Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy

Dosimetric and Radiobiological Comparison of Five Techniques for Postmastectomy Radiotherapy with Simultaneous Integrated Boost

“…Previous studies have demonstrated that IMRT and TomoTherapy outperformed conventional three-dimensional conformal radiotherapy (3DCRT) for the whole breast irradiation [ 6 – 8 ]. Several studies have already been published comparing various treatment modalities for PMRT treatment without the boost scheme [ 9 – 11 ] and the whole breast irradiation [ 8 , 12 , 13 ]. Very few publications, however, have focused on such comparison in PMRT with SIB.…”

Acute Toxicity From Breast Cancer Radiation Using Helical Tomotherapy With a Simultaneous Integrated Boost

“…24 Further complicating matters is that the TomoTherapy planning software itself may overestimate skin dose by anywhere between 3% and 13%. [25][26][27][28] Despite these limitations, adequate breast surface dose has been shown to be achievable utilizing TomoTherapy in clinical practice both at our institution, 29 as well as others. 30,31 Special care must be taken when treating patients with breast cancer having IMRT.…”

An alternative option to reduce lung dose for electron scar boost irradiation in post-mastectomy breast cancer patients with a thin chest wall

“…A common technique employed to reduce lung dose during the scar boost treatment is to use a bolus with the lowest available electron energy (Figure 1b). Although the use of a bolus reduces the dose to the underlying lungs with the added benefit of uniform dose distributions across uneven skin surfaces, it can also significantly increase the dose to the skin 4 7 , 15 Hence, the use of a bolus can exacerbate the acute skin erythema after chest wall irradiation, potentially also increasing late telangiectasia and thus compromising the cosmetic outcome following mastectomy.…”

“…[1][2][3] The dose regimen for PMRT is usually 50 Gy to the chest wall (CW) followed by additional 10-16 Gy to the surgical chest wall scar, especially for patients with close or positive mastectomy margins and large (i.e., ≥ 5 cm) tumours. 2,4 The most common treatment planning technique is opposed tangential megavoltage photon fields for the CW and an en face electron field for the scar boost. 2 While various treatment planning options such as electron beam only, combined photonelectron beams, proton therapy, intensity modulated radiation therapy or volumetric modulated radiation therapy have been used for CW irradiation, [5][6][7][8][9][10] the electron beam therapy is still the most common and preferred technique for scar boost irradiation because of the simplicity of treatment and the easy setups, 11 despite the availability of simultaneous integrated boost or high-dose rate treatments.…”

“…2 While various treatment planning options such as electron beam only, combined photonelectron beams, proton therapy, intensity modulated radiation therapy or volumetric modulated radiation therapy have been used for CW irradiation, [5][6][7][8][9][10] the electron beam therapy is still the most common and preferred technique for scar boost irradiation because of the simplicity of treatment and the easy setups, 11 despite the availability of simultaneous integrated boost or high-dose rate treatments. 4,11 However, one of the disadvantages of this en face electron field treatment technique is the radiation dose delivered to the underlying normal lungs, which can result in acute radiation induced toxicity such as radiation pneumonitis (RP). 7,12,13 Hence, minimising dose to underlying normal lungs is critical to avoiding acute lung toxicity in breast cancer patients undergoing PMRT.…”