La radiologia medica

, Volume 124, Issue 4, pp 309–314 | Cite as

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

  • Alba Fiorentino
  • Fabiana GregucciEmail author
  • Rosario Mazzola
  • Vanessa Figlia
  • Francesco Ricchetti
  • Gianluisa Sicignano
  • Niccolo Giajlevra
  • Ruggero Ruggieri
  • Sergio Fersino
  • Stefania Naccarato
  • Alberto Massocco
  • Stefanie Corradini
  • Filippo Alongi



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.


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.


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.


Breast cancer Elderly Intensity-modulated radiotherapy Volumetric modulated arc therapy 


Compliance with ethical standards

Conflict of interest

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.

Informed consent

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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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  • Alba Fiorentino
    • 1
  • Fabiana Gregucci
    • 1
    Email author
  • Rosario Mazzola
    • 1
  • Vanessa Figlia
    • 1
  • Francesco Ricchetti
    • 1
  • Gianluisa Sicignano
    • 1
  • Niccolo Giajlevra
    • 1
  • Ruggero Ruggieri
    • 1
  • Sergio Fersino
    • 1
  • Stefania Naccarato
    • 1
  • Alberto Massocco
    • 2
  • Stefanie Corradini
    • 3
  • Filippo Alongi
    • 1
    • 4
  1. 1.Radiation Oncology, Cancer Care CenterOspedale Sacro Cuore don CalabriaNegrar, VeronaItaly
  2. 2.Breast Unit, Cancer Care CenterOspedale Sacro Cuore don CalabriaNegrar, VeronaItaly
  3. 3.Radiation OncologyLudwig-Maximilians University of MunichMunichGermany
  4. 4.University of BresciaBresciaItaly

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