Helical tomotherapy for locoregional irradiation including the internal mammary chain in left-sided breast cancer: Dosimetric evaluation

Purpose: To compare a standard 3- or 4-field technique to intensity modulated radiotherapy with helical tomotherapy (IMRT-HT) in the planning of locoregional breast radiation including the internal mammary chain (IMC). Methods and materials: For 10 women with stage III left-sided breast cancer with a planning target volume (PTV) defined by the breast/chest wall and regional nodes, radiotherapy to a dose of 50 Gy in 25 fractions was planned using a standard 3- or 4-field technique and using IMRT-HT. Various metrics were extracted from dose-volume histograms, and were compared using the paired Student's t-test. Results: The PTV receiving at least 95% of the prescribed dose did not differ between the two plans, but the VD115% was significantly lower with IMRT-HT. The dose conformality was significantly better with IMRT-HT. The cardiac V30Gy was reduced with IMRT-HT. The mean lungs dose was lower with IMRT-HT, as well the V20Gy. With IMRT-HT, a greater volume of contralateral breast was irradiated to 5 Gy, but a smaller volume of soft tissue received dose above 50 Gy. Conclusions: Compared to a standard technique, IMRT-HT provides similar target coverage, improves dose conformality and dose homogeneity within the PTV, decreases mean lung dose and spares heart, lung and soft tissue from high dose exposure