What dose constraints do you use when treating a patient with bilateral breast cancer with RNI?

This article highlights lung, heart, esophagus, and dose homogeneity constraints we aim for when treating bilateral breast cancer and RNI.

Li et al., PMID 41272934

I look at each side individually and try to plan to meet ipsilateral lung constraints and delete contralateral lung constraints given bilateral. I also counsel patients on potential increased lung toxicity in these situations.

If treating bilateral IMNs, 3D-CRT is often very difficult, and I switch ...

Bilateral breast/chest wall irradiation with regional nodal irradiation (RNI) is one setting in which the dosimetric advantages of proton therapy are particularly pronounced (Mutter et al., PMID 34048815; Garda et al., PMID 35647397). In our health system, these patients are routinely referred for p...