title: The modified tangential irradiation technique for breast cancer: how to cover the entire axillary region.
abstract: OBJECTIVE
  The two-portal tangential irradiation technique has usually been applied to breast cancer patients after breast-conserving surgery (1, 2) and is expected to irradiate the axillary lymph node region to some extent (3). We investigated the range of the axillary region covered by this technique and tried to devise an optimal irradiation technique (modified tangential irradiation) that would cover the axillary lymph node region properly.
  
  
  METHODS
  We checked the status of the surgical clips left at axillary lymph node sites by reviewing the simulator films and planning CT scans of 63 patients who underwent axillary dissection of level I, I-II, or I-III lymph nodes. Then we created the modified tangential irradiation technique and applied this technique to 16 patients and checked the irradiation volume by CT scans.
  
  
  RESULTS
  We found that all of the surgical clips on lateral-view simulator films were on the ventral side of the dorsal edge line of the humeral head. All but one clip were on the caudal side of the caudal edge line of the humeral head. Accordingly, it is possible to irradiate almost all axillary lymph node regions by setting the dorsal edge of the irradiation field on lateral-view simulator films at the dorsal edge of the humeral head and the cranial edge at the caudal edge of the humeral head.
  
  
  CONCLUSIONS
  All breast tissue and the entire axillary lymph node region can be covered by the modified tangential irradiation technique without increasing the lung volume irradiated.
authors.affiliation: Department of Radiology, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Takeda
authors.forename: N
authors.initials: N
authors.lastname: Shigematsu
authors.forename: M
authors.initials: M
authors.lastname: Kondo
authors.forename: A
authors.initials: A
authors.lastname: Amemiya
authors.forename: O
authors.initials: O
authors.lastname: Kawaguchi
authors.forename: M
authors.initials: M
authors.lastname: Sato
authors.forename: S
authors.initials: S
authors.lastname: Kutsuki
authors.forename: K
authors.initials: K
authors.lastname: Toya
authors.forename: R
authors.initials: R
authors.lastname: Ishibashi
authors.forename: T
authors.initials: T
authors.lastname: Kawase
authors.forename: N
authors.initials: N
authors.lastname: Tsukamoto
authors.forename: A
authors.initials: A
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods*; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000379:methods; D013525:Surgical Instruments