Abstract
We evaluated dosimetric, toxicity and early clinical outcomes of volumetric-modulated arc therapy (VMAT) treating chest wall and regional nodes in locally advanced breast cancer. Between July 2016 and January 2018, treatment outcomes of 125 patients with stage II ∼III breast cancer treated with postoperative radiotherapy including chest wall and regional nodes using VMAT were analyzed. All patients underwent mastectomy. We gave radiation to the chest wall + infraclavicular region, supraclavicular area and part of the axillary bed for patients with axillary nodes 1-3 positive. For patients with axillary nodes ≥ 4 positive, internal mammary nodes were included additionally. Doses to chest wall and regional nodes were 50Gy, delivered in 25 fractions over 5 weeks. The median follow-up was 21 months, range 12–30 months. VMAT showed good homogeneity and improved conformity. The acute skin toxicity by the end of treatment was Grade 0 in 15/125 (12%) patients, Grade 1 in 88 /125(70%), Grade 2 in 22 /125 (18%), and Grade 3 in 0. No Grade 4 toxicities were observed. Sixty-five of 125(52%) underwent Grade 1 acute esophagitis. The incidence of lung toxicity of grade 2 or more was 2/125(1.6%), and cardiac toxicity was not observed. No patient developed local recurrence. VMAT appears safe for the treatment of locally advanced breast cancer. Long-term follow-up is needed to assess the benefit and harm of VMAT and careful patient selection is necessary in choosing VMAT as RT technique.
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