Make a treatment planning for female brast patient 3 cm lesion in

breast with TPS image

Creating a treatment plan for a female breast cancer patient with a 3 cm lesion involves a series of
steps. Treatment planning typically includes the use of a treatment planning system (TPS) to deliver
precise radiation therapy. Since I cannot create a TPS image directly, I can outline the essential steps
involved in the process of treatment planning, which would then be implemented in a TPS like
Eclipse, Pinnacle, or TomoTherapy.

Step-by-Step Treatment Planning Process for a Female Breast Cancer Patient with a 3 cm Lesion

Step 1: Initial Assessment and Imaging

 Patient Positioning:

o The patient is positioned in a supine position, ideally with their arms raised above
their head. This minimizes the dose to surrounding organs, such as the lung and
heart.

 Imaging for Contouring:

o CT Simulation: A CT scan is performed with the patient in the treatment position,

and the images are transferred to the TPS. The CT scan helps define the exact
location of the tumor and surrounding normal tissues.

o Breast Marking: The lesion and critical structures (e.g., heart, lungs, ribs, and skin)
are clearly identified and contoured in the planning system.

Step 2: Gross Tumor Volume (GTV) Delineation

 GTV (Gross Tumor Volume):

o The 3 cm lesion is outlined on the CT images as the GTV. This is the area containing
the visible tumor.

o The contours should include the tumor and any lymph nodes that are potentially
involved.

Step 3: Clinical Target Volume (CTV) Delineation

 CTV (Clinical Target Volume):

o The CTV includes the GTV as well as a margin to account for potential microscopic
disease spread. This margin typically ranges from 1 to 2 cm.

o Regional Lymph Nodes: Include any nearby lymph nodes (e.g., axillary nodes) that
might be involved in the disease.

o Margin: The CTV accounts for possible microscopic disease spread beyond the GTV.
Step 4: Planning Target Volume (PTV) Delineation

 PTV (Planning Target Volume):

o The PTV includes the CTV with an additional margin to account for variations in
patient positioning, organ motion, and respiratory movement.

o The margin can vary from 0.5 to 1 cm, depending on the technique and machine
used.

Step 5: Organ at Risk (OAR) Contouring

 OARs:

o Heart: Contour the heart, especially in left-sided breast cancer patients, to avoid
high-dose exposure.

o Lungs: Contour the ipsilateral lung to limit exposure to radiation.

o Spinal Cord: Ensure the spinal cord is not in the path of the radiation field, typically
keeping the dose to the spinal cord below 45-50 Gy.

o Skin: The skin should be contoured to avoid overdosing, typically maintaining the
dose to the skin below 40 Gy.

o Contralateral Breast: Ensure the contralateral breast receives a minimal dose to

avoid unnecessary exposure.

Step 6: Radiation Therapy Planning

 Beam Arrangement:

o Tangential Beams: For breast cancer, tangential radiation therapy is commonly used,
with two beams directed at the breast, typically 180° apart. These beams are
designed to deliver radiation to the tumor while minimizing dose to the lungs and
heart.

o Additional Boost: A boost may be delivered to the tumor bed after whole-breast
radiation, especially if there is a high risk of recurrence. This boost can be delivered
using electron or photon therapy.

o Lymph Node Irradiation: If regional lymph nodes (e.g., axillary, supraclavicular) are
involved, fields will be extended to include these areas.

 Treatment Technique:

o Conformal Radiotherapy (3D-CRT): The treatment fields are shaped to match the
tumor and critical organs using the contouring information.
 o Intensity-Modulated Radiation Therapy (IMRT): A more advanced technique that
allows for more precise dose delivery to the tumor while minimizing dose to normal
tissues.

o Volumetric Modulated Arc Therapy (VMAT): A rotational technique that delivers

highly conformal doses and is used to minimize the dose to organs at risk.

Step 7: Dose Prescription

 Whole-Breast Dose:

o The prescribed dose for whole-breast treatment is typically around 50 Gy in 25

fractions, delivered over 5 weeks.

o If the lesion is in a high-risk location or there is a higher risk of recurrence, a higher

dose may be prescribed.

 Boost Dose:

o For the tumor bed boost, a dose of approximately 10-16 Gy in 5-8 fractions is
commonly used, depending on the patient's risk factors.

 Normal Tissue Constraints:

o Heart: The mean heart dose should typically be kept below 4-5 Gy for left-sided
breast cancer patients.

o Lungs: The lung V20 (volume receiving 20 Gy or more) should be kept below 30%.

o Spinal Cord: The dose to the spinal cord should not exceed 45 Gy.

Step 8: Treatment Plan Evaluation

 Dose Distribution Review:

o The TPS will generate a dose distribution map for both the tumor and normal
tissues.

o The dose to the tumor and surrounding tissues should be evaluated to ensure the
planned doses meet clinical objectives and constraints for the organs at risk.

 Dose-Volume Histogram (DVH):

o Review the DVH for both the tumor and organs at risk. The DVH shows the
distribution of dose within the target and surrounding normal tissues.

o Ensure the prescribed dose is covering the PTV and that normal structures receive
acceptable doses.

Step 9: Plan Verification

 Quality Assurance:
 o Perform in vivo dosimetry or phantom verification to confirm the treatment plan
accuracy.

o Utilize treatment verification tools such as Electronic Portal Imaging Devices (EPID)
or IMRT QA phantoms to ensure the patient is receiving the correct dose
distribution.

 Patient Setup Verification:

o Ensure the patient’s setup for each treatment is consistent with the plan using
technologies such as kV imaging or cone-beam CT (CBCT).

Step 10: Treatment Delivery

 Treatment Delivery:

o The treatment plan is transferred to the treatment machine (e.g., linear accelerator).

o The patient is treated according to the planned dose fractionation, ensuring proper
alignment with the treatment fields.

Conclusion

This treatment plan ensures the best possible outcome for the patient with a 3 cm breast lesion by
delivering precise radiation therapy while minimizing the dose to surrounding organs. Each step,
from imaging and contouring to treatment delivery, is performed carefully using the TPS to optimize
the treatment plan and ensure patient safety.