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Research ArticleClinical Studies

Helical Tomotherapy of Lymph Node-negative Early-stage Breast Cancer After Breast-conserving Surgery: Long-term Results

FELIX ZWICKER, RUDOLF KLEPPER, HENRIK HAUSWALD, SEBASTIAN HOEFEL, LUIS RAETHER, PETER E. HUBER, JUERGEN DEBUS and MICHAEL SCHEMPP
Anticancer Research May 2023, 43 (5) 2041-2053; DOI: https://doi.org/10.21873/anticanres.16365
FELIX ZWICKER
1Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany;
2Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany;
3Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany;
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  • For correspondence: f.zwicker@dkfz.de
RUDOLF KLEPPER
2Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany;
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HENRIK HAUSWALD
1Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany;
4RNS Gemeinschaftspraxis, Wiesbaden, Germany;
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SEBASTIAN HOEFEL
2Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany;
5Department of Chemistry and Konstanz Research School Chemical Biology, University of Konstanz, Konstanz, Germany
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LUIS RAETHER
2Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany;
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PETER E. HUBER
1Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany;
3Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany;
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JUERGEN DEBUS
1Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany;
3Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany;
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MICHAEL SCHEMPP
2Clinic and Practice of Radiation Oncology/Practice of Radiology, Konstanz, Germany;
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Abstract

Background/Aim: Adjuvant radiotherapy is an integral part of the interdisciplinary curative treatment of breast cancer. We aimed to examine the long-term clinical results of helical tomotherapy in female patients with local restricted, lymph node negative breast cancer after breast-conserving surgery. Patients and Methods: In this single-centre analysis, 219 female patients with early-stage breast cancer (T1/2) and no lymph node metastasis (N0) following breast-conserving surgery and sentinel-node biopsy were treated with adjuvant fractionated whole breast radiation therapy using helical tomotherapy. When boost irradiation was indicated, it was administered sequentially or using the simultaneous-integrated boost technique. Local control (LC), metastasis and survival rates, acute toxicity, late toxicity, and secondary malignancy rates were analysed retrospectively. Results: The mean follow-up time was 71 months. The 5- and 8-year overall survival (OS) rates were 97.7% and 92.1%, respectively. The 5- and 8-year LC rates were 99.5% and 98.2%, while the 5- and 8-year metastasis-free survival (MFS) rates of 97.4% and 94.3%, respectively. Patients with G3 grading or negative hormone receptor status did not show significantly different results. Acute erythema occurred in 79% (grade 0-2) and 21% (grade 3) of the patients. Lymphedema of the ipsilateral arm and pneumonitis occurred in 6.4% and 1.8% of the treated patients. None of the patients developed >grade 3 toxicities during follow-up, while 1.8% developed a secondary malignancy during follow-up. Conclusion: Helical tomotherapy showed excellent long-term results and low toxicity rates. The incidence rates of secondary malignancy were relatively low and correlated with pre-existing data on radiotherapy, suggesting wider implementation of helical tomotherapy in adjuvant radiotherapy for breast cancer patients.

Key Words:
  • Breast cancer
  • radiotherapy
  • helical IMRT
  • tomotherapy
  • lymph node negative
  • secondary malignoma
  • lymphedema
  • long-term results
  • Received January 25, 2023.
  • Revision received March 23, 2023.
  • Accepted March 27, 2023.
  • Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.
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Anticancer Research: 43 (5)
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Helical Tomotherapy of Lymph Node-negative Early-stage Breast Cancer After Breast-conserving Surgery: Long-term Results
FELIX ZWICKER, RUDOLF KLEPPER, HENRIK HAUSWALD, SEBASTIAN HOEFEL, LUIS RAETHER, PETER E. HUBER, JUERGEN DEBUS, MICHAEL SCHEMPP
Anticancer Research May 2023, 43 (5) 2041-2053; DOI: 10.21873/anticanres.16365

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Helical Tomotherapy of Lymph Node-negative Early-stage Breast Cancer After Breast-conserving Surgery: Long-term Results
FELIX ZWICKER, RUDOLF KLEPPER, HENRIK HAUSWALD, SEBASTIAN HOEFEL, LUIS RAETHER, PETER E. HUBER, JUERGEN DEBUS, MICHAEL SCHEMPP
Anticancer Research May 2023, 43 (5) 2041-2053; DOI: 10.21873/anticanres.16365
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Keywords

  • Breast cancer
  • radiotherapy
  • helical IMRT
  • tomotherapy
  • lymph node negative
  • secondary malignoma
  • Lymphedema
  • long-term results
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