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| Home > Publications database > Hypofractionated and conventionally fractionated radiotherapy for synchronous bilateral breast cancer: clinical and dosimetric outcomes. |
| Home > Publications database > Hypofractionated and conventionally fractionated radiotherapy for synchronous bilateral breast cancer: clinical and dosimetric outcomes. |
| Journal Article | DKFZ-2026-01418 |
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2026
Springer Medizin
Heidelberg
Abstract: The irradiation of both breasts poses complex technical challenges. The overlapping treatment fields and large target volumes make dosimetry challenging, while data for hypofractionated regimens in this setting are limited.Bilateral breast cancer patients treated with moderately hypofractionated and conventionally fractionated radiotherapy were identified to evaluate dosimetric parameters, toxicity, and oncologic outcomes.Seventy patients treated with a median dose of 50.4 Gy in 28 fractions or 40.05 Gy in 15 fractions using 3D-CRT, IMRT, VMAT, or tomotherapy were identified. With a median follow-up of 45.3 months, the 1‑ and 5‑year overall survival rates were 96.1% and 88.7%, and the local control rates were 100% and 92.5%, respectively. The median lung and heart doses were 8.4 and 4.0 Gy for conventional fractionation and 7.6 and 3.1 Gy for hypofractionation, respectively. With conventional fractionation, acute toxicity (≥ grade 3) occurred in 11% of patients (skin), and late toxicity occurred in 4% (skin and cardiac). With hypofractionation, acute toxicity (≥ grade 3) occurred in 8% (skin); no late grade ≥ 3 toxicity was observed. Even though late skin toxicity was more frequent with conventional fractionation, this did not reach statistical significance (p = 0.056). Regarding RT techniques, only the use of helical tomotherapy was associated with higher incidences of acute ≥ grade 3 skin toxicity (p = 0.029).Our long-term findings support the use of moderately hypofractionated RT with VMAT as a safe option for bilateral whole-breast irradiation for synchronous bilateral breast cancer, demonstrating favorable outcomes. However, prospective data are still needed, especially for nodal and bilateral chest wall irradiation involving implants.
Keyword(s): Deep-inspiration breath hold ; Irradiation ; Radiation dermatitis ; Tomotherapy ; Toxicity ; Volumetric modulated arc therapy
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