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  • Title: Accelerated partial-breast intensity-modulated radiotherapy results in improved dose distribution when compared with three-dimensional treatment-planning techniques.
    Author: Rusthoven KE, Carter DL, Howell K, Kercher JM, Henkenberns P, Hunter KL, Leonard CE.
    Journal: Int J Radiat Oncol Biol Phys; 2008 Jan 01; 70(1):296-302. PubMed ID: 18086392.
    Abstract:
    PURPOSE: To compare dose distribution and normal tissue sparing in partial-breast treatment using three-dimensional conformal radiotherapy (3D-CRT) vs. intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Sixty-three patients with Tis-1N0M0 breast cancer were treated on a Phase II prospective accelerated partial-breast IMRT protocol at two facilities between April 2004 and January 2006. Fifty-six patients had data sets sufficient to adequately contour all structures. These cases were subsequently replanned with 3D-CRT techniques using the same contours, to compare the dose distribution patterns of 3D-CRT vs. IMRT. RESULTS: The average planning target volume (PTV) to ipsilateral breast (IB) ratio was 24% (range, 7-58%). The average volume of IB receiving 25%, 50%, 75%, and 100% of the prescribed dose was 4.0%, 5.0%, 5.5%, and 10.5% less with IMRT than with 3D (p < 0.01). The dose reduction to normal breast was further improved in the subset of patients whose PTV to IB ratio was >25%, and in patients with contoured breast volume <750 cm(3). No difference was detected in delivery to the lumpectomy cavity or clinical target volume. The PTV volume receiving 95% of the dose was higher in the 3D conformal plans (p < 0.01), but no significant difference was observed in the PTV volume receiving 90% (p = 0.17). The irradiated heart and lung volumes were small with both techniques but also favored IMRT. CONCLUSIONS: In T1N0 patients treated with external beam partial-breast radiotherapy, IMRT improves normal tissue sparing in the ipsilateral breast compared with 3DRT, without compromising dose delivery to the lumpectomy cavity and clinical target volume.
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