Principles and Practice of Modern Radiotherapy Techniques in Breast Cancer, Ayfer Haydaroglu,Gokhan Ozyigit, Editör, Springer, London/Berlin , New-York, ss.205-228, 2013
Breast cancer has been postoperatively treated with conventional tangential beams using standard dose 46–50Gy to the chest wall or whole breast and 10–16Gy boost with or without regional lymphatics for many years. In addition to successful cosmetic results and low rates of cardiac-pulmonary complications, high rates of local control have been achieved [1–3]. Significant advances have occurred in the area of imaging and irradiation techniques over the past 15 years. Despite these advances, several studies have also shown that dose uniformities can occur in a high percentage of breast volume (Fig. 17.1) [4, 5]. To achieve dose homogeneity in the target is difficult using conventional two-dimensional (2D) or three-dimensional (3D) tangential beams because of the complicated geometry of the breast and different depths of regional lymph nodes (Figs. 17.2 and 17.3). During tangential breast irradiation, particularly in the nipple, the entrance and exit points, and in the superior and inferior portions of the fields may achieve an inhomogeneous dose distribution, which in turn, causes less favorable cosmesis related to breast size, wedge angles, and beam energies (Fig. 17.4) [6, 7]. Irradiated volumes of lung and heart within the treatment fields are sometimes unacceptably large and irradiation of regional lymph nodes, especially in the mammaria interna area, delivers high doses to the heart, lung, and contralateral breast. Cardiac perfusion defects have been documented even in patients treated with advanced 3D planning techniques, although the clinical consequences of these defects are not yet clear . Potential interactions between cardiotoxic systemic agents such as doxorubicin and transtuzumab and radiotherapy (RT) must be considered [9, 10].