Implementation of a forearm support to reduce the amount of irradiated lung and heart in radiation therapy of the breast

We compared simulator images of medial tangential fields taken in two posit ions: (1) with the ipsilateral arm abducted, holding a 'L-bar' armrest and (2) with both arms extended above the head in a forearm support. The averag e maximum heart distance as well as the central lung distance decreased sig nificantly by 3.4 (SE 0.9) and 4.7 (SE 1.1) mm, respectively, when the new forearm support was used. The estimated normal tissue complication probabil ity for excess cardiac mortality decreased by on average 3.1% (SE 1.3%). Fo r some patients, a greater amount of the axilla was included in the field. We recommend the use of the forearm support during breast cancer treatment with tangential fields to decrease the amount of heart and lung inside the fields. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.