PMID- 36059658 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220907 IS - 2234-943X (Print) IS - 2234-943X (Electronic) IS - 2234-943X (Linking) VI - 12 DP - 2022 TI - Efficacy, safety, and feasibility of volumetric modulated arc therapy for synchronous bilateral breast cancer management. PG - 967479 LID - 10.3389/fonc.2022.967479 [doi] LID - 967479 AB - PURPOSE: Volumetric Modulated Arc Therapy (VMAT) exhibits potent advantages regarding target volume coverage and protection of organs at risk, notably in the context of anatomical constraints. Nevertheless, reports concerning VMAT for the treatment of synchronous bilateral breast cancers (SBBC) have been scarce to date. As such, we conducted this observational study to assess efficacy, safety and feasibility of VMAT in SBBC. MATERIALS AND METHODS: From August 2011 to December 2017, 54 consecutive patients with SBBC with or without axillary nodes involvement underwent a treatment protocol containing radiotherapy using VMAT. A total dose (TD) of 52.2Gy in 29 fractions was delivered to breast and internal mammary chain (IMC) nodes Planning Target Volume (PTV) plus, if applicable, a TD of 49.3Gy in 29 fractions to the supra- and infra-clavicular nodes PTV and a TD of 63.22Gy in 29 fractions to tumor boost PTV. Lungs, heart, esophagus, trachea, liver, thyroid and spinal cord were considered as organs at risk. VMAT feasibility and organ at risk sparing were evaluated by treatments planning of the 20 first enrolled patients. Tolerance and patients' outcome were prospectively monitored by acute/late toxicities records and by the analysis of overall survival (OS), locoregional recurrence-free survival (LRFS) and recurrence-free survival (RFS). RESULTS: Breast, supraclavicular nodes and boost PTV coverage was adequate with at least 98% of PTV encompassed by more than 95% of the prescribed dose. Less than 90% of IMC PTV was encompassed by 95% of the prescribed dose. Mean lung dose was 12.3Gy (range: 7.7 - 18.7); mean heart dose was 10.7Gy (range: 6.2 - 22.3). Concerning acute toxicities, only 2 patients experienced grade 3 skin toxicity (3.7%) and only 1 patient developed grade 1 pneumonitis. After a median follow-up of 5.3 years, grade 2 fibrosis and/or shrinking was observed in 5 patients (10%), and grade 3 fibrosis in 1 patients (2%). The 5-year LRFS-rate, RFS-rate and OS were 98% [95% CI= 86.12-99.70%], 96% [95% CI= 84.63-98.96%] and 100%, respectively. CI - Copyright (c) 2022 Quesada, Fenoglietto, Gourgou, Lemanski, Draghici, Ailleres, Prunaretty, Azria and Bourgier. FAU - Quesada, Stanislas AU - Quesada S AD - Faculty of Medicine, University of Montpellier, Montpellier, France. AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. FAU - Fenoglietto, Pascal AU - Fenoglietto P AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. FAU - Gourgou, Sophie AU - Gourgou S AD - Institute of Cancer Research of Montpellier (IRCM), Montpellier, France. FAU - Lemanski, Claire AU - Lemanski C AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. FAU - Draghici, Roxana AU - Draghici R AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. FAU - Ailleres, Norbert AU - Ailleres N AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. FAU - Prunaretty, Jessica AU - Prunaretty J AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. FAU - Azria, David AU - Azria D AD - Faculty of Medicine, University of Montpellier, Montpellier, France. AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. AD - Institute of Cancer Research of Montpellier (IRCM), Montpellier, France. FAU - Bourgier, Celine AU - Bourgier C AD - Faculty of Medicine, University of Montpellier, Montpellier, France. AD - Department of Radiation Oncology, Montpellier Cancer Institute (ICM), Montpellier, France. AD - Institute of Cancer Research of Montpellier (IRCM), Montpellier, France. LA - eng PT - Journal Article DEP - 20220818 PL - Switzerland TA - Front Oncol JT - Frontiers in oncology JID - 101568867 PMC - PMC9436014 OTO - NOTNLM OT - VMAT OT - bilateral breast cancer OT - cancer care OT - dosimetric analysis OT - radiotherapy OT - treatment outcome OT - treatment planning COIS- The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2022/09/06 06:00 MHDA- 2022/09/06 06:01 PMCR- 2022/01/01 CRDT- 2022/09/05 03:41 PHST- 2022/06/12 00:00 [received] PHST- 2022/08/02 00:00 [accepted] PHST- 2022/09/05 03:41 [entrez] PHST- 2022/09/06 06:00 [pubmed] PHST- 2022/09/06 06:01 [medline] PHST- 2022/01/01 00:00 [pmc-release] AID - 10.3389/fonc.2022.967479 [doi] PST - epublish SO - Front Oncol. 2022 Aug 18;12:967479. doi: 10.3389/fonc.2022.967479. eCollection 2022.