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Summary
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The NSABP/RTOG guidelines can be fulfilled by any external APBI techniques.
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With IMRT the dose to organs at risk can be reduced compared to the 3D-CRT.
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IMRT has more advantages in patients with more challenging anatomy.
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With fixed beam Tomotherapy treatments the dose to lung and heart can be
significantly reduced compared to the helical Tomotherapy.
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CyberKnife is a suitable techinque for delivering APBI with achievable normal tissue
constraints.
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The interfraction variations in prone position are comparable to those reported for
supine setup, prone APBI with IGRT is a feasible treatment technique.
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The lowest dose to organs at risk can be achieved with proton beam irradiation.
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Using patient setup with skin mark only, min. 10 mm CTV-PTV margin has to be
used. The margin can be decreased with registration by bony anatomy, but a 3 mm
residual error still remains even if the surgical clips are used for image guidance.
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With inspiration breath hold technique a further reduction of heart and ipsilateral
lung dose can be achieved.