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Intensity-modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elderly patients with breast cancer: comparison of acute and late toxicities

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Abstract

Purpose

To evaluate the differences between conventional fractionated intensity-modulated radiotherapy (IMRT) and hypofractionated (HypoRT) volumetric modulated arc therapy (VMAT) in elderly women affected by early-stage breast cancer (BC) in terms of RT-related acute/late side effect.

Materials and methods

Between October 2011 and July 2015, 80 consecutive elderly BC patients were treated with IMRT for 5 weeks (40 patients) or HypoRT-VMAT for 3 weeks (40 patients). Inclusion criteria were: age ≥ 70 years, early BC (pT1-2 pN0-1), no prior neoadjuvant chemotherapy and non-metastatic disease. For patients receiving IMRT or HypoRT-VMAT, a total dose of 50 Gy (25 fractions) or 40.5 Gy (15 fractions) was prescribed to the whole ipsilateral breast, respectively. All patients received a simultaneously integrated boost up to a total dose of 60 Gy for IMRT and 48 Gy for HypoRT-VMAT. Acute and late side effects were evaluated using the RTOG/EORTC radiation morbidity scoring system.

Results

With a median follow-up of 45 months, acute skin toxicity was overall very low, with grade 1 in 25 cases (62.5%) of the IMRT group and 21 cases (52.5%) of the HypoRT-VMAT group, while grade 2 toxicity was reported in 10 IMRT patients (25%) and 1 HypoRT-VMAT patient (2.5%) (p = 0.001). Regarding late adverse events, only grade 1 skin toxicity was recorded.

Conclusion

The present study showed that whole breast IMRT and HypoRT-VMAT are feasible and well tolerated in early-stage BC elderly patients and that HypoRT-VMAT is affected by lower risk of acute and late RT-related side effects.

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Authors and Affiliations

  1. Radiation Oncology, Cancer Care Center, Ospedale Sacro Cuore don Calabria, via Don Sempreboni 5, 37034, Negrar, Verona, Italy

    Alba Fiorentino, Fabiana Gregucci, Rosario Mazzola, Vanessa Figlia, Francesco Ricchetti, Gianluisa Sicignano, Niccolo Giajlevra, Ruggero Ruggieri, Sergio Fersino, Stefania Naccarato & Filippo Alongi

  2. Breast Unit, Cancer Care Center, Ospedale Sacro Cuore don Calabria, Negrar, Verona, Italy

    Alberto Massocco

  3. Radiation Oncology, Ludwig-Maximilians University of Munich, Munich, Germany

    Stefanie Corradini

  4. University of Brescia, Brescia, Italy

    Filippo Alongi

Authors
  1. Alba Fiorentino
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  2. Fabiana Gregucci
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  3. Rosario Mazzola
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  4. Vanessa Figlia
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  5. Francesco Ricchetti
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  6. Gianluisa Sicignano
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  7. Niccolo Giajlevra
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  8. Ruggero Ruggieri
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  9. Sergio Fersino
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  10. Stefania Naccarato
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  11. Alberto Massocco
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  13. Filippo Alongi
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Corresponding author

Correspondence to Fabiana Gregucci.

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The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. For this type of study, formal consent is not required.

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Fiorentino, A., Gregucci, F., Mazzola, R. et al. Intensity-modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elderly patients with breast cancer: comparison of acute and late toxicities. Radiol med 124, 309–314 (2019). https://doi.org/10.1007/s11547-018-0976-2

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  • DOI: https://doi.org/10.1007/s11547-018-0976-2

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