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• A semi-automatic technique for whole breast RT with tangential IMRT fields was set. • The technique was validated on a sample of 60 patients against manual clinical 3DCRT. • AutoIMRT was shown to improve PTV coverage and homogeneity. • No relevant differences in doses to OARs were observed. • AutoIMRT plans were shown to be robust toward isocenter displacements. To implement a semi-automatic planning technique for whole breast irradiation with two tangential IMRT fields and to test the produced dose distribution against clinical 3DCRT plans, for introducing the technique in clinical practice. The Auto-Planning module of the Pinnacle3 (Philips) treatment planning system was used for generating a Treatment Technique on left-sided breast cancer patients treated in free breathing or in deep inspiration breath hold (DIBH) and to right-sided breast cancer patients. The technique was evaluated against 3DCRT clinical plans in terms of dosimetric plan parameters. Plan robustness toward patient displacements was assessed on a subset of patients by inducing shifts to the isocenter. A statistically significant improvement in target coverage and dose homogeneity was observed for autoIMRT. No statistically significant differences were observed for ipsilateral organs, except for the ipsilateral lung in left DIBH, where slightly lower D mean and V 18% are registered for autoIMRT. Slightly higher D mean doses (although far below the constraints) to contralateral organs were observed for autoIMRT plans. AutoIMRT plans were shown to be as robust as 3DCRT plans toward isocenter shifts, with a maximum decrease in CTV coverage of −2.2% and −2.1% for autoIMRT and 3DCRT, respectively. Average planning times were 40 min for 3DCRT and 6 min for IMRT plans. The developed autoIMRT technique was proven to be advantageous for target coverage and homogeneity and sufficiently robust towards isocenter displacements. The use of automated planning consistently reduces the planning workload with improvements in plan quality. [ABSTRACT FROM AUTHOR]

Abstract: Background: The use of adjuvant radiotherapy in ductal carcinoma in situ is accepted by most radiation oncologists worldwide; the role of a boost on the tumor bed is however more controversial. Materials and methods: We reviewed our Institute experience in DCIS treatment, focusing on main prognostic factors and impact of radiation boost on local relapse. A total of 389 patients treated between 1990 and 2007 were retrospectively analyzed. All patients received adjuvant radiotherapy after breast-conserving surgery for a median dose of 50 Gy; 190 patients (48.8%) received and additional radiation boost on the tumor bed. Results: At a mean follow up of 7.7 years, we recorded 26 local recurrence (6.7%). Concerning local relapse-free survival, at Cox regression univariate analyses <1 mm surgical margins (p < 0.0001) and young age (p = 0.01) emerged as significant unfavorable prognostic factors. At multivariate analysis Cox regression model, surgical margins (p < 0.001) and radiation boost (p = 0.014) resulted as the significant independent predictors of recurrence. Conclusions: Our experience showed the negative prognostic impact of surgical margins <1 mm and the protective role of radiation boost on LR rate. Anyway, results from ongoing prospective Phase III studies are strongly necessary to better identify high-risk DCIS patients. [Copyright &y& Elsevier]

Abstract: Aims: We conducted a retrospective analysis in order to evaluate the impact of age on women aged less than 35 years affected by breast cancer. Materials and methods: Between January 1972 and December 2006, 346 patients aged less than 35 years underwent adjuvant treatment at Florence University. The mean age of the patient population was 32 years (range 22–35): 76 patients were under 30 years old, the remaining were above 30 years old. Results: In our series, 215 patients received adjuvant radiotherapy to whole breast after conservative surgery, 131 patients underwent mastectomy without subsequent radiation therapy and 323 patients had lymphadenectomy; 191 patients received adjuvant chemotherapy, 73 with anthracycline-containing regimen. With a median time of 2.5 years (range 6 months to 27.6 years) local relapses were observed in 67 cases (19.4%). At the multivariate analysis of local disease-free survival, ductal and ductal plus lobular histotypes, having more than 3 positive nodes, and age emerged as independent significant relapse predictors (p =0.018, p =0.0005, p =0.003 and p =0.024, respectively). For the DSS analysis, the median follow-up was 6.8 years (range 0.6–36.7 years). At the multivariate analysis, age (p =0.0038), positive nodes (p =0.0035) and distant metastases (p <0.0001) resulted to be independent death predictors. Patients younger than 30 had a worse prognosis. At the univariate analysis also local relapse resulted to be statistically significant (p =0.0004). Conclusions: Anthracycline-based chemotherapy seems to improve the outcome of these patients. However, there is an urgent need for tailored treatment investigations within the framework of randomized, controlled clinical trials. [Copyright &y& Elsevier]