Objective: To develop an alternative three-dimensional treatment plan with standardized fields class solution for whole-breast radiotherapy in patients with large/ pendulous breast and/or high body mass index (BMI). Methods: Two treatment plans [tangential fields and standardized five-fields technique (S5F)] for a total dose of 50 Gy/25 fractions were generated for patients with large breasts [planning target volume (PTV) .1000 cm 3 and/or BMI .25 kg m 22 ], supine positioned. S5F plans consist of two wedged tangential beams, anteroposterior: 20°for the right breast and 340°for the left breast, and posteroanterior: 181°for the right breast and 179°for the left breast. A field in field in medial-lateral beam and additional fields were added to reduce hot spot areas and extra-target-tissue irradiation and to improve dose distribution. The percentage of PTV receiving 95% of the prescribed dose (PTV V 95% ), percentage of PTV receiving 105% of the prescribed dose (PTV V 105% ), maximal dose to PTV (PTV D max ), homogeneity index (HI) and conformity index were recorded. V 10% , V 20% , V 105% and V 107% of a "proper" normal tissue structure (body-PTV healthy tissue) were recorded. Statistical analyses were performed using SYSTAT v.12.0 (SPSS, Chicago, IL). Results: In 38 patients included, S5F improved HI (8.4 vs 10.1; p # 0.001) and significantly reduced PTV D max and PTV V 105% . The extra-target-tissue irradiation was significantly reduced using S5F for V 105% (cm 3 ) and V 107% (cm 3 ) with a very high difference in tissue irradiation (46.6 vs 3.0 cm 3 , p # 0.001 for V 105% and 12.2 vs 0.0 cm 3 , p # 0.001 for V 107% for tangential field and S5F plans, respectively). Only a slight increase in low-dose extra-target-tissue irradiation (V 10% ) was observed (2.2719 vs 1.8261 cm 3 , p 5 0.002). Conclusion: The S5F technique in patients with large breast or high BMI increases HI and decreases hot spots in extra-target-tissues and can therefore be easily implemented in breast cancer radiotherapy. Advances in knowledge: The treatment planning strategy proposed in this study has several advantages: (a) it is extremely reliable as the standard supine positioning is used; (b) the standardized class solution allows for widespread use; (c) time and cost of treatment are not increased; and (d) it can be used for both large breasted and obese patients not compliant to different treatment positioning.