Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy

Rudat, Volker; Nour, Alaa; Ghaida, Salam Abou; Alaradi, Abdul Aziz

doi:10.1186/s13014-016-0674-y

Cited by 11 publications

(11 citation statements)

References 34 publications

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“… 14 Another retrospective study of 266 patients allowed IMRT for planning to reduce hot spots, and CFRT remained associated with greater grade 2 radiation dermatitis on multivariate analysis compared with HFRT (19.3% vs 1.7%; P < .001). 15 …”

Section: Discussionmentioning

confidence: 99%

“…Likewise, a study of 2309 patients in the Michigan Radiation Oncology Quality Consortium found that grade ≥2 skin toxicity developed in 27.4% of patients treated with HFRT versus 62.6% of patients treated with CFRT ( P < .001) 14 . Another retrospective study of 266 patients allowed IMRT for planning to reduce hot spots, and CFRT remained associated with greater grade 2 radiation dermatitis on multivariate analysis compared with HFRT (19.3% vs 1.7%; P < .001) 15 …”

Section: Discussionmentioning

confidence: 99%

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The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

Butler-Xu

Marietta

Zahra

et al. 2019

Advances in Radiation Oncology

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Purpose Hypofractionated radiation therapy (HFRT) remains underused, despite multiple randomized trials showing the equivalence of HFRT to conventional fractionated radiation therapy (CFRT). We sought to retrospectively review the relationship between breast volume and toxicity for HFRT versus CFRT. Methods and materials Data from 114 patients who received a diagnosis of early stage breast cancer and were treated with lumpectomy and whole breast radiation alone were reviewed. Breast cancer laterality, stage, grade, estrogen/progesterone receptor and human epidermal growth factor receptor 2 status, and systemic therapy use were recorded. Length of follow-up was calculated using the last day of radiation treatment and the date of the most recent follow-up. Results The median follow-up was 42 months. A total of 83 patients were treated with HFRT and 31 with CFRT. Rates of grade ≥2 skin toxicity were significantly higher in patients undergoing CFRT compared with HFRT (76% vs 28%; P < .0001). In a subset of patients with breast volume ≥1000 cm 3 , grade ≥2 skin toxicity trended higher for CFRT patients (73% vs 38%; P = .057). For posterior separation >25 cm, the percentage of patients with grade 2 skin toxicity was 43% for HFRT versus 57% for CFRT ( P = .67). The volume of breast tissue receiving >105% of the total prescription dose, including boost, was not significantly different for HFRT versus CFRT ( P = .70). Conclusions Use of HFRT resulted in lower acute skin toxicity rates compared with CFRT. Large breast size (volume ≥1000 cm 3 ) was associated with lower acute grade 2 toxicity with the use of HFRT despite achieving similar dosimetry compared with CFRT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

Butler-Xu

Marietta

Zahra

et al. 2019

Advances in Radiation Oncology

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“…The treatment planning and radiation techniques used for this study have been described in detail elsewhere [ 7 – 9 ]. In short, a non-contrast computed tomography (CT) simulation with a slice thickness of 5 mm was performed with the patient in the supine position.…”

Section: Methodsmentioning

confidence: 99%

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

et al. 2017

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BackgroundThe aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy.Patients and methodsPatients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction.ResultsIn all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3–4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF.ConclusionHF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF.

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“… 7 , 12 , 22 , 24 , 26 , 34 , 37 Clinical reports are confirming the long-term safety and feasibility of moderately hypofractionated schedules also in women with large breasts. 11 , 17 , 32 , 36 , 38 , 42 , 80 , 81 Most of the investigators attributed higher toxicity rates in BC radiotherapy to dose inhomogeneity and a higher percentage of hot spots, irrespective of breast volume. 7 , 12 , 17 , 31 V105–107 % of the prescribed dose (PD) was significantly related to increased desquamation, dermatitis, oedema, and pain 12 ; and V105 % PD 82 , 83 or V110 % PD 83 to long-term breast pain.…”

Section: Discussionmentioning

confidence: 99%

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Ratoša

Jenko

Oblak

2018

Radiology and Oncology

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BackgroundBreast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size.ConclusionsInhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.

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Impact of hypofractionation and tangential beam IMRT on the acute skin reaction in adjuvant breast cancer radiotherapy

Cited by 11 publications

References 34 publications

The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

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