An improved internal mammary irradiation technique in radiation treatment of locally advanced breast cancers.

The purpose of the present study was to compare a new internal mammary irradiation technique with traditional techniques for locally advanced breast cancers in terms of sparing ipsilateral lung and heart and reducing the "cold" and "hot spots"in breast tissue. The new technique uses wide tangential fields for the first eight fractions of treatment. A medial internal mammary field (IMF) of electrons matched with narrowed tangential fields is used for the remaining fractions. Intensity-modulated radiation therapy (IMRT) by means of segmented multileaf collimation (SMLC) is used in the narrowed tangential fields to improve the match between the electron and the photon fields. Treatment planning was performed to compare this technique to a wide-tangential-only technique and to a traditional oblique IMF technique for three patients with differing habitus. Film dosimetry was performed in a solid water phantom to confirm the planning results. For all three patients, the mean doses of the ipsilateral lung and the heart were significantly reduced with the new technique. The lung and the heart volumes were remarkably reduced at lowdose levels (< or =12 Gy) compared to the traditional IMF technique, and significantly reduced at all dose levels compared to the wide tangential technique. The new technique also reduced the "cold" and "hot spots" along the match plane between the IMF and the tangential fields compared to the traditional IMF technique. In conclusion, the new IMF technique shows dosimetric improvement compared to the traditional IMF technique in terms of the critical organ sparing and target dose uniformity.