Techniques of tumour bed boost irradiation in breast conserving therapy: Current evidence and suggested guidelines

References

• Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 2000; 18: 1220–9
   PubMed Web of Science ®Google Scholar
• Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty five years of follow-up of a randomized trial comparing Total Mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Eng J Med 2002; 347: 1233–41
   PubMed Web of Science ®Google Scholar
• Liljegren G, Holmberg L, Bergh J, Lindgren A, Tabar L, Nordgren H, et al. 10-year results after sector resection with or without postoperative radiotherapy for Stage I breast cancer: A randomized trial. J Clin Oncol 1999; 17: 2326–33
   PubMed Web of Science ®Google Scholar
• Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, Hamett AN, et al. Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish Trial. Lancet 1996; 348: 708–13
   PubMed Web of Science ®Google Scholar
• Early Breast Cancer Trialists' Collaborative Group. Radiotherapy for early breast cancer. Cochrane Database Syst Rev 2002;2:CD003647.
   Google Scholar
• Arriagada R, Le MG, Dunant A, Tubiana M, Contesso G. Twenty-five years of follow-up in patients with operable breast carcinoma. Correlation between clinicopathologic factors and the risk of death in each 5 year period. Cancer 2006; 106: 743–9
   PubMed Web of Science ®Google Scholar
• Arriagada R, Le MG, Guinebretiere JM, Dunant A, Rochard F, Tursz T. Late local recurrences in a randomized trial comparing conservative treatment with total mastectomy in early breast cancer patients. Ann Oncol 2003; 14: 1617–22
   PubMed Web of Science ®Google Scholar
• Whelan T, MacKenzie R, Julian J, Levine M, Shelley W, Grimard L, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst 2002; 94: 1143–50
   PubMedGoogle Scholar
• Bartelink H, Horiot JC, Poortmans P, Struikmans H, Van den Bogaert W, Barillot I, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Eng J Med 2001; 345: 1378–87
   PubMed Web of Science ®Google Scholar
• Collette L, Fourquet A, Horiot JC, et al. Impact of boost dose of 16 Gy on local control in patients with early breast cancer: The EORTC “Boost versus no boost” trial. Radiother Oncol 2000;56((Suppl. 1)):46 (Abstract).
   Google Scholar
• Bartelink H, Horiot JC, Poortmans P, Struikmans H, Bogaert WV, Barillot I, et al. Impact of radiation dose on local control, fibrosis and survival after breast conserving treatment: 10 years results of the EORTC Trial 22881–10882. San Antonio Conference, 2006 (Abstract).
   Google Scholar
• Vrieling C, Collette L, Forquet A, Hoogenraad WJ, Horiot JC, Jager JJ, et al. The influence of the boost in breast-conserving therapy on cosmetic outcome in the EORTC “boost versus no boost” trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. European Organization for Research and Treatment of Cancer. Int J Radiat Oncol Biol Phys 1999; 45: 677–85
   PubMed Web of Science ®Google Scholar
• Coles CE, Moody AM, Wilson CB, Burnet NG, et al. Reduction of radiotherapy-induced late complications in early breast cancer: The role of intensity-modulated radiation therapy and partial breast irradiation. Clin Oncol 2005; 17: 98–110
   Web of Science ®Google Scholar
• Polgar C, Fodor J, Major T, Orosz Z, Nemeth G, et al. The role of boost irradiation in the conservative treatment of Stage I–II breast cancer. Pathol Oncol Res 2001; 7: 241–50
   PubMedGoogle Scholar
• Graham P, Fourquet A. Placing the boost in breast-conservation radiotherapy: A review of the role, indications and techniques for breast-boost radiotherapy: Clin Oncol (R Coll Radiol) 2006;18:210–9.
