Definitive Radiotherapy With SBRT or IMRT Boost for Breast Cancer: Excellent Local Control and Cosmetic Outcome

Abstract

The gold standard for breast cancer treatment is surgery, but many women may desire to avoid surgery if possible. The purpose of this study was to evaluate whether breast cancer could be cured with modern sophisticated radiation techniques with good cosmetic outcome. We have treated 18 patients with operable breast cancer by conventional whole-breast irradiation followed by stereotactic body radiotherapy (primary tumor only) or intensity-modulated radiotherapy (tumor plus axillary nodes) boost. The planned doses were 50 Gy in 25 fractions, 18 to 25.5 Gy in 3 fractions, and 20 Gy in 8 fractions, respectively, for the 3 modalities. Stereotactic body radiotherapy was delivered with 7 to 9 coplanar and noncoplanar fixed beams, and intensity-modulated radiotherapy was given by tomotherapy. Chemotherapy and/or hormone therapy was used depending on the stage and receptor status. In 9 recent patients, hydrogen peroxide was intratumorally injected twice a week before whole-breast irradiation. All treatments were well tolerable and there were no grade ≥3 toxicities. With a median follow-up period of 35 months (range, 8-120 months), only 1 patient developed local recurrence and 2 patients developed distant metastasis. Overall survival, progression-free survival, and local control rates were 93%, 85%, and 92%, respectively, at 3 years. In 50% of the patients, the irradiated breast became better rounded, and the position of the nipple of the irradiated breast became ≥1 cm higher compared to that of the unirradiated breast. Thus, the treated breasts may be more aesthetically favorable than before irradiation in these patients. This may become a treatment option for patients with operable breast cancer.

Keywords: KORTUC; hydrogen peroxide; intensity-modulated radiotherapy; stereotactic radiotherapy; tomotherapy; whole-breast irradiation.

Figure 1.

Study flowchart and treatment details.

Figure 2.

Computed tomography (CT) images of a patient before and 5 years after treatment. A and B, Before treatment. Arrows indicate a mammary tumor (A) and an axillary lymph node (B). C and D, Five years after treatment, both the breast tumor and axillary lymph node are controlled. Note the marked enlargement of the right irradiated breast. The double-headed arrow in Figure 2C indicates the breast height on CT defined in this study.

Figure 3.

Kaplan-Meier overall survival (OS, ^), progression-free survival (PFS, •), and local control curves (LC, ▴) for 18 patients with operable breast cancer.

Figure 4.

Photograph of a patient with right breast cancer at 1 year after treatment. Note that the nipple of the irradiated right breast is at a higher position than the left nipple. The right breast is better rounded than the left breast.