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Inverse‐planned intensity modulated radiation therapy ( IP ‐ IMRT ) has potential benefits over other techniques for tangential intact breast radiotherapy. Possible benefits include increased homogeneity, faster planning time, less inter‐planner variability and lower doses to organs at risk ( OAR ). We therefore conducted a pilot study of previously treated intact breast patients to compare the current forward‐planned ‘field‐in‐field’ technique ( FP ‐ IMRT ) with an  IP ‐ IMRT  alternative.    Methods  The  IP ‐ IMRT  plans of 20 patients were generated from a template created for the planning system. All patients were prescribed adjuvant whole breast radiotherapy using a hypofractionated regimen of 40.05 Gy in 15 fractions over 3 weeks. Plans were assessed based on visual inspection of coverage as well as statistical analysis and compared to the clinically acceptable  FP ‐ IMRT  plans. Patients were planned retrospectively in Monaco 3.2 ®  using a laterality‐specific, tangential planning template. Minor adjustments were made as necessary to meet the planning criteria in the protocol. Dose coverage, maximums, homogeneity indices and doses to  OAR  were recorded.    Results  The  IP ‐ IMRT  plans provided more consistent coverage (38.18 Gy vs. 36.08 Gy of D95;  P  = 0.005), a comparable though higher average maximum (D2 = 42.52 Gy vs. 42.08 Gy;  P  = 0.0001), more homogeneous plans (homogeneity index = 0.908 vs. 0.861;  P  = 0.01) and somewhat lower V20 heart and lung doses (0.11% vs. 0.89% for heart; 5.4% vs. 7.52% for lung) than  FP ‐ IMRT  ( P  > 0.05).    Conclusion  Clinically acceptable plans have been generated using the  IP ‐ IMRT  templates in Monaco. Improvements in consistency and quality were seen when compared to the  FP ‐ IMRT  plans. The template‐based process is an efficient method to inversely plan  IMRT  for breast patients.

Tangential intensity modulated radiation therapy (IMRT) to the intact breast