   Google Scholar
• Fisher ER, Fisher ER, Anderson S, et al. Ipsilateral breast tumour recurrence and survival following lumpectomy and irradiation: Pathological findings from NSABP protocol B-06. Semin Surg Oncol 1992; 8: 161–6
   PubMedGoogle Scholar
• Schmidt-Ullrich R, Wazer DE, Tercilla O, Safaii H, Merchant DJ, Smith TJ, et al. Tumor margin assessment as a guide to optimal conservation surgery and irradiation in early stage breast carcinoma. Int J Radiat Oncol Biol Phys 1989; 17: 733–8
   PubMed Web of Science ®Google Scholar
• Kim KJ, Huh SJ, Yang JH, Park W, Nam SJ, Kim JH, et al. Treatment results and prognostic factors of early breast cancer treated with a breast conserving operation and radiotherapy. Jpn J Clin Oncol 2005; 35: 126–33
   PubMed Web of Science ®Google Scholar
• Pass H, Vicini FA, Kestin LL, Decker D, Pettinga J, et al. Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast-conserving therapy at a single institution. Cancer 2004; 101: 713–20
   PubMed Web of Science ®Google Scholar
• Fodor J, Mozsa E, Zaka Z, Polgar C, Major T, et al. Local relapse in young (< or =40 years) women with breast cancer after mastectomy or breast conserving surgery: 15-year results. Magy Onkol 2005; 49:203: 205–8
   Google Scholar
• Touboul E, Buffat L, Belkac Y, Lefranc JP, Uzan S, Lhuillier P, et al. Local recurrences and distant metastases after breast-conserving surgery and radiation therapy for early breast cancer. Int J Radiat Oncol Biol Phys 1999; 43: 25–38
   PubMed Web of Science ®Google Scholar
• Truong PT, Bernstein V, Lesperance M, Speers CH, Olivotto IA, et al. Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg 2006; 191: 749–55
   PubMed Web of Science ®Google Scholar
• Mansfield CM, Komarnicky LT, Schwartz GF, Rosenberg AL, Krishnan L, Jewell WR, et al. Ten-year results in 1070 patients with stages I and II breast cancer treated by conservative surgery and radiation therapy. Cancer 1995; 75: 2328–36
   PubMed Web of Science ®Google Scholar
• Romestaing P, Lehingue Y, Carrie C, Coquard R, Montbarbon X, Ardiet JM, et al. Role of a 10-Gy boost in the conservative treatment of early breast cancer: Results of a randomized clinical trial in Lyon, France. J Clin Oncol 1997; 15: 963–8
   PubMed Web of Science ®Google Scholar
• Teissier E, Henry M, Ramaioli A, et al. Boost in conservative treatment: 6 year results of randomized trial. Breast Cancer Res Treat 1998; 50: 345
   Google Scholar
• Polgar C, Major T, Fodor J, Nemeth G, Orosz Z, Sulyok Z, et al. High-dose-rate brachytherapy alone versus whole breast radiotherapy with or without tumor bed boost after breast-conserving surgery: Seven-year results of a comparative study. Int J Radiat Oncol Biol Phys 2004; 60: 1173–81
   PubMed Web of Science ®Google Scholar
• Polgar C, Orosz Z, Fodor J, Major T, Mangel L, Takacsi-Nagy Z, et al. The effect of tumour bed boost on local control after breast conserving surgery. First results of the randomized boost trial of the National Institute of Oncology. Magy Onkol 2001; 45: 385–91
   PubMedGoogle Scholar
• Graham P, Capp A, Fox C, Nasser E, Delaney G, Ahem V, et al. Why a breast boost should remain a controversial aspect of routine breast conservation management in Australia and New Zealand in 2002. Australas Radiol 2003; 47: 44–9
   PubMedGoogle Scholar
• Nagykalnai T, Nemeskeri CS, Mayer A, et al. Effectivity of boost radiotherapy on the local recurrence rate following breast conserving surgery plus whole breast irradiation. Proceedings of the 2nd European Congress on Senology: 1994. p 591–596.
