Influence of modifications in breast irradiation technique on dose outside the treatment volume

Purpose: There is increasing interest in potential long-term effects of radiotherapy (RT) in patients treated for breast cancer, particularly those in whom long-term survival can be expected. The purpose of the present study was to determine the effects of treatment techniques, including patient positioning (supine vs. prone) on the absorbed dose in organs at a distance from the treatment volume in breast RT. Methods and Materials: Dose distribution was studied in a Rando-Alderson phantom, modified with a simulated left breast of tissue-equivalent material. RT delivery was studied using 60 Co and 6 MV x-ray beams, as well as electrons and a 192 Ir source for tumor bed boost RT. Doses were measured in several organs and tissues of interest using LiF thermoluminescent dosimeters. Tangential breast RT was simulated using both supine and prone positioning. Results: Peripheral doses generally decreased approximately exponentially with distance from the edge of the treatment field. Peripheral doses in various target organs were significantly higher for supine than for prone tangential breast RT (for 50 Gy prescribed dose): 0.50 Gy vs. 0.25 Gy for the upper abdomen, 0.05 Gy vs. 0.02 Gy for pelvic organs, 0.17 Gy vs. 0.08 Gy for active bone marrow, and 0.47 Gy vs. 0.12 Gy for ipsilateral lung (discounting lung in primary beam). Conclusions: The present study suggests that peripheral doses in several organs and tissues of interest can be reduced by 40 to 75% by prone tangential breast RT. These results may have implications for future strategies in the treatment of screen-detected breast cancer.