• Radiotherapy Planning in Breast Cancer
  • Aida Karami,1,* Mohammad Hossein Jamshidi,2
    2. Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.


  • Introduction: Introduction: All patients with primary or recurrent breast cancer should be considered for postoperative radiotherapy as it reduces local recurrence following surgery for both invasive and in situ disease. Breast-conserving surgery followed by whole-breast radiotherapy (WBRT) is currently the gold standard for the majority of patients with early breast cancer. The aim is to better target the tumor while decreasing the dose administered to surrounding normal tissues.
  • Methods: Methods: The databases of PubMed and Google Scholar were explored by different combinations of terms: radiation therapy, breast cancer, treatment planning. The obtained results were selected for the title and abstracts. Finally, 12 relevant papers were selected and review full text.
  • Results: Results: Conventional single-plane two-dimensional radiotherapy breast plans can lead to substantial off-axis dose inhomogeneities, particularly in women with larger breasts. The gold standard imaging modality remains CT, with placement of surgical clips located in three dimensions by CT the favoured option. However, this is less than perfect in large part due to the intrinsic lack of contrast between soft tissues. A more complex form of radiotherapy, intensity modulated radiotherapy(IMRT), can produce superior dosimetry compared with conventional techniques, but the planning, treatment time, and quality assurance measures are time-consuming, and the equipment is not yet universally available in the UK. Parasternal radiation with standard fields does not allow for individual anatomical variability of the internal mammary lymph nodes. One possibility for individual treatment planning, taking into account the depth and lateral extension of the internal mammary lymph nodes, is to visualize this node chain by internal mammary lymphoscintigraphy (IMLS) prior to radiation. IMLS is easy to perform with standard equipment. MRI allows set up in the conventional treatment position. It gives exquisite detail of the primary cavity, nodes, and surrounding tissues, and the neighbouring organs at risk, without the use of contrast. However, MRI has potential limitations. Patient claustrophobia and contraindications to scanning (e.g. cardiac pacemaker) can be a problem, as well as image distortion secondary to either the machine or the patient.
  • Conclusion: Conclusion: Distortion correction algorithms can be applied in order to obtain more accurate imaging data. As MRI lacks the electron density information generated by CT, MR images are assigned bulk attenuation factors for the regions of interest, or fused with CT data for treatment planning. There may also be a future role for PET/CT in radiotherapy planning, particularly at sites of metastatic disease.
  • Keywords: Key words: Radiotherapy, Breast Cancer, Treatment Planning.