A practical alternative to conventional five-field irradiation postmastectomy for locally advanced breast cancer

A combination of electron and photon beams has been used as an alternative for the conventional five-field method to irradiate patients postmastectomy for locally advanced breast cancer. Anterior and posterior opposed photon beams treat in continuity the lateral chest wall, axilla, and supraclavicular lymph nodes. An adjacent anterior electron beam is used at an energy matched to the depth of the internal mammary nodes. It includes the anterior chest wall, but bolus is used in the lateral aspect to spare underlying lung. This electron beam eliminates the diverging junction between the internal mammary and medial tangential fields used in the conventional five-field technique. Overlaps along the junction between the photon and electron beams are minimized by placing the center of the photon field along its medial border. Measurements with an Alderson-Rando phantom show dose-distribution advantages for this technique over the conventional five-field approach. There is less chance of underdosing tumor cells or of overdosing normal tissue along beam junctions. Clinical studies on 29 patients treated by this technique between July 1985 and December 1989 show increased rates of acute skin reactions, but otherwise similar side effects compared with 57 breast cancer patients treated with the five-field technique over the same time period. Local recurrence rates and patient survival rates were similar for the two groups. Given the dose-distribution advantages of this technique and its simple adaptation to accommodate unusual surgical scars or cancer recurrences, its use should be considered for postmastectomy patients with locally advanced breast cancer in well-equipped cancer treatment centers.