Is superficial underdosing of hypofractionated breast RT acceptable in patients with a large breast separation?

The 3D dose distribution and DVHs should be carefully reviewed for target volume coverage, particularly if the lumpectomy bed PTV is superficial. The most important consideration is adequate coverage (>/=95%) of the tissue included in the region of the lumpectomy bed PTV. Whole breast PTV coverage is typically at a somewhat lower isodose. The volume of breast tissue requiring coverage at any specific isodose level is a clinical judgement, and depends upon the risk of local recurrence based on clinicopathologic features and molecular markers, the patient's anatomy, the use of systemic therapies and the extent of surgery and margins. Historically, such as during the 2D era or in the absence of target volume delineation of the ipsilateral whol...