Intensity-modulated Radiotherapy and Hypofractionated Volumetric Modulated Arc Therapy for Elderly Patients with Breast Cancer: Comparison of Acute and Late Toxicities

Overview

Journal Radiol Med

Specialty Radiology

Date 2018 Dec 15

PMID 30547358

Citations 19

Authors

Alba Fiorentino

Fabiana Gregucci

Rosario Mazzola

Vanessa Figlia

Francesco Ricchetti

Gianluisa Sicignano

Niccolo GiajLevra

Ruggero Ruggieri

Sergio Fersino

Stefania Naccarato

Alberto Massocco

Stefanie Corradini

Filippo Alongi

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the differences between conventional fractionated intensity-modulated radiotherapy (IMRT) and hypofractionated (HypoRT) volumetric modulated arc therapy (VMAT) in elderly women affected by early-stage breast cancer (BC) in terms of RT-related acute/late side effect.

Materials And Methods: Between October 2011 and July 2015, 80 consecutive elderly BC patients were treated with IMRT for 5 weeks (40 patients) or HypoRT-VMAT for 3 weeks (40 patients). Inclusion criteria were: age ≥ 70 years, early BC (pT1-2 pN0-1), no prior neoadjuvant chemotherapy and non-metastatic disease. For patients receiving IMRT or HypoRT-VMAT, a total dose of 50 Gy (25 fractions) or 40.5 Gy (15 fractions) was prescribed to the whole ipsilateral breast, respectively. All patients received a simultaneously integrated boost up to a total dose of 60 Gy for IMRT and 48 Gy for HypoRT-VMAT. Acute and late side effects were evaluated using the RTOG/EORTC radiation morbidity scoring system.

Results: With a median follow-up of 45 months, acute skin toxicity was overall very low, with grade 1 in 25 cases (62.5%) of the IMRT group and 21 cases (52.5%) of the HypoRT-VMAT group, while grade 2 toxicity was reported in 10 IMRT patients (25%) and 1 HypoRT-VMAT patient (2.5%) (p = 0.001). Regarding late adverse events, only grade 1 skin toxicity was recorded.

Conclusion: The present study showed that whole breast IMRT and HypoRT-VMAT are feasible and well tolerated in early-stage BC elderly patients and that HypoRT-VMAT is affected by lower risk of acute and late RT-related side effects.

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References

Fiorentino A, Caivano R, Chiumento C, Cozzolino M, Clemente S, Pedicini P . Comorbidity assessment and adjuvant radiochemotherapy in elderly affected by glioblastoma. Med Oncol. 2012; 29(5):3467-71. DOI: 10.1007/s12032-012-0246-4. View

Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M . Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011; 378(9804):1707-16. PMC: 3254252. DOI: 10.1016/S0140-6736(11)61629-2. View

Pignol J, Truong P, Rakovitch E, Sattler M, Whelan T, Olivotto I . Ten years results of the Canadian breast intensity modulated radiation therapy (IMRT) randomized controlled trial. Radiother Oncol. 2016; 121(3):414-419. DOI: 10.1016/j.radonc.2016.08.021. View

Dellas K, Vonthein R, Zimmer J, Dinges S, Boicev A, Andreas P . Hypofractionation with simultaneous integrated boost for early breast cancer: results of the German multicenter phase II trial (ARO-2010-01). Strahlenther Onkol. 2014; 190(7):646-53. DOI: 10.1007/s00066-014-0658-5. View

Giordano S . Radiotherapy in older women with low-risk breast cancer: why did practice not change?. J Clin Oncol. 2012; 30(14):1577-8. DOI: 10.1200/JCO.2011.40.7007. View

Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I . Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012; 13(4):e148-60. DOI: 10.1016/S1470-2045(11)70383-7. View

Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V . Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005; 366(9503):2087-106. DOI: 10.1016/S0140-6736(05)67887-7. View

Fiorentino A, Chiumento C, Fusco V . Do comorbidity influences acute toxicity and outcome in elderly patients with endometrial cancer treated by adjuvant radiotherapy plus brachytherapy?. Clin Transl Oncol. 2013; 15(8):665-9. DOI: 10.1007/s12094-012-0986-9. View

Singla R, King S, Albuquerque K, Creech S, Dogan N . Simultaneous-integrated boost intensity-modulated radiation therapy (SIB-IMRT) in the treatment of early-stage left-sided breast carcinoma. Med Dosim. 2006; 31(3):190-6. DOI: 10.1016/j.meddos.2005.11.001. View

10.

Eaton B, Jiang R, Torres M, Kahn S, Godette K, Lash T . Benefit of adjuvant radiotherapy after breast-conserving therapy among elderly women with T1-T2N0 estrogen receptor-negative breast cancer. Cancer. 2016; 122(19):3059-68. PMC: 5030146. DOI: 10.1002/cncr.30142. View

11.

Corradini S, Niyazi M, Niemoeller O, Li M, Roeder F, Eckel R . Adjuvant radiotherapy after breast conserving surgery - a comparative effectiveness research study. Radiother Oncol. 2014; 114(1):28-34. DOI: 10.1016/j.radonc.2014.08.027. View

12.

Kunkler I, Williams L, Jack W, Cameron D, Dixon J . Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015; 16(3):266-73. DOI: 10.1016/S1470-2045(14)71221-5. View

13.

Buwenge M, Cammelli S, Ammendolia I, Tolento G, Zamagni A, Arcelli A . Intensity modulated radiation therapy for breast cancer: current perspectives. Breast Cancer (Dove Med Press). 2017; 9:121-126. PMC: 5345691. DOI: 10.2147/BCTT.S113025. View

14.

Fiorentino A, Balducci M, De Bonis P, Chiesa S, De Filippo L, Mangiola A . Can elderly patients with newly diagnosed glioblastoma be enrolled in radiochemotherapy trials?. Am J Clin Oncol. 2013; 38(1):23-7. DOI: 10.1097/COC.0b013e3182868ea2. View

15.

Herskovic A, Wu X, Christos P, Nagar H . Omission of Adjuvant Radiotherapy in the Elderly Breast Cancer Patient: Missed Opportunity?. Clin Breast Cancer. 2018; 18(5):418-431. DOI: 10.1016/j.clbc.2018.02.006. View

16.

Diab S, Elledge R, Clark G . Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000; 92(7):550-6. DOI: 10.1093/jnci/92.7.550. View

17.

Agrawal R, Aird E, Barrett J, Barrett-Lee P, Bentzen S, Bliss J . The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008; 371(9618):1098-107. PMC: 2277488. DOI: 10.1016/S0140-6736(08)60348-7. View

18.

Bentzen S, Agrawal R, Aird E, Barrett J, Barrett-Lee P, Bliss J . The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008; 9(4):331-41. PMC: 2323709. DOI: 10.1016/S1470-2045(08)70077-9. View

19.

Morganti A, Cilla S, Valentini V, Digesu C, Macchia G, Deodato F . Phase I-II studies on accelerated IMRT in breast carcinoma: technical comparison and acute toxicity in 332 patients. Radiother Oncol. 2008; 90(1):86-92. DOI: 10.1016/j.radonc.2008.10.017. View

20.

Whelan T, Pignol J, Levine M, Julian J, MacKenzie R, Parpia S . Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010; 362(6):513-20. DOI: 10.1056/NEJMoa0906260. View