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Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Feasibility of accelerated partial breast irradiation with volumetric-modulated arc therapy in elderly and frail patients

Authors: Olivier Riou, Pascal Fenoglietto, Céline Bourgier, Olivier Lauche, Fatiha Boulbair, Marie Charissoux, Angélique Ducteil, Norbert Aillères, Claire Lemanski, David Azria

Published in: Radiation Oncology | Issue 1/2015

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Abstract

Background

Accelerated partial breast irradiation (APBI) is an option for adjuvant radiotherapy according to ASTRO and ESTRO recommendations. Among the available techniques, volumetric-modulated arc therapy (VMAT) is attractive but has not been extensively studied for APBI. This study assessed its feasibility, tolerance and early oncological outcomes.

Methods

We analysed the data of nine patients (median age 74 years) with ten lesions (one bilateral cancer) treated from May 2011 to July 2012 with APBI using VMAT. The radiation oncologist delineated the surgical tumour bed, and added an 18 mm isotropic margin to obtain the planning target volume (PTV). The dose was 40 Gy prescribed in 4 Gy fractions given twice a day over five days. Patients were regularly followed for toxicities and oncological outcomes.

Results

Mean PTV was 100.0 cm3 and 95 % of the PTV received a mean dose of 99.7 % of the prescribed dose. Hot spots represented 0.3 % of the PTV. 6.2 %, 1.6 % and 0.3 % of the ipsilateral lung volume received 5 Gy (V5Gy), 10 Gy (V10Gy) and 20 Gy (V20Gy), respectively. Regarding the contralateral lung, V5Gy was 0.3 %, and V10Gy and V20Gy were nil. V5Gy accounted for 3.1 % of the heart. An average 580 monitor units were delivered. No acute or late grade ≥ 2 toxicities were observed. With a median follow-up of 26 months, no relapses occurred.

Conclusion

In our study, VMAT allowed optimal dosimetry with consequential high therapeutic ratio in elderly and frail patients.
Literature
1.
Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. 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;366:2087–106.CrossRefPubMed
2.
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRefPubMed
3.
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRefPubMed
4.
Lemanski C, Azria D, Gourgon-Bourgade S, Gutowski M, Rouanet P, Saint-Aubert B, et al. Intraoperative radiotherapy in early-stage breast cancer: results of the montpellier phase II trial. Int J Radiat Oncol Biol Phys. 2010;76:698–703.CrossRefPubMed
5.
Polgár C, Major T, Fodor J, Sulyok Z, Somogyi A, Lövey K, et al. Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study. Radiother Oncol. 2010;94:274–9.CrossRefPubMed
6.
Njeh CF, Saunders MW, Langton CM. Accelerated partial breast irradiation using external beam conformal radiation therapy: a review. Crit Rev Oncol Hematol. 2012;81:1–20.CrossRefPubMed
7.
Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.CrossRefPubMed
8.
Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet. 2014;383:603–13.CrossRefPubMed
9.
Vaidya JS, Baum M, Tobias JS, Wenz F, Massarut S, Keshtgar M, et al. Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery. Int J Radiat Oncol Biol Phys. 2011;81:1091–7.CrossRefPubMed
10.
Chen PY, Wallace M, Mitchell C, Grills I, Kestin L, Fowler A, et al. Four-year efficacy, cosmesis, and toxicity using three-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:991–7.CrossRefPubMed
11.
Chafe S, Moughan J, McCormick B, Wong J, Pass H, Rabinovitch R, et al. Late toxicity and patient self-assessment of breast appearance/satisfaction on RTOG 0319: a phase 2 trial of 3-dimensional conformal radiation therapy-accelerated partial breast irradiation following lumpectomy for stages I and II breast cancer. Int J Radiat Oncol Biol Phys. 2013;86:854–9.CrossRefPubMed
12.
Formenti SC, Hsu H, Fenton-Kerimian M, Roses D, Guth A, Jozsef G, et al. Prone accelerated partial breast irradiation after breast-conserving surgery: five-year results of 100 patients. Int J Radiat Oncol Biol Phys. 2012;84:606–11.PubMedCentralCrossRefPubMed
13.
Azria D, Bourgier C. Partial breast irradiation: new standard for selected patients. The Lancet. 2010;376:71–2.CrossRef
14.
Smith GL, Xu Y, Buchholz TA, Giordano SH, Jiang J, Shih Y-CT, et al. Association between treatment with brachytherapy vs whole-breast irradiation and subsequent mastectomy, complications, and survival among older women with invasive breast cancer. JAMA. 2012;307:1827–37.PubMedCentralPubMed
15.
Jagsi R, Ben-David MA, Moran JM, Marsh RB, Griffith KA, Hayman JA, et al. Unacceptable cosmesis in a protocol investigating intensity-modulated radiotherapy with active breathing control for accelerated partial-breast irradiation. Int J Radiat Oncol Biol Phys. 2010;76:71–8.PubMedCentralCrossRefPubMed
16.
Bourgier C, Acevedo-Henao C, Dunant A, Rossier C, Levy A, Nemr ME, et al. Higher toxicity with 42 Gy in 10 fractions as a total dose for 3D-conformal accelerated partial breast irradiation: results from a dose escalation phase II trial. Radiat Oncol. 2012;7:141.PubMedCentralCrossRefPubMed
17.
Livi L, Buonamici FB, Simontacchi G, Scotti V, Fambrini M, Compagnucci A, et al. Accelerated Partial Breast Irradiation With IMRT: New Technical Approach and Interim Analysis of Acute Toxicity in a Phase III Randomized Clinical Trial. Int J Radiat Oncol Biol Phys. 2010;77:509–15.CrossRefPubMed
18.
Livi L, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51:451–63.CrossRefPubMed
19.
Vieillot S, Azria D, Lemanski C, Moscardo CL, Gourgou S, Dubois J-B, et al. Plan comparison of volumetric-modulated arc therapy (RapidArc) and conventional intensity-modulated radiation therapy (IMRT) in anal canal cancer. Radiat Oncol. 2010;5:92.PubMedCentralCrossRefPubMed
20.
Riou O, Regnault de la Mothe P, Azria D, Aillères N, Dubois J-B, Fenoglietto P. Simultaneous integrated boost plan comparison of volumetric-modulated arc therapy and sliding window intensity-modulated radiotherapy for whole pelvis irradiation of locally advanced prostate cancer. J Appl Clin Med Phys. 2013;14:4094.PubMed
21.
Vieillot S, Azria D, Riou O, Moscardo CL, Dubois J-B, Aillères N, et al. Bilateral kidney preservation by volumetric-modulated arc therapy (RapidArc) compared to conventional radiation therapy (3D-CRT) in pancreatic and bile duct malignancies. Radiat Oncol. 2011;6:147.PubMedCentralCrossRefPubMed
22.
Qiu J-J, Chang Z, Wu QJ, Yoo S, Horton J, Yin F-F. Impact of volumetric modulated arc therapy technique on treatment with partial breast irradiation. Int J Radiat Oncol Biol Phys. 2010;78:288–96.CrossRefPubMed
23.
Essers M, Osman SOS, Hol S, Donkers T, Poortmans PM. Accelerated partial breast irradiation (APBI): are breath-hold and volumetric radiation therapy techniques useful? Acta Oncol. 2014;53:788–94.CrossRefPubMed
24.
Polgár C, Van Limbergen E, Pötter R, Kovács G, Polo A, Lyczek J, et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol. 2010;94:264–73.CrossRefPubMed
25.
Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74:987–1001.CrossRefPubMed
26.
Bourgier C, Pichenot C, Verstraet R, El NM, Heymann S, Biron B, et al. Early side effects of three-dimensional conformal external beam accelerated partial breast irradiation to a total dose of 40 Gy in one week (a phase II trial). Int J Radiat Oncol Biol Phys. 2011;81:1228–35.CrossRefPubMed
27.
Riou O, Fenoglietto P, Lemanski C, Azria D. Radiothérapie conformationnelle avec modulation d’intensité dans les cancers du sein : intérêt, limitations, modalités techniques. Cancer/Radiothérapie. 2012;16:479–84.CrossRef
Metadata
Title
Feasibility of accelerated partial breast irradiation with volumetric-modulated arc therapy in elderly and frail patients
Authors
Olivier Riou
Pascal Fenoglietto
Céline Bourgier
Olivier Lauche
Fatiha Boulbair
Marie Charissoux
Angélique Ducteil
Norbert Aillères
Claire Lemanski
David Azria
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-015-0516-3

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