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Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation

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Abstract

The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II–III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy® System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012–2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0–35 months). 70.8% (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7% of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.

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Acknowledgements

The authors wish to thank Mrs. Verlie Anne Jones for language revision. This work was partially supported by a research grant from Accuray Inc. entitled “Data collection and analysis of Tomotherapy and CyberKnife breast clinical studies, breast physics studies and prostate study” and by Fondazione Umberto Veronesi (FUV), project title “AXILL-ART: Biology-based radiotherapy volume definition for 1–2 macrometastatic sentinel lymph nodes without further dissection in breast cancer conservative surgery”.

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Author notes

  1. Rosalinda Ricotti, Luigi Santoro, Sara Ronchi—Affiliated with European Institute of Oncology at the time of the study.

  2. Roberto Orecchia and Damaris Patricia Rojas: Co-first authors: these authors equally contributed to the work and thus should be considered as co-first authors.

  3. Maria Cristina Leonardi and Barbara Alicja Jereczek-Fossa: Co-last authors: these authors equally contributed to the work and thus should be considered as co-last authors.

Authors and Affiliations

  1. Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy

    Roberto Orecchia

  2. Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy

    Roberto Orecchia, Damaris Patricia Rojas, Samantha Dicuonzo, Sara Ronchi, Alessia Surgo & Barbara Alicja Jereczek-Fossa

  3. Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy

    Damaris Patricia Rojas, Rosalinda Ricotti, Anna Morra, Samantha Dicuonzo, Sara Ronchi, Alessia Surgo, Veronica Dell’ Acqua, Cristiana Fodor, Maria Cristina Leonardi & Barbara Alicja Jereczek-Fossa

  4. Unit of Medical Physics, European Institute of Oncology, Milan, Italy

    Federica Cattani, Raffaella Cambria & Rosa Luraschi

  5. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Luigi Santoro

  6. Division of Breast Surgery, European Institute of Oncology, Milan, Italy

    Paolo Veronesi

  7. Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy

    Francesca De Lorenzi

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  1. Roberto Orecchia
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Correspondence to Maria Cristina Leonardi.

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Conflict of interest

Leonardi MC received a speaker honorarium from Accuray International; Ricotti R had research grant from Accuray Inc. (Data collection and analysis of Tomotherapy and CyberKnife breast clinical studies, breast physics studies and prostate study); Orecchia R declared no conflict of interest; Rojas DM declared no conflict of interest; Cattani F declared no conflict of interest; Santoro L declared no conflict of interest; Morra A declared no conflict of interest; Cambria R declared no conflict of interest; Luraschi R declared no conflict of interest; Dicuonzo S declared no conflict of interest; Ronchi S declared no conflict of interest; Surgo A declared no conflict of interest; Dell’ Acqua V declared no conflict of interest; Veronesi V declared no conflict of interest; De Lorenzi F declared no conflict of interest; Fodor C declared no conflict of interest; Jereczek-Fossa BA declared no conflict of interest.

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Orecchia, R., Rojas, D.P., Cattani, F. et al. Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation. Med Oncol 35, 39 (2018). https://doi.org/10.1007/s12032-018-1095-6

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