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Predictive parameters in hypofractionated whole-breast 3D conformal radiotherapy according to the Ontario Canadian trial

Authors Lazzari G, Terlizzi A, Della Vittoria Scarpati G, Perri F, De Chiara V, Turi B, Silvano G

Received 16 November 2016

Accepted for publication 11 February 2017

Published 24 March 2017 Volume 2017:10 Pages 1835—1842

DOI https://doi.org/10.2147/OTT.S127833

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Samir Farghaly

Grazia Lazzari,1 Angela Terlizzi,2 Giuseppina Della Vittoria Scarpati,3 Francesco Perri,3 Vincenzo De Chiara,4 Barbara Turi,1 Giovanni Silvano1

1Radiation Oncology Unit, 2Physics Department, 3Medical Oncology Unit, Saint Giuseppe Moscati Hospital, 4Radiation Therapy Unit, Saints Giovanni Di Dio and Ruggi di Aragona, University of Salerno, Taranto, Italy

Aim: To evaluate the possible role of dosimetric parameters according Normal Tissue Complication Probability (NTCP) model as predictive of late toxicity and cosmesis in hypofractionated whole-breast three-dimensional conformal radiotherapy.
Patients and methods: A retrospective analysis on 215 consecutive early breast cancer patients treated with breast conserving surgery and adjuvant hypofractionated whole-breast radiotherapy (according the Ontario Canadian trial), with a 6 years median follow-up was conducted. To assess the impact of 10%–20% dose hotspots on different percent values of planning target volume (PTV) of the breast, we retrospectively employed the NTCP model of Lyman. PTV breast (PTVbr), V110 were identified. For statistical analysis the χ2 and paired t-test were used to find a correlation between late skin and subcutaneous toxicity and cosmetic outcome with dosimetrical parameters Multivariate analysis was performed with the aim to assess independently the impact of dosimetric and clinical parameters on late toxicity and cosmesis using Pearson’s covariance.
Results:
Late skin toxicity was recorded in 47/215 (22%); and G3 toxicity occurred in 11 patients (5%). Cosmesis with excellent–good score was found in 172 patients (80%) while fair–poor score was found in 43 patients (20%). In univariate χ2 analysis the V110 >10% of the PTV breast significantly correlated with higher toxicity (P<0.005, OR 9.60 [CI 3.89–23.72]). Cosmesis related to V110 >10% and PTV breast volume over 1,300 cc was significant at multivariate analysis (P<0.005, OR 6.07 [CI 2.36–15.59]).
Conclusion:
To safely use one of the most important whole-breast hypofractionated radiotherapy schedules, we found some predictive paramaters on the basis of NTCP model by Lyman. These parameters may be useful in selection of elegible patients.

Keywords: NTCP model, Ontario Canadian Trial, hypofractionated radiotherapy, whole-breast, cosmesis, toxicity, PTV breast, V110, early breast cancer

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