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Bi-tangential hybrid IMRT for sparing the shoulder in whole breast irradiation

Bitangentiale Hybrid-IMRT zur Schonung der Schulter bei Ganzbrustbestrahlung

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An Erratum to this article was published on 22 November 2013

Abstract

Background and purpose

A bi-tangential technique is proposed to reduce undesired doses to the shoulder produced by standard tangential irradiation.

Patients and methods

A total of 6 patients affected by shoulder pain and reduced functional capacity after whole-breast irradiation were retrospectively analysed. The standard tangential plan used for treatment was compared with (1) a single bi-tangential plan where, to spare the shoulder, the lateral open tangent was split into two half-beams at isocentre, with the superior portion rotated by 10–20° medially with respect to the standard lateral beam; (2) a double bi-tangential plan, where both the tangential open beams were split. The planning target volume (PTV) coverage and the dose to the portion of muscles and axilla included in the standard tangential beams were compared.

Results

PTV95 % of standard plan (91.9 ± 3.8) was not significantly different from single bi-tangential plan (91.8 ± 3.4); a small but significant (p < 0.01) decrease was observed with the double bi-tangential plan (90.1 ± 3.7). A marked dose reduction to the muscle was produced by the single bi-tangential plan around 30–40 Gy. The application of the double bi-tangential technique further reduced the volume receiving around 20 Gy, but did not markedly affect the higher doses. The dose to the axilla was reduced both in the single and the double bi-tangential plans.

Conclusion

The single bi-tangential technique would have been able to reduce the dose to shoulder and axilla, without compromising target coverage. This simple technique is valuable for irradiation after axillary lymph node dissection or in patients without dissection due to negative or low-volume sentinel lymph node disease.

Zusammenfassung

Hintergrund und Ziel

Um die von tangentialer Standardbestrahlung produzierte unerwünschte Dosis in der Schulter zu reduzieren, wird vorgeschlagen, eine bitangentiale Technik zu verwenden.

Patienten und Methoden

Insgesamt 6 Patienten, die nach Bestrahlung der gesamten Brust an Schmerzen und reduzierter Funktionsfähigkeit der Schulter leiden, wurden retrospektiv analysiert. Der zur Bestrahlung verwendete tangentiale Standardbehandlungsplan wurde verglichen: (1) Mit einem einzel-bitangentialen Plan, wobei zur Schonung der Schulter, die laterale Tangente in zwei Felder im Isozentrum mittels „Half-Beam“-Technik aufgeteilt wurde. Der obere Abschnitt wurde dabei 10–20° medial in Bezug auf den lateralen Strahl gedreht. (2) Mit einem doppel-bitangentialen Plan, in dem beide tangentialen Felder aufgeteilt wurden. Die Planungszielvolumen-(PTV-)Abdeckung und die Dosis auf dem Abschnitt der Muskeln und der Achselhöhle, die in den tangentialen Standardfeldern erfasst waren, wurden verglichen.

Ergebnisse

PTV95 % der Standardpläne (91,9 ± 3,8) zeigten keine signifikanten Unterschiede im Vergleich zu einzel-bitangentialen Plänen (91,8 ± 3,4); eine kleine, aber signifikante (p < 0,01) Abnahme wurde mit dem doppel-bitangentialen Plan (90,1 ± 3,7) beobachtet. Eine deutliche Reduzierung der Dosis im Muskel wurde mit bitangentialen Plänen bei 30–40 Gy erreicht. Die Verwendung der doppel-bitangentialen Technik führte zu kleineren Volumen, welche 20 Gy erhielten, beeinflusste aber die Hochdosisbereiche nicht merklich. Die Dosis in der Achselhöhle wurde sowohl in den bitangentialen Plänen als auch in den doppel-bitangentialen Pläne reduziert.

Schlussfolgerung

Die bitangentiale Technik könnte die Dosis in der Schulter und Achselhöhle reduzieren, wobei die Dosis im Zielvolumen nicht beeinträchtigt wird. Diese einfache Technik ist geeignet für Bestrahlungen nach axillärer Lymphknotensektion oder aber auch für Patienten, für die keine Sektion vorgenommen wurde, da die Sentinellymphknoten nur gering oder gar nicht beeinträchtigt sind.

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Compliance with ethical guidelines

Conflict of interest. P. Farace, M.A. Deidda, I. Iamundo, E. Deiana, R. Farigu, G. Lay and S. Porru state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Radio-Oncology, Regional Oncological Hospital, via Jenner, 09121, Cagliari, Italy

    P. Farace, M.A. Deidda, I. Iamundo de Curtis, E. Deiana, R. Farigu, G. Lay & S. Porru

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  1. P. Farace
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  2. M.A. Deidda
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  3. I. Iamundo de Curtis
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  4. E. Deiana
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  5. R. Farigu
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  6. G. Lay
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  7. S. Porru
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Correspondence to P. Farace.

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Farace, P., Deidda, M., Iamundo de Curtis, I. et al. Bi-tangential hybrid IMRT for sparing the shoulder in whole breast irradiation. Strahlenther Onkol 189, 967–971 (2013). https://doi.org/10.1007/s00066-013-0428-9

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  • DOI: https://doi.org/10.1007/s00066-013-0428-9

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