title: Simultaneous integrated bilateral breast and nodal irradiation with volumetric arc therapy: case report and literature review.
abstract: OBJECTIVE
  For simultaneous bilateral breast cancer (SBBC) treatment, conventional radiotherapy (RT) has a number of critical shortcomings. Thus, the usefulness of volumetric arc therapy (VMAT) for SBBC is undeniable.
  
  
  METHODS
  A 34-year-old woman with SBBC received neoadjuvant chemotherapy followed by breast-conserving surgery and bilateral lymph node dissection. Given the conservative surgery and the nodal involvement after neoadjuvant chemotherapy, bilateral adjuvant RT to the breasts and regional nodes with doses of 50 Gy in 25 fractions and a simultaneous integrated boost (SIB) of 60 Gy to the surgical bed was proposed. Monoisocentric VMAT using 2 pairs of arcs was performed with adequate target dose coverage and low doses to the organs at risk. The results of this case were compared with those of previous studies in terms of RT technique and irradiated volumes.
  
  
  CONCLUSIONS
  VMAT is feasible and safe in the treatment of SBBC with SIB and nodal irradiation.
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Alba
authors.initials: A
authors.lastname: Fiorentino
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Tebano
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Ruggieri
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ricchetti
authors.affiliation: Department of Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar (Verona) - Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods