Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience.

Abstract

PURPOSE:

To evaluate acute and late skin/subcutaneous toxicities and radiation-induced lung fibrosis (RILF) in patients treated with adjuvant radiotherapy (RT) for synchronous bilateral breast cancers (SBBC), after conservative surgery.

METHODS/PATIENTS:

Twenty-five patients were treated with volumetric-modulated arc therapy (VMAT/RapidArc®) on both breasts, and checked clinically for detecting RT toxicities during and after treatment. A high-resolution computed tomography (HRCT) was performed, for detecting RILF during follow-up.

RESULTS:

We registered acute Grade-1 skin toxicity in 18 patients (72%), while six patients (24%) experienced Grade-2 toxicity. No breath symptoms were reported during and after RT. Late Grade-1 subcutaneous toxicity and late Grade-2 skin toxicity were registered in four patients (16%) and one patient (4%), respectively, at a mean follow-up of 36 months. Grade-1 RILF was detected in six patients (30%). The median volume of fibrosis area was 6.5 cc (range 1.3-21.5 cc). The partial volumes receiving a specified dose (V20, V30, V40, and V50) in patients who developed lung fibrosis were significantly bigger than who did not (p < 0.01). We showed that the mean volume of the tumour boost of patients who developed fibrosis (77.7 cc) was not significantly different from the other patients (90.8 cc) (p = 0.5).

CONCLUSION:

The clinical impact of this technique is favourable, and this is the first clinical study showing RILF by HRCT in a setting of SBBC. Further study with larger accrual is mandatory.

• Authors: M Valli, S Cima, D Gaudino, R Cartolari, L Deantonio, M Frapolli, D Daniele, G A Pesce, F Martucci, N C Azinwi, D Bosetti, S Presilla, A Richetti
• Journal: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico (Clin Transl Oncol) Vol. 21 Issue 11 Pg. 1492-1498 (Nov 2019) ISSN: 1699-3055 [Electronic] Italy
• PMID: 30875061 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Breast Neoplasms (diagnostic imaging, radiotherapy)
• Feasibility Studies
• Female
• Humans
• Lung (diagnostic imaging, radiation effects)
• Middle Aged
• Neoplasms, Multiple Primary (diagnostic imaging, radiotherapy)
• Organs at Risk (diagnostic imaging, radiation effects)
• Radiation Pneumonitis (diagnostic imaging, etiology)
• Radiotherapy Planning, Computer-Assisted (methods)
• Radiotherapy, Adjuvant (adverse effects)
• Radiotherapy, Intensity-Modulated (adverse effects)
• Retrospective Studies
• Skin (radiation effects)
• Tomography, X-Ray Computed (methods)