Improvement of dose distribution with irregular surface compensator in whole breast radiotherapy

Aim of this study was to compare the dosimetric aspects of whole breast radiotherapy (WBRT) between an irregular surface compensator (ISC) and a conventional tangential field technique using physical wedges. Treatment plans were produced for 20 patients. The Eclipse treatment planning system (Varian Medical Systems) was used for the dose calculation: For the physical wedge technique, the wedge angle was selected to provide the best dose homogeneity; for the ISC technique, the fluence editor application was used to extend the optimal fluence. These two treatment plans were compared in terms of doses in the planning target volume, the dose homogeneity index, the maximum dose, ipsilateral lung and heart doses for left breast irradiation, and the monitor unit counts required for treatment. Compared with the physical wedge technique, the ISC technique significantly reduced the dose homogeneity index, the maximum dose, the volumes received at 105% of the prescription dose, as well as reducing both the ipsilateral lung and heart doses (P < 0.01 for all comparisons). However, the monitor unit counts were not significantly different between the techniques (P > 0.05). Thus, the ISC technique for WBRT enables significantly better dose distribution in the planning target volume.