Intensity-Modulated Radiotherapy Results in Significant Decrease in Clinical Toxicities Compared With Conventional Wedge-Based Breast Radiotherapy

Harsolia, Asif; Kestin, Larry L.; Grills, I.S.; Wallace, Michelle; Jolly, Shruti; Jones, Cortney V; Lala, M.; Martínez, Álvaro; Schell, Scott R.; Vicini, Frank A.

doi:10.1016/j.ijrobp.2007.02.044

Cited by 218 publications

(145 citation statements)

References 22 publications

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“…Excellent-to-good cosmesis after prone WBI is achieved in about 80% to 90% of patients (14,15). Chronic toxicity and cosmesis seem to compare favorably with the supine results (24)(25)(26). Comparison is, however, difficult because of the different scoring of endpoints and different patient cohorts.…”

Section: Discussionmentioning

confidence: 99%

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Paelinck

Gulybán²,

Lakosi³

et al. 2017

Radiotherapy and Oncology

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SummaryThis is the first randomized trial reporting on the 2-year cosmetic outcome of prone and supine whole-breast irradiation in 94 patients with a cup size of at least C. Better cosmetic outcome was observed in prone-treated patients after 2 years with less skin color changes (PZ.05), less edema (PZ.06), and less worsening of cosmesis assessed by the Breast Cancer Conservation Treatment.cosmetic results software on digital photographs with both arms elevated.Purpose: To report the 2-year cosmetic outcome of a randomized trial comparing prone and supine whole-breast irradiation in large-breasted patients. Methods and Materials: One hundred patients with a (European) cup size C were included. Before and 2 years after radiation therapy, clinical endpoints were scored and digital photographs were taken with the arms alongside the body and with the arms elevated 180 . Three observers rated the photographs using the 4-point Harvard cosmesis scale. Cosmesis was also evaluated with the commercially available Breast Cancer Conservation Treatment.cosmetic results (BCCT.core) software. Results: Two-year follow-up data and photographs were available for 94 patients (47 supine treated and 47 prone treated). Patient and treatment characteristics were not significantly different between the 2 cohorts. Aworsening of color change occurred more frequently in the supine than in the prone cohort (19/46 vs 10/46 patients, respectively, PZ.04). Five patients in the prone group (11%) and 12 patients in the supine group (26%) presented with a worse scoring of edema at 2-year follow-up (PZ.06). For retraction and fibrosis, no significant differences were found between the 2 cohorts, although scores were generally worse in the supine cohort. The cosmetic scoring by 3 observers did not reveal differences between the prone and supine groups. On the photographs with the hands up, 7 patients in the supine group versus none in the prone group had a worsening of cosmesis of 2 categories using the BCCT.org software (PZ.02). Conclusion: With a limited follow-up of 2 years, better cosmetic outcome was observed in prone-treated than in supine-treated patients. Ó

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Section: Discussionmentioning

confidence: 99%

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Paelinck

Gulybán²,

Lakosi³

et al. 2017

Radiotherapy and Oncology

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“…In the past, chemotherapy has been reported to result in a worsening of long-term fibrosis and cosmetic outcome [36,37]. The impact of modern anthracycline-based regimens in patients treated with HF-WBI is unknown.…”

Section: Discussionmentioning

confidence: 99%

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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“…25 Similarly, a study carried out after 4.7 years of median follow-up showed a reduction in chronic breast oedema (3% vs 30%; p 5 0.007) and hyperpigmentation (3 vs 41%; p 5 0.001), especially in patients with larger breasts (volume .1600 cm 3 ). 26 Even though breast cancer RT is one of the most diffused applications of radiation oncology, this technique is not, however, always available in all RT centres, as the use of IMRT is not always justified due to the cost of technology, particularly when less expensive alternatives that yield similar target dose coverage and normal organ sparing are readily available.…”

Section: Discussionmentioning

confidence: 99%

A new three-dimensional conformal radiotherapy (3DCRT) technique for large breast and/or high body mass index patients: evaluation of a novel fields assessment aimed to reduce extra–target-tissue irradiation

Gerardina¹,

I²,

Sonia³

et al. 2016

BJR

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Objective: To develop an alternative three-dimensional treatment plan with standardized fields class solution for whole-breast radiotherapy in patients with large/ pendulous breast and/or high body mass index (BMI). Methods: Two treatment plans [tangential fields and standardized five-fields technique (S5F)] for a total dose of 50 Gy/25 fractions were generated for patients with large breasts [planning target volume (PTV) .1000 cm 3 and/or BMI .25 kg m 22 ], supine positioned. S5F plans consist of two wedged tangential beams, anteroposterior: 20°for the right breast and 340°for the left breast, and posteroanterior: 181°for the right breast and 179°for the left breast. A field in field in medial-lateral beam and additional fields were added to reduce hot spot areas and extra-target-tissue irradiation and to improve dose distribution. The percentage of PTV receiving 95% of the prescribed dose (PTV V 95% ), percentage of PTV receiving 105% of the prescribed dose (PTV V 105% ), maximal dose to PTV (PTV D max ), homogeneity index (HI) and conformity index were recorded. V 10% , V 20% , V 105% and V 107% of a "proper" normal tissue structure (body-PTV healthy tissue) were recorded. Statistical analyses were performed using SYSTAT v.12.0 (SPSS, Chicago, IL). Results: In 38 patients included, S5F improved HI (8.4 vs 10.1; p # 0.001) and significantly reduced PTV D max and PTV V 105% . The extra-target-tissue irradiation was significantly reduced using S5F for V 105% (cm 3 ) and V 107% (cm 3 ) with a very high difference in tissue irradiation (46.6 vs 3.0 cm 3 , p # 0.001 for V 105% and 12.2 vs 0.0 cm 3 , p # 0.001 for V 107% for tangential field and S5F plans, respectively). Only a slight increase in low-dose extra-target-tissue irradiation (V 10% ) was observed (2.2719 vs 1.8261 cm 3 , p 5 0.002). Conclusion: The S5F technique in patients with large breast or high BMI increases HI and decreases hot spots in extra-target-tissues and can therefore be easily implemented in breast cancer radiotherapy. Advances in knowledge: The treatment planning strategy proposed in this study has several advantages: (a) it is extremely reliable as the standard supine positioning is used; (b) the standardized class solution allows for widespread use; (c) time and cost of treatment are not increased; and (d) it can be used for both large breasted and obese patients not compliant to different treatment positioning.

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Intensity-Modulated Radiotherapy Results in Significant Decrease in Clinical Toxicities Compared With Conventional Wedge-Based Breast Radiotherapy

Cited by 218 publications

References 22 publications

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial

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

A new three-dimensional conformal radiotherapy (3DCRT) technique for large breast and/or high body mass index patients: evaluation of a novel fields assessment aimed to reduce extra–target-tissue irradiation

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