Helical Tomotherapy for Inoperable Breast Cancer: A New Promising Tool

Abstract

Background. We investigated the feasibility of helical tomotherapy (HT) for inoperable large breast tumors, after failing to achieve adequate treatment planning with conformal radiation techniques. Material and Methods. Five consecutive patients with locally advanced breast cancer (LABC) were treated by preoperative HT. All patients received up-front chemotherapy before HT. Irradiated volumes included breast and nodal areas (45–50 Gy) in 4 patients. One patient received a simultaneous integrated boost (55 Gy) to gross tumor volume (GTV) without lymph node irradiation. Acute toxicity was assessed with Common Toxicity Criteria for Adverse Events v.4. Patients were evaluated for surgery at the end of treatment. Results. Patients were staged IIB to IIIC (according to the AJCC staging system 2010). HT was associated in 4 patients with concomitant chemotherapy (5-fluorouracil and vinorelbine). Two patients were scored with grade 3 skin toxicity (had not completed HT) and one with grade 3 febrile neutropenia. One patient stopped HT with grade 2 skin toxicity. All patients were able to undergo mastectomy at a median interval of 43 days (31–52) from HT. Pathological partial response was seen in all patients. Conclusions. HT is feasible with acceptable toxicity profiles, potentially increased by chemotherapy. These preliminary results prompt us to consider a phase II study.

Five-year survival outcomes of intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) using forward IMRT or Tomotherapy for breast cancer

“…We believe SIB is more economically efficient in terms of time and money. Tomotherapy appears to improve target coverage while sparing OAR because of its high conformity; when paired with SIB, it maintains the ability to deliver adequate dose coverage 38 . Studies have reported that helical Tomotherapy avoided unnecessary breast overdose while improving ipsilateral lung dosimetry 16,38 ; furthermore, static ports of Tomotherapy in TomoDirect were proven to prevent unwanted dosages to the surrounding normal tissues 39 .…”

État de l’art de l’irradiation des ganglions de la chaîne mammaire interne

“…Pour améliorer les résultats en termes de tolérance, certaines équipes ont proposé une alternance hebdomadaire des faisceaux de photons et d'électrons, mais on assiste actuellement à une révolution des techniques utilisées en fonction de l'indication (après mastectomie, avec ou sans implant, ou après traitement conservateur) mettant en oeuvre des techniques d'irradiation conformationnelle avec modulation d'intensité de la dose délivrée par photons [20][21][22][23] ou électrons [24,25].…”

“…Elle donne des solutions dosimétriques avantageuses lorsque les volumes cibles incluent des chaînes ganglionnaires, comme par exemple dans la sphère ORL. Dans notre institut, elle a été d'abord appliquée dans la pathologie mammaire aux cas de tumeurs non opérables [23], puis nous l'avons appliquée aux cas complexes de l'irradiation après reconstruction [21]. Dans ces deux cas cliniques très différents, l'irradiation conformationnelle donnait toujours des résultats sub-optimaux quant à la couverture des volumes cibles.…”

Rotation Errors of Breast Cancer on 3D-CRT in TomoDirect

“…The intensity-modulated radiation therapy (IMRT) also can use to improve dose distributions compared with 3D-CRT while showing a clinical benefit. 1,2) Tomotherapy (Accuray Inc., Sunnyvale, CA) combines a linear accelerator (LINAC), and achieved by the use of a gantry head with a 360° rotating and couch motion that the possibility to deliver IMRT with megavoltage computed tomography (MVCT) imaging system. Radiation delivering by gantry rotation is not appropriate in WBRT because of increasing delivered volume to the normal organs.…”