Do you ever use VMAT for breast cancer?

We do use it for RNI if can’t meet OAR constraints or when doing SIB boost.

Aim for V 20 < 25% for ipsilateral lung and mean heart dose of <2-3 Gy depending on the importance of covering IMN.

Certainly, coverage and conformity are better with VMAT. Low dose volume is larger with VMAT but prescription dose volume is larger with 3D.

One important aspect I want to bring up when doing this is the esophagus dose. I have seen people using a mean of 35 or less like cancer which is too high a dose.

I follo...

“Why is VMAT not considered the standard of care for locoregional radiation therapy for breast cancer patients?”

Kendall et al., Advances in Radiation Oncology 2025

This study tracks with my experience and makes a compelling case that it should be the standard of care.

• In most cases, it is superior to 3D planning with regards to the most important OARs (heart and lung), while providing improved target coverage.
• It is less complicated to plan, once the treatment planning team has experience.
• Wo...

For standard tangents, I do not use VMAT, and use field in field. For locally advanced breast cancer, I almost always use 3DCRT with rare use of IMRT for cases primarily where I am treating IM nodes and reconstruction is present and a 3DCRT plan cannot meet constraints. I have used VMAT in a few of those cases.

In these cases, advantage of VMAT is lung and heart doses with the trade off being higher contralateral breast dose in many cases.

For partial breast irradiation, we have been using VMAT,...

I consider IMRT/VMAT for complex RNI/PMRT cases when meeting constraints with 3D is challenging (when more comprehensive coverage is desired, unusual anatomy/chest shape). One disclaimer is that Mayo Clinic has proton therapy, which is a really nice solution for many complex/comprehensive plans (bilateral or deep nodal boosts, etc). With that, I probably turn to IMRT/VMAT 2-3 times per year with a dedicated breast practice. The main trade-offs are often a higher mean heart dose (though lower max...