title: Helical TomoTherapy for locally advanced or recurrent breast cancer.
abstract: OBJECTIVE
  We report our experience of using helical tomotherapy (HT) to treat large and irregular shaped loco-regional advanced breast cancer target volumes embracing various organs at risk.
  
  
  METHODS
  We retrospectively analyzed 26 patients treated for very large, irregular shaped breast cancers. Patients were treated either with the intent to achieve local control in a primary setting (n = 14) or in a reirradiation setting (n = 12). The recurrence group was heavily pretreated with systemic therapy. Tumors were characterized by wide infiltration of the skin, encompassing mostly a complete hemithorax. The primary group underwent irradiation of supraclavicular, infraclavicular, axillary and parasternal lymphonodal region. Radiotherapy was combined with chemotherapy (n = 11). We assessed the PTV volume and its craniocaudal extension, the dose to the organs at risk, acute toxicity and survival.
  
  
  RESULTS
  Median PTV was 2276 cm3(1476-6837 cm3) with a median cranio-caudal extension of 28 cm (15-52 cm). The median dose to PTV was 40 Gy (32-60Gy). HT could be carried out in all patients without interruption. The acute toxicities were mild to moderate. The median LRFS and OS after radiotherapy was 21 and 57 months for the primary group versus 10 and 11 months for the recurrence group. Median PFS was 18 months (primary group) and 7 months (recurrence group).
  
  
  CONCLUSIONS
  HT is feasible for advanced thorax embracing target volumes with acceptable acute toxicity. Both curative and palliative indications can be considered good indications based on treatment volume and anatomical constellation.
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany. Marciana.Duma@mri.tum.de.|Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany. Marciana.Duma@mri.tum.de.
authors.forename: M N
authors.initials: MN
authors.lastname: Duma
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.|Praxis für Strahlentherapie, Hausham, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Heinrich
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schönknecht
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Chizzali
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Mayinger
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Devecka
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kampfer
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, München, Germany.|Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, München, Germany.
authors.forename: S E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy*; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Acute toxicity; Breast cancer; Chemoradiation; Helical tomo therapy; Reirradiation