title: Accelerated partial breast irradiation using 3D conformal radiotherapy: toxicity and cosmetic outcome.
abstract: OBJECTIVE
  The aim of this paper is to analyze the incidence of acute and late toxicity and cosmetic outcome in breast cancer patients submitted to breast conserving surgery and three-dimensional conformal radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation (APBI).
  
  
  METHODS
  84 patients were treated with 3D-CRT for APBI. This technique was assessed in patients with low risk stage I breast cancer enrolled from September 2005 to July 2011. The prescribed dose was 34/38.5 Gy delivered in 10 fractions twice daily over 5 consecutive days. Four to five no-coplanar 6 MV beams were used. In all CT scans Gross Tumor Volume (GTV) was defined around the surgical clips. A 1.5 cm margin was added by defining a Clinical Target Volume (CTV). A margin of 1 cm was added to CTV to define the planning target volume (PTV). The dose-volume constraints were followed in accordance with the NSABP/RTOG protocol. Late toxicity was evaluated according to the RTOG grading schema. The cosmetic assessment was performed using the Harvard scale.
  
  
  RESULTS
  Median patient age was 66 years (range 51-87). Median follow-up was 36.5 months (range 13-83). The overall incidence of acute skin toxicities was 46.4% for grade 1 and 1% for grade 2. The incidence of late toxicity was 16.7% for grade 1, 2.4% for grade 2 and 3.6% for grade 3. No grade 4 toxicity was observed. The most pronounced grade 2 late toxicity was telangiectasia, developed in three patients. Cosmetics results were excellent for 52%, good for 42%, fair for 5% and poor for 1% of the patients. There was no statistical correlation between toxicity rates and prescribed doses (p = 0.33) or irradiated volume (p = 0.45).
  
  
  CONCLUSIONS
  APBI using 3D-CRT is technically feasible with very low acute and late toxicity. Long-term results are needed to assess its efficacy in reducing the incidence of breast relapse.
authors: Unit of Radiation Oncology, Fondazione del Piemonte per l'Oncologia/Institute for Cancer Research and Treatment of Candiolo (IRCCS), Italy. Electronic address: marco.gatti@ircc.it.
authors: M
authors: M
authors: Gatti
authors: R
authors: R
authors: Ponzone
authors: S
authors: S
authors: Bresciani
authors: R
authors: R
authors: Panaia
authors: F
authors: F
authors: Kubatzki
authors: F
authors: F
authors: Maggiorotto
authors: M R
authors: MR
authors: Di Virgilio
authors: A
authors: A
authors: Salatino
authors: B
authors: B
authors: Baiotto
authors: F
authors: F
authors: Montemurro
authors: M
authors: M
authors: Stasi
authors: P
authors: P
authors: Gabriele
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D019583:Dose Fractionation, Radiation; D004954:Esthetics; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D008875:Middle Aged; D009336:Necrosis / Q000000981:diagnostic imaging / Q000209:etiology; D010146:Pain / Q000209:etiology; D011832:Radiation Injuries / Q000209:etiology*; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D012867:Skin / Q000528:radiation effects*; D013684:Telangiectasis / Q000209:etiology
keywords: Breast cancer; Breast-conserving therapy; Partial breast irradiation; Three-dimensional conformal irradiation