Concomitant intensity modulated boost during whole breast hypofractionated radiotherapy - A feasibility and toxicity study |
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Authors: | Amy Yuen Meei Teh Lorraine Walsh Thomas G. Purdie Allen MosseriWei Xu Wilfred Levin C. Anne Koch Anthony Fyles Fei-Fei Liu B.C. John Cho |
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Affiliation: | a Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Canada b Radiation Physics, Princess Margaret Hospital, University Health Network, Toronto, Canada c Department of Radiation Oncology, University of Toronto, Canada d Department of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, Canada |
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Abstract: | BackgroundBreast cancer sensitivity to large fraction size may be enhanced using hypofractionated concomitant boost radiotherapy (CBRT), thereby shortening overall treatment time. This ethics approved, prospective single cohort feasibility study was designed to evaluate the dosimetry and toxicity of CBRT using an intensity-modulated radiotherapy (IMRT) technique, compared with a standard sequential boost technique (SBT).MethodsFifteen women (11 right-sided; 4 left-sided) received 42.4 Gy to the whole breast and an additional 10.08 Gy to the tumor bed in 16 daily fractions, using IMRT and standard dose constraints. Each patient was replanned with the SBT, using mixed photon-electrons. Clinical target volume (CTV), dose evaluation volume (DEV), and organs at risk (OAR) dose distributions were compared with the SBT. Toxicity and treatment times were prospectively recorded.ResultsAll 15 CBRT plans achieved the desired CTV (V49.9Gy ? 99%) and DEV (V49.9Gy ? 95%), coverage of the boost, compared with only 10 (66.7%, p = 0.03), and 12 (80%, p = 0.125) SBT plans, respectively. Ipsilateral lung (p < 0.0001), and heart (right-sided, p = 0.001; left-sided, p = 0.13) doses were lower. Grade 3 acute toxicity occurred in 1 (6.7%) patient. At 1 year, two (13.3%) additional patients had overall grade 2 late toxicity, compared with baseline. No grade 3-4 late toxicity was observed.ConclusionsCBRT using IMRT improved boost coverage and lowered OAR doses, compared with SBT. Toxicities were acceptable using a daily boost of 3.28 Gy. While resource utilization was greater, overall treatment time was reduced. |
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Keywords: | Hypofractionated Concomitant Breast boost Toxicity Intensity modulated |
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