title: Intensity-modulated adjuvant whole breast radiation delivered with static angle tomotherapy (TomoDirect): a prospective case series.
abstract: OBJECTIVE
  To report the 2-year outcomes of whole breast intensity-modulated radiotherapy (IMRT) after conserving surgery for early breast cancer (EBC) delivered with static angle tomotherapy (TomoDirect) (TD).
  
  
  METHODS
  A prospective cohort of 120 EBC patients underwent whole breast IMRT with TD between 2010 and 2012. Radiation was delivered to a conventionally fractionated whole breast total dose of 50 Gy with TD, followed by a sequential conventionally fractionated tumor bed boost dose of 10-16 Gy with helical tomotherapy (HT). Clinical endpoints include acute and late toxicity, cosmesis, quality of life and local control.
  
  
  RESULTS
  Median follow-up was 24 months (range 12-36 months); maximum detected acute skin toxicity was G0 22 %; G1 63 %; G2 12 % and G3 3 %. Predictors of acute dermatitis were as follows: volume of the whole breast minus boost volume receiving 105, 110 and 115 % of prescription dose, whole breast and boost volume, breast thickness and soft tissue thickness. Late skin toxicity was mild with no >G2 events. Cosmesis was good/excellent in 91.7 % of patients and fair/poor in 8.3 %. Quality of life was preserved over time, but for fatigue, transiently increased.
  
  
  CONCLUSIONS
  Adjuvant whole breast IMRT delivered sequentially with both TD and HT provides consistent clinical results. An observed unintended excessive dose outside the tumor bed might increase acute toxicity and eventually affect long-term clinical endpoints. The incorporation of the boost dose within the whole breast phase employing a simultaneous integrated boost (SIB) approach might mitigate this issue.
authors.affiliation: Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale 'U. Parini', AUSL Valle d'Aosta, Viale Ginevra 3, 11100, Aosta, Italy, pfranco@ausl.vda.it.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.forename: Michele
authors.initials: M
authors.lastname: Zeverino
authors.forename: Fernanda
authors.initials: F
authors.lastname: Migliaccio
authors.forename: Piera
authors.initials: P
authors.lastname: Sciacero
authors.forename: Domenico
authors.initials: D
authors.lastname: Cante
authors.forename: Valeria
authors.initials: V
authors.lastname: Casanova Borca
authors.forename: Paolo
authors.initials: P
authors.lastname: Torielli
authors.forename: Cecilia
authors.initials: C
authors.lastname: Arrichiello
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Girelli
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: La Porta
authors.forename: Santi
authors.initials: S
authors.lastname: Tofani
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011788:Quality of Life; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*
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