Helical tomotherapy based intensity modulated radiotherapy for the management of difficult clinical situations in breast cancer

Helical tomotherapy (HT) can achieve a homogenous dose distribution in the planning target volume while minimizing the dose to the organ at risk. Tomotherapy has been used for complex breast cancer radiotherapy including bilateral breast irradiation, pectus excavatum, and internal mammary chain (IMC) nodal irradiation. This report details our experience of using HT in breast cancers in newer clinical indications. Three patients with SCF nodal involvement (case 1), high level III axillary node recurrence (case 2), and composite irradiation of SCF, IMC, and whole breast (case 3) were treated using brachial plexus sparing HT. It was possible to boost the SCF, reirradiate the high level Ill axillary nodal recurrence and treat complex volume of breast, SCF, and IMC with acceptable and safe dose volume histogram constraints and with good homogeneity and conformity indices. The treatment was successful in controlling disease locoregionally at a 15 months follow-up. No patients reported symptoms suggestive of brachial plexopathy.