WB was 42.5 Gy, a total of 16 fractions, followed by 4 fractions consecutive increase doses in PTV for TB, with 2.66 Gy for each fraction [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. According to the prescription dose requirements and organ-endangering dose limitations, at least 95% of PTVs are required to reach the prescribed dose, optimizing the irradiation dose for the whole heart, atrium, ventricle, coronary artery, heart valve, lung, spinal cord, and contralateral breast.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eDosimetric evaluation\u003c/h2\u003e\n \u003cp\u003eThe assessment of PTV was done by the conformal index (CI) and homogeneity index (HI). The data of V100% indicates the PTV coverage percent is the same as the prescribed dose line we designed.\u003c/p\u003e\n \u003cp\u003eCI is calculated using the following formula:\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eThe Ref. isodose volume of the PTV provides the data of the absolute volume of the PTV covered by the prescribed dose while the absolute volume covered by the prescribed dose was reflected by Ref. isodose volume [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003eHI can be described as:\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eHI = (D2 − D98) / D5\u003c/h2\u003e\n \u003cp\u003eDoses covering 2% and 98% of the PTV are presented by D2 and D98 [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]. Dmax, Dmean, and Dmin represent the max dose, the mean dose, and the min dose respectively in the evaluation of the whole heart, atrium, ventricle, coronary artery, heart valve, lung, spinal cord, and contralateral breast. Moreover, the volumes that received ≥ 5 Gy, 10 Gy, 15 Gy, 20 Gy, 30 Gy and 40 Gy (V5, V10, V15, V 20, V30 and V40, respectively) were recorded. The monitor unit (MU) was adopted as the tool for treatment plan verification.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical methods\u003c/h2\u003e\n \u003cp\u003eSPSS 27.0 software (IBM Corporation, Armonk, NY, USA) finished the statistical analysis of this study. We used paired-sample t-tests, means, and standard deviations to deal with normally distributed data; Wilcoxon signed rank test, medians and ranges were for non-normally distributed data. The comparison of dosimetric parameters of the target OARs was performed by Wilcoxon signed-rank test and paired-sample t-tests depending on different tissue structures. P \u0026lt; 0.05 was the threshold for statistical significance.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e1. Patient characteristics\u003c/h2\u003e \u003cp\u003e56 individuals diagnosed with early-stage breast cancer who underwent HFWBI post-BCS within the timeframe of January 2021- March 2022 were enrolled in our study. The median age of the participants ranged from 30 to 60, with a median of 46 years old. All cases involved stage I or II breast cancer (T1N0M0-T2N0M0) on the left side, adhering to the 7th edition of the American Joint Committee on Cancer guidelines. Surgical interventions included lumpectomy coupled with either sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND) were adopted to ensure tumor-free margins. Detailed demographic specifics are delineated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, and the images of the dose distribution of a typical patient receiving the WBI-SEQ and WBI-SIB plans are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Dose distribution of a representative case using the sequential boost technique (A) versus the simultaneous integrated boost technique (B)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient and tumor characteristics (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumbers of Patients (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian(range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(39\u0026ndash;79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInvasive ductal carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistologic grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003cp\u003eII\u003c/p\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(26.0)\u003c/p\u003e \u003cp\u003e16(28.0)\u003c/p\u003e \u003cp\u003e25(46.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft inner quadrant\u003c/p\u003e \u003cp\u003eLeft outer quadrant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(64.0)\u003c/p\u003e \u003cp\u003e20(36.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(71)\u003c/p\u003e \u003cp\u003e16(29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHormone receptor status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER-or PR-positive\u003c/p\u003e \u003cp\u003eER-and PR-negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(64.0)\u003c/p\u003e \u003cp\u003e20(36.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHER2/neu\u0026thinsp;+\u0026thinsp;receptor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(18.0)\u003c/p\u003e \u003cp\u003e46(82.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2. Dosimetric Evaluation of Target Regions in SEB HFWBI vs. SIB HFWBI Plans\u003c/h2\u003e \u003cp\u003eDosimetric parameters, encompassing D2, D98, and V100% for the PTVtb and V100% for PTVwb (refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), displayed notably higher values in the SEQ HFWBI plan vis-a-vis the SIB HFWBI plan utilizing H-VMAT (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The CI values, indicative of target area conformity, exhibited similarity between the SEQ-HFWBI and SIB-HFWBI plans (p\u0026thinsp;=\u0026thinsp;0.276), denoting high conformity in both strategies (the SEQ-HFWBI PTVtb 1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.001, the SIB-HFWBI PTVtb 1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.008, P\u0026thinsp;=\u0026thinsp;0.276, the SEQ-HFWBI PTVwb 0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.008, the SIB-HFWBI PTVwb0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.009, P\u0026thinsp;=\u0026thinsp;0.27 see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for details). Nonetheless, discrepancies were noted in the HI values, reflecting dose uniformity within the target region (the SEQ-HFWBI PTVtb 0.