Summary
Purpose
To determine the dose received by the contralateral breast during primary breast irradiation using IMRT compared to conventional tangential field techniques.
Methods and materials
Between March 2003 and March 2004, 83 patients with breast carcinoma were treated using 6, 10, or mixed 6/18 MV photons (65 with tangential IMRT technique and 18 with 3-dimensional technique using tangential fields with wedges) for primary breast irradiation following breast-conserving surgery. Paired thermoluminescent dosimeters (TLDs) were placed on each patient’s contralateral breast, 4 and 8 cm from the center of the medial border of the tangential field. The TLDs were left on the patient during a single fraction and then measured 24 h afterwards.
Results
The mean dose delivered with photons to the primary breast for all patients was 4999 cGy (SD=52) with a mean single fraction dose of 199 cGy (SD=8). The mean percent of the prescribed dose to the contralateral breast measured at the 4- and 8-cm positions were 7.19% (SD=2.28) and 4.63% (SD=2.12), respectively, for patients treated with IMRT compared to 11.22% (SD=2.73) and 10.70% (SD=3.44), respectively, for the patients treated with conventional tangential field techniques. This represented a 36% and 57% reduction at the 4 and 8-cm contralateral positions, respectively, in the mean dose to the contralateral breast using IMRT compared to 3-D technique which was statistically significant (p<0.0005, <0.0005, respectively).
Conclusion
Primary breast irradiation with tangential IMRT technique significantly reduces the dose to the contralateral breast compared to conventional tangential field techniques.
Similar content being viewed by others
References
American Cancer Society: Cancer Facts & Figures 2003. American Cancer Society, Atlanta, 2003
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N, Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer N Engl J Med 347:1233–1241, 2002
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E, Twenty-year follow-up a of randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 1227–1232, 2002
NIH Consensus Conference: Treatment of early-stage breast cancer. JAMA 265:391–395, 1991
Osteen RT, Karnell LH, The National Cancer Data Base report on breast cancer Cancer 73:1994–2000, 1994
Lazovich D, Solomon CC, Thomas DB, Moe RE, White E, Breast conservation therapy in the United States following the 1990 National Institute of Health Consensus Development Conference on the treatment of patients with early stage invasive breast carcinoma Cancer 86:628–637, 1999
Land CE, Boice JD Jr, Shore RE, Norman JE, Tokunaga M, Breast cancer risk from low-dose exposure to ionizing radiation: results of parallel analysis of three exposed populations of women J Natl Cancer Inst 65:353–376, 1980
Hall EJ, Radiation carcinogenesis. In: Hall EJ, (ed) Radiobiology for the Radiologist. 5. Philadelphia: Lippincott Williams & Wilkins; 1994. pp 144–165
Boice JD Jr, Harvey EB, Blettner M, Stovall M, Flannery JT, Cancer in the contralateral breast after radiotherapy for breast cancer N Engl J Med 326:781–785, 1992
Obedian E, Fischer DB, Hafty BG, Second malignancies after treatment of early-stage breast cancer: lumpectomy and radiation therapy versus mastectomy J Clin Oncol 18:2406–2412, 2000
Fraass BA, Roberson PL, Lichter AS, Dose to the contralateral breast due to primary breast irradiation Int J Radiat Oncol Biol Phys 11:485–497, 1985
Muller-Runkel R, Kalokhe UP, Scatter dose from tangential breast irradiation to the uninvolved breast Radiology175:873–876, 1990
Zelefsky MJ, Fuks Z, Hunt M, Yamada Y, Marion C, Ling CC, Amols H, Venkatraman ES, Leibel SA, High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients Int J Radiat Oncol Biol Phys 53:1111–1116, 2002
Hong L, Hunt M, Chui C, Spirou S, Forster K, Lee H, Yahalom J, Kutcher GJ, McCormick B, Intensity-modulated tangential beam irradiation of the intact breast Int J Radiat Oncol Biol Phys 44:1155–1164, 1999
Heron DE, Gerszten K, Selvaraj RN, King GC, Sonnik D, Gallion H, Comerci J, Edwards RP, Wu A, Andrade RS, Kalnicki S, Conventional 3D conformal versus intensity-modulated radiotherapy for the adjuvant treatment of gynecologic malignancies: a comparative dosimetric study of dose–volume histograms Gynecol Oncol 91 39–45, 2003
Krueger EA, Fraass BA, Pierce LJ, Clinical aspects of intensity-modulated radiotherapy in the treatment of breast cancer Semin Radiat Oncol 12:250–259, 2002
Chang SX, Deschesne KM, Cullip TJ, Parker SA, Ernhart J, A comparison of different intensity modulation treatment techniques for tangential breast irradiation Int J Radiat Oncol Biol Phys 45:1305–1314, 1999
Landau D, Adams EJ, Webb S, Ross G, Cardiac avoidance in breast radiotherapy: a comparison of simple shielding techniques with intensity-modulated radiotherapy Radiother Oncol 60:247–255, 2001
Kestin LL, Sharpe MB, Frazier RC, Vicini FA, Yam D, Matter RC, Martinez AA, Wong JW, Intensity modulation to improve dose uniformity with tangential breast radiotherapy: initial clinical experience Int J Radiat Oncol Biol Phys 48:1559–1568, 2000
Vicini FA, Sharpe M, Kestin L, Martinez A, Mitchell CK, Wallace MF, Matter R, Wong J, Optimizing breast cancer treatment efficacy with intensity-modulated radiotherapy Int J Radiat Oncol Biol Phys 54:1336–1344, 2002
Acknowledgement
We would like to posthumously thank Debbie Sonnik for her time and assistance in the preparation of this article.
Author information
Authors and Affiliations
Corresponding author
Additional information
*Presented in part of the 46th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Atlanta, GA, October 2004.
Rights and permissions
About this article
Cite this article
Bhatnagar, A.K., Brandner, E., Sonnik, D. et al. Intensity modulated radiation therapy (IMRT) reduces the dose to the contralateral breast when compared to conventional tangential fields for primary breast irradiation. Breast Cancer Res Treat 96, 41–46 (2006). https://doi.org/10.1007/s10549-005-9032-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-005-9032-8