Background: To report toxicity and early clinical outcomes of hypofractionated simultaneous integrated boost (SIB)\napproach with Volumetric Modulated Arc Therapy (VMAT) as adjuvant treatment after breast-conserving surgery.\nMethods: Patients presenting early-stage breast cancer were enrolled in a phase II trial. Eligibility criteria: age > 18 years\nold, invasive cancer or ductal carcinoma in situ (DCIS), Stage I-II (T < 3 cm and N ââ?°Â¤ 3), breast-conserving surgery without\noncoplastic reconstruction. Any systemic therapy was allowed in neoadjuvant or adjuvant setting. All patients\nunderwent VMAT-SIB technique to irradiate the whole breast and the tumor bed. Doses to whole breast and surgical\nbed were 40.5 Gy and 48 Gy, respectively, delivered in 15 fractions over 3 weeks. Acute and late skin toxicities were\nrecorded. Cosmetic outcome was assessed as excellent/good or fair/poor.\nResults: The present study focused on results of a cohort of 144 patients with a minimum follow-up of 24 months\n(median 37, range 24ââ?¬â??55 months). Median age was 62 years old (range 30ââ?¬â??88). All patients had an invasive\ncarcinoma (no patients with DCIS were present in this subset). At one year, the highest reported skin toxicity was\nG1, in 14 % of the patients; this data dropped to 4 % at the last follow-up, after more than 2 years. Breast pain was\nrecorded in 21.6 % of the patients 6 months after treatment, while it was present in 3.5 % of the patients at the\nlast follow-up, showing a significant improvement with time. Correlation between liponecrosis and boost target\nvolume was found not significant. Breast pain was correlated with breast volume. No pulmonary or cardiological\ntoxicities were recorded. After an early evaluation of clinical outcomes, only one case presented disease relapse, as\nliver metastases.\nConclusions: The 3-week VMAT-SIB course as adjuvant treatment after breast-conserving surgery showed to be\nwell tolerated and was associated with optimal local control. Long-term follow-up data are needed to assess late\ntoxicity and clinical outcomes.
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