title: Is helical tomotherapy-based intensity-modulated radiotherapy feasible and effective in bilateral synchronous breast cancer? A two-center experience.
abstract: OBJECTIVE
  This study describes the early clinical results and dosimetric parameters of intensity-modulated radiation therapy (IMRT) using a tomotherapy device in patients with primary bilateral synchronous breast cancer (PSBBC).
  
  
  METHODS
  Fourteen patients with bilateral breast cancer were treated with tomotherapy between January 2011 and October 2014. The treatment planning objectives were to cover 95% of the planning target volume using a 95% isodose, with a minimum dose of 90% and a maximum dose of 107%. The organs at risk (OAR), such as the lungs, heart, esophagus and spinal cord, were contoured. Acute toxicity was recorded during and after radiation therapy.
  
  
  RESULTS
  The advantages included better treatment conformity with lower dosages to minimize the risk to susceptible organs, such as the lungs, heart and spinal cord. There was improved coverage of the planning target volume, including the regional nodes, without any field junction problems. The median homogeneity index was 0.13 and the median conformity index 1.32. The median V20, V15, V10 and V5 for the total lungs were 18.5, 23.3, 24.2 and 60%, respectively. Skin acute toxicity was grade 1 in 72% and grade 2 in 14% of the patients. Esophageal acute toxicity was grade 1 in 43% of the patients.
  
  
  CONCLUSIONS
  Tomotherapy delivers treatment that is well-tolerated, with high homogeneity and coverage indexes and the capability to reduce the irradiation dose received by the lungs and heart in PSBBC patients. This technique is therefore feasible and safe for the treatment of bilateral breast cancer.
authors.affiliation: Department of Radiation Oncology, Medical Faculty, Inonu University, Malatya, Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Ekici
authors.forename: Tumay
authors.initials: T
authors.lastname: Gokce
authors.forename: Ilker
authors.initials: I
authors.lastname: Karadogan
authors.forename: Aysun
authors.initials: A
authors.lastname: Fatma Eraslan
authors.forename: Cimen
authors.initials: C
authors.lastname: Akcay
authors.forename: Oztun
authors.initials: O
authors.lastname: Temelli
authors.forename: Eda
authors.initials: E
authors.lastname: Kaya Pepele
authors.forename: Funda
authors.initials: F
authors.lastname: Durmus Manalp
authors.forename: Caglar
authors.initials: C
authors.lastname: Keles
authors.forename: Arpaslan
authors.initials: A
authors.lastname: Mayadagli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000532:radiotherapy*; D058958:Organs at Risk; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D036542:Tomography, Spiral Computed / Q000379:methods*