title: Body mass index and patient CT measurements as a predictor of benefit of intensity-modulated radiotherapy to the supraclavicular fossa.
abstract: BACKGROUND
  Irradiation of the supraclavicular fossa is commonly used as part of adjuvant breast radiotherapy. Intensity-modulated radiotherapy (IMRT) may be used to target this region accurately, and there are subgroups of patients that may benefit more from IMRT than others. We identify the benefit of IMRT over fixed-depth dose prescription to the supraclavicular fossa in patients of different builds in a clinical setting.
  
  
  METHODS
  Fifteen patients who received radiotherapy to the left breast and supraclavicular fossa were selected. Computed tomographic planning was used to generate plans for supraclavicular fossa coverage. Dose prescription to 1.5 cm and 3.0 cm depths was compared with IMRT plans. Coverage of the planning target volume and dose to the organs at risk were compared and correlated with patient body mass index (BMI) and computed tomography measurements.
  
  
  RESULTS
  Within the IMRT group, increasing depth of the supraclavicular fossa produced significantly better coverage of the planning target volume with IMRT. IMRT resulted in lower mean doses to the brachial plexus (P = 0.00) when compared with 1.5 cm and 3 cm depth dose prescriptions, but higher maximum brachial plexus doses. IMRT was more beneficial in patients with lower BMI because this resulted in a decreased maximum brachial plexus dose (P-values of 0.03 and 0.001 when compared with 1.5 cm and 3.0 cm depth dose prescriptions, respectively). Higher patient BMI resulted in a lower dose contribution of IMRT to the cord (P-values 0.066 and 0.034 when compared with 1.5 cm and 3.0 cm depth dose prescriptions respectively).
  
  
  CONCLUSIONS
  IMRT of the supraclavicular fossa results in lower brachial plexus doses for patients with low BMI while patients with higher BMI benefit from lower mean cord doses. IMRT provides superior coverage of the planning target volume, especially in patients with a deeper supraclavicular fossa.
authors.affiliation: Department of Radiation Oncology, National University Cancer Institute, Singapore.
authors.forename: Vicky
authors.initials: V
authors.lastname: Koh
authors.forename: Johann I
authors.initials: JI
authors.lastname: Tang
authors.forename: Bok Ai
authors.initials: BA
authors.lastname: Choo
authors.forename: Chek Wee
authors.initials: CW
authors.lastname: Tan
authors.forename: Boon Keat
authors.initials: BK
authors.lastname: Lim
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.forename: Jiade Jay
authors.initials: JJ
authors.lastname: Lu
keywords: breast cancer; intensity-modulated radiotherapy; radiotherapy; supraclavicular fossa