Helical TomoTherapy for locally advanced or recurrent breast cancer

Abstract

PurposeWe report our experience of using helical tomotherapy (HT) to treat large and irregular shaped loco-regional advanced breast cancer target volumes embracing various organs at risk.Patients and methodsWe retrospectively analyzed 26 patients treated for very large, irregular shaped breast cancers. Patients were treated either with the intent to achieve local control in a primary setting (n = 14) or in a reirradiation setting (n = 12). The recurrence group was heavily pretreated with systemic therapy. Tumors were characterized by wide infiltration of the skin, encompassing mostly a complete hemithorax. The primary group underwent irradiation of supraclavicular, infraclavicular, axillary and parasternal lymphonodal region. Radiotherapy was combined with chemotherapy (n = 11). We assessed the PTV volume and its craniocaudal extension, the dose to the organs at risk, acute toxicity and survival.ResultsMedian PTV was 2276 cm3 (1476–6837 cm3) with a median cranio-caudal extension of 28 cm (15–52 cm). The median dose to PTV was 40 Gy (32–60Gy). HT could be carried out in all patients without interruption. The acute toxicities were mild to moderate. The median LRFS and OS after radiotherapy was 21 and 57 months for the primary group versus 10 and 11 months for the recurrence group. Median PFS was 18 months (primary group) and 7 months (recurrence group).ConclusionsHT is feasible for advanced thorax embracing target volumes with acceptable acute toxicity. Both curative and palliative indications can be considered good indications based on treatment volume and anatomical constellation.

Dosimetric comparison of helical tomotherapy, volume-modulated arc therapy, and fixed-field intensity-modulated radiation therapy in nasopharyngeal and cervical cancers

“…Growing Evidences have shown that HT can sculpt radiation doses to complex-shaped tumorous regions and avoid high-dose regions to OARs through the rapid opening and closing of leaves in a collimator rotating around the patient [22]. Therefore, HT is frequently used in various diseases [23][24][25][26], including NPC and CC [27,28], nowadays. In this study, results showed that the three IMRT techniques met the clinical demand, but HT showed an evidently sharp dose gradient with the optimal HI and CI in NPC and CC.…”

Use of helical tomotherapy in locally advanced and/or metastatic breast cancer for locoregional treatment

“…More recently, a retrospective study of 29 patients with locally advanced breast cancer by Duma et al found acceptable acute toxicity for target volumes that surrounded a significant area of the thoracic region. 34 Finally, Lamberth et al selected nine cases, where 3D conformal dosimetry was unacceptable and replanned them using HT. The potential indications were obesity, previous irradiation, pectus excavatum, and bilateral tumours.…”

Helical tomotherapy: Comparison of Hi-ART and Radixact clinical patient treatments at the Technical University of Munich

“…Advantages and disadvantages. One major advantage of HT lies in the avoidance of field junctions and dose gaps especially for complex and long target volumes [2][3][4] . Furthermore, by using helical treatment technique in combination with a relatively small field and the binary MLC, optimal sparing of healthy tissue can be reached while the target volume is homogenously covered with dose.…”

“…Mainly favorable results can be found in numerous scientific investigations 5 . They comprise prostate cancer [10][11][12][13] , head and neck tumors [14][15][16][17][18] , gastrointestinal tumors [19][20][21][22] , breast cancer 2,[23][24][25][26][27] , lung cancer [28][29][30][31][32] and intracranial lesions [33][34][35][36][37] .…”

“…Chiara et al 42 demonstrated the feasibility of HT for inoperable breast cancer with acceptable toxicity profiles. Duma et al 2 showed the usage of tomotherapy for locally advanced breast cancer and found moderate acute toxicity.…”