Simultaneous integrated boost in breast conserving treatment of breast cancer: A dosimetric comparison of helical tomotherapy and three-dimensional conformal radiotherapy

Background and purpose: To evaluate the dosimetry of helical tomotherapy (HT) and three-dimensional conformal radiotherapy (3D-CRT) in breast cancer patients undergoing whole breast radiation with simultaneous integrated boost (SIB) of the tumor bed. Material and methods: Thirteen patients with breast cancer treated by lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned using both HT and 3D-CRT using the field-infield technique. The whole breast and tumor bed were prescribed 50.68 Gy and 64.4 Gy, respectively, in 28 fractions. Dosimetries for both techniques were compared. Results: Coverage of the whole breast was adequate with both techniques (V-95% = 96.22% vs. 96.25%, with HT and 3D-CRT, respectively; p = 0.64). Adequate tumor bed coverage was also achieved, although it was significantly lower with HT (V-95% = 97.18% vs. 99.72%; p < 0.001). Overdose of the breast volume outside the tumor bed was significantly lower with HT (V-54.23Gy = 12.47% vs. 30.83%; p < 0.001). Ipsilateral lung V-20Gy (6.34% vs. 10.17%; p < 0.001), V-5Gy (16.54% vs. 18.53%; p < 0.05) and mean dose (4.05 Gy vs. 6.36 Gy; p < 0.001) were significantly lower with HT. In patients with left-sided tumors, heart V-30Gy (0.03% vs. 1.14%; p < 0.05) and mean dose (1.35 Gy vs. 2.22 Gy; p < 0.01) were significantly lower with HT, but not V-5Gy. Contralateral breast V-5Gy (0.27% vs. 0.00%; p < 0.01) and maximum dose were significantly increased with HT. Conclusions: In breast cancer treated with SIB, both HT and 3D-CRT provided adequate target volume coverage and low heart doses. Tumor bed coverage was slightly lower with HT, but HT avoided unnecessary breast overdosage while improving ipsilateral lung dosimetry. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 94 (2010) 300-306