What strategies do you use for large breasted women receiving whole breast radiation?

If we can't do prone, we use a styroform wedge in the inframammary region to decrease the breast fold and thus, decrease the inferior margin and amount of inframammary fold we have to treat. I would initially try hypofractionation with mixed beam with a field-in-field technique and if the dose homog...

One other comment I would make is we too routinely assume a patient needs whole breast irradiation. For larger breasted women with T1-2 (< 3 cm) N0 tumors partial breast irradiation with 40 Gy/15 fractions (IMPORT LOW) or 30 Gy/5 fractions (Livi et al., PMID 25605582) can be considered to reduce dos...

We have two options to reduce volume and thus morbidity. One is to import low-volume techniques for 26 Gy in 5 fractions or 40 Gy in 15 fractions, based on dose homogeneity, or APBI 30 Gy in 5 fractions. Selection can be based on pathology and the technology available.