title: Hybrid IMRT plans--concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time.
abstract: OBJECTIVE
  To evaluate a hybrid intensity modulated radiation therapy (IMRT) technique as a class solution for treatment of the intact breast.
  
  
  METHODS
  The following five plan techniques were compared for 10 breast patients using dose-volume histogram analysis: conventional wedged-field tangents (Tangents), forward-planned field-within-a-field tangents (FIF), IMRT-only tangents (IMRT tangents), conventional open plus IMRT tangents (4-field hybrid), and conventional open plus IMRT tangents with 2 anterior oblique IMRT beams (6-field hybrid).
  
  
  RESULTS
  The 4-field hybrid and FIF achieved dose distributions better than Tangents and IMRT tangents. The volume of tissue outside the planning target volume receiving > or =110% of prescribed dose was largest for IMRT tangents (average 158 cc) and least for 6-field hybrid (average 1 cc); the FIF and 4-field hybrid were comparable (average 15 cc). Heart volume > or =30 Gy averaged 13 cc for all techniques, except Tangents, for which it was 32 cc. Average total lung volume > or =20 Gy was 7% for all. Contralateral breast doses were < 3% for all. Planning time for hybrid techniques was significantly less than for conventional FIF technique.
  
  
  CONCLUSIONS
  The 4-field hybrid technique is a viable class solution. The 6-field hybrid technique creates the most conformal dose distribution at the expense of more normal tissue receiving low dose.
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical School, UMASS/Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA. mayoc@ummhc.org
authors.forename: Charles S
authors.initials: CS
authors.lastname: Mayo
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Urie
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fitzgerald
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods