Hypofractionation with simultaneous boost in breast cancer patients receiving adjuvant chemotherapy: A prospective evaluation of a case series and review of the literature |
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| Institution: | 1. Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery Dept, Milan, Rozzano, Italy;2. Humanitas Research Hospital and Cancer Center, Pathology Dept, Milan, Rozzano, Italy;3. Humanitas Research Hospital and Cancer Center, Medical Oncology Dept, Milan, Rozzano, Italy;4. Humanitas Research Hospital and Cancer Center, Breast Surgery Dept, Milan, Rozzano, Italy;5. Humanitas University, Biomedical Science Faculty, Milan, Rozzano, Italy;1. Liverpool and Macarthur Cancer Therapy Centre, Sydney, Australia;2. South West Sydney Clinical School, University of New South Wales, Australia;3. Ingham Institute for Applied Medical Research, Sydney, Australia;4. Centre for Medical Radiation Physics, University of Wollongong, Australia;5. Siemens Healthineers, Baltimore, MD, USA;1. Service d’oncologie-radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, Bordeaux, France;2. U1312-BRIC, eq BioGO, Inserm, université de Bordeaux, 33000 Bordeaux, France;1. Département d''Hémato-Oncologie, CISSS Montérégie Centre/Hôpital Charles-Lemoyne, Centre Affilié de l''Université de Sherbrooke, Greenfield Park, Qc, Canada;2. Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium;3. Department of Oncology, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy;4. Hospital de Santa Maria and Instituto de Medicina Molecular, Faculdade de Leducuba, Universidade de Lisboa, Lisbon, Portugal;5. Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium;6. Medical Oncology, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 8-10, 27100, Pavia, Italy;7. UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Via Roma 67, 56126, Pisa, Italy;8. Investigative Clinical Oncology (INCO), FPO-Candiolo Cancer Institute (IRCSS), Strada Provinciale 142, 10060, Candiolo, Italy;9. Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Azienda USL Toscana Centro, Via Suor Niccolina Infermiera 20, 59100, Prato, Italy;10. Department of Medical Oncology, Clinica di Oncologia Medica, Ospedale Policlinico San Martino-IST, Largo Rosanna Benzi 10, 16132, Genova, Italy;11. Department of Medical Oncology, San Paolo Hospital, Savona, Italy;12. Department of Medical Oncology, AOU Ospedale Santissima Annunziata, Via Enrico de Nicola, Sassari, Italy;13. Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, Ospedale Policlinico San Martino-IST, Largo Rosanna Benzi 10, 16132, Genova, Italy;14. Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy;1. Centre for Cancer Research and Cell Biology, Queen’s University, Belfast, UK;2. Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK;3. PTW, Freiburg, Germany;7. Brustcentrum Aachen Marienhospital, Aachen, Germany;8. University Medical Center and Luisenhospital, Aachen, Germany;9. Brustzentrum Mittelland Kantonsspitaeler Aarau/Olten, Switzerland;10. Breast Center Sint Augustinus, Wilrijk, Antwerpen, Belgium;11. Centro di Senologia della Svizzera Italiana, Ospedali Regionali di Lugano, Bellinzona e Valli, Switzerland;12. Klinik Engeried, Breast Centre Bern, Division of Gynaecology & Surgical Oncology, Lindenhofgruppe, Bern, Switzerland;13. Breast Cancer Unit, Policlinico Sant’Orsola Malpighi, University of Bologna, Italy;14. GIPMa, Comprensorio Sanitario di Bolzano, Italy;15. University of Antwerp, Breast Clinic Voorkempen, Brasschaat, Belgium;p. Brustzentrum St. Joseph-Stift, Bremen, Germany;q. Breast Unit and Prevention Center Isala, Department Gynecology-Obstetrics, CHU-UMC St Pierre, Brussels, Belgium;r. Centro Senologia Multimedica, Italy;s. Catharina Hospital, Eindhoven, the Netherlands;t. West German Cancer Center, Breast Unit, University Hospital Essen, Germany;u. Breast Unit, Kliniken Essen-Mitte, Germany;v. Breast Unit e Gruppo Oncologico Multidisciplinare Tumori della Mammella, DAI Oncologico e di Chirurgia ad indirizzo robotico, Azienda Ospedaliero Universitaria Careggi, Firenze, Florence, Italy;w. Breast Unit, Klinikum Frankfurt Höchst, Academic Hospital, Frankfurt, Germany;x. Department of Obstetrics & Gynecology, University of Goettingen, Germany;y. Mammazentrum, Hamburg, Germany;z. Breast Unit University of Heidelberg, Germany;11. Breast Unit Humanitas Cancer Center, Rozzano, Italy;12. Leitender Oberarzt BGZ Tirol Univ, Frauenklinik Innsbruck, Austria;13. Borstkliniek Kortrijk AZ Groeninge, Belgium;14. University Hospital Klinkum Rechts der Isar, Department of Gynecology, Technical University Munich, Germany;15. Breast Center, University of Munich LMU, Germany;16. Breast Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy;17. AUSL Romagna, Breast Unit Rimini, Italy;18. Breast Surgery Unit, University of Rome La Sapienza, Sant''Andrea Hospital, Rome, Italy;19. Centro di Senologia Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy;110. SSD Breast Unit - ASUITS - Azienda Sanitaria Universitaria Integrata di Trieste, Italy;111. Comprehensive Cancer Center Ulm, Germany;112. Breast Unit, Dr. Horst Schmidt Klinken, Wiesbaden, Germany;113. Breast Center Zurich Seefeld, Switzerland;1. Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Italy;2. School of Medicine, Cardiff University, United Kingdom;3. AOU Città della Salute e della Scienza, CPO Piemonte and EUSOMA Data Centre, Turin, Italy;4. University of Heidelberg, Germany;5. Nuovo Ospedale di Prato, Italy;6. EUSOMA, Florence, Italy |
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| Abstract: | IntroductionTo evaluate acute toxicity and cosmetic outcomes of hypofractionated simultaneous integrated boost (SIB) as adjuvant treatment after breast-conserving surgery and adjuvant chemotherapy and to review the association of chemotherapy and short fractionation with boost.Materials and methodsPatients presenting early-stage breast cancer were enrolled in a phase II trial. All patients received VMAT-SIB technique to the whole breast and tumor bed in 15 fractions, for a total dose of 40.5 and 48 Gy. Acute and late skin toxicities and breast pain were recorded. Cosmetic outcomes were also assessed as excellent/good or fair/poor.ResultsBetween August 2010 and December 2015, 787 consecutive patients were treated and had at least 2 year follow-up. A subset of 175 patients underwent adjuvant chemotherapy (median age of 55 years) and was analysed. The median follow up was 39 months (range 24–80). At the end of RT treatment, skin toxicity was G1 in 51.1% of patients, G2 in 9.7%. At 2 years of follow up, it was G1 in 13.5% of patients, no cases ≥ G2; cosmetic outcome was excellent in 63.5% and good in 36.5% of the patients. No significant difference compared to the patients without systemic therapy was observed.ConclusionHypofractionated VMAT-SIB in patients who had undergone adjuvant systemic therapy was safe and well tolerated in terms of acute and early late settings and cosmesis. Our data confirmed the results of other studies published on the association of hypofractionation and chemotherapy or concomitant boost. |
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| Keywords: | Breast cancer Chemotherapy Hypofractionation VMAT SIB |
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