Critical appraisal of a non-coplanar technique for radiotherapy of breast minimising lung involvement

Background and purpose: To appraise the potential benefit of a conformal technique with non-coplanar fields to minimise lung irradiation in the radiation treatment of breast. Patients and methods: A comparative study was carried out at planning level for six patients selected for their inadequate sparing of healthy lung tissue with the reference tangential technique. Plans were designed for the conventional tangential technique, for an alternative conformal approach with three beams and for the newly proposed technique with two non-coplanar beams. Results: In average for the new technique compared to the reference, mean lung dose dropped from ∼16 to 10.5 Gy, V20Gy from 29.5 to 18.2% and the dose delivered to 1/3 (1/4) of the lung volume dropped from 28.5% (67.3%) to 8.7% (13.4%). For PTV, the volume receiving at least 90% of the prescribed dose resulted 97.4% for the new and 97.3% for the reference. Conformity index improved significantly from 2.58 for the reference to 1.84 for the new technique. Conclusions: For a subgroup population of breast cancer patients, where conventional techniques failed to achieve high conformal avoidance, a treatment modality with non-coplanar beams was developed and clinically tested for six patients. It resulted dosimetrically adequate, particularly when the risk of toxicity is relevant