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VMAT partial-breast irradiation: acute toxicity of hypofractionated schedules of 30 Gy in five daily fractions

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Abstract

Purpose

To report acute toxicities in breast cancer (BC) patients (pts) recruited in a prospective trial and treated with accelerated partial-breast irradiation (APBI) using Volumetric Modulated Arc Therapy (VMAT) delivered with a hypofractionated schedule.

Methods

From March 2014 to June 2019, pts with early-stage BC (Stage I), who underwent breast conservative surgery (BCS), were recruited in a prospective study started at the National Cancer Institute of Milan. Pts received APBI with a hypofractionated schedule of 30 Gy in five daily fractions. Radiotherapy treatment (RT) was delivered using VMAT. Acute toxicity was assessed according to RTOG/EORTC criteria at the end of RT.

Results

Between March 2014 and June 2019, 151 pts were enrolled in this study. 79 Pts had right-side and 72 had left-side breast cancer. Median age was 69 (range 43–92). All pts presented with pathological stage IA BC, molecular classification was Luminal A in 128/151 (85%) and Luminal B in 23/151 (15%) cases. Acute toxicity, assessed at the end of RT, consisted of G1 erythema in 37/151 (24. 5%) pts and skin toxicities higher than G1, did not occur. Fibrosis G1 and G2 were reported in 41/151 (27. 1%) pts and in 2/151 pts (1. 3%), respectively. Edema G1 occurred in 8/151 (5. 3%) pts and asthenia G1 occurred in 1/151 (0. 6%) pts.

Conclusions

APBI with VMAT proved to be feasible and can be a valid alternative treatment option after BCS in selected early breast cancer pts according to ASTRO guidelines. A longer follow-up is needed to assess late toxicity.

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Author information

Author notes

  1. F. Bonfantini

    Present address: Radiotherapy and Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy

Authors and Affiliations

  1. Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    E. La Rocca, L. Lozza, M. Dispinzieri, C. Giandini & M. C. De Santis

  2. Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milan, Milano, Italy

    E. La Rocca, C. Giandini & R. Valdagni

  3. Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    E. D’ Ippolito, F. Bonfantini & E. Pignoli

  4. Radiation Oncology 1 and Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    R. Valdagni

  5. Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    S. Folli

  6. Biomarker Unit, Department of Applied Research and Technological Development (DRAST), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    S. Di Cosimo

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Contributions

Study conception and design: EL, MCD, LL; data acquisition: EL, ED, CG and MD; quality control of data and algorithms; EL, ED, FB; data analysis and interpretation: MCD, FB and EL; statistical analysis: EL, ED and FB; manuscript preparation: MCD, EL; manuscript editing: MCD, EL and FB; manuscript review: LL, RV, SD, MCD, FB, EL, EP and SF.

Corresponding author

Correspondence to M. C. De Santis.

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Conflict of interest

We declare that we do not have any conflict of interest.

Ethical approval

The present study has been reviewed and approved by the Internal Review Board of the Department of Radiation Oncology 1 of National Cancer Institute, Milan, Italy.

Research involving in human and animal rights

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

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La Rocca, E., Lozza, L., D’ Ippolito, E. et al. VMAT partial-breast irradiation: acute toxicity of hypofractionated schedules of 30 Gy in five daily fractions. Clin Transl Oncol 22, 1802–1808 (2020). https://doi.org/10.1007/s12094-020-02319-5

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  • DOI: https://doi.org/10.1007/s12094-020-02319-5

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