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Volumetric modulated arc therapy (VMAT) to deliver nodal irradiation in breast cancer patients

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Abstract

To evaluate feasibility, safety, toxicity profile and dosimetric results of volumetric modulated arc therapy (VMAT) to deliver regional nodal irradiation (RNI) after either mastectomy or breast conservation (BCS) in high-risk breast cancer patients. Between January 2015 and January 2017, a total of 45 patients were treated with VMAT to deliver RNI together with whole breast or post-mastectomy radiotherapy. The fractionation schedule comprised 50 Gy in 25 fractions given to supraclavicular and axillary apex nodes and to whole breast (after BCS) or chest wall (after mastectomy). Two opposite 50°–60° width arcs were employed for breast ad chest wall irradiation, while a single VMAT arc was used for nodal treatment. Treatment was generally well tolerated. Acute skin toxicity was G2 in 13.3% of patients. Late skin toxicity consisted of G1 induration/fibrosis in six patients (13.3%) and G2 in 1 (2.2%). Dosimetric results were consistent in terms of both target coverage and normal tissue sparing. In conclusion, VMAT proved to be a feasible, safe and effective strategy to deliver RNI in breast cancer patients after either BCS or mastectomy with promising dosimetric results and a mild toxicity profile.

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Authors and Affiliations

  1. Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy

    Giuseppe Carlo Iorio, Pierfrancesco Franco, Stefania Martini & Umberto Ricardi

  2. Department of Medical Imaging, Medical Physics, AOU Città della Salute e della Scienza, Turin, Italy

    Elena Gallio & Francesca Romana Giglioli

  3. Department of Oncology, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy

    Francesca Arcadipane, Sara Bartoncini & Nadia Rondi

  4. Breast Surgery Unit, Department of General and Specialistic Surgery, AOU Città della Salute e della Scienza, Turin, Italy

    Ada Ala

  5. Department of Oncology, Medical Oncology 2, AOU Città della Salute e della Scienza, Turin, Italy

    Mario Airoldi

  6. Breast Oncology Unit, Department of Oncology, Turin, Italy

    Michela Donadio

  7. Breast Unit, Department of Gynecology and Obstetrics, AOU Città della Salute e della Scienza, Turin, Italy

    Corrado De Sanctis

  8. Pathology Unit, Department of Medical Sciences, University of Torino, Turin, Italy

    Isabella Castellano

Authors
  1. Giuseppe Carlo Iorio
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  2. Pierfrancesco Franco
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  3. Elena Gallio
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  4. Stefania Martini
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  5. Francesca Arcadipane
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  6. Sara Bartoncini
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  7. Nadia Rondi
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  8. Francesca Romana Giglioli
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  9. Ada Ala
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  10. Mario Airoldi
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  11. Michela Donadio
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  12. Corrado De Sanctis
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  13. Isabella Castellano
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  14. Umberto Ricardi
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Corresponding author

Correspondence to Pierfrancesco Franco.

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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 Oncology of the University of Turin at AOU Citta’ della Salute e della Scienza, Turin, Italy.

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.

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Iorio, G.C., Franco, P., Gallio, E. et al. Volumetric modulated arc therapy (VMAT) to deliver nodal irradiation in breast cancer patients. Med Oncol 35, 1 (2018). https://doi.org/10.1007/s12032-017-1061-8

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  • DOI: https://doi.org/10.1007/s12032-017-1061-8

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