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J Korean Soc Ther Radiol Oncol > Volume 27(1); 2009 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2009;27(1): 35-41. doi: https://doi.org/10.3857/jkstro.2009.27.1.35
A Study of the Radiotherapy Techniques for the Breast Including Internal Mammary Lymph Nodes
Kyoungkeun Jeong, Su Jung Shim, Sei Hwan You, Yong Bae Kim, Ki Chang Keum, Jong Dae Kim, Chang Ok Suh
Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, Korea. cosuh317@yuhs.ac
This study was designed to determine the optimum radiotherapy technique for internal mammary node (IMN) irradiation after breast-conserving surgery.
We selected ten cases of early stage partial mastectomy for plan comparison. Five of the patients were treated to the right-side breast and the rest of the patients were treated to the left-side breast. For each case, four different treatment plans were made to irradiate the entire breast, IMNs and supraclavicular lymph nodes (SCLs). The four planning techniques include a standard tangential field (STF), wide tangential field (WTF), partially wide tangential field (PWT) and a photon-electron mixed field (PEM). We prescribed a dose of 50.4 Gy to the SCL field at a 3 cm depth and isocenter of the breast field.
The dose distribution showed clear characteristics depending on the technique used. All of the techniques covered the breast tissue well. IMN coverage was also good, except for the STF, which was not intended to cover IMNs. For the cases of the left-side breasts, the volume of the heart that received more than 30 Gy was larger (in order) for the WTF, PWT, PEM and STF. For radiation pneumonitis normal tissue complication probability (NTCP), the PWT showed the best results followed by the STF.
Despite the variety of patient body shapes, the PWT technique showed the best results for coverage of IMNs and for reducing the lung and heart dose.
Key Words: Radiotherapy techniques, Breast cancer, Internal mammary lymph node
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