1. Acute and intermediate toxicity of 3-week radiotherapy with simultaneous integrated boost using TomoDirect: prospective series of 287 early breast cancer patients
- Author
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Mattia Zaffaroni, Paolo Veronesi, F. Pansini, Damaris Patricia Rojas, Barbara Alicja Jereczek-Fossa, Anna Morra, M.A. Zerella, Vincenzo Bagnardi, Cristiana Fodor, Marianna Alessandra Gerardi, M.C. Leonardi, Giulia Corrao, Samantha Dicuonzo, Sara Raimondi, R. Luraschi, Roberto Orecchia, Federica Cattani, Dicuonzo, S, Leonardi, M, Raimondi, S, Corrao, G, Bagnardi, V, Gerardi, M, Morra, A, Zerella, M, Zaffaroni, M, Pansini, F, Cattani, F, Luraschi, R, Fodor, C, Veronesi, P, Orecchia, R, Rojas, D, and Jereczek-Fossa, B
- Subjects
Adult ,0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Breast Neoplasms ,Hypofractionated radiotherapy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Clinical endpoint ,Simultaneous integrated boost ,Humans ,Prospective Studies ,Radiation Injuries ,Radiation treatment planning ,Chronic toxicity ,Aged ,Univariate analysis ,Toxicity ,business.industry ,Early breast cancer ,Cosmesis ,General Medicine ,Middle Aged ,Acute toxicity ,Radiation therapy ,030104 developmental biology ,030220 oncology & carcinogenesis ,Acute Disease ,Female ,Radiation Dose Hypofractionation ,Radiotherapy, Intensity-Modulated ,business - Abstract
Aims: To report toxicity of a hypofractionated scheme of whole-breast (WB) intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the tumor bed (TB) using Tomotherapy® with Direct modality. Methods: Patients with early breast cancer, undergoing radiotherapy (RT) in 15 daily fractions to WB (prescription dose 40.05 Gy) and SIB to the TB (48 Gy), between 2013 and 2017, was analyzed. Primary endpoint was acute and intermediate toxicity assessed at the end and within 6 months from RT, according to Radiation Therapy Oncology Group (RTOG) scale. Secondary endpoints included early chronic toxicity at 12-months follow-up, using the Late Effects Normal Tissue Task Subjective, Objective, Management, and Analytic (LENT-SOMA) scale, and cosmesis using Harvard criteria. Results: The study population was of 287 patients. Acute and intermediate toxicity was collected among 183 patients with data available at the end of RT and within 6 months, 85 (46%) experienced G2 toxicity and 84 (46%) G1 toxicity, while 14 (8%) did not report toxicity at any time. A significant reduction of any grade toxicity was observed between the two time points, with the majority of patients reporting no clinically relevant toxicity at 6 months. At univariate analysis, age < 40 years, breast volume > 1000 cm3 and Dmax ≤ 115% of prescription dose were predictive factors of clinically relevant acute toxicity (G ≥ 2) at any time. At multivariable analysis, only age and breast volume were confirmed as predictive factors, with Relative Risks (95% Confidence Intervals): 2.02 (1.13–3.63) and 1.84 (1.26–2.67), respectively. At 12-month follow-up, 113 patients had complete information on any toxicity with 53% of toxicity G < 2, while cosmetic evaluation, available for 102 patients, reported a good–excellent result for 86% of patients. Conclusions: Hypofractionated WB IMRT with a SIB to the TB, delivered with TomoDirect modality, is safe and well-tolerated. Most patients reported no toxicity after 6 months and good–excellent cosmesis. Predictive factors of clinically relevant toxicity might be considered during treatment planning in order to further reduce side effects.
- Published
- 2021
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