An Improved Internal Mammary Irradiation Technique in Treatment of Locally Advanced Breast Cancers

Department of Radiation Oncology, Siteman Cancer Center, Washington University Medical Center, St. Louis, Missouri 63110, USA.
Journal of Applied Clinical Medical Physics (Impact Factor: 1.17). 02/2005; 6(1):84-93. DOI: 10.1120/jacmp.2023.25324
Source: PubMed


The purpose of the present study was to compare a new internal mammary irradiation technique with traditional techniques for locally advanced breast cancers in terms of sparing ipsilateral lung and heart and reducing the "cold" and "hot spots"in breast tissue. The new technique uses wide tangential fields for the first eight fractions of treatment. A medial internal mammary field (IMF) of electrons matched with narrowed tangential fields is used for the remaining fractions. Intensity-modulated radiation therapy (IMRT) by means of segmented multileaf collimation (SMLC) is used in the narrowed tangential fields to improve the match between the electron and the photon fields. Treatment planning was performed to compare this technique to a wide-tangential-only technique and to a traditional oblique IMF technique for three patients with differing habitus. Film dosimetry was performed in a solid water phantom to confirm the planning results. For all three patients, the mean doses of the ipsilateral lung and the heart were significantly reduced with the new technique. The lung and the heart volumes were remarkably reduced at lowdose levels (< or =12 Gy) compared to the traditional IMF technique, and significantly reduced at all dose levels compared to the wide tangential technique. The new technique also reduced the "cold" and "hot spots" along the match plane between the IMF and the tangential fields compared to the traditional IMF technique. In conclusion, the new IMF technique shows dosimetric improvement compared to the traditional IMF technique in terms of the critical organ sparing and target dose uniformity.

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Available from: jian-yue Jin, Jan 08, 2014
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    • "Current techniques of using tangential photon adjunct fields abutting supraclavicular and posterior axillary fields are difficult enough without the addition of treating a separate medial breast internal mammary field with a mixture of photon and electrons. Though there has been extensive work to optimize these techniques (Jin et al 2005), there are shortcomings due to match-line problems and delivery of unacceptable doses to volumes of heart, lung and contra lateral breast. Ma et al (2003) compared conventional radiotherapy, IMRT and MERT for breast cancer treatment. "
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