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Hybrid IMRT plans - Concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time

by Charles S. Mayo, Marcia M. Urie, Thomas J. Fitzgerald
International Journal of Radiation Oncology Biology Physics ()
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Purpose: To evaluate a hybrid intensity modulated radiation therapy (IMRT) technique as a class solution for treatment of the intact breast. Methods and Materials: The following five plan techniques were compared for 10 breast patients using dose-volume histogram analysis: conventional wedged-field tangents (Tangents), forward-planned field-within-a-field tangents (FIF), IMRT-only tangents (IMRT tangents), conventional open plus IMRT tangents (4-field hybrid), and conventional open plus IMRT tangents with 2 anterior oblique IMRT beams (6-field hybrid). Results: The 4-field hybrid and FIF achieved dose distributions better than Tangents and IMRT tangents. The volume of tissue outside the planning target volume receiving <110% of prescribed dose was largest for IMRT tangents (average 158 cc) and least for 6-field hybrid (average 1 cc); the FIF and 4-field hybrid were comparable (average 15 cc). Heart volume <30 Gy averaged 13 cc for all techniques, except Tangents, for which it was 32 cc. Average total lung volume <20 Gy was 7% for all. Contralateral breast doses were <3% for all. Planning time for hybrid techniques was significantly less than for conventional FIF technique. Conclusions: The 4-field hybrid technique is a viable class solution. The 6-field hybrid technique creates the most conformal dose distribution at the expense of more normal tissue receiving low dose. ?? 2005 Elsevier Inc.

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