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61, the SIB-HFWBI PTVtb 0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95, \u0026lt;\u0026thinsp;0.001; the SEQ-HFWBI PTVwb-tb 0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12, the SIB-HFWBI PTVwb 0.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84, \u0026lt;\u0026thinsp;0.001, see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for details).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDosimetric evaluation of the targets for the SEQ-HFWBI and SIB-HFWBI plans\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSEQ-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSIB-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eZ-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTVtb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD2(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e64.82(61.38\u0026ndash;68.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e58.57(56.90-61.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD98(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e57.32(55.83\u0026ndash;60.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e49.29(48.88\u0026ndash;49.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e61.59(58.34\u0026ndash;65.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e54.31(53.18\u0026ndash;55.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e49.03(36.75\u0026ndash;62.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e48.91(36.00-62.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTVwb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e893.44(724.17-1150.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e893.44(724.17-1052.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTVwb-tb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD2(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e63.95(60.76\u0026ndash;66.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e56.81(53.80-58.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-6.485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD98(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e40.78(40.00-41.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e40.78(40.28\u0026ndash;41.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.851\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e813.88(654.70-1069.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e796.60(635.50\u0026ndash;1052.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-6.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the CI and HI for the targets between SEQ-HFWBI and SIB-HFWBI plans\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSEQ-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSIB-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eT-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTVtb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.00\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.00\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTVwb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.98\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.98\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTVwb-tb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.46\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.33\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-8.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e3. Comparative Dosimetric Analysis of OARs in SEQ HFWBI vs. SIB HFWBI Plans\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eRegarding OARs, the SIB-HFWBI plan showcased considerably lower average dose parameters (Dmean, V5, V10, V15, V20, V30, V40) for the ipsilateral lung compared to the SEQ-HFWBI plan (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Conversely, when individuals with left-sided breast cancer subjecting to the SEQ, they manifested elevated dose parameters for the heart, atrium, ventricle, coronary artery, and heart valve (comprising Dmax, Dmean, V5, V10, V20, V30, V40) in contrast to the SIB-HFWBI plan in the same position(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, refer to Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). No significant distinctions were observed in dose parameters (Dmax, Dmean, Dmean, V5, V10, V20, V30, and V40) towards the contralateral breast between both protocols. Additionally, the SIB configuration necessitated fewer MUs than the SEB setup, with statistically significant variations (refer to Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDosimetric evaluation of the IPSL and Contralateral breast cancer patients between the SEQ-HFWBI and SIB-HFWBI plans\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSEQ-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSIB-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIpsilateral lung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e57.01\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e43.95\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;4.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV10(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e32.70\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e26.35\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ev15(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e25.18\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;3.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e19.74\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV20(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e20.08\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15.36\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV30(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e12.90\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8.86\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV40(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.41\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.13\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e11.86\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9.28\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContralateral breast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e24.06\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;15.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e23.93\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;11.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.946\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV10(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7.31\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;6.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e6.95\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;5.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV20(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.70\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e1.27\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV30(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.62\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e0.67\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;3.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV40(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.39\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e0.39\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e401.19\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;129.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e399.27\u0026thinsp;\u003cb\u003e\u0026plusmn;\u003c/b\u003e\u0026thinsp;161.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1056.18\u0026thinsp;\u0026plusmn;\u0026thinsp;103.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e878.56\u0026thinsp;\u0026plusmn;\u0026thinsp;179.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDosimetric evaluation of the heart between the SEQ-HFWBI and SIB-HFWBI plans\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSEQ-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSIB-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e47.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e43.43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e45.88\u0026thinsp;\u0026plusmn;\u0026thinsp;11.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e29.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV10(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e15.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV20(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV30(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e2.33(1.61.-3.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.40(0.83\u0026ndash;1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV40(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e0.36(0.07\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.11(0.00-0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e57.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e49.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e11.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e57.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e43.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV10(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e32.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e26.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV20(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e20.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV30(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e8.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV40(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e6.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight atrium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e11.0(3.05\u0026ndash;28.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.83(0.82\u0026ndash;17.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft atrium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e9.80\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e7.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.97(0.49\u0026ndash;7.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.07(0.00-0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight ventricle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e37.76\u0026thinsp;\u0026plusmn;\u0026thinsp;8.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e33.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean(Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e8.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e71.76\u0026thinsp;\u0026plusmn;\u0026thinsp;16.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e50.69\u0026thinsp;\u0026plusmn;\u0026thinsp;21.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV10(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e23.94\u0026thinsp;\u0026plusmn;\u0026thinsp;12.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV20(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3.61(1.58\u0026ndash;8.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.49(0.29\u0026ndash;4.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV30(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e0.59(0.04\u0026ndash;2.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.12(0.00-0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDosimetric evaluation of the heart between the SEQ-HFWBI and SIB-HFWBI plans\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eparameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSEQ-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSIB-HFWBI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft ventricle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e45.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e41.42\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e55.54\u0026thinsp;\u0026plusmn;\u0026thinsp;18.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e30.40\u0026thinsp;\u0026plusmn;\u0026thinsp;9.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV10(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e21.81\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e13.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV20(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e10.03\u0026thinsp;\u0026plusmn;\u0026thinsp;3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV30(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV40(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0.44(0.04\u0026ndash;1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.05(0.00-0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary artery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e47.72\u0026thinsp;\u0026plusmn;\u0026thinsp;25.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26.26\u0026thinsp;\u0026plusmn;\u0026thinsp;20.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV10(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6.55(0.47\u0026ndash;13.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.53(0.00-3.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSuperior vena cave\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAscending aorta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e23.79(5.80-47.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.68(0.00-28.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAortic valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1..03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e12.08\u0026thinsp;\u0026plusmn;\u0026thinsp;5.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eV5(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e63.60\u0026thinsp;\u0026plusmn;\u0026thinsp;27.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e43.70\u0026thinsp;\u0026plusmn;\u0026thinsp;30.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMitral valve\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmax (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmin (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDmean (Gy)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWBI following early-stage breast cancer surgery plays a crucial role in reducing the risk of local recurrence of invasive breast cancer, thereby extending overall survival. Additional irradiation further enhances the local control rate [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Currently, the CFWBI regimen typically involves daily doses of 1.8-2.0 Gy, with a total WBI dose of 50 Gy and an additional 10\u0026ndash;16 Gy sequentially to the TB, spanning a treatment period of 5\u0026ndash;7 weeks. However, due to its prolonged duration, high cost, and potential intolerance, this approach may face resistance [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Despite the widespread acceptance of CFWBI, approximately 15\u0026ndash;20% of BCS patients opt out of radiotherapy due to its lengthy course [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In contrast, adjuvant hypofractionated radiotherapy post-breast-conserving surgery presents several advantages, including reduced treatment duration [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], minimized normal tissue exposure, lowered treatment costs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and improved patient compliance [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Research has indicated that early-stage breast cancer patients undergoing adjuvant hypofractionated radiotherapy achieve comparable tumor local control rates and incidence of adverse effects as those receiving conventional fractionated radiotherapy [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Consequently, HFWBI has rapidly replaced conventional radiotherapy globally, emerging as a recommended standard treatment modality.\u003c/p\u003e \u003cp\u003eRegarding the TB boost in HFWBI, its inclusion is pivotal in the standard HFWBI setup [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, existing studies lack consensus on the optimal parameters for the TB boost post-HFWBI, including the ideal dose, fractionation schedule, delivery method, and timing. Notably, a Canadian multicenter trial demonstrated the equivalence of HFWBI (42.5 Gy in 16 fractions) to CFWBI (50 Gy in 25 fractions) for early-stage breast cancer patients, albeit without a TB boost. In contrast, the UK START Trial A administered a boost of 10 Gy to the TB in five fractions following HFWBI sequentially [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Recent investigations have delved into the regimen for the TB boost in the context of HFWBI.\u003c/p\u003e \u003cp\u003eFor instance, Gupta et al. conducted a phase 2 randomized trial of HFWBI with a 5-year follow-up, delivering a whole breast dose of 36.63 Gy in 11 fractions followed by a TB boost of 13.32 Gy in 4 fractions. The outcomes at the 5-year mark revealed a locoregional control rate of 97.7%, an excellent breast cosmesis rate of 95%, and relatively low rates of acute and late toxicities [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe comparison between sequential and simultaneous integrated boosts in HFWBI is a topic of interest in radiotherapy research. A phase III randomized study by Paelinck et al. revealed differences in toxicity outcomes between the two approaches. Initially, grade 2/3 dermatitis was more frequent in the sequential integrated boost (SEB) arm, while edema incidence was lower in the SIB arm [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, recent data showed no significant differences in physician-assessed two-year toxicity and photographic analysis between the SIB and SEB treatments [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a pioneering study utilizing H-VMAT when comparing dosimetric parameters between SEQ-HFWBI and SIB-HFWBI, we found the CI value for both plans was close to 1, aligning with the ideal value as suggested by previous studies. Additionally, the HI analysis indicated that the SIB plans exhibited better dose homogeneity for the tumor bed (PTVtb) and the whole breast excluding the tumor bed (PTVwb-tb) compared to the SEQ plans, consistent with findings from Yu et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBesides, radiation pneumonitis (RP) is a significant nonfatal complication in breast cancer radiotherapy. Dose-volume histogram (DVH) analysis plays a crucial role in understanding the relationship between OAR irradiation doses, volumes, and RP occurrence. Optimal optimization of DVH