Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

Hannan, Raquibul; Thompson, Reid F.; Chen, Yu; Bernstein, Karen De Amorim; Kabarriti, Rafi; Skinner, William; Chen, Chin C.; Landau, Evan; Miller, Eirwen M.; Spierer, M.; Hong, Linda; Kalnicki, Shalom

doi:10.1016/j.ijrobp.2012.01.093

Cited by 45 publications

(48 citation statements)

References 24 publications

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“…Such findings can be explained by the fact that in the prone position, respiratory movement of the lung along with breast dislocation is minimal compared with the supine position. The present result is in agreement with previous studies . It is also important to note that even the maximum dose to the lung was well within our treatment constraint.…”

Section: Discussionsupporting

confidence: 94%

“…20 With 3D-CRT-based treatment, an increase in breast size resulted in a significant difference in the mean dosage delivered to the heart. This is in agreement with an IMRT-based hypofractionated therapy study carried out by Hannan et al 21 Such results can be explained by the fact that patients with large breasts have markedly increased CWS (26 cm) compared with patients with small breasts (19 cm), with statistical significance (P < 0.0001). Larger CWS indicates that there is more tangential field to the organs at risk.…”

Section: Discussionsupporting

confidence: 91%

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Hypofractionated whole‐breast radiotherapy using a three‐dimensional conformal technique: Toxicity comparison in different breast sizes

Kim

Forouzannia

Saini

et al. 2018

Precision Radiation Oncology

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Objectives Patients with larger breast sizes have been considered to be contraindicated for hypofractionated radiation therapy. In the present retrospective study, we analyzed the dosimetric and clinical toxicity outcomes of patients with different breast sizes and treatment positions. We conclude that three‐dimensional conformal radiotherapy (3D‐CRT) hypofractionated radiation therapy can be therapeutically applied regardless of the breast size and treatment position. The aim of this study is to report a comparison of the dosimetry and toxicity of 3D‐CRT on patients with different breast volumes who received whole‐breast hypofractionated radiation therapy. Methods From November 2014 to May 2017, 106 patients with stage 0–IIA breast cancers were treated at Florida Hospital Altamonte Radiation Oncology. The patients were divided into two groups, group 1: large breast (chest wall separation >25 cm or planning target volume [PTV] >1500 cm3; n = 30); and group 2: small breast (chest wall separation <25 cm and PTV <1500 cm; n = 76). Patients were treated in the prone or supine position. Patients underwent hypofractionated 3D‐CRT to the whole breast (42.56 Gy in 16 fractions) followed by a boost dose (10 Gy in 5 fractions). A comparison of dosimetric and clinical toxicity outcomes during acute and subacute follow up among the two groups were analyzed and reported. Results The mean PTV V95 (percentage of volume receiving ≥95% of prescribed dose) was 99.07%, and the mean V105 (percentage of volume receiving ≥105% of prescribed dose) was 30.77%, whereas the mean V107 (percentage of volume receiving ≥107% of prescribed dose) was 6.25%. The maximum cardiac dose was comparable between the two groups, and did not correlate with the breast size or volume (P = 0.41). The maximum cardiac point dose in group 1 was 26 Gy, and that of Group 2 was 22 Gy. The maximum skin dose was 45.5 Gy for both groups, and did not increase with increased breast size (P = 0.92). The maximum dose to the ipsilateral lung did not increase with breast size (P = 0.08), but the mean dose to the ipsilateral lung did increase with the breast size (P < 0.0001). When comparing supine and prone treatment positions, PTV of the breast in the supine position was significantly larger compared with the prone position (P < 0.0042). Likewise, the mean ipsilateral lung dose was substantially increased in the supine position compared with the prone position (P < 0.0001). Radiation Therapy Oncology Group grade 0, 1, and 2 skin toxicities during therapy were noted in 2%, 56%, and 36% of patients, respectively. Large breasted patients had higher grade 1 skin toxicity compared with small breasted patients (60% vs 55%), but without statistical significance (P > 0.05). Likewise, the small breasted group had higher acute grade 2 skin toxicity compared with the large breasted group (30% vs 38%), but without statistical significance (P > 0.07). Conclusions For early‐stage breast cancer (0–IIA), adequate PTV coverage and toxicities to the heart, lung, and skin were ach...

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 91%

Hypofractionated whole‐breast radiotherapy using a three‐dimensional conformal technique: Toxicity comparison in different breast sizes

Kim

Forouzannia

Saini

et al. 2018

Precision Radiation Oncology

View full text Add to dashboard Cite

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“…In this prospectively followed tri‐racial/ethnic cohort of breast cancer patients receiving adjuvant RT to the intact breast after breast‐conserving surgery, the overall incidence of NCI CTCAE grade 2 or greater skin toxicity was 52%, and 21% developed moist desquamation, consistent with the majority of published series . We identified higher BMI, higher disease stage, PR‐negative tumor status, and conventionally fractionated regimens as predictors for higher skin toxicity grade.…”

Section: Discussionsupporting

confidence: 80%

Prospective evaluation of radiation‐induced skin toxicity in a race/ethnically diverse breast cancer population

et al. 2016

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We evaluated predictors of radiation‐induced skin toxicity in a prospective study of a tri‐racial/ethnic breast cancer population. We evaluated patient demographics, tumor characteristics, and treatment variables in the first 392 patients in a prospective study assessing radiation‐induced skin toxicity. Logistic regression analyses were conducted to evaluate potential predictors of skin toxicity. The study consists of 59 non‐Hispanic whites (NHW; 15%), 241 Hispanic Whites (HW; 62%), 79 black or African Americans (AA; 20%), and 13 others (3%). Overall, 48% developed grade 0–1 skin toxicity, 49.8% grade 2, and 2.2% grade 3 by the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) scale. Twenty‐one percent developed moist desquamation. In multivariate analysis, higher body mass index (BMI; OR = 2.09; 95%CI = 1.15, 3.82), higher disease stage (OR = 1.82; 95%CI = 1.06, 3.11), ER‐positive/PR‐negative status (OR = 2.74; 95%CI = 1.26, 5.98), and conventionally fractionated regimens (OR = 3.25; 95%CI = 1.76, 6.01) were significantly associated with higher skin toxicity grade after adjustment for age, race, ethnicity, ER status, and breast volume. BMI specifically predicted for moist desquamation, but not degree of erythema. In this racially and ethnically diverse cohort of breast cancer patients receiving radiation to the intact breast, risk factors including BMI, disease stage, and conventionally fractionated radiation predicted for higher skin toxicity grade, whereas age, race, ethnicity, and breast volume did not. BMI specifically predicted for moist desquamation, suggesting that preventive measures to address this particular outcome should be investigated.

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“…larger WB-CTV) (p=0.209), similar to that observed in other trials [31,32,33]. In contrast, some authors have reported strong correlations between breast volume or size and severity of acute skin toxicity [34,35].…”

Section: Discussionsupporting

confidence: 84%

Prospective evaluation of weekly concomitant tumor bed boost with three-week hypofractionated whole breast irradiation in early breast cancer

et al. 2017

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Objectives: A prospective study was conducted to assess the acute and late toxicity of hypofractionated whole breast irradiation with a weekly concomitant boost for women with early breast cancer (EBC). Methods:Women with EBC who underwent breast-conserving surgery were eligible. A dose of 40Gy in 15 fractions over 3 weeks was delivered to the whole breast with a concomitant weekly boost to the post-operative cavity of 3Gy in 3 fractions. Toxicity was graded using the RTOG acute toxicity and RTOG/EORTC late toxicity scales.Results: A total of 67 women were enrolled with a median age of 49 years (range 31Ð69). Median follow up was 25 months (range 11-34). Acute skin reactions included grade (G) 1 (n=47, 70%), G2 (n=10, 13%) and G3 (n=1, 1.5%). Late skin toxicity was observed in 13 patients (19%), all of whom experienced G1 toxicity only. On multivariable analysis, diabetes mellitus was predictive of acute skin toxicity (p=0.003), while age less than 50 years (p=0.029) and diabetes mellitus (p=0.013) were predictive of late skin toxicity. Conclusions:Whole breast irradiation with concomitant weekly boost appears feasible and safe. Further investigation is required to fully evaluate this schedule as an alternative to conventional whole breast irradiation with a sequential boost.

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Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

Cited by 45 publications

References 24 publications

Hypofractionated whole‐breast radiotherapy using a three‐dimensional conformal technique: Toxicity comparison in different breast sizes

Hypofractionated whole‐breast radiotherapy using a three‐dimensional conformal technique: Toxicity comparison in different breast sizes

Prospective evaluation of radiation‐induced skin toxicity in a race/ethnically diverse breast cancer population

Prospective evaluation of weekly concomitant tumor bed boost with three-week hypofractionated whole breast irradiation in early breast cancer

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