title: Phase I-II studies on accelerated IMRT in breast carcinoma: technical comparison and acute toxicity in 332 patients.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Campobasso, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Cinzia
authors.initials: C
authors.lastname: Digesu'
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.forename: M Grazia
authors.initials: MG
authors.lastname: Cece
authors.forename: Massimo
authors.initials: M
authors.lastname: Cirocco
authors.forename: Giorgia
authors.initials: G
authors.lastname: Garganese
authors.forename: Liberato
authors.initials: L
authors.lastname: Di Lullo
authors.forename: Divina
authors.initials: D
authors.lastname: Traficante
authors.forename: Francesca
authors.initials: F
authors.lastname: Scarabeo
authors.forename: Simona
authors.initials: S
authors.lastname: Panunzi
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gaetano
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Sallustio
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
authors.forename: Luigi
authors.initials: L
authors.lastname: Sofo
authors.forename: Angelo
authors.initials: A
authors.lastname: Piermattei
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome