title: Critical appraisal of treatment techniques based on conventional photon beams, intensity modulated photon beams and proton beams for therapy of intact breast.
abstract: OBJECTIVE
  To analyse different treatment techniques with conventional photon beams, intensity modulated photon beams, and proton beams for intact breast irradiation for patients in whom conventional irradiation would cause potentially dangerous lung irradiation.
  
  
  METHODS
  Five breast cancer patients with highly concave breast tissue volume around the lung were considered at planning level in order to assess the suitability of different irradiation techniques. Three-dimensional dose distributions for conventional two-field tangential photon treatment, two-field intensity modulated radiotherapy (IMRT), three-field non-IMRT, three-field IMRT, and single-field proton treatment were investigated, aiming at assessing the possibility to reduce lung irradiation below risk levels. Analysis of dose-volume histograms and related physical and biological parameters (significant minimum, maximum and mean doses, conformity indexes and equivalent uniform dose (EUD)) for planned target volume (PTV) and lung was carried out. Dose plans were compared with the conventional two-field tangential photon technique.
  
  
  RESULTS
  PTV coverage was comparable for non-IMRT and IMRT techniques (EUD from 47.1 to 49.4 Gy), and improved with single-field proton treatment (EUD=49.8 Gy). Lung irradiation was reduced, in terms of mean dose, with three-field (9.5 Gy) and proton technique (3.5 Gy), with respect to the conventional two-field treatment (12.9 Gy); also a reduction of the lung volume irradiated at high doses was observed. Better results could be achieved with protons. In addition, cardiac irradiation was also reduced with those techniques.
  
  
  CONCLUSIONS
  Geometrically difficult breast cancer patients could be irradiated with a three-field non-IMRT technique thus reducing the dose to the lung which is proposed as standard for this category of patients. Intensity modulated techniques were only marginally more successful than the corresponding non-IMRT treatments, while protons offer excellent results.
authors.affiliation: Radiation Oncology Department, Medical Physics Unit, Oncology Institute of Southern Switzerland, c/o Ospedale S. Giovanni, 6504 Bellinzona, Switzerland.
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bolsi
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
mesh_terms: D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000532:radiotherapy*; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000517:prevention & control*; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D011882:Radiotherapy, High-Energy / Q000379:methods*