title: Respiratory gated simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) after breast conservative surgery for carcinoma of the breast: The Salmaniya Medical complex experience.
abstract: OBJECTIVE
  To present our clinical experience using SIB-IMRT Technique for Intact Breast cancer.
  
  
  METHODS
  A retrospective review of 45 cases of Stage I-IV breast cancer patients treated with SIB-IMRT with respiratory gating after Conservative treatments from 25th November 2008 to 16th February 2010. The most common fractionation was 1.8 Gy to Ipsilateral Breast tissue and 2.2 Gy to the lumpectomy cavity giving whole breast dose as 50.4 Gy and Lumpectomy cavity dose as 61.6 Gy over 28 fractions concomitantly. Respiratory gating was done and CT-images were taken in inspiratory breath hold position.
  
  
  RESULTS
  A total of 45 patients with breast cancer - stage I (17.7%), II (71%), III (8.9%), IV (2.2%) were treated with SIB- IMRT with respiratory gated radiotherapy. Out of 45 patients, 24 are of left sided breast cancer and 21 are of right sided breast cancer patients. The median, Dose maximum (D-max) in SIB-IMRT is 106.2% of prescribed lumpectomy site dose. The median isodose line prescribed to PTV-2 is 100%. The Conformity index (CI) is 0.9688 (median value) and Homogeneity index (HI) 1.06 (median). The median ipsilateral lung, mean dose is 21.66 Gy and V-20 is 37.4%. For left sided cases the median value of mean heart dose, V-30 and V-40 are 22.98 Gy, 23.45% and 9.45 % respectively. Acute skin toxicity was of Grade-I in 2.2 %, Grade-II in 64.4 %, Grade-III in 31.1 %, and Grade-IV in 2.2 %. The global Breast cosmoses were seen excellent in majority (93%) of case at median follow up of 8 months duration.
  
  
  CONCLUSIONS
  Breast SIB-IMRT Technique is feasible and comparable with other treatment techniques with reduced treatment duration by six fractions. At median follow up of 8 months the skin toxicity and cosmoses are excellent in high percentage of cases.
authors: Department of Radiation Oncology, Salmaniya Medical Complex, Bahrain. sarojmajumdar@gmail.com
authors: D
authors: D
authors: Majumdar
authors: S S
authors: SS
authors: Mohammed
authors: M A
authors: MA
authors: Naseer
authors: J
authors: J
authors: Jacob
authors: R
authors: R
authors: Mohan
authors: S B
authors: SB
authors: Ebenezer
authors: B
authors: B
authors: Al Najar
authors: S
authors: S
authors: Al-Janahi
authors: V
authors: V
authors: Ramanathan
authors: S A
authors: SA
authors: Sabt
authors: R S
authors: RS
authors: Patnaik
authors: A
authors: A
authors: Hassan
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D060787:Neoplasm Grading; D011829:Radiation Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012867:Skin / Q000528:radiation effects