Table 1.
Dose Prescription Guidelines for All Targets.
| Volume | Whole Breast Irradiation With No Boost | Whole Breast Irradiation With Boost | Chest Wall or Breast and Regional Nodes |
|---|---|---|---|
| Target breast volume (TBV) | |||
| Ideal | 95% TBV receives ≥47.5 Gy (95% of 50 Gy) | 95% TBV receives ≥47.5 Gy (95% of 50 Gy) | 95% TBV receives ≥47.5 Gy (95% of 50 Gy) |
| Acceptable | 90% TBV receives ≥45 Gy (90% of 50 Gy) | 90% TBV receives ≥45 Gy (90% of 50 Gy) | 90% TBV receives ≥45 Gy (90% of 50 Gy) |
| Lumpectomy cavity PTV | |||
| Ideal | 100% of 50 Gy covers lumpectomy PTV | Final boost dose covers 100% lumpectomy PTV | Final boost dose covers 100% lumpectomy PTV |
| Acceptable | Final boost dose covers 95% of lumpectomy PTV | Final boost dose covers 95% of lumpectomy PTV | |
| Breast (ipsilateral) | Hotspot (<3 cm3) ≤ 108% | Hotspot (<3 cm3) ≤ 108% of final boost dose, V54 < 50%, V(breast at final boost dose) ≤ 30% | |
| Target chest wall volume (TCV) | NA | NA | Same constraints as with TBV only using the chest wall volume |
| Mastectomy scar (PTV) | NA | NA | |
| Supraclavicular nodes (SCN) | NA | NA | 95% receives ≥47.5 Gy (95% of 50 Gy) |
| Axillary nodal volume (Ax) | NA | NA | 95% receives ≥45 Gy |
| Internal mammary nodes (IMN) | |||
| Ideal | NA | NA | 95% receives ≥45 Gy |
| Acceptable | NA | NA | 90% receives ≥40 Gy |
| Lung | |||
| Ideal | V20 ipsilateral lung ≤ 10% | V20 ipsilateral lung ≤ 10% | V20 ipsilateral lung ≤ 25% |
| Heart | |||
| Ideal | V25 < 5%, mean heart dose <3 Gy | V25 < 5%, mean heart dose <3 Gy | V25 < 5%, mean heart dose <3 Gy |
| Acceptable | V25 < 9%, mean heart dose <5 Gy | ||
Abbreviations: NA, not available; PTV, planning target volume.