The use of IMRT and IGRT for Breast Cancer Treatment
The management of breast cancer transcends adjuvant treatment of early and locally advanced stage to palliative treatment of metastasis. The use of radiation therapy has been demonstrated to improve local, local-regional control and overall survival rates (1). While the principal design of the treatment of breast using radiation is well established, the technical implementation has been limited by the availability of sophisticated computerized treatment planning systems and more accurate radiation delivery systems.
Recent developments in the imaging technology and advanced intensity modulated radiation therapy (IMRT) (2) present more accurate radiation dose calculations and delivery techniques that have greatly improved dose conformity and homogeneity. These advancements force clinicians to focus on the breast target delineation in order to isolate normal critical organs such as lungs and heart. This results into sharp dose fall-off at the IMRT field edges and tight conformity of dose.
Unfortunately, the accurate delivery of radiation using this highly focused technique assumes that the breast target is a stationary object. In reality, this is not possible because of the inter fractional motion in the patient set up and intra-fraction motion of lungs. The former motion can be reduced by using better immobilization techniques. However the latter continues to present challenges because of inconsistencies in the breathing mechanisms of some patients. A combination of advanced immobilization and Image Guided Radiation Therapy (IGRT) (3) for localization of the breast target volume using the chest wall as landmarks is helpful in targeting the breast target more precisely.
This is responsible for the reduction of the radiation dose to the heart and lungs resulting into a reduction in toxicity and better disease control (4).
Medical Specialty International, Atlanta GA would be happy to discuss with your facility on how to implement this technology and other advanced treatment technology efficiently and cost effectively. Your facility will take pride in offering this state-of-the-art IMRT and IGRT treatment methodology.
1. Fischer B, Anderson S, Bryant J et al. (2002) Twenty-year follow-up of randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Eng J Med 347: 1233-1241
2. Strom E A (2002) Breast IMRT: new tools leading to new vision. Int J Radiat Oncol Biol Phys 54: 1297-1298
3. Bortfeld T, Schmidt-Ullrich R, De Neve W and Wazer D E (2006) Image-Guided IMRT Springer-Verlag Berlin Heidelberg, Germany.
4. Vicini F A, Sharp M, Kestin L et al. (2002) Optimizing breast cancer treatment efficacy with intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys 54: 1336-1344