How do you approach the use of IMRT/VMAT boost for grossly involved internal mammary nodes in breast cancer patients?

We have to get over this idea that "IMRT/VMAT IS BAD FOR BREAST CANCER" mentality. ASTRO pursued this for nearly a decade, but finally removed from "Choosing Wisely".

VMAT/IMRT is a tool like any other tool. It is (usually) as good or as bad as the contouring and treatment planning. In some cases, forward planned FiF with tangents + additional fields will provide a very good plan.

If there is a situation where I know I have to go to 60-66 Gy (2 Gy equivalent) to an IMN node, I would do a VMAT plan from the start, particularly if left sided. It should not be difficult to get approval in this scenario.

Things to consider

• Simulate with DIBH and my IGRT preference is daily imaging with surface guidance; if not, consider alternate daily imag...