title: Post-mastectomy radiotherapy in Denmark: from 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group.
abstract: This paper describes the procedure of changing from 2D to 3D treatment planning guidelines for post-mastectomy radiotherapy in Denmark. The aim of introducing 3D planning for post-mastectomy radiotherapy was to optimize the target coverage and minimize the dose to the normal tissues. Initially, it was investigated whether it was possible to find a treatment technique alternative to the one recommended by the Danish Breast Cancer Cooperative Group (DBCG). A dosimetric comparison of a combined photon/electron 3-field technique (3F) and a partial wide tangent technique (PWT) was carried out on individual planning CT-scans from seven patients selected to represent a wide range of sizes and shapes of chest walls. The heart dose was lower for PWT than for 3F, however, for both techniques the dose was within the accepted constraints. The lung dose was higher but acceptable for six of the seven patients with PWT. The dose to the internal mammary nodes (IMN) was not satisfactory for five of the seven patients for 3F, whereas only two of the seven patients had a minimum dose lower than 95% of the prescribed dose with PWT. Finally, the dose to the contralateral breast was increased when using PWT compared to 3F. It was concluded that PWT was an appropriate choice of technique for future radiation treatment of post-mastectomy patients. A working group was formed and guidelines for 3D planning were developed during a series of workshops where radiation oncologists and physicists from all radiotherapy centres participated. This work also included a definition of the tissue structures needed to be outlined on the planning CT-scan. The work was initiated in 2003 and the guidelines were approved by the DBCG Radiotherapy Committee in 2006. The first of January 2007 the 3D guidelines had been fully implemented in five of the seven radiotherapy centres.
authors.affiliation: Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mette S
authors.initials: MS
authors.lastname: Thomsen
authors.forename: Martin
authors.initials: M
authors.lastname: Berg
authors.forename: Hanne M
authors.initials: HM
authors.lastname: Nielsen
authors.forename: Aanders N
authors.initials: AN
authors.lastname: Pedersen
authors.forename: Marie
authors.initials: M
authors.lastname: Overgaard
authors.forename: Marianne
authors.initials: M
authors.lastname: Ewertz
authors.forename: Thomas
authors.initials: T
authors.lastname: Block
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Brodersen
authors.forename: Claudio
authors.initials: C
authors.lastname: Caldera
authors.forename: Erik
authors.initials: E
authors.lastname: Jakobsen
authors.forename: Claus
authors.initials: C
authors.lastname: Kamby
authors.forename: Flemming
authors.initials: F
authors.lastname: Kjaer-Kristoffersen
authors.forename: Dorte
authors.initials: D
authors.lastname: Klitgaard
authors.forename: Mette M
authors.initials: MM
authors.lastname: Nielsen
authors.forename: Lars
authors.initials: L
authors.lastname: Stenbygaard
authors.forename: Sune J
authors.initials: SJ
authors.lastname: Zimmermann
authors.forename: Cai
authors.initials: C
authors.lastname: Grau
mesh_terms: D001940:Breast / Q000528:radiation effects; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D003718:Denmark; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D017410:Practice Guidelines as Topic; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*