   Google Scholar
• Holland R, Veling SH, Mravunac M, Hendriks JH. Histologic multifocality of Tis, T1-2 breast carcinomas. Implications for clinical trials of breast-conserving surgery. Cancer 1985; 56: 979–90
   PubMed Web of Science ®Google Scholar
• Vicini FA, Kestin LL, Goldstein NS, et al. Defining the clinical target volume for patients with early-stage breast cancer treated with lumpectomy and accelerated partial breast irradiation: A pathologic analysis. Int J Radiat Oncol Biol Phys 2004; 60: 722–30
   PubMed Web of Science ®Google Scholar
• Vaidya JS, Vyas JJ, Chinoy RF, Merchant N, Sharma OP, Mittra I. Multicentricity of breast cancer: Whole-organ analysis and clinical implications. Br J Cancer 1996; 74: 820–4
   PubMed Web of Science ®Google Scholar
• Machtay M, Lanciano R, Hoffman J, Hanks GE, et al. Inaccuracies in using the lumpectomy scar for planning electron boosts in primary breast carcinoma. Int J Radiat Oncol Biol Phys 1994; 30: 43–8
   PubMed Web of Science ®Google Scholar
• Kovner F, Agay R, Merimsky O, Stadler J, Klausner J, Inbar M. Clips and scar as the guidelines for breast radiation boost after lumpectomy. Eur J Surg Oncol 1999; 25: 483–6
   PubMed Web of Science ®Google Scholar
• Deboise DA, Horwitz EM, Martinez AA, Edmundson GK, Chen PY, Gustafson GS, Edmundson GK, Chen PY, Gustafson GS, et al. The use of ultrasonography in the localisation of lumpectomy cavity for interstitial brachytherapy of breast. Int J Radiat Oncol Biol Phys 1997; 38: 755–9
   PubMed Web of Science ®Google Scholar
• Rabinovitch R, Finlayson C, Pan Z, Lewin J, Humphires Z, Biffl W, et al. Radiographic evaluation of surgical clips is better than ultrasound for defining the lumpectomy cavity in breast boost treatment planning: A prospective clinical study. Int J Radiat Oncol Biol Phys 2000; 47: 313–7
   PubMed Web of Science ®Google Scholar
• Denham JW, Hamilton CS, Cross P, et al. Boost dosage to the excision site following conservative surgery for breast cancer: It's easy to miss!: Clin Oncol (R Coll Radiol) 1991; 3: 257–61
   Google Scholar
• Harrington KJ, Harrison M, Bayle P, Evans K, Dunn PA, Lambert HE, et al. Surgical clips in planning the electron boost in breast cancer: A qualitative and quantitative evaluation. Int J Radiat Oncol Biol Phys 1996; 34: 579–84
   PubMed Web of Science ®Google Scholar
• Weed DW, Yan D, Martinez AA, Vicini FA, Wilkinson TJ, Wong J, et al. The validity of surgical clips as a radiographic surrogate for lumpectomy cavity in image guided Accelerated Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2004; 60: 484–92
   PubMed Web of Science ®Google Scholar
• Bedwinek J. Breast conserving surgery and irradiation: The importance of demarcating the excision cavity with surgical clips. Int J Radiat Oncol Biol 1993; 26: 675–9
   PubMed Web of Science ®Google Scholar
• Goldberg H, Prosnitz RG, Olson JA, Marks LB, et al. Definition of postlumpectomy tumor bed for radiotherapy for radiotherapy boost field planning: CT versus surgical clips. Int J Radiat Oncol Biol Phys 2005; 63: 209–13
   PubMed Web of Science ®Google Scholar
• Regine WF, Ayyangar KM, Komarnicky LT, Komarnicky LT, Bhandare N, Mansfield CM, et al. Computer-CT planning of the electron boost in definitive breast irradiation. Int J Radiat Oncol Biol Phys 1991; 20: 121–5
   PubMed Web of Science ®Google Scholar
• Smitt MC, Birdwell RL, Goffinet DR, et al. Breast electron boost planning: Comparison of CT and US. Radiology 2001; 219: 203–6
   PubMed Web of Science ®Google Scholar
• Fein DA, Fowble BL, Hanlon AL, Hoffman JP, Sigurdson ER, Eisenberg BL, et al. Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast-conserving surgery and irradiation?. Int J Radiat Oncol Biol Phys 1996; 34: 100–17
   Web of Science ®Google Scholar
• Kokubo M, Mitsumori M, Yamamoto C, Fujishiro S, Mise K, Kodama H, et al. Impact of boost irradiation with surgically placed radiopaque clips on local control in breast-conserving therapy. Breast Cancer 2001; 8: 222–8
   PubMedGoogle Scholar
• Arriagada R, Mouriesse H, Sarrazin D, Clark RM, Deboer G. Radiotherapy alone in breast cancer. I. Analysis of tumor parameters, tumor dose and local control: The experience of the Gustave-Roussy Institute and the Princess Margaret Hospital. Int J Radiat Oncol Biol Phys 1985; 11: 1751–7
   PubMed Web of Science ®Google Scholar
• Jalali R, Malde R, Sarin R, Budrukkar A, Badwe RA, Dinshaw KA. Concomitant weekly tumour bed boost with whole breast irradiation in patients with locally advanced breast cancer undergoing breast conservation therapy: A prospective study. Eur J Cancer Suppl 2005;3:112.
