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. 2013 Nov;139(11):1927-36.
doi: 10.1007/s00432-013-1515-0. Epub 2013 Sep 14.

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

Pierfrancesco Franco  1 , Michele Zeverino, Fernanda Migliaccio, Piera Sciacero, Domenico Cante, Valeria Casanova Borca, Paolo Torielli, Cecilia Arrichiello, Giuseppe Girelli, Gianmauro Numico, Maria Rosa La Porta, Santi Tofani, Umberto Ricardi
Affiliations

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

Pierfrancesco Franco et al. J Cancer Res Clin Oncol. 2013 Nov.

Abstract

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 G0 22 %; G1 63 %; G2 12 % and G3 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 >G2 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.

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Figures

Fig. 1
Fig. 1
Predictors of acute toxicity. BMI body mass index, thck thickness, Vol volume (cm3), WB-Vol 105% whole breast volume receiving 105 % of the prescribed dose, V 52.5Gy–V 55Gy–V 57.5Gy whole breast volume minus boost volume receiving 52.5 Gy–55 Gy–57.5 Gy
Fig. 2
Fig. 2
Quality of life
See this image and copyright information in PMC

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