Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation

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Abstract

The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II–III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy® System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012–2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0–35 months). 70.8% (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7% of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.

Original languageEnglish
Article number39
JournalMedical Oncology
Volume35
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Intensity-Modulated Radiotherapy
Mammaplasty
Radiotherapy
Thoracic Wall
Organs at Risk
Breast Neoplasms
Appointments and Schedules
Therapeutics
Population

Keywords

  • Hypofractionation
  • Immediate breast reconstruction
  • Locoregional radiotherapy
  • Tomotherapy
  • Toxicity

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

Cite this

@article{b964874e2d864689999fdd600ad083a0,
title = "Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation",
abstract = "The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II–III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy{\circledR} System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012–2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0–35 months). 70.8{\%} (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7{\%} of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.",
keywords = "Hypofractionation, Immediate breast reconstruction, Locoregional radiotherapy, Tomotherapy, Toxicity",
author = "Roberto Orecchia and Rojas, {Damaris Patricia} and Federica Cattani and Rosalinda Ricotti and Luigi Santoro and Anna Morra and Raffaella Cambria and Rosa Luraschi and Samantha Dicuonzo and Sara Ronchi and Alessia Surgo and {Dell’ Acqua}, Veronica and Paolo Veronesi and {De Lorenzi}, Francesca and Cristiana Fodor and Leonardi, {Maria Cristina} and Jereczek-Fossa, {Barbara Alicja}",
year = "2018",
month = "3",
day = "1",
doi = "10.1007/s12032-018-1095-6",
language = "English",
volume = "35",
journal = "Medical Oncology",
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TY - JOUR

T1 - Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction

T2 - dosimetric results and acute/intermediate toxicity evaluation

AU - Orecchia, Roberto

AU - Rojas, Damaris Patricia

AU - Cattani, Federica

AU - Ricotti, Rosalinda

AU - Santoro, Luigi

AU - Morra, Anna

AU - Cambria, Raffaella

AU - Luraschi, Rosa

AU - Dicuonzo, Samantha

AU - Ronchi, Sara

AU - Surgo, Alessia

AU - Dell’ Acqua, Veronica

AU - Veronesi, Paolo

AU - De Lorenzi, Francesca

AU - Fodor, Cristiana

AU - Leonardi, Maria Cristina

AU - Jereczek-Fossa, Barbara Alicja

PY - 2018/3/1

Y1 - 2018/3/1

N2 - The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II–III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy® System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012–2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0–35 months). 70.8% (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7% of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.

AB - The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II–III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy® System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012–2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0–35 months). 70.8% (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7% of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.

KW - Hypofractionation

KW - Immediate breast reconstruction

KW - Locoregional radiotherapy

KW - Tomotherapy

KW - Toxicity

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