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Synchronous bilateral breast cancer irradiation: clinical and dosimetrical issues using volumetric modulated arc therapy and simultaneous integrated boost

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Abstract

Objectives

The aim of the present retrospective analysis was to evaluate dosimetric parameters, feasibility and outcome for Synchronous Bilateral Breast Cancer (SBBC) patients treated with adjuvant radiotherapy (RT) by Volumetric Modulated Arc Therapy (VMAT).

Methods

From September 2011 to April 2016, 1100 Breast Cancer (BC) patients were referred to our institution to receive adjuvant breast RT, and those with SBBC were selected for the present analysis. A total of 16 patients were identified. A total dose of 50 Gy in 25 fractions was prescribed to the Planning Target Volume of the whole bilateral breast (PTVBN) with or without the supraclavicular and infraclavicular nodes, while a total dose of 60 Gy in 25 fractions was prescribed to the surgical bed (PTVboost). Several V xGy and Dx% parameters were analyzed for the PTVs, together with Conformity and Homogeneity indexes (CI, HI), and for the critical Organs at risk (OARs), lungs and heart first.

Results

With a median follow-up of 24 months, no acute or late side effects more than grade 2 were observed. All patients are alive without any sign of disease. For target dose coverage, our observed inter-patients averages (±1 sd) were V 95% Dp = 96.7 ± 1.6% (96.3 ± 1.8%) to the left (right) PTVBN, V 95% Dp = 98.6 ± 2.7% (99.4 ± 0.9%) to the left (right) PTVboost, and D 2% = 64.4 ± 1.8 Gy (65.0 ± 2.0 Gy) to the left (right) PTVboost, respectively. With regard to the heart, the inter-patient average of D mean was 8.3 ± 3.3 Gy. For the lungs, the inter-patient average of D mean, V 5 Gy and V 20 Gy were 11.8 ± 2.3 Gy, 78.9 ± 15.3% and 15.7 ± 5%, respectively.

Conclusions

The present retrospective analysis showed the feasibility, tolerability and safety of VMAT in the treatment of SBBC patients. Further studies are necessary to confirm these preliminary data.

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Abbreviations

SBBC:

Synchronous bilateral breast cancer

BC:

Breast cancer

RT:

Radiotherapy

VMAT:

Volumetric modulated arc therapy

PTVBN :

Planning target volume of the whole bilateral breast

PTVboost :

Planning target volume of the surgical bed

V xGy :

Organ’s volume that receives x Gy of dose

Dx%:

Near maximum target dose of 2%

CI:

Conformity Index

HI:

Homogeneity index

OARs:

Organs at risk

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Authors and Affiliations

  1. Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, via Don Sempreboni 5, 37034, Negrar, Verona, Italy

    Alba Fiorentino, Rosario Mazzola, Stefania Naccarato, Niccolò Giaj-Levra, Sergio Fersino, Gianluisa Sicignano, Francesco Ricchetti, Ruggero Ruggieri & Filippo Alongi

  2. Radiation Oncology School, University of Padua, Padua, Italy

    Umberto Tebano

Authors
  1. Alba Fiorentino
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  2. Rosario Mazzola
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  3. Stefania Naccarato
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  4. Niccolò Giaj-Levra
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  5. Sergio Fersino
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  6. Gianluisa Sicignano
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  10. Filippo Alongi
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Corresponding author

Correspondence to Rosario Mazzola.

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This study did not receive grants.

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All the authors declare no conflict of interest.

Ethical approval

All procedures involving human participants in this study have been approved by the ethical committee and have been carried out in accordance with The Code of Ethics of the Declaration of Helsinki.

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Fiorentino, A., Mazzola, R., Naccarato, S. et al. Synchronous bilateral breast cancer irradiation: clinical and dosimetrical issues using volumetric modulated arc therapy and simultaneous integrated boost. Radiol med 122, 464–471 (2017). https://doi.org/10.1007/s11547-017-0741-y

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  • DOI: https://doi.org/10.1007/s11547-017-0741-y

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