الفهرس 
Introduction
Anatomy of the breastOnly 14 pages are availabe for public view
 |  | from | 127 |  |  |
| | | from | 127 | | |
Abstract
Most patients with early breast cancer have been treated with breast-conserving treatment (BCT), consisting of wide excision and postoperative radiation therapy (RT). Adjuvant loco-regional radiotherapy in addition to systemic treatment for lymph node positive breast cancer has been shown to reduce loco-regional recurrence and the risk of death from breast cancer (Vinh-Hung et al., 2002; Whelan et al., 2000).Tangential photon field breast cancer radiotherapy is mainly employed adjuvantly to breast-conserving surgery in order to improve local control and survival (Peto, 2005). For those otherwise healthy women, a primary concern is the unwanted pulmonary and cardiac irradiation, which poses a risk of late injury. This is particularly the case, when the ipsilateral internal mammary lymph nodes (IMN) and periclavicular nodes are included in the target definition, implying use of deep tangential fields and a supraclavicular field (Arthur et al., 2000; Hurkmans et al., 2005). The myocardial perfusion defects, detected with single photon emission computed tomography (SPECT), were related to the irradiated cardiac volume and the period of receiving RT (Gyenes et al., 1998; Marks et al., 2005). RT-induced cardiovascular diseases were documented in populations irradiated for peptic ulcer and in Japanese atomic bomb survivors. Therefore, it is necessary to reduce the irradiated cardiac volume to lessen the cardiac toxicity (Carp et al., 2005; Trott and Schultz-Hector, 2007). To minimise the dose to the heart, some advocate the use of an abutting oblique electron field over the parasternal area to treat the internal mammary nodes (Hurkmans et al., 2000). The cardiac benefit comes, however, on the expense of decreased dose homogeneity, in particular along the match-line between the medial tangential photon and the electron fields. Notably, another drawback refers to obese patients where a high e-energy is required to deliver sufficient dose to the internal mammary nodes, thereby also delivering a high dose to lung and heart (Korreman et al., 2005) Another currently intensively studied approach to breast irradiation with the aim of reducing dose to organs at risk and/or homogenising the dose to the breast is intensity modulated radiotherapy (IMRT). One of the drawbacks of complicated (multiple-field inverse-planned) IMRT for breast cancer is that the dose to contralateral organs, particularly the contralateral breast, will be inevitably increased (Lomax et al., 2003(.