title: Early experience of tomotherapy-based intensity-modulated radiotherapy for breast cancer treatment.
abstract: OBJECTIVE
  New technology - specifically intensity-modulated radiotherapy (IMRT) - is now being applied to breast radiotherapy and a recent dosimetric analysis confirmed the advantages of IMRT over 'wedge-only' plans. Such application to everyday practice raises new issues and here we present the early experience of IMRT-based breast irradiation in a single centre.
  
  
  METHODS
  We present cases of breast cancer treated by Tomotherapy-based IMRT, where the perceived advantages of IMRT are considerable. Cases presented are bilateral disease, left breast irradiation, pectus excavatum, prominent contralateral prosthesis and internal mammary chain disease. We discuss the practicalities of such treatment and the advantages over standard breast irradiation techniques.
  
  
  RESULTS
  Advantages include better conformity of treatment with lowering of dosages to underlying organs at risk, for example ipsilateral lung and heart. There is improved coverage of the planning target volume, including regional nodes, without field junction problems. Planning, quality assurance and treatment delivery are more time consuming than for standard breast irradiation and the low dose 'bath' is increased.
  
  
  CONCLUSIONS
  The standard radiotherapy tangential technique for breast/chest wall treatments has not significantly changed over many decades, whereas across many other tumour sites there have been great advances in radiotherapy technology. The dosimetric advantages of IMRT are readily apparent from our early experience. The wider spread of the lower dose zone (the low dose 'bath' of radiation) is a potential concern regarding late oncogenesis and methods to minimise such risks should be considered.
authors.affiliation: Department of Radiotherapy, St Bartholomew's Hospital, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: O'Donnell
authors.forename: K
authors.initials: K
authors.lastname: Cooke
authors.forename: N
authors.initials: N
authors.lastname: Walsh
authors.forename: P N
authors.initials: PN
authors.lastname: Plowman
mesh_terms: D001940:Breast / Q000528:radiation effects*; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed