The modified inverse hockey stick technique for adjuvant irradiation after mastectomy

To present the technique of irradiation of post-mastectomy patients used in the Holycross Cancer Centre in Kielce.The paper presents a detailed description of the technique which is referred to as the 'modified inverse hockey stick technique (MIHS)'. The dosimetric characteristic of dose distribution for the MIHS technique is presented basing on dose distributions calculated for 40 patients. The measurements used to evaluate dose distribution included standard deviation of the dose in the Planning Target Volume (PTV) and the percentage of the PTV volume receiving a dose larger than 110% and smaller than 90%; the lung volume received at least 20 Gy (LV20) and the heart volume received at least 30 Gy (HV30). The distribution of the electron beam energy is also presented. The standard deviation of the dose in the PTV was approx. 10% in a majority of patients. About 12% of the PTV volume received a dose more than 10% smaller than intended and about 10% of the PTV volume received a dose more than 10% greater than intended. For patients irradiated on the left side of the chest wall the LV20 was always lesser than 25% and for patients irradiated on the right side of the chest wall - always less than 35%, except for one patient, in whom it reached 37%. The HV30 was always below 8%. The MIHS technique is a safe and reliable modality. The main advantages of the technique include very convenient and easily repeated positioning of the patient and small doses applied to the organs at risk. The individually calculated bolus plays an important role in diminishing the dose to the lung and heart. The disadvantages of the technique include poor dose homogeneity within the PTV and long matching lines of the electron and photon beams. (author)