Advanced TP

What about second cancer risk?

• VMAT and multibeam-IMRT compared to 3D-CRT and tangential-IMRT: - More beams  larger volume of normal tissue is exposed to a ‘low-dose-bath’ - Require a longer beam-on time  integral dose can increase because of head leakage and collimator scatter

 Multibeam-IMRT and VMAT:

- for patients with left-sided cancer with high cardiac dose using 3D-CRT or t-IMRT - in RT Internal Mammary Nodes, in special anatomy (funnel chest)  reduction in the risk of cardiac and lung complications

Abo Madyan RO 2014, Ibrahim BMC Cancer 2012, Boyce NEJM 2002