Vol 26, No 6 (2021)
Research paper
Published online: 2021-11-16

open access

Page views 5694
Article views/downloads 273
Get Citation

Connect on Social Media

Connect on Social Media

A comparative study evaluating the dose volume parameters in 3D conformal radiation of left sided whole breast irradiation including regional lymphnodes — a need of resource constrained countries

Surekha Goyal1, Richa Tiwari1, Geeta S. Narayanan1, Soumya S. Narayanan1
Rep Pract Oncol Radiother 2021;26(6):1003-1009.


Background: The purpose of this study was to compare four 3D conformal radiation techniques in treatment of left breast cancer patients.

Materials and methods: Radiation was planned for 20 patients to the left breast and regional lymph nodes using four techniques: partially wide tangents, photon-photon mix, photon-electron mix and 30/70 photon-electron mix. All plans were evaluated for internal mammary nodes (IMN) coverage, hotspot and normal tissue constraints.

Result: The 85% of planning target volume (PTV) coverage was lesser for upper IMN than the lower IMN (below the lower border of the clavicular head) for all four techniques. The lower IMN coverage was better for partially wide tangent (80.46%) and photon-photon mix (88.88%). The lowest value of hotspot was seen in the partially wide tangent technique (112.69% ± 1.92). Hotspot is unacceptably high in both photon-electron mix and 30/70 photon-electron mix (> 120%). Left lung mean dose for all techniques on a pair-wise comparison showed no statistical difference. Left lung V20 values for partially wide tangent was 37.56% ± 8.17 and for photon-photon mix it was 40.49% ± 3.36. The mean heart dose with partially wide tangent was 9.43 ± 3.15 Gy and with photon-photon mix it was 10.10 ± 2.70 Gy. The mean heart dose for photon-electron mix was 7.56 ± 1.95 Gy and for 30/70 photon-electron mix it was 7.98 ± 2.16 Gy.

Conclusion: No single technique satisfies all the criteria. The decision should be made on a case-by-case basis, considering the anatomy of the patient, availability of electron facilities and setup accuracy and reproducibility. 

Article available in PDF format

View PDF Download PDF file


  1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  2. Three-Year Report of Population Based Cancer Registries 2012–2014. https://main.icmr.nic.in/sites/default/files/reports/Preliminary_Pages_Printed1.pdf.
  3. Doval DC, Radhakrishna S, Tripathi R, et al. A multi-institutional real world data study from India of 3453 non-metastatic breast cancer patients undergoing upfront surgery. Sci Rep. 2020; 10(1): 5886.
  4. Poortmans P, Weltens C, Fortpied C, et al. Internal mammary and medial supraclavicular lymph node chain irradiation in stage I–III breast cancer (EORTC 22922/10925): 15-year results of a randomised, phase 3 trial. Lancet Oncol. 2020; 21(12): 1602–1610.
  5. Duane FK, McGale P, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11): 987–998.
  6. Severin D, Connors S, Thompson H, et al. Breast radiotherapy with inclusion of internal mammary nodes: a comparison of techniques with three-dimensional planning. Int J Radiat Oncol Biol Phys. 2003; 55(3): 633–644.
  7. Pierce LJ, Butler JB, Martel MK, et al. Postmastectomy radiotherapy of the chest wall: dosimetric comparison of common techniques. Int J Radiat Oncol Biol Phys. 2002; 52(5): 1220–1230.
  8. Lingos TI, Recht A, Vicini F, et al. Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1991; 21(2): 355–360.
  9. Graham MV, Purdy JA, Emami B, et al. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1999; 45(2): 323–329.
  10. Thomsen MS, Berg M, Nielsen HM, et al. Danish Breast Cancer Cooperative Group. Post-mastectomy radiotherapy in Denmark: from 2D to 3D treatment planning guidelines of The Danish Breast Cancer Cooperative Group. Acta Oncol. 2008; 47(4): 654–661.
  11. Marks LB, Clough R, Fan M, et al. Radiation (RT)-induced pneumonitis following tangential breast/chestwall irradiation. Int J Radiat Oncol Biol Phys. 2000; 48(3): 294–295.
  12. Arthur DW, Arnfield MR, Warwicke LA, et al. Internal mammary node coverage: an investigation of presently accepted techniques. Int J Radiat Oncol Biol Phys. 2000; 48(1): 139–146.
  13. Gagliardi G, Constine LS, Moiseenko V, et al. Radiation dose-volume effects in the heart. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl): S77–S85.
  14. van der Laan HP, Dolsma WV, van 't Veld AA, et al. Comparison of normal tissue dose with three-dimensional conformal techniques for breast cancer irradiation including the internal mammary nodes. Int J Radiat Oncol Biol Phys. 2005; 63(5): 1522–1530.

Reports of Practical Oncology and Radiotherapy