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Intensity-Modulated Radiation Therapy for Breast Cancer

Improving Treatment Efficacy

  • Current Opinion
  • Published:
American Journal of Cancer

Abstract

Over the past 2 decades, numerous advances and innovations have occurred in all technical aspects of radiation therapy (RT), including three-dimensional (3D) treatment planning, conformal radiation delivery, intensity-modulated radiation therapy (IMRT), patient immobilization, and precise treatment verification. Despite incredible progress on all fronts, standard RT for breast cancer has changed very little and has not fully exploited many of the advances commonly used to treat most other malignancies. Increasing data have also accumulated, indicating that dose non-uniformities within the breast with traditional RT techniques can be greater than in many other anatomic sites. These significant dose inhomogeneities can produce unnecessary acute and chronic toxicities as well as unacceptable long-term cosmetic results. In addition, the lack of accurate verification of target volume coverage (e.g. lumpectomy cavity or chest wall) may result in diminished tumor control.

In this review, we demonstrate how 3D treatment planning combined with IMRT using our in-house step and shoot, multi-leaf collimator (sMLC) technique for tangential whole-breast RT can be an efficient and reliable method for achieving a more uniform dose throughout the whole breast. Strict dose-volume constraints can be readily met in the majority of patients, resulting in both improved coverage of breast tissue as well as a potential reduction in acute and chronic toxicities. Since the median number of sMLC segments required per patient is only eight, treatment time is not significantly increased. As a result, widespread implementation of this technology can be achieved for most patients with breast cancer with minimal imposition on clinic resources and time constraints. In addition, since lung and heart volumes are also identified, doses to these structures can be maintained at predefined ‘safe’ levels by the treating physician.

With the increased use of potentially cardiotoxic drugs in a substantial number of patients with breast cancer, the use of RT in these patients will take on greater significance. It remains to be seen whether the previously noted improvements in survival of patients with postmastectomy RT can be maintained using ‘standard’ techniques combined with these cardiotoxic drugs or whether more technologically sophisticated RT approaches (e.g. IMRT) will be required.

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Acknowledgements

Supported in part by a grant from the NCI R01 CA 76182 and an educational grant from Elekta Oncology Systems.

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Authors and Affiliations

  1. Department of Radiation Oncology, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI, 48073, USA

    Frank A. Vicini, Michael Sharpe, Larry Kestin, Alvaro Martinez & John Wong

Authors
  1. Frank A. Vicini
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  2. Michael Sharpe
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  3. Larry Kestin
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  4. Alvaro Martinez
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  5. John Wong
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Correspondence to Frank A. Vicini.

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Vicini, F.A., Sharpe, M., Kestin, L. et al. Intensity-Modulated Radiation Therapy for Breast Cancer. Am J Cancer 1, 237–245 (2002). https://doi.org/10.2165/00024669-200201040-00001

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