Volumetric modulated arc therapy (VMAT) to deliver nodal irradiation in breast cancer patients
Tóm tắt
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.
Tài liệu tham khảo
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, et al. 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;378:1707–16.
Cante D, Franco P, Sciacero P, Girelli G, Marra AM, Pasquino M, et al. Five-year results of a prospective case series of accelerated hypofractionated whole breast radiation with concomitant boost to the tumor bed after conserving surgery for early breast cancer. Med Oncol. 2013;30:518.
Cante D, Petrucci E, Sciacero P, Piva C, Ferrario S, et al. Ten-year results of accelerated hypofractionated adjuvant whole-breast radiation with concomitant boost to the lumpectomy cavity after conserving surgery for early breast cancer. Med Oncol. 2017;34:152.
Cante D, Franco P, Sciacero P, Girelli G, Marra AM, Pasquino M, et al. Hypofractionation and concomitant boost to deliver adjuvant whole-breast radiation in ductal carcinoma in situ (DCIS): a subgroup analysis of a prospective case series. Med Oncol. 2014;31:838.
Franco P, Cante D, Sciacero P, Girelli G, La Porta MR, Ricardi U. Tumor bed boost integration during whole breast radiotherapy: a review of the current evidence. Breast Care. 2015;10:44–9.
EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, Correa C, Cutter D, Duane F, Ewertz M, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet Oncol. 2014;383:2127–35.
Poortmans PM, Struikmans H, Bartelink H. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:1879–80.
Franco P, Catuzzo P, Cante D, La Porta MR, Sciacero P, Girelli G, et al. TomoDirect: an efficient means to deliver radiation at static angles with tomotherapy. Tumori. 2011;97:498–502.
Coffey A, Renucci L, Hunzeker A, Lenards N. Whole breast nodal irradiation using supine VMAT and prone 3D planning: a case study. Med Dosim. 2017;42:185–9.
Borca VC, Franco P, Catuzzo P, Migliaccio F, Zenone F, Aimonetto S, et al. Does TomoDirect 3DCRT represent a suitable option for post-operative whole breast irradiation? A hypothesis-generating pilot study. Radiat Oncol. 2012;7:211.
Franco P, Zeverino M, Migliaccio F, Sciacero P, Cante D, Casanova Borca V, et al. Intensity-modulated adjuvant whole breast radiation delivered with static angle tomotherapy (TomoDirect): a prospective case series. J Cancer Res Clin Oncol. 2013;139:1927–36.
Teoh M, Clark CH, Wood K, Whitaker S, Nisbet A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol. 2011;84:967–96.
Franco P, Arcadipane F, Ragona R, Mistrangelo M, Cassoni P, Munoz F, et al. Volumetric modulated arc therapy (VMAT) in the combined modality treatment of anal cancer patients. Br J Radiol. 1060;2016(89):20150832.
Arcadipane F, Franco P, De Colle C, Rondi N, Di Muzio J, Pelle E, et al. Hypofractionation with no boost after breast conservation in early-stage breast cancer patients. Med Oncol. 2016;33:108.
Madu CN, Quint DJ, Normolle DP, Marsh RB, Wang EY, Pierce LJ. Definition of the supraclavicular and infraclavicular nodes: implications for three-dimensional CT-based conformal radiation therapy. Radiology. 2001;221:333–9.
RTOG Breast Cancer Atlas. Radiation Therapy Oncology Group website. https://www.rtog.org. Accessed on October 2nd 2017.
Radiation Therapy Oncology Group. Acute radiation morbidity scoring criteria. http://www.rtog.org. Accessed 2 Oct 2017.
National Cancer Institute Cancer Therapy Evaluation Program. Common Toxiity Criteria for Adverse Events. Version 4.02. http://ctep.cancer.gov. Accessed 2 Oct 2017.
Rose MA, Olivotto IA, Cady B, Koufman C, Osteen R, Silver B, et al. Conservative surgery and radiation therapy for early stage breast cancer: long-term cosmetic results. Arch Surg. 1989;124:153–7.
Poortmans P. Evidence-based radiation oncology. Breast Cancer Radiother Oncol. 2007;84:84–101.
Cante D, Rosa La Porta M, Casanova-Borca V, Sciacero P, Girelli G, Pasquino M, et al. Accelerated hypofractionated adjuvant whole breast radiotherapy with concomitant photon boost after conserving surgery for early stage breast cancer: a prospective evaluation on 463 patients. Breast J. 2011;17:586–93.
Cante D, Franco P, Sciacero P, Girelli G, Pasquino M, Borca Casanova, et al. Hypofractionated whole-breast radiotherapy and concomitant boost after breast conservation in elderly patients. Tumori. 2016;102:196–202.
Moreno AS, Shaitelman SF, Bucholz TA. A clinical perspective on regional irradiation for breast cancer. The Breast. 2017;34:S85–90.
Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. N Engl J Med. 1997;337:949–55.
Poortmans P, Collette S, Kirkove C, Van Limbergen E, Budach V, Struikmans H, et al. Internal mammary and medial supraclavicular irradiation in breast cancer. N Engl J Med. 2015;373:317–27.
Whelan TJ, Olivotto IA, Parulekar WR, Ackerman I, Chua BH, Nabid A, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med. 2015;373:307–16.
De Bari B, Fiorentino A, Arcangeli S, Franco P, D’Angelillo RM, Alongi F. From radiobiology to technology: what is changing in radiotherapy for prostate cancer. Expert Rev Anticancer Ther. 2014;14:553–64.
Franco P, Zeverino M, Migliaccio F, Cante D, Sciecero P, Casanova Borca V, et al. Intensity-modulated and hypofractionated simultaneous integrated boost adjuvant breast radiation employing statics ports of tomotherapy (TomoDirect): a prospective phase II trial. J Cancer Res Clin Oncol. 2014;140:167–77.
Macchia G, Deodato F, Cilla S, Cammelli S, Guido A, Ferioli M, et al. Volumetric modulated arc therapy for treatment of solid tumors: current insights. Onco Targets Ther. 2017;10:3755–72.
Popescu CC, Olivotto IA, Beckham WA, Ansbacher W, Zavgorodni S, Shaffer R, et al. Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity-modulated radiotherapy for loco-regional radiotherapy of left-sided breast cancer and internal mammary nodes. Int J Radiat Oncol Biol Phys. 2010;76:287–95.