   Google Scholar
• Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: Long-term results of a randomised trial. Lancet Oncol 2006; 7: 467–71
   PubMed Web of Science ®Google Scholar
• Yarnold J, Ashton A, Bliss J, Homewood J, Harper C, Hanson J, et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: Long-term results of a randomised trial. Radiother Oncol 2005; 75: 9–17
   PubMed Web of Science ®Google Scholar
• Fourquet A, Campana F, Zafrani B, Mosseri V, Vielh P, Durand JC, et al. Prognostic factors of breast recurrence in the conservative management of early breast cancer: A 25-year follow-up. Int J Radiat Oncol Biol Phys 1989; 17: 719–25
   PubMed Web of Science ®Google Scholar
• Nixon AJ, Neuberg D, Hayes DF, Gelman R, Connolly JL, Schnitt S, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994; 12: 888–94
   PubMed Web of Science ®Google Scholar
• Kurtz JM. Which patients don't need a tumor-bed boost after whole-breast radiotherapy?. Strahlenther Onkol 2001; 177: 33–6
   PubMed Web of Science ®Google Scholar
• Kurtz JM. Recurrence in the conserved breast: Why all this fuss about risk factors?. Eur J Cancer 1999; 35: 1752–4
   PubMed Web of Science ®Google Scholar
• Kurtz JM. How to predict the risk of local relapse in the preserved breast: Recent results. Cancer Res 1996; 140: 263–72
   Google Scholar
• Rapiti E, Fioretta G, Verkooijen HM, Vlastos G, Schafer P, Sappino AP, et al. Survival of young and older breast cancer patients in Geneva from 1990 to 2001. Eur J Cancer 2005; 41: 1446–52
   PubMed Web of Science ®Google Scholar
• Ryoo MC, Kagan AR, Wollin M, Tome MA, Rao AR, Hintz BL, et al. Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma. Radiology 1989; 172: 555–9
   PubMed Web of Science ®Google Scholar
• Zafrani B, Vielh P, Fourquet A, Mosseri V, Durand JC, Salmon RJ, et al. Conservative treatment of early breast cancer: Prognostic value of the ductal in situ component and other pathological variables on local control and survival. Long-term results. Eur J Cancer Clin Oncol 1989; 25: 1645–50
   PubMedGoogle Scholar
• Cabioglu N, Hunt KK, Buchholz TA, Mirza N, Singletary SE, Kuerer HM, et al. Improving local control with breast-conserving therapy: A 27-year single-institution experience. Cancer 2005; 104: 20–9
   PubMed Web of Science ®Google Scholar
• Dinshaw KA, Sarin R, Budrukkar AN, Shrivastava SK, Deshpande DD, Chinoy RF, et al. Safety and feasibility of breast conserving therapy in Indian women: Two decades of experience at Tata Memorial Hospital. J Surg Oncol 2006; 94: 105–13
   PubMed Web of Science ®Google Scholar
• Sinn HP, Anton HW, Magener A, von Fournier D, Bastert G, Otto HF, et al. Extensive and predominant in situ component in breast carcinoma: Their influence on treatment results after breast-conserving therapy. Eur J Cancer 1998; 34: 646–53
   PubMed Web of Science ®Google Scholar
• Chu AM, Cope O, Russo R, Lew R. Patterns of local-regional recurrence and results in Stages I and II breast cancer treated by irradiation following limited surgery: An update. Am J Clin Oncol 1984; 7: 221–9
   PubMed Web of Science ®Google Scholar
• Neuschatz CA, DiPetrillo T, Safaii H, Price LL, Schmidt-Ullrich, Wazer DE. Long-term follow-up of a prospective policy of margin-directed radiation dose escalation in breast-conserving therapy. Cancer 2003; 97: 30–9
   PubMed Web of Science ®Google Scholar
