title: Helical tomotherapy and volumetric modulated arc therapy: New therapeutic arms in the breast cancer radiotherapy.
abstract: OBJECTIVE
  To analyse clinical and dosimetric results of helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) in complex adjuvant breast and nodes irradiation.
  
  
  METHODS
  Seventy-three patients were included (31 HT and 42 VMAT). Dose were 63.8 Gy (HT) and 63.2 Gy (VMAT) in the tumour bed, 52.2 Gy in the breast, 50.4 Gy in supraclavicular nodes (SCN) and internal mammary chain (IMC) with HT and 52.2 Gy and 49.3 Gy in IMC and SCN with VMAT in 29 fractions. Margins to particle tracking velocimetry were greater in the VMAT cohort (7 mm vs 5 mm).
  
  
  RESULTS
  For the HT cohort, the coverage of clinical target volumes was as follows: Tumour bed: 99.4% ± 2.4%; breast: 98.4% ± 4.3%; SCN: 99.5% ± 1.2%; IMC: 96.5% ± 13.9%. For the VMAT cohort, the coverage was as follows: Tumour bed: 99.7% ± 0.5%, breast: 99.3% ± 0.7%; SCN: 99.6% ± 1.4%; IMC: 99.3% ± 3%. For ipsilateral lung, Dmean and V20 were 13.6 ± 1.2 Gy, 21.1% ± 5% (HT) and 13.6 ± 1.4 Gy, 20.1% ± 3.2% (VMAT). Dmean and V30 of the heart were 7.4 ± 1.4 Gy, 1% ± 1% (HT) and 10.3 ± 4.2 Gy, 2.5% ± 3.9% (VMAT). For controlateral breast Dmean was 3.6 ± 0.2 Gy (HT) and 4.6 ± 0.9 Gy (VMAT). Acute skin toxicity grade 3 was 5% in the two cohorts.
  
  
  CONCLUSIONS
  HT and VMAT in complex adjuvant breast irradiation allow a good coverage of target volumes with an acceptable acute tolerance. A longer follow-up is needed to assess the impact of low doses to healthy tissues.
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lauche
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Youlia M
authors.initials: YM
authors.lastname: Kirova
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Fenoglietto
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Costa
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Lemanski
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Celine
authors.initials: C
authors.lastname: Bourgier
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Riou
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Tiberi
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Campana
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Fourquet
authors.affiliation: Olivier Lauche, Youlia M Kirova, Emilie Costa, Francois Campana, Alain Fourquet, Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Azria
keywords: Breast cancer radiotherapy; Helical tomotherapy; Intensity modulated radiation therapy; Three-dimensional conformal radiotherapy; Toxicity; Volumetric modulated arc therapy