title: Do breast cups improve breast cancer dosimetry? A comparative study for patients with large or pendulous breasts.
abstract: OBJECTIVE
  Treating patients with large or pendulous breasts is challenging. Although brassiere cups are currently in use, no study has yet been carried out to assess their dosimetric impact. The aim of the present study was to evaluate the possible dosimetric advantages of the use of breast cups on patients with large or pendulous breasts.
  
  
  METHODS
  Two CT studies were carried out on 12 breast cancer patients with large or pendulous breasts, with one study involving the use of breast cups. Radiation plans were developed in accordance with each of the CT studies. The following were compared: planning target volume (PTV), volume irradiated by the 95% isodose, conformity index, homogeneity index, mean lung dose, and mean heart dose was also compared for left breast treatment. The plan involving the use of cups was found to be the best option, leading to all patients being treated with cups. The resulting acute toxicity and cosmesis were also recorded. Both scenarios involved the use of film dosimetry to evaluate the skin doses.
  
  
  RESULTS
  The use of breast cups resulted in a significant reduction of the PTV volume (from 1640 cm3 to 1283 cm3), of the irradiated volume (from 2154 cm3 to 1477 cm3) and of the conformity index (from 1383 to 1213). Despite slight improvements in the homogeneity index (from 0.12 to 0.10), statistical significance was not attained. The use of breast cups also led to significant dose reductions in V20 for lung (from 13.7% to 1.7%) and V5 for heart (from 9.8% to 2.7%). No differences in acute toxicity or cosmesis were observed compared to patients treated without cups.
  
  
  CONCLUSIONS
  Our results show that the use of brassiere cups during breast radiation therapy leads to improvements in the main dosimetric factors analyzed. Furthermore, modifications to standard irradiation protocols are not required. In summary, we consider the technique of using breast cups with radiation therapy highly appropriate when treating breast cancer patients with large or pendulous breasts.
authors.affiliation: Hospital Universitari Sant Joan, Radiation Oncology, Institut d'Investigacions Sanit ries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV) , Reus , Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Arenas
authors.forename: Víctor
authors.initials: V
authors.lastname: Hernández
authors.forename: Blanca
authors.initials: B
authors.lastname: Farrús
authors.forename: Katrin
authors.initials: K
authors.lastname: Müller
authors.forename: Marina
authors.initials: M
authors.lastname: Gascón
authors.forename: Alida
authors.initials: A
authors.lastname: Pardo
authors.forename: Roberto
authors.initials: R
authors.lastname: Berenguer
authors.forename: Sebastia
authors.initials: S
authors.lastname: Sabater
mesh_terms: D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002277:Carcinoma / Q000532:radiotherapy*; D004864:Equipment and Supplies; D005260:Female; D006801:Humans; D008327:Mammography; D009929:Organ Size; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed