Breast size impact on clinical adverse effects and radiotherapy treatment planning parameters

Abstract

Background: Radiotherapy is the treatment of choice after breast conserving surgery. One of the important individual factors affecting final cosmetic outcome after radiation therapy is breast size. The purpose of this review is to summarize clinical toxic effects profile of adjuvant radiotherapy and to evaluate treatment planning studies in women with breasts of various sizes.

Conclusions: Large planning target volume per se as well as dose inhomogeneity and excessive radiation dose (hot spots) contribute to higher rates of acute adverse events and suboptimal final cosmetic outcome. This effects are seen in both conventional or hypofractionation radiation schedules. Improvement in homogeneity leads to lower rates of toxicity and can be achieved with three dimensional conformal or modulated radiotherapy techniques. Researchers assume that there could be an association between body habitus and higher mean dose to the ipsilateral lung and whole heart in left-sided breast cancer patients. Thoughtful use of dose prescription, partial breast irradiation and technical innovations such as deep inspiration breath-hold, prone or lateral decubitus position and thermoplastic bra can be useful to mitigate the risk of radiation adverse effects in every single patient.