Abstract
Purpose
To report the dosimetric feasibility of the radiation technique HALFMOON (Helical ALtered Fractionation for iMplant partial OmissiON) for post-mastectomy radiation therapy (PMRT) in intermediate–high-risk breast cancer patients with implant-based immediate breast reconstruction, where the clinical target volume (CTV) does not include the whole implant (implant-sparing approach).
Methods
In the HALFMOON technique, the CTV consisted of skin, subcutaneous tissues, and pectoralis major muscle, excluding the implant, chest wall muscles, and rib plane. The HALFMOON plans were compared with conventionally contoured CTV plans, in which the whole implant, chest wall muscles, and ribs plane were included in the CTV, in a ratio 1:3. All patients underwent hypofractionated treatment of 40.05 Gy/15 fractions, using helical Tomotherapy®.
Results
Eighteen patients undergoing HALFMOON technique were compared to 54 subjects treated with conventionally contoured CTV plans. No difference was found in the planning target volume coverage between the two groups. Conversely, a statistically relevant dose reduction in HALFMOON patients was observed for ipsilateral lung (D15%, p < 0.0001; D20%, p < 0.0001; D35%, p = 0.003), contralateral lung (D20%, p = 0.048), contralateral breast (D15%, p = 0.031; D20%, p = 0.047), and stomach (Dmean, p = 0.011). Regarding the implant, V90% and D50% decreased by 46% and 8%, respectively, in the HALFMOON plans (p < 0.0001).
Conclusion
The HALFMOON approach is technically feasible and resulted in high-dose conformity of the target with a significant reduction of radiation dose delivered to implant and other organs. A clinical study is needed to assess the impact on reconstruction cosmetic outcome and local control.
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Acknowledgements
The authors thank Piccolo Consilia, La Fauci Francesco and Gebbia Andrea for re-planning the control group in 3D-CRT. 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 IEO-CCM fellowship, project title “HALFMOON Study (Helical ALtered Fractionation for iMplant partial OmissiON): hypofractionated scheme of implant-sparing helical tomotherapy for intermediate/high-risk breast cancer”.
Funding
Miglietta E has received a research grant from Accuray Inc. (Data collection and analysis of Tomotherapy and CyberKnife breast clinical studies, breast physics studies, and prostate study). The sponsor did not play any role in the study design, collection, analysis, and interpretation of data, nor in the writing of the manuscript, nor in the decision to submit the manuscript for publication.
Spoto R has received a fellowship from Fondazione IEO-CCM for clinical implementation of HALFMOON study with the tile: “Helical ALtered Fractionation for iMplant partial OmissiON): Implant-sparing helical tomotherapy with hypofractionated scheme for intermediate/high-risk breast cancer”.
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Leonardi MC, Dell’Acqua V, Cattani F, and Jereczek-Fossa BA received a speaker honorarium from Accuracy International. All other authors declare that they have no conflict of interest.
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All procedures performed in the present study 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. This article does not contain any studies with animals performed by any of the authors.
The dosimetric study has been approved by the institutional Ethical Committee as part of the research project entitled “Adjuvant radiation treatments with intensity-modulated radiotherapy and/or hypofractionated schedules for breast cancer” (26 May 2016, Milan, Italy).
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Leonardi, M.C., Spoto, R., Miglietta, E. et al. HALFMOON TomoTherapy (Helical ALtered Fractionation for iMplant partial OmissiON): implant-sparing post-mastectomy radiotherapy reshaping the clinical target volume in the reconstructed breast. J Cancer Res Clin Oncol 145, 1887–1896 (2019). https://doi.org/10.1007/s00432-019-02938-8
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DOI: https://doi.org/10.1007/s00432-019-02938-8