Strahlentherapie und Onkologie

, Volume 190, Issue 7, pp 646–653 | Cite as

Hypofractionation with simultaneous integrated boost for early breast cancer

Results of the German multicenter phase II trial (ARO-2010-01)
  • Kathrin DellasEmail author
  • Reinhard Vonthein
  • Jörg Zimmer
  • Stefan Dinges
  • Alexander D. Boicev
  • Peter Andreas
  • Dorothea Fischer
  • Cornelia Winkler
  • Andreas Ziegler
  • Jürgen Dunst
  • ARO Study Group
Original article



To evaluate the feasibility of hypofractionation with SIB in all settings in Germany to prepare a multicenter treatment comparison.


Eligible patients had histopathologically confirmed breast cancer operated by BCS. Patients received WBI 40.0 Gy in 16 fractions of 2.5 Gy. A SIB with 0.5 Gy per fraction was administered to the tumor bed, thereby giving 48.0 Gy in 16 fractions to the boost-PTV sparing heart, LAD, lung, contralateral breast. The primary study objective was feasibility, administration of specified dose in 16 fractions within 22–29 days with adherence to certain dose constraints (heart; LAD; contralateral breast); secondary endpoints were toxicity, QoL.


151 patients were recruited from 7 institutions between 07/11-10/12. 10 patients met exclusion criteria prior to irradiation. All but two patients (99 %) received the prescribed dose in the PTVs. Adherence to dose constraints and time limits was achieved in 89 % (95 % CI 82 % to 93 %). 11 AE were reported in 10 patients; five related to concurrent endocrine therapy. Two of the AEs were related to radiotherapy: grade 3 hot flushes in two cases. QoL remained unchanged.


Hypofractionation with a SIB is feasible and was well tolerated in this study.


Breast cancer Hypofractionation Simultaneous integrated boost Feasibility Toxicity 



Three-dimensional conformal radiotherapy


Adverse event


Arbeitsgemeinschaft Radiologische Onkologie (Research Group on Radiological Oncology in the German Cancer Society)


Breast-conserving surgery


Conventional radiotherapy


Diffusing capacity of the lung for carbon monoxide


Dose–volume histogram


European Organisation for Research and Treatment of Cancer


Forced expiratory volume in 1 s


Intensity modulated radiotherapy


Left coronary artery


National Cancer Institute Common Toxicity Criteria


Planning target volume


Ramus interventriculares anterior


Simultaneous integrated boost




Volumetric modulated arc therapy


Whole breast irradiation

Hypofraktionierte Bestrahlung mit simultan-integriertem Boost beim frühen Mammakarzinom

Ergebnisse einer deutschen Phase-II-Multizenterstudie (ARO-2010-01)



Die ARO-2010-01-Studie prüfte die Durchführbarkeit einer hypofraktionierten Bestrahlung mit simultan-integriertem Boost (SIB) in unterschiedlichen Versorgungseinrichtungen zur Vorbereitung einer multizentrischen Vergleichsstudie.


In die Studie rekrutiert wurden Patientinnen mit histopathologisch gesichertem Mammakarzinom nach brusterhaltender Operation. Bestrahlt wurde die Brust mit 40,0 Gy in 16 Fraktionen à 2,5 Gy Einzeldosis; zusätzlich wurde bei jeder Fraktion ein simultan- integrierter Boost mit 0,5 Gy appliziert, so dass im Boost-PTV (Planungszielvolumen) eine Dosis von 48 Gy in 16 Fraktionen erreicht wurde. Das primäre Zielkriterium war die Durchführbarkeit, definiert als Verabreichung von 48 Gy GD in 16 Fraktionen in mindestens 22 d bis maximal 29 d Therapiezeit unter Einhaltung von Grenzdosen (Lunge, Herz, LAD, kontralaterale Brust); sekundäre Endpunkte waren Toxizität und Lebensqualität.


Zwischen 07/2011 und 10/2012 wurden 151 Patientinnen in 7 Prüfzentren rekrutiert. Bei 10 Patientinnen wurden vor der Strahlentherapie Ausschlusskriterien festgestellt. Fast alle Patientinnen (99 %) erhielten die verschriebene Dosis im PTV. Grenzdosen und Zeitlimits wurden in 89 % (95 % CI 82 % bis 93 %) eingehalten. 11 unerwünschte Ereignisse wurden bei 10 Patientinnen gemeldet; fünf in Verbindung mit gleichzeitiger endokriner Therapie. In 2 Fällen wurde eine kausale Beziehung zur Strahlentherapie angegeben: Grad-3-Hitzewallungen. Die Lebensqualität blieb unverändert.


Die hypofraktionierte Bestrahlung mit simultan-integriertem Boost konnte in dieser multizentrischen Studie in Praxen und Strahlenkliniken problemlos durchgeführt werden. Die Verträglichkeit war in dieser Studie gut.


Mammakarzinom Hypofraktionierung Simultan-integrierter Boost Durchführbarkeit Toxizität 


Compliance with ethical guidelines

Conflict of interest

K. Dellas, R. Vonthein, J. Zimmer, S. Dinges, A.D. Boivcev, P. Andreas, D. Fischer, C. Winkler, A. Ziegler, and J. Dunst state that there are no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Kathrin Dellas
    • 1
    • 2
    Email author
  • Reinhard Vonthein
    • 3
    • 4
  • Jörg Zimmer
    • 5
  • Stefan Dinges
    • 6
  • Alexander D. Boicev
    • 7
  • Peter Andreas
    • 8
  • Dorothea Fischer
    • 9
  • Cornelia Winkler
    • 10
  • Andreas Ziegler
    • 3
    • 4
  • Jürgen Dunst
    • 1
    • 2
    • 11
  • ARO Study Group
  1. 1.Department of RadiooncologyUniversity of KielKielGermany
  2. 2.Department of RadiooncologyUniversity of LübeckLübeckGermany
  3. 3.Institute of Medical Biometry and Statistics, University of Lübeck, University Medical Center Schleswig-HolsteinCampus LübeckLübeckGermany
  4. 4.Center for Clinical TrialsUniversity of LübeckLübeckGermany
  5. 5.Private Practice of RadiooncologyDresdenGermany
  6. 6.Department of RadiooncologyKlinikum LüneburgLüneburgGermany
  7. 7.Department of RadiooncologyKlinikum ZwickauZwickauGermany
  8. 8.Department of RadiooncologyKrankenhaus BuchholzBuchholzGermany
  9. 9.Department of GynecologyUniversity of LübeckLübeckGermany
  10. 10.Department of RadiooncologyTU MunichMunichGermany
  11. 11.University of CopenhagenCopenhagenDenmark

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