title: Radiation therapy of large intact breasts using a beam spoiler or photons with mixed energies.
abstract: Radiation treatment of large intact breasts with separations of more than 24 cm is typically performed using x-rays with energies of 10 MV and higher, to eliminate high-dose regions in tissue. The disadvantage of the higher energy beams is the reduced dose to superficial tissue in the buildup region. We evaluated 2 methods of avoiding this underdosage: (1) a beam spoiler: 1.7-cm-thick Lucite plate positioned in the blocking tray 35 cm from the isocenter, with 15-MV x-rays; and (2) combining 6- and 15-MV x-rays through the same portal. For the beam with the spoiler, we measured the dose distribution for normal and oblique incidence using a film and ion chamber in polystyrene, as well as a scanning diode in a water tank. In the mixed-energy approach, we calculated the dose distributions in the buildup region for different proportions of 6- and 15-MV beams. The dose enhancement due to the beam spoiler exhibited significant dependence upon the source-to-skin distance (SSD), field size, and the angle of incidence. In the center of a 20 x 20-cm(2) field at 90-cm SSD, the beam spoiler raises the dose at 5-mm depth from 77% to 87% of the prescription, while maintaining the skin dose below 57%. Comparison of calculated dose with measurements suggested a practical way of treatment planning with the spoiler--usage of 2-mm "beam" bolus--a special option offered by in-house treatment planning system. A second method of increasing buildup doses is to mix 6- and 15-MV beams. For example, in the case of a parallel-opposed irradiation of a 27-cm-thick phantom, dose to D(max) for each energy, with respect to midplane, is 114% for pure 6-, 107% for 15-MV beam with the spoiler, and 108% for a 3:1 mixture of 15- and 6-MV beams. Both methods are practical for radiation therapy of large intact breasts.
authors.affiliation: Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY, USA. ELief@cristhospital.org
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Lief
authors.forename: Margie A
authors.initials: MA
authors.lastname: Hunt
authors.forename: Linda X
authors.initials: LX
authors.lastname: Hong
authors.forename: Howard I
authors.initials: HI
authors.lastname: Amols
mesh_terms: D001943:Breast Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D017785:Photons / Q000627:therapeutic use*; D011879:Radiotherapy Dosage; D012867:Skin / Q000528:radiation effects