• Voogd AC, Neilsen M, Peterse JL, Blichert-Toft M, Bartelink H, Overgaard M, et al. Differences in risk factors for local and distant recurrence after breast conserving therapy or mastectomy for Stage I and II breast cancer: Pooled results of two large European trials. J Clin Oncol 2001; 19: 1688–97
   PubMed Web of Science ®Google Scholar
• Schnitt SJ, Abner A, Gelman R, Connolly JL, Recht A, Duda RB, et al. The relationship between microscopic margins of resection and the risk of local recurrence in patients with breast cancer treated with breast-conserving surgery and radiation therapy. Cancer 1994; 74: 1660–1
   PubMed Web of Science ®Google Scholar
• Solin LJ, Fowble BL, Schultz DJ, Goodman RL. The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer. Int J Radiat Oncol Biol Phys 1991; 21: 279–87
   PubMed Web of Science ®Google Scholar
• Omlin A, Amichetti M, Azria D, Cole BF, Fourneret P, Poortmans P, et al. Boost radiotherapy in young women with ductal carcinoma in situ: A multicentre, retrospective study of the Rare Cancer Network. Lancet Oncol 2006; 7: 652–6
   PubMed Web of Science ®Google Scholar
• Yau TK, Chan K, Chan M, Lau HW, Soong IS, Cheung P, et al. Wide local excision and radiotherapy for the treatment of ductal carcinoma in situ of the breast: The Hong Kong experience. Clin Oncol 2006; 18: 447–52
   Web of Science ®Google Scholar
• Vicini FA, Kestin LL, Goldstein S, Chen PY, Pettinga J, Frazier RC, et al. Impact of young age on outcome in patients with ductal carcinoma in situ treated with breast conserving therapy. J Clin Oncol 2000; 18: 296–306
   PubMed Web of Science ®Google Scholar
• Haba Y, Britton P, Sinnatamby R, Sycamore CM, Wilson C. Can ultrasound improve the accuracy of delivery of electron boost treatment following breast conserving surgery? Eur J Cancer 2001;37:38 (Abstract).
   Google Scholar
• Leonard C, Harlow CL, Coffin C, Drose J, Norton L, Kinzie J. Use of ultrasound to guide radiation boost planning following lumpectomy for carcinoma of the breast. Int J Radiat Oncol Biol Phys 1993; 27: 1193–7
   PubMed Web of Science ®Google Scholar
• Perez CA, Taylor ME, Halverson K, Garcia D, Kuske RR, Lockett MA. Brachytherapy or electron beam boost in conservation therapy of carcinoma of the breast: A nonrandomized comparison. Int J Radiat Oncol Biol Phys 1996; 34: 995–1007
   PubMed Web of Science ®Google Scholar
• Touboul E, Belkacemi Y, Lefranc JP, Uzan S, Ozsahin M, Korbas D, et al. Early breast cancer: Influence of type of boost (electrons vs. iridium-192 implant) on local control and cosmesis after conservative surgery and radiation therapy. Radiother Oncol 1995; 34: 105–13
   PubMed Web of Science ®Google Scholar
• Horton JK, Halle JS, Chang SX, Sartor CI. Comparison of three concomitant boost techniques for early stage breast cancer. Int J Radiat Oncol Biol Phys 2006; 64: 168–75
   PubMed Web of Science ®Google Scholar
• Conway L, Tsang Y. A forward-planning solution for the IMPORT HIGH Breast IMRT Trial. Clin Oncol 2007; 19: 15
   Web of Science ®Google Scholar
• Formenti SC, Truong MT, Goldberg JD, Mukhi V, Rosenstein B, Roses D, et al. Prone accelerated partial breast conserving surgery: preliminary clinical results and dose volume histogram analysis. Int J Radiat Oncol Biol Phys 2004; 60: 493–504
   PubMed Web of Science ®Google Scholar
• Pradier O, Schmidberger H, Weiss E, Bouscayrol H, Daban A, Hess CF. Accuracy of alignment in breast irradiation: A retrospective analysis of clinical practice. Br J Radiol 1999; 72: 685–90
