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Title: Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?

Abstract

Purpose: To evaluate the effects of breast size on dose-volume histogram parameters and clinical toxicity in whole-breast hypofractionated radiation therapy using intensity modulated radiation therapy (IMRT). Materials and Methods: In this retrospective study, all patients undergoing breast-conserving therapy between 2005 and 2009 were screened, and qualifying consecutive patients were included in 1 of 2 cohorts: large-breasted patients (chest wall separation >25 cm or planning target volume [PTV] >1500 cm{sub 3}) (n=97) and small-breasted patients (chest wall separation <25 cm and PTV <1500 cm{sub 3}) (n=32). All patients were treated prone or supine with hypofractionated IMRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost dose (9.6 Gy in 4 fractions). Dosimetric and clinical toxicity data were collected and analyzed using the R statistical package (version 2.12). Results: The mean PTV V95 (percentage of volume receiving >= 95% of prescribed dose) was 90.18% and the mean V105 percentage of volume receiving >= 105% of prescribed dose was 3.55% with no dose greater than 107%. PTV dose was independent of breast size, whereas heart dose and maximum point dose to skin correlated with increasing breast size. Lung dose was markedly decreased in prone compared with supine treatments. Radiationmore » Therapy Oncology Group grade 0, 1, and 2 skin toxicities were noted acutely in 6%, 69%, and 25% of patients, respectively, and at later follow-up (>3 months) in 43%, 57%, and 0% of patients, respectively. Large breast size contributed to increased acute grade 2 toxicity (28% vs 12%, P=.008). Conclusions: Adequate PTV coverage with acceptable hot spots and excellent sparing of organs at risk was achieved by use of IMRT regardless of treatment position and breast size. Although increasing breast size leads to increased heart dose and maximum skin dose, heart dose remained within our institutional constraints and the incidence of overall skin toxicity was comparable to that reported in the literature. Taken together, these data suggest that hypofractionated radiation therapy using IMRT is a viable and appropriate therapeutic modality in large-breasted patients.« less

Authors:
 [1]; ; ; ; ;  [2];  [3]; ; ; ; ;  [2]
  1. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States)
  2. Department of Radiation Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (United States)
  3. Department of Radiation Oncology, Columbia University Medical Center, New York, New York (United States)
Publication Date:
OSTI Identifier:
22149621
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 4; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CHEST; HEALTH HAZARDS; HEART; LUNGS; MAMMARY GLANDS; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY; SKIN; TOXICITY

Citation Formats

Hannan, Raquibul, E-mail: Raquibul.Hannan@gmail.com, Thompson, Reid F., Chen Yu, Bernstein, Karen, Kabarriti, Rafi, Skinner, William, Chen, Chin C., Landau, Evan, Miller, Ekeni, Spierer, Marnee, Hong, Linda, and Kalnicki, Shalom. Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.01.093.
Hannan, Raquibul, E-mail: Raquibul.Hannan@gmail.com, Thompson, Reid F., Chen Yu, Bernstein, Karen, Kabarriti, Rafi, Skinner, William, Chen, Chin C., Landau, Evan, Miller, Ekeni, Spierer, Marnee, Hong, Linda, & Kalnicki, Shalom. Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?. United States. doi:10.1016/J.IJROBP.2012.01.093.
Hannan, Raquibul, E-mail: Raquibul.Hannan@gmail.com, Thompson, Reid F., Chen Yu, Bernstein, Karen, Kabarriti, Rafi, Skinner, William, Chen, Chin C., Landau, Evan, Miller, Ekeni, Spierer, Marnee, Hong, Linda, and Kalnicki, Shalom. Thu . "Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?". United States. doi:10.1016/J.IJROBP.2012.01.093.
@article{osti_22149621,
title = {Hypofractionated Whole-Breast Radiation Therapy: Does Breast Size Matter?},
author = {Hannan, Raquibul, E-mail: Raquibul.Hannan@gmail.com and Thompson, Reid F. and Chen Yu and Bernstein, Karen and Kabarriti, Rafi and Skinner, William and Chen, Chin C. and Landau, Evan and Miller, Ekeni and Spierer, Marnee and Hong, Linda and Kalnicki, Shalom},
abstractNote = {Purpose: To evaluate the effects of breast size on dose-volume histogram parameters and clinical toxicity in whole-breast hypofractionated radiation therapy using intensity modulated radiation therapy (IMRT). Materials and Methods: In this retrospective study, all patients undergoing breast-conserving therapy between 2005 and 2009 were screened, and qualifying consecutive patients were included in 1 of 2 cohorts: large-breasted patients (chest wall separation >25 cm or planning target volume [PTV] >1500 cm{sub 3}) (n=97) and small-breasted patients (chest wall separation <25 cm and PTV <1500 cm{sub 3}) (n=32). All patients were treated prone or supine with hypofractionated IMRT to the whole breast (42.4 Gy in 16 fractions) followed by a boost dose (9.6 Gy in 4 fractions). Dosimetric and clinical toxicity data were collected and analyzed using the R statistical package (version 2.12). Results: The mean PTV V95 (percentage of volume receiving >= 95% of prescribed dose) was 90.18% and the mean V105 percentage of volume receiving >= 105% of prescribed dose was 3.55% with no dose greater than 107%. PTV dose was independent of breast size, whereas heart dose and maximum point dose to skin correlated with increasing breast size. Lung dose was markedly decreased in prone compared with supine treatments. Radiation Therapy Oncology Group grade 0, 1, and 2 skin toxicities were noted acutely in 6%, 69%, and 25% of patients, respectively, and at later follow-up (>3 months) in 43%, 57%, and 0% of patients, respectively. Large breast size contributed to increased acute grade 2 toxicity (28% vs 12%, P=.008). Conclusions: Adequate PTV coverage with acceptable hot spots and excellent sparing of organs at risk was achieved by use of IMRT regardless of treatment position and breast size. Although increasing breast size leads to increased heart dose and maximum skin dose, heart dose remained within our institutional constraints and the incidence of overall skin toxicity was comparable to that reported in the literature. Taken together, these data suggest that hypofractionated radiation therapy using IMRT is a viable and appropriate therapeutic modality in large-breasted patients.},
doi = {10.1016/J.IJROBP.2012.01.093},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}