title: An improved technique for breast cancer irradiation including the locoregional lymph nodes.
abstract: OBJECTIVE
  To find an irradiation technique for locoregional irradiation of breast cancer patients which, compared with a standard technique, improves the dose distribution to the internal mammary-medial supraclavicular (IM-MS) lymph nodes. The improved technique is intended to minimize the lung dose and reduce the dose to the heart.
  
  
  METHODS
  The standard technique consists of an anterior mixed electron/photon IM-MS field. In the improved technique, an oblique electron and an oblique asymmetric photon field are combined to irradiate the IM lymph nodes. To irradiate the MS lymph nodes, a combination of an anterior electron and an anterior asymmetric photon field is used. For both the standard and the improved technique, tangential photon fields are used to irradiate the breast. Three-dimensional (3D) treatment planning was performed for 8 patients with various breast sizes for these two techniques. Dose-volume histograms (DVHs) and normal tissue complication probabilities (NTCPs) were compared for both techniques. The field dimensions and energy of the standard technique were determined at simulation, whereas for the improved technique the fields were designed by CT-based treatment planning.
  
  
  RESULTS
  The dose in the breast planning target volume was essentially the same for both techniques. For the improved technique, combined with 3D localization information, an improvement in the IM-MS planning target coverage is seen. The volume within the 95% isodose surface was on average 25% (range, 0-64%) and 74% (range, 43-90%) for the standard and improved technique, respectively. The heart generally receives less dose with the improved technique. However, sometimes a small but acceptable increase in lung dose is found.
  
  
  CONCLUSIONS
  The improved technique, combined with localization information of the IM-MS lymph nodes, greatly improves the dose distribution in the planning target volume for a large group of patients without significantly increasing the dose to organs at risk.
authors.affiliation: The Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis, Plesmanlaan, Amsterdam. hurkmans@nki.nl
authors.forename: C W
authors.initials: CW
authors.lastname: Hurkmans
authors.forename: A E
authors.initials: AE
authors.lastname: Saarnak
authors.forename: B R
authors.initials: BR
authors.lastname: Pieters
authors.forename: J H
authors.initials: JH
authors.lastname: Borger
authors.forename: I A
authors.initials: IA
authors.lastname: Bruinvis
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006321:Heart; D006801:Humans; D008168:Lung; D015182:Lymphatic Irradiation / Q000379:methods*; D055585:Physical Phenomena; D010825:Physics; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal; D012016:Reference Values; D012189:Retrospective Studies; D013116:Spinal Cord; D014057:Tomography, X-Ray Computed