title: Accelerated partial breast irradiation: what is dosimetric effect of advanced technology approaches?
abstract: OBJECTIVE
  The present treatment planning study compared whole breast radiotherapy (WBRT) to accelerated partial breast irradiation (APBI) for different external beam techniques and geometries (e.g., free breathing [FB] and deep inspiration breath hold [DIBH]).
  
  
  METHODS
  After approval by our institutional review board, a treatment planning study was performed of 10 patients with left-sided Stage 0-I breast cancer enrolled in a Phase I-II study of APBI using intensity-modulated radiotherapy (IMRT). After lumpectomy, patients underwent planning computed tomography scans during FB and using an active breathing control device at DIBH. For the FB geometry, standard WBRT and three-dimensional conformal radiotherapy (3D-CRT) APBI plans were created. For the DIBH geometry with active breathing control, WBRT, 3D-CRT, and IMRT APBI plans were created.
  
  
  RESULTS
  All APBI techniques had excellent planning target volume coverage. The maximal planning target volume dose was reduced from 116% of the prescription dose to 108% with the IMRT(DIBH) APBI plan. The maximal heart dose was >30 Gy for the WBRT techniques, 8.2 Gy for 3D-CRT(FB), and <5.0 Gy for 3D-CRT(DIBH) and IMRT(DIBH) techniques. The mean left anterior descending artery dose was significantly reduced from 11.4 Gy with WBRT(FB) to 4.2 with WBRT(DIBH) and <2.0 Gy with all APBI techniques.
  
  
  CONCLUSIONS
  Although planning target volume coverage was acceptable with all techniques, the plans using the DIBH geometry resulted in a marked reduction in the normal tissue dose compared with WBRT planned in the absence of cardiac blocking. Additional study is needed to determine whether these techniques result in clinical benefits.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109-0010, USA. jmmoran@med.umich.edu
authors.forename: Jean M
authors.initials: JM
authors.lastname: Moran
authors.forename: Merav A
authors.initials: MA
authors.lastname: Ben-David
authors.forename: Robin B
authors.initials: RB
authors.lastname: Marsh
authors.forename: James M
authors.initials: JM
authors.lastname: Balter
authors.forename: Kent A
authors.initials: KA
authors.lastname: Griffith
authors.forename: James A
authors.initials: JA
authors.lastname: Hayman
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Pierce
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D003331:Coronary Vessels / Q000528:radiation effects; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D015412:Mastectomy, Segmental; D009068:Movement; D011832:Radiation Injuries / Q000517:prevention & control; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D015656:Respiratory Mechanics; D047368:Tumor Burden