title: Skin-sparing radiation using intensity-modulated radiotherapy after conservative surgery in early-stage breast cancer: a planning study.
abstract: OBJECTIVE
  To evaluate the feasibility of skin-sparing by configuring it as an organ-at-risk (OAR) while delivering whole-breast intensity-modulated radiotherapy (IMRT) in early breast cancer.
  
  
  METHODS
  Archival computed tomography scan images of 14 left-sided early-breast tumor patients who had undergone lumpectomy were selected for this study. Skin was contoured as a 4- to 5-mm strip extending from the patient outline to anterior margin of the breast planning target volume (PTV). Two IMRT plans were generated by the helical tomotherapy approach to deliver 50 Gy in 25 fractions to the breast alone: one with skin dose constraints (skin-sparing plan) and the other without (non-skin-sparing plan). Comparison of the plans was done using a two-sided paired Student t test.
  
  
  RESULTS
  The mean skin dose and volume of skin receiving 50 Gy were significantly less with the skin-sparing plan compared with non-skin-sparing plan (42.3 Gy vs. 47.7 Gy and 12.2% vs. 57.8% respectively; p < 0.001). The reduction in skin dose was confirmed by TLD measurements in anthropomorphic phantom using the same plans. Dose-volume analyses for other OARs were similar in both plans.
  
  
  CONCLUSIONS
  By configuring the skin as an OAR, it is possible to achieve skin dose reduction while delivering whole-breast IMRT without compromising dose profiles to PTV and OARs.
authors: Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.
authors: Elantholi P
authors: EP
authors: Saibishkumar
authors: Marc A
authors: MA
authors: MacKenzie
authors: Diane
authors: D
authors: Severin
authors: Alina
authors: A
authors: Mihai
authors: John
authors: J
authors: Hanson
authors: Helene
authors: H
authors: Daly
authors: Gino
authors: G
authors: Fallone
authors: Matthew B
authors: MB
authors: Parliament
authors: Bassam S
authors: BS
authors: Abdulkarim
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D012867:Skin / Q000528:radiation effects*; D047368:Tumor Burden