SU-E-T-567: A Three-Field Mono-Isocentric Inverse Treatment Planning Method for the Patients with Larger Breasts

Abstract

Purpose: The purpose of this study is to develop a three-field monoisocentric inverse breast treatment planning technique without the use of half-beam block. Methods: Conventional three-field breast treatment with supraclavicular half-beam blocked requires two isocenters when the breast is too large to be contained within half-beam. The inferior border of the supraclavicular field and superior borders of the breast fields are matched on patient's skin with the light field. This method causes a large dose variation in the matching region due to daily setup uncertainties and requires a longer treatment setup time. We developed a three-field mono-isocentric planning method for the treatment of larger breasts. The three fields share the same isocenter located in the breast. Beam matching is achieved by rotating collimator, couch and gantry. Furthermore, we employed a mixed open-IMRT inverse optimization method to improve dose uniformity and coverage. Results: Perfect geometric beam matching was achieved by rotating couch, collimator and gantry together. Treatment setup time was significantly reduced without light-field matching during treatment deliveries. Inverse mixed open-IMRT optimization method achieved better dose uniformity and PTV coverage while keeping sufficient air flash to compensate setup and breast shape changes in daily treatments. Conclusion: By eliminating light field matching, the three-field mono-isocentric treatment method can significantly reduce setup time and uncertainty for large breast patients. Plan quality is further improved by inverse IMRT planning.