title: [Preliminary results of whole breast helical tomotherapy with simultaneous integrated boost in the adjuvant treatment of breast cancer].
abstract: OBJECTIVE
  To evaluate the dosimetry and acute toxicity of helical tomotherapy for locoregional irradiation of patients after breast-conserving surgery.
  
  
  METHODS
  Twenty breast cancer patients with breast-conserving surgery treated by helical tomotherapy have been studied. The median age was 49 (min: 25, max: 69). The whole breast, tumour bed and lymph nodes were prescribed 52.2 Gy, 63.8 Gy and 50.4 Gy, all in 29 fractions. The dose per fraction was 2.2 Gy to the boost, 1.8 Gy to the breast and 1.74 Gy to the lymph node volumes. The reproducibility was analysed by recording the daily shifts in x, y and z directions and roll rotation. All toxicities were described using the Common Terminology Criteria for Adverse Effects v3.0.
  
  
  RESULTS
  Twenty-two tumours were irradiated. Six-eight percent were located in the inner quadrant. In 90 % of patients supraclavicular and internal mammary nodes were treated. The coverage of planning target volumes (PTV) was as follows: PTV boost: V107 = 0.3 % ± 0.5 SD, V95 = 98.4 % ± 1.9 SD; PTV breast: -V107 = 7.8 % ± 17.3 SD, V95 = 96.8 % ± 2.2 SD; PTV LN: V107 = 2.5 % ± 4.2 SD, V95 = 92.7 % ± 13.2 SD. The mean V20 of the homolateral lung was 18.9 % ± 3.5 SD. For left side lesion, the mean V30 of the heart was 0.9 % ± 0.8 SD. The mean V5 was: V5 homolateral lung: 73.1 % ± 11.8 ET, controlateral lung: 38.9 % ± 21, heart (left side breast): 57.3 % ± 21, controlateral breast: 15.5 % ± 9.6. Median shifts were as follow: x-axis -0.04 mm (IC 95: -0.4 +0.38), y-axis -0.37 mm ± 5.51 (IC 95: -0.88 +0.14), z-axis 2.90 mm ± 5.42 (IC 95:+2.4+3.4) and roll rotation 0.22 ± 1.10 (IC 95: -0.1+0.32). The treatment tolerance was acceptable with 1 definitive interruption couple of fractions before the end and 3 temporal interruptions for skin toxicity. No grade 3 or 4 toxicity. Ninety-five percent of patients experienced skin toxicity: 45 % grade 2. There were 3 cases of oesophagitis. The median follow-up of presented series is 9.7 months and all of the patients are free of disease without any residual early or late toxicity.
  
  
  CONCLUSIONS
  Helical tomotherapy can achieve full target coverage while protected to the heart and ipsilateral lung. This treatment was well tolerated and reproducible. However, the low doses to normal tissue volumes need to be reduced in future studies.
authors: Département d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Département universitaire de radiothérapie curiethérapie, centre Oscar-Lambret, université Nord de France, 59800 Lille, France.
authors: X
authors: X
authors: Liem
authors: Département d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors: C
authors: C
authors: Chira
authors: Département d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors: A
authors: A
authors: Fourquet
authors: Département d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors: F
authors: F
authors: Campana
authors: Département d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors: D
authors: D
authors: Peurien
authors: Département d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors: N
authors: N
authors: Fournier-Bidoz
authors: Département d'oncologie radiothérapie, institut Curie, 26, rue d'Ulm, 75005 Paris, France. Electronic address: youlia.kirova@curie.net.
authors: Y M
authors: YM
authors: Kirova
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004941:Esophagitis / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015182:Lymphatic Irradiation; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments; D058958:Organs at Risk; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068878:Trastuzumab
keywords: Adjuvant treatment; Boost intégré; Breast cancer; Cancer du sein; Conserving surgery; Helical tomotherapy; Radiation therapy; Radiothérapie adjuvante; Simultaneous integrated boost; Tomothérapie hélicoïdale; Traitement conservateur