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

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Abstract

Purpose

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.

Methods/patients

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Via Ospedale, 6500, Bellinzona, Switzerland

    M. Valli, S. Cima, L. Deantonio, M. Frapolli, D. Daniele, G. A. Pesce, F. Martucci, N. C. Azinwi, D. Bosetti & A. Richetti

  2. Medical Physics Service, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    D. Gaudino & S. Presilla

  3. Radiology Service, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    R. Cartolari

Authors
  1. M. Valli
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  2. S. Cima
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  3. D. Gaudino
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  4. R. Cartolari
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  5. L. Deantonio
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  6. M. Frapolli
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  7. D. Daniele
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  8. G. A. Pesce
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  9. F. Martucci
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  13. A. Richetti
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Correspondence to M. Valli.

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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.

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Valli, M., Cima, S., Gaudino, D. et al. Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience. Clin Transl Oncol 21, 1492–1498 (2019). https://doi.org/10.1007/s12094-019-02077-z

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  • DOI: https://doi.org/10.1007/s12094-019-02077-z

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