A prospective cohort study on postoperative radiotherapy with TomoDirect using simultaneous integrated boost technique in early breast cancer

Abstract

Purpose: To evaluate the technical feasibility and toxicity of TomoDirect in breast cancer patients who received radiotherapy after breast-conserving surgery. Methods: 155 consecutive patients with breast carcinoma in situ or T1-2 breast cancer with negative lymph node received breast irradiation with TomoDirect using simultaneous integrated boost technique in the prospective cohort study. A radiation dose of 50.4 Gy and 57.4 Gy in 28 fractions was prescribed to the ipsilateral breast and tumor bed, respectively. Dosimetric parameters of target and organ at risk and acute complication were assessed prospectively.Results: The mean dose for the tumor bed is 58.90 Gy. The mean values of V 54.53Gy (95% of the prescribed dose) , V 63.14Gy (110% of the prescribed dose) , and V 66.01Gy (115% of the prescribed dose) were 99.97%, 1.26%, and 0%, respectively. The mean value of radiation conformality index was 1.01. The mean value of radical dose homogeneity index was 0.89. The average dose irradiated to the ipsilateral lung, heart, and contralateral breast was 4.72 Gy, 1.09 Gy, and 0.19 Gy, respectively. The most common toxicity was dermatitis. During breast irradiation, grade 2 and 3 dermatitis occurred in 41 (26.5%) and 6 (3.9%) of the 155 patients, respectively. Two patients had arm lymphedema during breast irradiation. Two patients had grade 2 pneumonitis 1 month after breast irradiation. Conclusions: Radiotherapy using TomoDirect in early breast cancer patients showed acceptable toxicities and optimal results in terms of target coverage and organ at risk sparing.

Clinical Evaluation of Onrad, A New Low-cost Version of TomoTherapy that Uses Only Static Beams

“…Grade 2 or higher acute radiation dermatitis was observed in 15.8% of the patients and grade 2 radiation pneumonitis in 2.7%. Similar clinical results were reported by Lee et al [15] These clinical data indicate the feasibility of the TomoDirect mode. The dose distribution for breast cancer in Onrad plans is equal to that in Tomo-Direct.…”

“…Breast conservative therapy is widely accepted in Japan, even in rural areas. Recently, IMRT has been clinically applied to breast conservative therapy in some institutions [12,15]. Concurrent chemoradiotherapy is the standard treatment for stage III lung cancer [16,17].…”

Dosimetric comparison of TomoDirect, helical tomotherapy, and volumetric modulated arc therapy for postmastectomy treatment

“…The prescription dose for all patients was 50 Gy in 25 fractions. The dosimetric constraints were determined from various publications and recommendations 5–12 . The dose to OARs was divided into two dose constraints (Table 1), the patients in the first situation followed the constraint for the CW only irradiation.…”

Dosimetric comparison of helical tomotherapy and conventional Linac-based X-knife stereotactic body radiation therapy for primary lung cancer or pulmonary metastases

“…Previous studies also used these options to design other plans (22)(23)(24). Moreover, to avoid this inefficiency of beam usage, static ports (TomoDirect ® mode) for the treatment of locally advanced lung cancer has been developed, making it possible to reduce the lung volume receiving low dose radiation (25,26). Meanwhile, it is essential to optimize equipment, a newly developed dynamic jaw technology (TomoEDGE) has been introduced.…”