Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience

  • M. ValliEmail author
  • S. Cima
  • D. Gaudino
  • R. Cartolari
  • L. Deantonio
  • M. Frapolli
  • D. Daniele
  • G. A. Pesce
  • F. Martucci
  • N. C. Azinwi
  • D. Bosetti
  • S. Presilla
  • A. Richetti
Research Article



To evaluate acute and late skin/subcutaneous toxicities and radiation-induced lung fibrosis (RILF) in patients treated with adjuvant radiotherapy (RT) for synchronous bilateral breast cancers (SBBC), after conservative surgery.


Twenty-five patients were treated with volumetric-modulated arc therapy (VMAT/RapidArc®) on both breasts, and checked clinically for detecting RT toxicities during and after treatment. A high-resolution computed tomography (HRCT) was performed, for detecting RILF during follow-up.


We registered acute Grade-1 skin toxicity in 18 patients (72%), while six patients (24%) experienced Grade-2 toxicity. No breath symptoms were reported during and after RT. Late Grade-1 subcutaneous toxicity and late Grade-2 skin toxicity were registered in four patients (16%) and one patient (4%), respectively, at a mean follow-up of 36 months. Grade-1 RILF was detected in six patients (30%). The median volume of fibrosis area was 6.5 cc (range 1.3–21.5 cc). The partial volumes receiving a specified dose (V20, V30, V40, and V50) in patients who developed lung fibrosis were significantly bigger than who did not (p < 0.01). We showed that the mean volume of the tumour boost of patients who developed fibrosis (77.7 cc) was not significantly different from the other patients (90.8 cc) (p = 0.5).


The clinical impact of this technique is favourable, and this is the first clinical study showing RILF by HRCT in a setting of SBBC. Further study with larger accrual is mandatory.


Synchronous bilateral breast cancer Radiation-induced lung fibrosis Volumetric-modulated arc therapy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  • M. Valli
    • 1
    Email author
  • S. Cima
    • 1
  • D. Gaudino
    • 2
  • R. Cartolari
    • 3
  • L. Deantonio
    • 1
  • M. Frapolli
    • 1
  • D. Daniele
    • 1
  • G. A. Pesce
    • 1
  • F. Martucci
    • 1
  • N. C. Azinwi
    • 1
  • D. Bosetti
    • 1
  • S. Presilla
    • 2
  • A. Richetti
    • 1
  1. 1.Radiation Oncology ClinicOncology Institute of Southern Switzerland, Bellinzona-LuganoBellinzonaSwitzerland
  2. 2.Medical Physics ServiceEnte Ospedaliero CantonaleBellinzonaSwitzerland
  3. 3.Radiology ServiceEnte Ospedaliero CantonaleBellinzonaSwitzerland

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