{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:56:33Z","timestamp":1790787393618,"version":"4.1.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T00:00:00Z","timestamp":1660780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Volumetric Modulated Arc Therapy (VMAT) exhibits potent advantages regarding target volume coverage and protection of organs at risk, notably in the context of anatomical constraints. Nevertheless, reports concerning VMAT for the treatment of synchronous bilateral breast cancers (SBBC) have been scarce to date. As such, we conducted this observational study to assess efficacy, safety and feasibility of VMAT in SBBC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>From August 2011 to December 2017, 54 consecutive patients with SBBC with or without axillary nodes involvement underwent a treatment protocol containing radiotherapy using VMAT. A total dose (TD) of 52.2Gy in 29 fractions was delivered to breast and internal mammary chain (IMC) nodes Planning Target Volume (PTV) plus, if applicable, a TD of 49.3Gy in 29 fractions to the supra- and infra-clavicular nodes PTV and a TD of 63.22Gy in 29 fractions to tumor boost PTV. Lungs, heart, esophagus, trachea, liver, thyroid and spinal cord were considered as organs at risk. VMAT feasibility and organ at risk sparing were evaluated by treatments planning of the 20 first enrolled patients. Tolerance and patients\u2019 outcome were prospectively monitored by acute\/late toxicities records and by the analysis of overall survival (OS), locoregional recurrence-free survival (LRFS) and recurrence-free survival (RFS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Breast, supraclavicular nodes and boost PTV coverage was adequate with at least 98% of PTV encompassed by more than 95% of the prescribed dose. Less than 90% of IMC PTV was encompassed by 95% of the prescribed dose. Mean lung dose was 12.3Gy (range: 7.7 \u2013 18.7); mean heart dose was 10.7Gy (range: 6.2 \u2013 22.3). Concerning acute toxicities, only 2 patients experienced grade 3 skin toxicity (3.7%) and only 1 patient developed grade 1 pneumonitis. After a median follow-up of 5.3 years, grade 2 fibrosis and\/or shrinking was observed in 5 patients (10%), and grade 3 fibrosis in 1 patients (2%). The 5-year LRFS-rate, RFS-rate and OS were 98% [95% CI= 86.12-99.70%], 96% [95% CI= 84.63-98.96%] and 100%, respectively.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.967479","type":"journal-article","created":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T05:11:52Z","timestamp":1660799512000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy, safety, and feasibility of volumetric modulated arc therapy for synchronous bilateral breast cancer management"],"prefix":"10.3389","volume":"12","author":[{"given":"Stanislas","family":"Quesada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Fenoglietto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Gourgou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Lemanski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Draghici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Ailleres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Prunaretty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Azria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Bourgier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA A Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-010-1057-y","article-title":"Bilateral breast cancer: analysis of incidence, outcome, survival and disease characteristics","volume":"126","author":"Kheirelseid","year":"2011","journal-title":"Breast Cancer Res Treat"},{"key":"B3","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s13014-020-01501-x","article-title":"Recent advances in radiotherapy of breast cancer","volume":"15","author":"Haussmann","year":"2020","journal-title":"Radiat Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61629-2","article-title":"Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials","volume":"378","year":"2011","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)30067-5","article-title":"10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study","volume":"17","author":"van Maaren","year":"2016","journal-title":"Lancet Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1259\/bjr\/24112047","article-title":"Dosimetric advantages of generalised equivalent uniform dose-based optimisation on dose-volume objectives in intensity-modulated radiotherapy planning for\u00a0bilateral breast cancer","volume":"85","author":"Lee","year":"2012","journal-title":"Br J Radiol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1186\/1748-717X-4-27","article-title":"Simultaneous integrated boost radiotherapy for bilateral breast: a treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapy","volume":"4","author":"Nicolini","year":"2009","journal-title":"Radiat Oncol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.meddos.2017.08.003","article-title":"Radiation therapy of synchronous bilateral breast carcinoma (SBBC) using multiple techniques","volume":"43","author":"Kim","year":"2018","journal-title":"Med Dosim"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.meddos.2020.01.006","article-title":"Dosimetric comparison of helical tomotherapy, volumetric-modulated arc therapy, intensity-modulated radiotherapy, and field-in-field technique for synchronous bilateral breast cancer","volume":"45","author":"Cheng","year":"2020","journal-title":"Med Dosim"},{"key":"B10","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.rpor.2015.05.011","article-title":"Volumetric modulated arc therapy for synchronous bilateral whole breast irradiation - a case study","volume":"20","author":"Sepp\u00e4l\u00e4","year":"2015","journal-title":"Rep Pract Oncol Radiother"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1186\/1748-717X-7-145","article-title":"Phase I-II study of hypofractionated simultaneous integrated boost using volumetric modulated arc therapy for adjuvant radiation therapy in breast cancer patients: a report of feasibility and early toxicity results in the first 50 treatments","volume":"7","author":"Scorsetti","year":"2012","journal-title":"Radiat Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-011-0652-7","article-title":"Helical tomotherapy in patients with breast cancer and complex treatment volumes","volume":"13","author":"Cendales","year":"2011","journal-title":"Clin Transl Oncol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.breast.2016.05.004","article-title":"Helical tomotherapy for bilateral breast cancer: Clinical experience","volume":"28","author":"Kaidar-Person","year":"2016","journal-title":"Breast"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s11547-017-0741-y","article-title":"Synchronous bilateral breast cancer irradiation: clinical and dosimetrical issues using volumetric modulated arc therapy and simultaneous integrated boost","volume":"122","author":"Fiorentino","year":"2017","journal-title":"Radiol Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s12094-019-02077-z","article-title":"Skin and lung toxicity in synchronous bilateral breast cancer treated with volumetric-modulated arc radiotherapy: a mono-institutional experience","volume":"21","author":"Valli","year":"2019","journal-title":"Clin Transl Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.07.2292","article-title":"Exposure of the heart in breast cancer radiation therapy: A systematic review of heart doses published during 2003 to 2013","volume":"93","author":"Taylor","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3626","DOI":"10.1038\/s41598-021-83159-3","article-title":"Correlation between toxicity and dosimetric parameters for adjuvant intensity modulated radiation therapy of breast cancer: a prospective study","volume":"11","author":"Pasquier","year":"2021","journal-title":"Sci Rep"},{"key":"B18","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1097\/01.coc.0000197661.09628.03","article-title":"Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer","volume":"29","author":"Freedman","year":"2006","journal-title":"Am J Clin Oncol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"998","DOI":"10.1016\/j.ijrobp.2009.03.027","article-title":"Radiosensitization of chemotherapy-refractory, locally advanced or locally recurrent breast cancer with trastuzumab: a phase II trial","volume":"76","author":"Horton","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.967479\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T05:11:55Z","timestamp":1660799515000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.967479\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,18]]},"references-count":19,"alternative-id":["10.3389\/fonc.2022.967479"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.967479","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,18]]},"article-number":"967479"}}