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Helical Tomotherapy as a Means of Delivering Accelerated Partial Breast Irradiation (p. 639-646)

A novel treatment approach utilizing helical tomotherapy for partial breast irradiation for patients with early-stage breast cancer is described. This technique may serve as an alternative to high dose-rate (HDR) interstitial brachytherapy and standard linac-based approaches. Through helical tomotherapy, highly conformal irradiation of target volumes and avoidance of normal sensitive structures can be achieved. Unlike HDR brachytherapy, it is noninvasive. Unlike other linac-based techniques, it provides image-guided adaptive radiotherapy along with intensity modulation. A treatment planning CT scan was obtained as usual on a post-lumpectomy patient undergoing HDR interstitial breast brachytherapy. The patient underwent catheter placement for HDR treatment and was positioned prone on a specially designed position-supporting mattress during CT. The planning target volume (PTV) was defined as the lumpectomy bed plus a 20 mm margin. The prescription dose was 34 Gy (10 fx of 3.4 Gy) in both the CT based HDR and on the tomotherapy plan. Cumulative dose-volume histograms (DVHs) were generated and analyzed for the target, lung, heart, skin, pectoralis muscle, and chest wall for both HDR brachytherapy and helical tomotherapy. Dosimetric coverage of the target with helical tomotherapy was conformal and homogeneous. ?Hot spots? (≥150% isodose line) were present around implanted dwell positions in brachytherapy plan whereas no isodose lines higher than 109% were present in the helical tomotherapy plan. Similar dose coverage was achieved for lung, pectoralis muscle, heart, chest wall and breast skin with the two methods. We also compared our results to that obtained using conventional linac-based three dimensional (3D) conformal accelerated partial breast irradiation. Dose homogeneity is excellent with 3D conformal irradiation, and lung, heart and chest wall dose is less than for either HDR brachytherapy or helical tomotherapy but skin and pectoral muscle doses were higher than with the other techniques. Our results suggest that helical tomotherapy can serve as an effective means of delivering accelerated partial breast irradiation and may offer superior dose homogeneity compared to HDR brachytherapy.

Key words: Breast cancer, Brachytherapy, Helical tomotherapy.

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TCRT December 2004

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Volume 3
No. 6 (p 525-670)
December 2004
ISSN 1533-0338

Susanta K. Hui, Ph.D.1,a,*
Rupak K. Das, Ph.D.1
Jeff Kapatoes, Ph.D.3
Gustavo Oliviera, Ph.D.3
Stuart Becker, M.S.2
Heath Odau, M.S.2
John D. Fenwick, Ph.D.1,2
Rakesh Patel, M.D.1
Robert Kuske, M.D.1
Minesh Mehta, M.D.1
Bhudatt Paliwal, Ph.D.1,2
Thomas R. Mackie, Ph.D.1,2,3
Jack F. Fowler, D.Sc.1
James S. Welsh, M.S., M.D.1

1Department of Human Oncology
2Department of Medical Physics
University of Wisconsin-Madison
600 Highland Avenue
Madison WI 53792 USA
3Tomotherapy Incorporated
1240 Deming Way
Madison, WI 53717 USA

aPresent Address:
Therapeutic Radiology
University of Minnesota
MMC 494 Mayo 8494
420 Delaware St. S.E.
Minneapolis, MN 55455 USA