title: Postmastectomy electron beam chest wall irradiation in women with breast cancer: a clinical step toward conformal electron therapy.
abstract: OBJECTIVE
  Electron beam radiotherapy of the chest wall with or without lymph node irradiation has been used at the Institut Curie for >20 years. The purpose of this report was to show the latest improvements of our technique developed to avoid hot spots and improve the homogeneity.
  
  
  METHODS
  The study was split into two parts. A new electron irradiation technique was designed and compared with the standard one (dosimetric study). The dose distributions were calculated using our treatment planning software ISIS (Technologie Diffusion). The dose calculation was performed using the same calculation parameters for the new and standard techniques. Next, the early skin toxicity of our new technique was evaluated prospectively in the first 25 patients using Radiation Therapy Oncology Group criteria (clinical study).
  
  
  RESULTS
  The maximal dose found on the five slices was 53.4 +/- 1.1 Gy for the new technique and 59.1 +/- 2.3 Gy for the standard technique. The hot spots of the standard technique plans were situated at the overlap between the internal mammary chain and chest wall fields. The use of one unique field that included both chest wall and internal mammary chain volumes solved the problem of junction. To date, 25 patients have been treated with the new technique. Of these patients, 12% developed Grade 0, 48% Grade 1, 32% Grade 2, and 8% Grade 3 toxicity.
  
  
  CONCLUSIONS
  This report describes an improvement in the standard postmastectomy electron beam technique of the chest wall. This new technique provides improved target homogeneity and conformality compared with the standard technique. This treatment was well tolerated, with a low rate of early toxicity events.
authors: Department of Radiation Oncology, Institut Curie, Paris, France. youlia.kirova@curie.net
authors: Youlia M
authors: YM
authors: Kirova
authors: Francois
authors: F
authors: Campana
authors: Nathalie
authors: N
authors: Fournier-Bidoz
authors: Anne
authors: A
authors: Stilhart
authors: Remi
authors: R
authors: Dendale
authors: Marc A
authors: MA
authors: Bollet
authors: Alain
authors: A
authors: Fourquet
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D004583:Electrons / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation; D008408:Mastectomy; D011446:Prospective Studies; D011855:Radiodermatitis / Q000473:pathology*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D020266:Radiotherapy, Conformal / Q000379:methods* / Q000592:standards; D035441:Thoracic Wall / Q000528:radiation effects*