title: Robotic stereotactic radioablation concomitant with neo-adjuvant chemotherapy for breast tumors.
abstract: OBJECTIVE
  Robotic stereotactic radioablation (RSR) allows stereotactic irradiation of thoracic tumors; however, it has never been used for breast tumors and may have a real potential. We conducted a Phase I study, including neoadjuvant chemotherapy (NACT), a two-level dose-escalation study (6.5 Gy x 3 fractions and 7.5 Gy x 3 fractions) using RSR and breast-conserving surgery followed by conventional radiotherapy.
  
  
  METHODS
  To define toxicity, we performed a dermatologic exam (DE) including clinical examination by two independent observers and technical examination by colorimetry, dermoscopy, and skin ultrasound. DE was performed before NACT (DE0), at 36 days (DE1), at 56 days (DE2), after the NACT treatment onset, and before surgery (DE3). Surgery was performed 4-8 weeks after the last chemotherapy session. A pathologic examination was also performed.
  
  
  RESULTS
  There were two clinical complete responses and four clinical partial responses at D56 and D85. Maximum tolerable dose was not reached. All patients tolerated RSR with no fatigue; 2 patients presented with mild pain after the third fraction of the treatment. There was no significant toxicity measured with ultrasound and dermoscopy tests. Postoperative irradiation (50 Gy) has been delivered without toxicity.
  
  
  CONCLUSIONS
  The study showed the feasibility of irradiation with RSR combined with chemotherapy and surgery for breast tumors. There was no skin toxicity at a dose of 19.5 Gy or 22.5 Gy delivered in three fractions combined with chemotherapy. Lack of toxicity suggested that the dose could be increased further. Pathologic response was acceptable.
authors.affiliation: Département de radiothérapie, Centre Antoine Lacassagne, Nice, France. pierre-yves.bondiau@cal.nice.fnclcc.fr
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Bondiau
authors.forename: Phillipe
authors.initials: P
authors.lastname: Bahadoran
authors.forename: Michel
authors.initials: M
authors.lastname: Lallement
authors.forename: Isabelle
authors.initials: I
authors.lastname: Birtwisle-Peyrottes
authors.forename: Claire
authors.initials: C
authors.lastname: Chapellier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chamorey
authors.forename: Adel
authors.initials: A
authors.lastname: Courdi
authors.forename: Catherine
authors.initials: C
authors.lastname: Quielle-Roussel
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Ferrero
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002985:Clinical Protocols; D003124:Colorimetry; D003520:Cyclophosphamide / Q000008:administration & dosage; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011855:Radiodermatitis / Q000175:diagnosis / Q000473:pathology; D016634:Radiosurgery / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012074:Remission Induction; D012371:Robotics / Q000379:methods*; D043823:Taxoids / Q000008:administration & dosage; D047368:Tumor Burden
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil