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

Radiation Oncology

David Azria²  Claire Lemanski²  Norbert Aillères²  Angélique Ducteil²  Marie Charissoux²  Fatiha Boulbair¹  Olivier Lauche²  Céline Bourgier²  Pascal Fenoglietto²  Olivier Riou² 

[1] Radiotherapy Department, Mulhouse Hospital, Mulhouse, France;Radiation Oncology Department, Institut régional du Cancer de Montpellier (ICM), Val d’Aurelle, 208 avenue des Apothicaires, 34298, Montpellier cedex 5, France

关键词: Organs at risk;    Accelerated partial breast irradiation;    Breast cancer;    Arc therapy;    Intensity-modulated radiotherapy;   

Others  :  1228937
DOI  :  10.1186/s13014-015-0516-3

 received in 2015-04-26, accepted in 2015-10-06,  发布年份 2015

【 摘 要 】

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 cm ³and 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 (V _5Gy ), 10 Gy (V _10Gy ) and 20 Gy (V _20Gy ), respectively. Regarding the contralateral lung, V _5Gywas 0.3 %, and V _10Gyand V _20Gywere nil. V _5Gyaccounted 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.

【 授权许可】

   
2015 Riou et al.

【 图 表 】

Fig. 1.

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