parameters, such as V5, V10, V15, V20, V30, and Mean lung dose (MLD), is essential in preventing RP. Studies have highlighted the importance of minimizing low-dose lung volumes (e.g., V5) to reduce RP risk. Studies by Kharofa and Pinnix have shown that specific thresholds of V5 are associated with RP occurrence in lung cancer and mediastinal lymphoma patients, respectively [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. It has been observed that even low doses of radiation to a large lung volume can increase the risk of acute lung toxicity. Therefore, it is preferable to irradiate a smaller lung volume with higher doses rather than a larger volume with lower doses to reduce the risk of RP. V20 has been identified as an important risk factor for RP occurrence in breast cancer patients [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, we found that the SIB plan significantly reduced V5, V10, V15, V30, and V40 compared to the SEQ plan, indicating its superiority in reducing low-dose exposure to normal lung tissue. This aligns with the findings from Kim et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, we observed a decrease in Dmean for the left lung in the SIB plan compared to the SEQ plan, consistent with previous research. The advantages of SIB include the delivery of a higher biologically effective dose to the target volume, shorter overall treatment time, and more homogeneous and conformal dose distributions.\u003c/p\u003e \u003cp\u003eMoreover, the impact of radiotherapy on cardiac function in breast cancer patients is a growing concern, with studies showing an increased risk of cardiovascular complications post-radiotherapy, particularly after 20 years, with a positive association with radiation dose [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Studies in China have highlighted the relationship between radiotherapy dose and cardiomyocyte damage, emphasizing the non-homogeneous dose distribution in the heart, particularly in the LAD territory [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Damage to the LAD, a major coronary artery, can lead to serious ischemic heart disease, underscoring the importance of monitoring cardiac doses and protecting cardiac substructures during radiotherapy. To be specific, based on the anatomy of the LAD, its distal segments can easily be included in the radiation fields. As a major coronary artery, it plays a pivotal role in myocardial perfusion, and any radiation-induced damage to this artery can lead to significant cardiac complications, including ischemic heart disease [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Recent studies have underscored the importance of protecting the LAD and left ventricle during radiotherapy for left breast cancer, as these structures are often exposed to high radiation doses [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. It has also been found that the left ventricle and LAD of left-sided breast cancer patients are the most dose-exposed cardiac substructures, which are closely associated with long-term cardiac damage, and that Dmean higher than 20 Gy in the LAD increases the risk of developing late coronary stenosis by 5-fold [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], so the irradiation dose to cardiac substructures has come under scrutiny. Advanced radiotherapy techniques, such as VMAT and SIB technique, have been instrumental in optimizing dose distribution and reducing radiation exposure to the heart [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe finding in our study supports that the WBI-SIB group significantly reduced Dmax, Dmean, Dmin, and V5-V40 (%) in the whole heart compared with WBI-SEQ (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and secondly, for all sub-structures of the heart, these data were different degrees of decreases, especially in the LAD, atria, and ventricles. We also observed a difference between atrial and ventricular doses received, with Dmax, Dmean, Dmin, and V5 all decreasing in the former and all statistically significant. Whereas V10-V40 also decreased but the difference was not statistically significant due to the lower doses received. Few studies have reported dose data for cardiac substructures. The results of this study suggest that SIB has a dosimetric advantage over SEQ in terms of the amount of cardiac substructures subjected to the dose, which significantly reduces the irradiated dose to various cardiac substructures, and is expected to reduce the risk of long-term adverse cardiac events in the later stages. Moreover, our study identified the LAD and left ventricle as the most exposed cardiac substructures during left breast cancer radiotherapy, consistent with findings by Naimi Z [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The discrepancy between the decrease in Dmean for the whole heart and the LAD/left ventricle underscores the importance of considering these structures independently to effectively protect the heart [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Limiting the Dmean of the whole heart alone may not sufficiently shield the LAD, nor comprehensively assess the dose and damage to cardiac substructures. Due to its limited predictive value, the mean heart dose (MHD) may not reliably reflect the dose to cardiac subvolumes (including the LAD). For optimal cardiac sparing in radiotherapy, we recommend treating the left ventricle and LAD as independent dose\u0026ndash;limiting organs to comprehensively protect the heart. Finally, the SIB plan significantly reduces the MU, potentially reducing machine inefficiency.