Intensity-modulated adjuvant whole breast radiation delivered with static angle tomotherapy (TomoDirect): a prospective case series

• Published in: Journal of cancer research and clinical oncology 2013-11, Vol.139 (11), p.1927-1936
• Main Authors: Franco, Pierfrancesco, Zeverino, Michele, Migliaccio, Fernanda, Sciacero, Piera, Cante, Domenico, Casanova Borca, Valeria, Torielli, Paolo, Arrichiello, Cecilia, Girelli, Giuseppe, Numico, Gianmauro, La Porta, Maria Rosa, Tofani, Santi, Ricardi, Umberto
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Antineoplastic agents; Biological and medical sciences; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer Research; Cancer surgery; Cohort Studies; Dose-Response Relationship, Radiation; Female; Hematology; Humans; Internal Medicine; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Original Paper; Pharmacology. Drug treatments; Prospective Studies; Quality of Life; Radiation therapy; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-013-1515-0

Purpose To report the 2-year outcomes of whole breast intensity-modulated radiotherapy (IMRT) after conserving surgery for early breast cancer (EBC) delivered with static angle tomotherapy (TomoDirect) (TD). Methods A prospective cohort of 120 EBC patients underwent whole breast IMRT with TD between 2010 and 2012. Radiation was delivered to a conventionally fractionated whole breast total dose of 50 Gy with TD, followed by a sequential conventionally fractionated tumor bed boost dose of 10–16 Gy with helical tomotherapy (HT). Clinical endpoints include acute and late toxicity, cosmesis, quality of life and local control. Results Median follow-up was 24 months (range 12–36 months); maximum detected acute skin toxicity was G 0 22 %; G 1 63 %; G 2 12 % and G 3 3 %. Predictors of acute dermatitis were as follows: volume of the whole breast minus boost volume receiving 105, 110 and 115 % of prescription dose, whole breast and boost volume, breast thickness and soft tissue thickness. Late skin toxicity was mild with no > G 2 events. Cosmesis was good/excellent in 91.7 % of patients and fair/poor in 8.3 %. Quality of life was preserved over time, but for fatigue, transiently increased. Conclusion Adjuvant whole breast IMRT delivered sequentially with both TD and HT provides consistent clinical results. An observed unintended excessive dose outside the tumor bed might increase acute toxicity and eventually affect long-term clinical endpoints. The incorporation of the boost dose within the whole breast phase employing a simultaneous integrated boost (SIB) approach might mitigate this issue.