title: Technique alternatives for breast radiation oncology: Conventional radiation therapy to tomotherapy.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, Paris 75005, France.
authors.forename: N
authors.initials: N
authors.lastname: Fournier-Bidoz
authors.forename: Y
authors.initials: Y
authors.lastname: Kirova
authors.forename: F
authors.initials: F
authors.lastname: Campana
authors.forename: J
authors.initials: J
authors.lastname: El Barouky
authors.forename: S
authors.initials: S
authors.lastname: Zefkili
authors.forename: R
authors.initials: R
authors.lastname: Dendale
authors.forename: M A
authors.initials: MA
authors.lastname: Bollet
authors.forename: A
authors.initials: A
authors.lastname: Mazal
authors.forename: A
authors.initials: A
authors.lastname: Fourquet