Technique alternatives for breast radiation oncology: Conventional radiation therapy to tomotherapy.
Breast conserving radiotherapy uses tangential fields and compensating wedges. This conventional approach can be improved by a field-in-field technique using the linac multi-leaf collimator (MLC). A simplified field-in-field technique that planners can easily achieve and which improves dose uniformity in the breast volume is presented here. Field junction problems are more easily solved by the use of a virtual simulation. A unique isocenter can be set at the junction between the supra-clavicular field and the breast tangential fields. However, careful quality assurance of the treatment planning system must be performed. Tomotherapy has promising clinical advantages: the ability of a tomographic image to correct for random set-up errors, a continuous cranio-caudal delivery which suppresses junction problems, the conformality of the dose distribution throughout the complex volumes formed by the lymph nodes and the breasts. Tomotherapy is a valuable recourse for complex irradiations like bilateral breast or mammary plus axillary irradiation while a field-in-field associated with a unique isocenter technique can be used for majority of the patients.
Fournier-Bidoz
N
N
Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, Paris 75005, France.
Kirova
Y
Y
Campana
F
F
El Barouky
J
J
Zefkili
S
S
Dendale
R
R
Bollet
M A
MA
Mazal
A
A
Fourquet
A
A