When do you use IMRT in breast radiotherapy?

We seldom use it. Our limited dosimetric experience shows that even though coverage of regional nodes improves, the V10 and V20 of the lung and the mean heart dose also increase. Thus, the small benefit of improved coverage (EORTC and Canadian data showed small improvement in DFS) has to be weighed against increased lung and cardiac morbidity (Darby data). We, in most of these situations, use conventional bean arrangement with inverse optimization if necessary and accept lower coverage and dose to IM nodal region.