Intensity Modulated Therapy for Patients With Breast Cancer. Practical Guidelines and Tips for an Effective Treatment Planning Strategy

Abstract

PurposePractical guidelines and tips for effective and robust radiotherapy treatment planning for breast cancer patients are addressed for intensity-modulated fixed field or volumetric modulated arc therapy techniques. The concepts described here are general and valid on all the treatment planning systems. However, some details have been shown here applied to the Varian platforms used at the authors’ institutions. MethodsThe specific aspects of using C-arm or O-ring mounted linear accelerators are covered in the document, as well as tips for dealing with certain resource constraints, target cropping and skin flash aiming to reduce risks of skin toxicity and to manage (residual after breath control) respiration motion or oedema. ResultsA decision tree is presented, and practical solutions are discussed for cases where a target volume is contoured or not; where volumetric modulated arc therapy or fixed beams intensity modulation should be applied and details about the technical implementation (tangential IMRT, butterfly IMRT or VMAT, large partial VMAT arcs). Target cropping and skin flash implications are discussed in detail, and links to plan robustness are outlined. ConclusionsPractical guidelines for breast planning are presented and summarized with a decision tree and technical summaries.