Chest Wall Radiation Therapy Planning and Techniques

Comprehensive vocabulary flashcards covering post-mastectomy chest wall irradiation criteria, field borders, bolus protocols, monoisocentric and two-isocenter setups, nodal boosts, QUANTEC organ-at-risk limits, and bilateral planning techniques.

Post-Mastectomy Chest Wall Irradiation Criteria

Clinical indications for treating the chest wall and regional lymph nodes to prevent locoregional recurrence, including Stage III disease, T4 tumors, pectoral fascia involvement, primary tumor size larger than $5\,\text{cm}$, 4 or more positive axillary lymph nodes (with mixed recommendations for 1 to 3 nodes), inflammatory breast cancer, and locally advanced disease.

Chest Wall Standard Prescription

The standard dose delivered to the chest wall, supraclavicular fossa (SCV), and internal mammary chain (IMC), prescribed to $50\,\text{Gy}$ delivered in $25\,\text{fx}$.

Chest Wall Electron Scar Boost

A supplemental electron boost delivering $10\,\text{Gy}$ in $5\,\text{fx}$ targeting the surgical scar with a $2\,\text{cm}$ expansion margin around the mastectomy incision.

Wide Tangent Fields

tangent fields that cover IMN

Chest Wall Bolus Protocol

The use of a $0.5\,\text{cm}$ ($3\text{--}5\,\text{mm}$) tissue-equivalent bolus applied every other day to elevate superficial skin dose to $85\%$ of prescription, or daily in inflammatory breast cancer to attain $95\%$ of prescription dose.

Inflammatory Breast Cancer (Radiation Setup)

An aggressive cancer presentation characterized clinically by skin thickening and peau d'orange, managed dosimetrically with daily bolus to maximize surface dose and a potential $3\,\text{mm}$ overlap between abutting fields.

Lung $V_{20}$ Primary Determinant

The anatomical position and alignment of the matchline separating the supraclavicular and tangential treatment fields, serving as the most influential planning parameter for lung $V_{20}$.

Newest astro hypo guidelines

types of accelerated partial breast irradiation

multicatheter internal, balloon internal radiation, 3D conformal external beam rt

bragg peak

Just before the protons run out of energy and stop completely, they slow down and release the majority of their kinetic energy in a very tight burst—this is the Bragg peak

how to pull dose closer to skin in proton tx

by using range shifters to pull dose closer to skin

for prone breast, Repeat simulation in the supine position is typically performed for

tumor bed boost planning