title: [Inversely planned intensity modulated radiotherapy for irradiation of a woman with breast cancer and funnel chest].
abstract: BACKGROUND
  A 44-year old woman with breast cancer was transferred to our institution for irradiation. Due to a pronounced funnel chest no satisfying dose distribution was obtained by conventional techniques. Thus an intensity-modulated radiotherapy (IMRT) based on inverse optimisation was carried out. IMRT was compared to conventional techniques regarding dose distribution and feasibility.
  
  
  METHODS
  Tumor site was in the right middle lower quadrant. Target volume included the right breast and the parasternal lymph nodes. Target dose was 50.4 Gy. Based on inverse optimisation irradiation was carried out in "step-and-shoot"-technique with twelve intensity modulated beams with six intensity steps. Additionally, treatment plans were calculated using conventional techniques (technique A with two tangential wedged 6-MV photon beams, technique B with additional oblique 15-MeV electron portal). We analysed conformality and homogeneity of target volume and dose distribution within normal tissue.
  
  
  RESULTS
  Dose conformality was substantially improved by IMRT. Dose homogeneity was slightly decreased compared to technique A. Lung volume irradiated with a dose higher than 20 Gy was reduced from 56.8% with technique A and 40.1% with technique B, respectively to 22.1% with IMRT. Treatment was tolerated well by the patient without relevant side effects. Mean treatment time was 19.5 min.
  
  
  CONCLUSIONS
  The inversely planned IMRT using multiple beam directions is suitable for breast irradiation following breast conserving surgery. In the present case of a woman with funnel chest lung dose was substantially reduced without reduction of target dose. In which was the complex treatment technique leads to a clinically detectable advantage is examined at present, in the context of a study.
authors.affiliation: Klinische Kooperationseinheit Strahlentherapie, Deutsches Krebsforschungszentrum, Heidelberg, Germany. c.thilmann@dkfz.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Thilmann
authors.forename: Angelika
authors.initials: A
authors.lastname: Zabel
authors.forename: Sabine
authors.initials: S
authors.lastname: Kuhn
authors.forename: Rolf
authors.initials: R
authors.lastname: Bendl
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rhein
authors.forename: Michael
authors.initials: M
authors.lastname: Wannenmacher
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D005660:Funnel Chest / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008197:Lymph Node Excision; D015182:Lymphatic Irradiation; D008279:Magnetic Resonance Imaging; D015412:Mastectomy, Segmental; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal