Re: Coronary Artery Findings After Left-Sided Compared With Right-Sided Radiation Treatment for Early-Stage Breast Cancer

Phase I-II Trial of Prone Accelerated Intensity Modulated Radiation
Therapy to the Breast to Optimally Spare Normal Tissue

Silvia C. Formenti, Daniela Gidea-Addeo, Judith D. Goldberg, Daniel F.
Roses, Amber Guth, Barry S. Rosenstein, Keith J. DeWyngaert

From the Department of Radiation Oncology, Division of Biostatistics;
and the Department of Surgery, New York University Cancer Institute
and New York University School of Medicine, New York, NY

Address reprint requests to Silvia C. Formenti, MD, New York
University School of Medicine, THI98, 566 First Ave, New York, NY
10016; e-mail: silvia.formenti@xxxxxxxxxxx

ABSTRACT

Purpose: To report the clinical feasibility of a trial of accelerated
whole-breast intensity modulated radiotherapy, with the patient in
prone position, optimally to spare the heart and lung.

Patients and Methods: Patients with stages I or II breast cancer,
excised by breast conserving surgery with negative margins, were
eligible for this institutional review board-approved prospective
trial. Computed tomography simulation was performed with the patient
prone on a dedicated breast board, in the exact position used for
treatment. A dose of 40.5 Gy, delivered at 2.7 Gy in 15 fractions, was
prescribed to the index breast with an additional concomitant boost of
0.5 Gy delivered to the tumor bed, for a total dose of 48 Gy to the
lumpectomy site. Physics constraints consisted of limiting 5% of the
heart volume to receive 18 Gy and 10% of the ipsilateral lung volume
to receive 20 Gy.

Results: Between September 2003 and August 2005, 91 patients were
enrolled on the study. Median length of follow-up was 12 months
(range, 1 to 28 months). In all patients the technique was feasible
and heart and lung sparing was achieved as prescribed by the protocol.
Acute toxicities consisting mostly of reversible grades 1-2 skin
dermatitis (67%) and fatigue (18%) occurred in 75 patients. One
patient sustained a regional recurrence rapidly followed by distant
metastases.

Conclusion: Accelerated whole breast intensity modulated radiotherapy
in the prone position is feasible and it permits a drastic reduction
in the volume of lung and heart tissue exposed to significant
radiation.




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