title: Three-dimensional conformal simultaneously integrated boost technique for breast-conserving radiotherapy.
abstract: OBJECTIVE
  To compare the target coverage and normal tissue dose with the simultaneously integrated boost (SIB) and the sequential boost technique in breast cancer, and to evaluate the incidence of acute skin toxicity in patients treated with the SIB technique.
  
  
  METHODS
  Thirty patients with early-stage left-sided breast cancer underwent breast-conserving radiotherapy using the SIB technique. The breast and boost planning target volumes (PTVs) were treated simultaneously (i.e., for each fraction, the breast and boost PTVs received 1.81 Gy and 2.3 Gy, respectively). Three-dimensional conformal beams with wedges were shaped and weighted using forward planning. Dose-volume histograms of the PTVs and organs at risk with the SIB technique, 28 x (1.81 + 0.49 Gy), were compared with those for the sequential boost technique, 25 x 2 Gy + 8 x 2 Gy. Acute skin toxicity was evaluated for 90 patients treated with the SIB technique according to Common Terminology Criteria for Adverse Events, version 3.0.
  
  
  RESULTS
  PTV coverage was adequate with both techniques. With SIB, more efficiently shaped boost beams resulted in smaller irradiated volumes. The mean volume receiving > or =107% of the breast dose was reduced by 20%, the mean volume outside the boost PTV receiving > or =95% of the boost dose was reduced by 54%, and the mean heart and lung dose were reduced by 10%. Of the evaluated patients, 32.2% had Grade 2 or worse toxicity.
  
  
  CONCLUSIONS
  The SIB technique is proposed for standard use in breast-conserving radiotherapy because of its dose-limiting capabilities, easy implementation, reduced number of treatment fractions, and relatively low incidence of acute skin toxicity.
authors: Department of Radiation Oncology, University Medical Center Groningen/University of Groningen, 9700 RB Groningen, The Netherlands. h.p.van.der.laan@rt.umcg.nl
authors: Hans Paul
authors: HP
authors: van der Laan
authors: Wil V
authors: WV
authors: Dolsma
authors: John H
authors: JH
authors: Maduro
authors: Erik W
authors: EW
authors: Korevaar
authors: Miranda
authors: M
authors: Hollander
authors: Johannes A
authors: JA
authors: Langendijk
mesh_terms: D001940:Breast / Q000528:radiation effects; D001943:Breast Neoplasms / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D011855:Radiodermatitis / Q000209:etiology*; D020266:Radiotherapy, Conformal / Q000379:methods*