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J Cancer Res Clin Oncol ; 145(7): 1887-1896, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31144158

RESUMO

PURPOSE: To report the dosimetric feasibility of the radiation technique HALFMOON (Helical ALtered Fractionation for iMplant partial OmissiON) for post-mastectomy radiation therapy (PMRT) in intermediate-high-risk breast cancer patients with implant-based immediate breast reconstruction, where the clinical target volume (CTV) does not include the whole implant (implant-sparing approach). METHODS: In the HALFMOON technique, the CTV consisted of skin, subcutaneous tissues, and pectoralis major muscle, excluding the implant, chest wall muscles, and rib plane. The HALFMOON plans were compared with conventionally contoured CTV plans, in which the whole implant, chest wall muscles, and ribs plane were included in the CTV, in a ratio 1:3. All patients underwent hypofractionated treatment of 40.05 Gy/15 fractions, using helical Tomotherapy®. RESULTS: Eighteen patients undergoing HALFMOON technique were compared to 54 subjects treated with conventionally contoured CTV plans. No difference was found in the planning target volume coverage between the two groups. Conversely, a statistically relevant dose reduction in HALFMOON patients was observed for ipsilateral lung (D15%, p < 0.0001; D20%, p < 0.0001; D35%, p = 0.003), contralateral lung (D20%, p = 0.048), contralateral breast (D15%, p = 0.031; D20%, p = 0.047), and stomach (Dmean, p = 0.011). Regarding the implant, V90% and D50% decreased by 46% and 8%, respectively, in the HALFMOON plans (p < 0.0001). CONCLUSION: The HALFMOON approach is technically feasible and resulted in high-dose conformity of the target with a significant reduction of radiation dose delivered to implant and other organs. A clinical study is needed to assess the impact on reconstruction cosmetic outcome and local control.


Assuntos
Implantes de Mama , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias da Mama/diagnóstico por imagem , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Hipofracionamento da Dose de Radiação , Radioterapia Adjuvante , Radioterapia de Intensidade Modulada/métodos , Tomografia Computadorizada por Raios X/métodos
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