The purpose of this study was to determine if intensity modulated radiation therapy (IMRT) offers a better treatment plan compared to conventional radiotherapy for patients with pectus excavatum desiring breast-conserving therapy and to assess the feasibility of simultaneous modulated accelerated radiation therapy (SMART) boost. A patient with pectus excavatum desired breast-conserving therapy for her early stage breast cancer. She underwent lumpectomy and axillary lymph node dissection followed by chemotherapy. She was then referred for radiotherapy. A breast board (Med-Tec) with aquaplast body cast was used to limit the movement of the patient, chest wall, and breasts before planning a computed tomography (CT) scan. IMRT including dose-volume histogram (DVH) was compared to that of the conventional plan using parallel opposed tangential beams with a 15-degree wedge pair. Forty-five gray was prescribed to the whole breast to each plan, while 50 Gy was prescribed to the tumor bed using IMRT with SMART boost in 25 fractions over 5 weeks. The coverage of the whole breast was adequate for both plans. IMRT allowed a more homogeneous dose distribution within the breast at the desired dose range. With IMRT there is less volume of ipsilateral lung receiving the radiation dose that is above the tolerance threshold of 15 Gy when compared to that of the conventional plan. However, there is more volume of surrounding normal tissues (the heart, spinal cord, and contralateral breast and lung) receiving low-dose irradiation when IMRT was employed. SMART boost was feasible, allowing a mean dose of 57 Gy to be delivered to the tumor bed simultaneously along with the rest of the breast in 5 weeks. IMRT is feasible in treating early breast cancer patients with pectus excavatum by decreasing the ipsilateral lung volume receiving high-dose radiation when compared to the conventional method. SMART boost shortens the overall treatment time that may have potential radiobiological benefit.

Purpose: To compare the stereotactic radiosurgery treatment plans generated by a conventional radiosurgery treatment system with the plan generated by a system using intensity modulated beams.Methods and Materials: Optimized conformal radiation treatment plans were generated for both single and multiple intracranial lesions using a conventional radiosurgery treatment-planning system computer and the Peacock treatment-planning computer, The Peacock system is a conformal therapy system that uses intensity modulated beams, back projection, and the simulated annealing optimization technique, The dose delivered to critical structures and the target volume were compared by means of dose volume histograms between plans generated by the two different systems, The Radiation Therapy Oncology Group (RTOG) stereotactic radiosurgery criteria were also used to evaluate each plan.Results: (a) For a single small target, radiosurgery plans generated by the conventional radiosurgery system and the Peacock system were comparable, (b) For two separate small targets, where nonoverlapping arcs could be used, plans generated by the two systems were also comparable, (c) For a single large (>4 cm) irregular-shaped target, the Peacock system appeared to be able to generate a treatment plan superior to that of the conventional radiosurgery system.Conclusions: A treatment plan generated using intensity modulated beams appears to be superior to a multiple isocenter plan using a conventional radiosurgery system, for the treatment of a large irregular shaped intracranial target.