optimum treatment planning technique evaluation for synchronous bilateral breast cancer with left side supraclavicular lymph nodes

Introduction: bilateral breast cancer cases are classified as complex in radiotherapy treatment, especially those with the left side mastectomy and right-side lumpectomy with left side supraclavicular lymph nodes patients. the purpose of this study is to find the optimum treatment planning technique among the three available techniques: 3dimentional conformal radiotherapy (3d-crt), intensity modulated radiation therapy (imrt), and volumetric modulated arc therapu (vmat).material and methods: ten bilateral breast cancer included in this study with left-side mastectomy and right-side lumpectomy with left-side supraclavicular lymph nodes. the patients are delineated by oncologists and prepared for radiation planning by monaco 5.1 treatment planning system (tps) with an x-ray photon beam of 6 mv or 10 mv energy using ‎elekta‏’‏s agility linear accelerator. the prescribed dose is set at 4005 ccy per 15 fractions. statistically with anova test among each other.results: the treatment with 3d-crt, imrt, and vmat show a significant difference in the results. vmat gives high dose distribution for the left mastectomy breast and its regional supraclavicular lymph nodes, while the imrt gives a higher value for the right side breast with lumpectomy. the good homogeneity index is acquired with imrt, while vmat gives a better conformity index. the 3d-crt planning technique lowers the dose to the heart and lunges better than the other techniques.conclusion: depending on the patient health and stage, the optimum treatment planning is applied. vmat and imrt give effective results than the 3d-crt.