Vol.:(0123456789) 1 3 La radiologia medica https://doi.org/10.1007/s11547-018-0976-2 RADIOTHERAPY Intensity‑modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elderly patients with breast cancer: comparison of acute and late toxicities Alba Fiorentino 1  · Fabiana Gregucci 1  · Rosario Mazzola 1  · Vanessa Figlia 1  · Francesco Ricchetti 1  · Gianluisa Sicignano 1  · Niccolo Giajlevra 1  · Ruggero Ruggieri 1  · Sergio Fersino 1  · Stefania Naccarato 1  · Alberto Massocco 2  · Stefanie Corradini 3  · Filippo Alongi 1,4 Received: 26 January 2018 / Accepted: 5 December 2018 © Italian Society of Medical Radiology 2018 Abstract Purpose To evaluate the diferences between conventional fractionated intensity-modulated radiotherapy (IMRT) and hypo- fractionated (HypoRT) volumetric modulated arc therapy (VMAT) in elderly women afected by early-stage breast cancer (BC) in terms of RT-related acute/late side efect. Materials and methods Between October 2011 and July 2015, 80 consecutive elderly BC patients were treated with IMRT for 5 weeks (40 patients) or HypoRT-VMAT for 3 weeks (40 patients). Inclusion criteria were: age ≥ 70 years, early BC (pT1-2 pN0-1), no prior neoadjuvant chemotherapy and non-metastatic disease. For patients receiving IMRT or HypoRT-VMAT, a total dose of 50 Gy (25 fractions) or 40.5 Gy (15 fractions) was prescribed to the whole ipsilateral breast, respectively. All patients received a simultaneously integrated boost up to a total dose of 60 Gy for IMRT and 48 Gy for HypoRT-VMAT. Acute and late side efects were evaluated using the RTOG/EORTC radiation morbidity scoring system. Results With a median follow-up of 45 months, acute skin toxicity was overall very low, with grade 1 in 25 cases (62.5%) of the IMRT group and 21 cases (52.5%) of the HypoRT-VMAT group, while grade 2 toxicity was reported in 10 IMRT patients (25%) and 1 HypoRT-VMAT patient (2.5%) (p = 0.001). Regarding late adverse events, only grade 1 skin toxicity was recorded. Conclusion The present study showed that whole breast IMRT and HypoRT-VMAT are feasible and well tolerated in early- stage BC elderly patients and that HypoRT-VMAT is afected by lower risk of acute and late RT-related side efects. Keywords Breast cancer · Elderly · Intensity-modulated radiotherapy · Volumetric modulated arc therapy Introduction The standard of care for patients with early-stage breast cancer (BC) consists of lumpectomy followed by adjuvant whole breast radiotherapy (RT), which results in a signif- cant reduction in ipsilateral breast recurrences and BC-spe- cifc mortality [1]. Standard whole breast RT is usually per- formed over 6 weeks: 45–50 Gy delivered over 4.5–5 weeks (1.8–2.0 Gy/fraction) followed by a boost to the surgical bed (10–16 Gy over 1–1.5 weeks) in patients with a higher risk of recurrence. A recent randomized trial showed that boost delivery reduces the risk of local recurrence at 20 years even in elderly patients over 60 years of age: The gain is small but statistically signifcant and is linked to the compromise of an increased local risk of fbrosis [2]. In recent decades, sev- eral randomized trials evaluated the role of hypofractionated * Fabiana Gregucci fabianagregucci@gmail.com 1 Radiation Oncology, Cancer Care Center, Ospedale Sacro Cuore don Calabria, via Don Sempreboni 5, 37034 Negrar, Verona, Italy 2 Breast Unit, Cancer Care Center, Ospedale Sacro Cuore don Calabria, Negrar, Verona, Italy 3 Radiation Oncology, Ludwig-Maximilians University of Munich, Munich, Germany 4 University of Brescia, Brescia, Italy