The use of helical tomotherapy in the treatment of early stage breast cancer: indications, tolerance, efficacy—a single center experience

Abstract

// Alexandre Arsene-Henry 1 , Jean-Philippe Foy 2 , Magalie Robilliard 1 , Hao-Ping Xu 1, 3 , Louis Bazire 1 , Dominique Peurien 1 , Philip Poortmans 1 , Alain Fourquet 1 and Youlia M. Kirova 1 1 Department of Radiation Oncology, Institut Curie, Paris, France 2 University Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Lyon, France 3 Department of Radiation Oncology, Ruijin Hospital, Shanghai, China Correspondence to: Youlia M. Kirova, email: youlia.kirova@curie.fr Keywords: helical tomotherapy; early stage breast cancer; indications; tolerance; efficacy Received: January 24, 2018      Accepted: March 12, 2018      Published: May 04, 2018 ABSTRACT Purpose: to evaluate our experience in terms of local control, survival, adverse effects in patients treated by adjuvant helical tomotherapy (HT) for breast cancer (BC). Results: We studied 179 consecutive patients with 194 treated breasts with adjuvant HT. Median follow-up was 38.1 months. Median age was 53 years. Chemotherapy was administered to 83% of patients. All 133 hormone receptor positive tumours received hormonal therapy. As concurrent treatment, apart from trastuzumab monotherapy, 6 patients received systemic therapy concomitant to RT. The HT was generally well tolerated with mostly grade 1 and 2 skin reactions and esophagitis. Only 3% grade III early skin reactions. At last follow-up, there were 2 local recurrences, 1 regional lymph node (LN) recurrence and 6 with metastatic progression. The 5-year progression-free survival was 90.5% (95% CI 84.2–97.3). Materials and Methods: A retrospective study of all patients treated by HT between 2009 and 2015 was done. Patients excluded were those with: breast implants, advanced or metastatic BC, recurrent disease. All patients received breast+/-boost or chest wall irradiation and most received with LN irradiation. Dose constraints for organs at risk were defined using optimization scale developed in our Department. Evaluation of early and late toxicity was done using Common Terminology Adverse Criteria Events v.4.0. Conclusions: HT can be used for a well selected group of breast cancer as bilateral tumours, complex anatomy and target volumes where the conventional radiation therapy techniques cannot ensure an optimal dose distribution. Longer follow-up is necessary to confirm and validate these results.