Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Breast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size.

Conclusions

Inhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.

Language:: English

Publication timeframe:: 4 times per year
Journal Subjects:: Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology

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Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Ivica Ratosa

Aljasa Jenko

Irena Oblak

Article Category: Review

Published Online: Aug 02, 2018

Page range: 233 - 244

Received: Mar 30, 2018

Accepted: Jun 12, 2018

DOI: https://doi.org/10.2478/raon-2018-0026

Keywordsbreast cancer, breast size, radiation side effects, organs at risk, treatment planning

© 2018 Ivica Ratosa, Aljasa Jenko, Irena Oblak, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background

Conclusions

Keywords
breast cancer, breast size, radiation side effects, organs at risk, treatment planning