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe potential benefits of the SIB plan include reduced doses of OARs, improved dose conformity, and a shortened overall treatment duration, thereby enhancing patient convenience. The plan also underscores the importance of continued monitoring and assessment to ensure the efficacy and safety of radiation therapy in the management of breast cancer. Long-term follow-up data are essential to evaluate whether the dosimetric advantages of the WBI-SIB plan could translate into improved clinical outcomes and reduce late cardiac toxicities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOAR: Organ at risk; BCS: Breast-conserving surgery; HFWBI: Hypofractionated whole breast irradiation; SEQ: Sequential boost; SIB: Simultaneous integrated boost; TB: Tumor bed; H-VMAT: Hybrid volumetric modulated arc therapy; Dmax: Max dose; Dmean: Mean dose; Dmin: Min dose; LAD: Left\u0026emsp;anterior\u0026emsp;descending; CFWBI: Conventional fractionation WBI; WBI: Whole breast irradiation; CTV: Clinical target volume; PTV: Planning target volume; WB: Whole breast; RTOG: Radiation Therapy Oncology Group; 3D-CT: Three-dimensional computed tomography; 3D-CRT: Three-dimensional conformal therapy; CI: Conformal index; HI: Homogeneity index; MU: Monitor unit; SLND: Sentinel lymph node dissection; ALND: Axillary lymph node dissection; RP: Radiation pneumonitis; DVH: Dose-volume histogram; MLD: Mean lung dose.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the\u0026nbsp;institutional research ethics board of the Wenzhou Central Hospital Ethics Committee\u0026nbsp;(approval number: 202402231026000561941).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConception and design: SD and RZH; methodology: SD; software: HHL; validation: EYQ; formal analysis: HZ; investigation: YJX; resources: WQJ; data: WQJ; Manuscript writing: All authors; final approval of manuscript: All authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Comprehensive Cancer Network. 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Cardiac substructures exposure in left-sided breast cancer radiotherapy: Is the mean heart dose a reliable predictor of cardiac toxicity? Cancer/Radioth\u0026eacute;rapie. 2021;25(3):229\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor C, McGale P, Br\u0026oslash;nnum D, et al. Cardiac Structure Injury After Radiotherapy for Breast Cancer: Cross-Sectional Study With Individual Patient Data. J Clin oncology: official J Am Soc Clin Oncol. 2018;36(22):2288\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuma MN, Baumann R, Budach W, et al. Heart-sparing radiotherapy techniques in breast cancer patients: a recommendation of the breast cancer expert panel of the German society of radiation oncology (DEGRO). Strahlenther Onkol. 2019;195(10):861\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVir\u0026eacute;n T, Heikkil\u0026auml; J, Myllyoja K, et al. Tangential volumetric modulated arc therapy technique for left-sided breast cancer radiotherapy. Radiation Oncol (London England). 2015;10:79.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, hypofractionated whole breast irradiation, sequential boost, simultaneous integrated boost","lastPublishedDoi":"10.21203/rs.3.rs-4242199/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4242199/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e This study aimed to compare dosimetry of the target region and organ at risk (OAR) according to two different radiation plans for patients after breast-conserving surgery (BCS), hypofractionated whole breast irradiation (HFWBI) combined with an additional sequential boost (SEQ) versus simultaneous integrated boost (SIB), and further explore better radiotherapy after breast-conserving surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe included 56 patients with early-stage left-sided breast cancer. Hybrid volumetric modulated arc therapy (H-VMAT) plus sentinel lymph node biopsy was given to all participants. The following SIB and SEQ treatments were planned for each patient. The radiation doses delivered to OAR and dose-volume histogram were analyzed. The comparison of the max dose (Dmax), the mean dose (Dmean), the min dose (Dmin), and the volume of each organ that received x Gy (Vx) was accomplished.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe V5, V10, and V20 of the heart and the ipsilateral lung were lower in the SIB plan than SEQ, while among patients receiving the SIB plan, the V5 and V10 of the right and the left ventricle were lower. The Dmean for the heart, left\u0026emsp;anterior\u0026emsp;descending (LAD), right ventricle, left ventricle and the ipsilateral lung was lower for the SIB plan (heart: 5.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75 Gy vs. 6.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92Gy, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; lad: 9.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07Gy vs. 11.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40Gy, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; right ventricle 6.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54Gy vs. 8.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88Gy, left ventricle 6.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33Gy vs. 8.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.80Gy, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; lung: 9.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07Gy vs. 11.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41Gy, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eRegarding the dosimetry among the heart, LAD, ventricle, and left lung, SIB radiotherapy achieved better results, suggesting that the SIB plan might be more suitable for postoperative radiotherapy after BCS for early-stage breast cancer patients. We also witnessed that large daily radiation doses could be safe and effective when combined with the radiobiology of breast cancer.\u003c/p\u003e","manuscriptTitle":"Hypofractionated wholebreast irradiation with sequential or simultaneous integrated boost for early breast cancer after-surgery treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 17:24:26","doi":"10.21203/rs.3.rs-4242199/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7ebab33-c577-467b-bb1a-2a98b3a50434","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-24T13:12:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 17:24:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4242199","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4242199","identity":"rs-4242199","version":["v1"]},"buildId":"CiT4i_kKBbxQbnFL0ufpk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}