   PubMed Web of Science ®Google Scholar
• Formenti SC. External beam partial breast irradiation. Semin Radiat Oncol 2005; 15: 92–9
   PubMed Web of Science ®Google Scholar
• van Tienhoven G, Lanson JH, Crabeels D, Heukelom S, Mijnheer BJ. Accuracy in tangential breast treatment set-up: A portal imaging study. Radiother Oncol 1991; 22: 317–22
   PubMed Web of Science ®Google Scholar
• Dobbs JH. Radiation therapy for breast cancer at the millennium. Radiother Oncol 2000; 54: 191–200
   PubMed Web of Science ®Google Scholar
• Algan O, Fowble B, Mcneelay S, Fein D. Use of the prone position in radiation treatment for women with early stage breast cancer. Int J Radiat Oncol Biol Phys 1996; 36: 281
   PubMed Web of Science ®Google Scholar
• Letts N, Remouchamps V, Martinez A., Vicini F, Wong J. Set-up inaccuracies in breast irradiation: A comparison of free breathing and Active Breathing Control (ABC) treatment using Electronic Portal Images (EPI). Int J Radiat Oncol Biol Phys 2003; 57: 309
   Google Scholar
• Sarrut D, Boldea V, Ayadi M, Badel JN, Ginestet C, Clippe S, et al. Nonrigid registration method to assess reproducibility of breath-holding with ABC in lung cancer. Int J Radiat Oncol Biol Phys 2005; 61: 594–607
   PubMed Web of Science ®Google Scholar
• Smith RP, Bloch P, Harris EE, McDonough J, Sarkar A, Kassaee A, et al. Analysis of interfraction and intrafraction variation during tangential breast irradiation with an electronic portal imaging device. Int J Radiat Oncol Biol Phys 2005; 62: 373–8
   PubMed Web of Science ®Google Scholar
• Berson AM, Emery R, Rodriguez L, Richards GM, Ng T, Sanghavi S, et al. Clinical experience using respiratory gated radiation therapy: Comparison of free-breathing and breath-hold techniques. Int J Radiat Oncol Biol Phys 2004; 60: 419–26
   PubMed Web of Science ®Google Scholar
• Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15 years survival: An overview of the randomised trials. Lancet 2005; 366(9503)2087–106
   PubMed Web of Science ®Google Scholar
• Thilmanl C, Zabel A, Nill S, Rhein B, Hoess A, Haering P, et al. Intensity-modulated radiotherapy of the female breast. Med Dosim 2002; 27: 79–90
   PubMedGoogle Scholar
• Vicini FA, Sharpe M, Kestin L, Martinez A, Mitchell CK, Wallace MF, et al. Optimizing breast cancer treatment efficacy with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2002; 54: 1336–44
   PubMed Web of Science ®Google Scholar
• Probst H, Griffiths S. Moving to a high-tech approach to the irradiation of early breast cancer: Is it possible to balance efficacy, morbidity and resource use?. Clin Oncol 2006; 18: 268–75
   Web of Science ®Google Scholar
• Ma CM, Ding M, Li JS. A comparative dosimetric study on tangential photon beams, intensity-modulated radiation therapy (IMRT) and modulated electron radiotherapy (MERT) for breast cancer treatment. Phys Med Biol 2003; 48: 909–24
   PubMed Web of Science ®Google Scholar
• Vass S, Bairati I. A cosmetic evaluation of breast cancer treatment: A randomized study of radiotherapy boost technique: Int J Radiat Oncol Biol Phys 2005; 62: 1274–82
   Google Scholar
• Sarin R, Dinshaw KA, Shrivastava SK, Sharma V, Deore SM. Therapeutic factors influencing the cosmetic outcome and late complications in the conservative management of early breast cancer. Int J Radiat Oncol Biol Phys 1993; 27: 285–92
   PubMed Web of Science ®Google Scholar