Samuel Swisher-McClure, Presenter: Nothing to Disclose

Brian Allen Plants MD, Abstract Co-Author: Nothing to Disclose

Steven J. Jubelirer MD, Abstract Co-Author: Nothing to Disclose

Dimitris Mihailidis PhD, Abstract Co-Author: Nothing to Disclose

Christine A. Welch MS, Abstract Co-Author: Nothing to Disclose

To evaluate the acute toxicities experienced by women with breast cancer treated with Intensity Modulated Radiation Therapy (IMRT).

A retrospective analysis was performed of 216 patients treated with IMRT for breast cancer over a two year period by Charleston Radiation Therapy Consultants (CRTC). One patient was excluded because of a history of prior radiation treatment to the breast. Patients with early-stage disease received whole-breast radiation following breast conservation surgery with or without previous chemotherapy. Patients with advanced disease received radiation to the chest wall, axillae, and supraclavicular fossa following modified radical mastectomy and chemotherapy. A median dose of 5040 cGy in 28 fractions was delivered to a large field using IMRT. A boost of 1000 cGy was given to the lumpectomy cavity or surgical scar using either 3D photons or an en fosse electron. Patients were treated in the supine position on a breast board with both arms overhead to limit breathing motion. Optimal beam arrangements were chosen based on patient anatomy and consisted of 2-9 beams. In high-risk patients, regional lymphatics were included in the large field using only one isocenter. No field junctions were necessary. Inverse planning was used to optimize beam segments and weighting. Toxicities were documented and graded according to the NCI Common Terminology Criteria for Adverse Events (CTCAE v3.0).

216 patients with breast cancer and an average age of 60 years, were treated with IMRT between January 2004 and May 2006. The treatment group included patients with DCIS (17.6%), early stage disease (71.8%) and advanced stage disease (10.7%). One-hundred ninety-two (89%) had breast conservation therapy. Twenty-three (11%) received post-mastectomy chemotherapy and radiation. Moist desquamation of the skin occurred in 57 (26%) women, most commonly in the inframmamary fold or axillae. Skin toxicity of CTCAE of grade 2 or less was noted in 99%. Transient breast edema and fatigue were reported by 42 (20%) and 80 (37%), respectively. Five (2.3%) women developed grade 2 esophagitis with dysphagia. No patients developed pulmonary or cardiac complications. The median follow-up time was 20 months. The 3-year overall survival was 98.3% + 1.3 (mean + sem), while the local and distant disease free survival at 3-years were both 95.9 + 3.5.

IMRT for early-stage and locally advanced breast cancer is effective and well-tolerated. Acute toxicity is minimal. Further follow-up is necessary to determine the long-term tumor control, but initial data is very promising.

Swisher-McClure, S, Plants, B, Jubelirer, S, Mihailidis, D, Welch, C, Acute Toxicity Outcomes after Intensity Modulated Radiation Therapy in Breast Cancer.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/6001008.html