Phase I–II studies on accelerated IMRT in breast carcinoma: Technical comparison and acute toxicity in 332 patients

Morganti, Alessio G.; Cilla, Savino; Valentini, Vincenzo; Digesu’, Cinzia; Macchia, Gabriella; Deodato, Francesco; Ferrandina, Gabriella; Cece, M. Grazia; Cirocco, Massimo; Garganese, Giorgia; Lullo, Liberato Di; Traficante, Divina; Scarabeo, Francesca; Panunzi, Simona; Gaetano, Andrea De; Sallustio, Giuseppina; Cellini, Numa; Sofo, Luigi; Piermattei, Angelo; Scambia, Giovanni

doi:10.1016/j.radonc.2008.10.017

« Previous Next »Radiotherapy & Oncology
Volume 90, Issue 1 , Pages 86-92, January 2009

Phase I–II studies on accelerated IMRT in breast carcinoma: Technical comparison and acute toxicity in 332 patients☆

Alessio G. Morganti
- Department of Radiotherapy, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Savino Cilla
- Department of Physics, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Vincenzo Valentini
- Department of Radiotherapy, “Agostino Gemelli”, Policlinico Universitario, Catholic University, Rome, Italy
Cinzia Digesu’
- Department of Radiotherapy, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Gabriella Macchia
- Department of Radiotherapy, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
- Corresponding author. Address: Department of Oncology, Catholic University-Campobasso, Largo A. Gemelli 1, 86100 Campobasso, Italy.
Francesco Deodato
- Department of Radiotherapy, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Gabriella Ferrandina
- Department of Gynaecology, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
M. Grazia Cece
- Department of Radiotherapy, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
- Present address: Department of Radiology of the General Hospital “Mazzolani-Vandini”, Argenta, Italy.
Massimo Cirocco
- Department of Radiotherapy, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
- Present address: Department of Radiology of the General Hospital “S. Pietro e Paolo”, Borgo Sesia, Italy.
Giorgia Garganese
- Department of Gynaecology, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Liberato Di Lullo
- Department of Oncology, General Hospital, Isernia, Italy
Divina Traficante
- Department of Oncology, General Hospital, Isernia, Italy
Francesca Scarabeo
- Department of Surgery, General Hospital, Isernia, Italy
Simona Panunzi
- CNR – Institute of Systems Analysis and Computer Science (IASI), BioMathLab, Rome, Italy
Andrea De Gaetano
- CNR – Institute of Systems Analysis and Computer Science (IASI), BioMathLab, Rome, Italy
Giuseppina Sallustio
- Department of Radiology, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Numa Cellini
- Department of Radiotherapy, “Agostino Gemelli”, Policlinico Universitario, Catholic University, Rome, Italy
Luigi Sofo
- Department of Surgery, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Angelo Piermattei
- Department of Physics, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy
Giovanni Scambia
- Department of Gynaecology, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy

Received 29 April 2008; received in revised form 23 October 2008; accepted 23 October 2008. published online 17 November 2008.

Abstract

Background and purpose

To evaluate the results in terms of dosimetric parameters and acute toxicity of two clinical studies (MARA-1 and MARA-2) on accelerated IMRT-based postoperative radiotherapy. These results are compared with historical control group (CG) of patients treated with “standard” 3D postoperative radiotherapy.

Materials and methods

Prescribed dose to the breast was 50.4Gy in the CG, 40Gy in MARA-1 (low risk of local recurrence), and 50Gy in MARA-2 (medium-high risk of recurrence). The tumor bed total dose was 60.4Gy (sequential 10Gy electron boost), 44Gy (concomitant 4Gy boost), and 60Gy (concomitant 10Gy boost) in CG, MARA-1 and MARA-2 studies, respectively. Overall treatment time was of 32 fractions for CG (6.4weeks); 16 fractions for MARA-1 study (3.2weeks) and 25 fractions for MARA-2 study (5weeks).

Results

Three hundred and thirty two patients were included in the analysis. Dosimetric analysis showed D_max and V_107% reduction (p<0.001) and D_min improvement (p<0.001) in the PTV in patients treated with IMRT. Grade 2 acute skin toxicity was 33.6%, 13.1%, and 45.1% in the CG, MARA-1, and MARA-2, respectively (p<0.001), and grade 3 acute skin toxicity was 3.1%, 1.0%, and 2.0%, respectively. Similarly, larger PTV and use of chemotherapy with anthracyclines and taxanes were associated with a greater acute toxicity. With a median follow-up of 31 months, no patients showed local or nodal relapse.

Conclusions

A simplified step and shoot IMRT technique allowed better PTV coverage and reduced overall treatment time (CG, 6.6weeks; MARA-1, 3.2weeks; MARA-2, 5weeks) with acceptable short-term toxicity.

Keywords: Breast cancer, IMRT, Acute toxicity, Dosimetry