{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:57:46Z","timestamp":1760057866918,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: this study aimed to evaluate the evolution of planned dose distribution quality in two groups of breast cancer patients treated with hypofractionated intensity-modulated radiotherapy (IMRT) using Helical TomoTherapy\u00ae at our institute 5 years apart. Methods: the analysis included two cohorts of patients who underwent implant-based immediate breast reconstruction (IBR) and received post-mastectomy IMRT to the chest wall and infra\/supraclavicular lymph nodes, following a 15-fraction regimen (2.67 Gy per fraction). The first group was treated between 2012 and 2015, while the second received treatment between 2019 and 2020. Dosimetric indices derived from dose\u2013volume histograms used in clinical practice were analyzed to assess dose distribution quality. A quantitative scoring system was applied retrospectively to compare the two groups in terms of target coverage and organ-at-risk (OAR) sparing. Additionally, capsular contracture (CC) incidence was examined in both cohorts. Results: A total of 240 patients were included in the study. The percentage of optimal treatment plans increased from 70.8% in the 2012\u20132015 cohort to 77.5% in the 2019\u20132020 cohort, while compromised plans decreased from 10.8% to 7.5%. Furthermore, the incidence of moderate-to-severe CC dropped from 54.8% in the earlier cohort to 43.5% in the later one. Conclusions: Helical Tomotherapy\u00ae has demonstrated the ability to achieve a high rate of optimal treatment plans concerning both PTV coverage and OAR sparing in a challenging population of postmastectomy patients with IBR. The learning curve showed that, after 5 years, the rate of optimal plans was increased, accompanied by a reduction in compromised plans and treatment-related toxicity.<\/jats:p>","DOI":"10.3390\/jcm14051630","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T02:48:37Z","timestamp":1740710917000},"page":"1630","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Plan Quality Comparison at Five Years in Two Cohorts of Breast Cancer Patients Treated with Helical Tomotherapy"],"prefix":"10.3390","volume":"14","author":[{"given":"Samantha","family":"Dicuonzo","sequence":"first","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0992-9022","authenticated-orcid":false,"given":"Maria Alessia","family":"Zerella","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4655-4634","authenticated-orcid":false,"given":"Mattia","family":"Zaffaroni","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7830-3149","authenticated-orcid":false,"given":"Maria Giulia","family":"Vincini","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Amin","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"},{"name":"Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Ronci","sequence":"additional","affiliation":[{"name":"Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micol","family":"D\u2019arcangelo","sequence":"additional","affiliation":[{"name":"Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8074-5042","authenticated-orcid":false,"given":"Damaris Patricia","family":"Rojas","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Morra","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna Alessandra","family":"Gerardi","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiana","family":"Fodor","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9894-068X","authenticated-orcid":false,"given":"Raffaella","family":"Cambria","sequence":"additional","affiliation":[{"name":"Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6882-3340","authenticated-orcid":false,"given":"Rosa","family":"Luraschi","sequence":"additional","affiliation":[{"name":"Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2488-7385","authenticated-orcid":false,"given":"Federica","family":"Cattani","sequence":"additional","affiliation":[{"name":"Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Veronesi","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy"},{"name":"Division of Breast Surgery, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6050-898X","authenticated-orcid":false,"given":"Francesca","family":"De Lorenzi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, IEO, IRCCS European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Rietjens","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, IEO, IRCCS European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Orecchia","sequence":"additional","affiliation":[{"name":"Scientifc Directorate, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Cristina","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-3673","authenticated-orcid":false,"given":"Barbara Alicja","family":"Jereczek-Fossa","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, European Institute of Oncology IRCCS, 20141 Milan, Italy"},{"name":"Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"EBCTCG (Early Breast Cancer Trialists\u2019 Collaborative Group), McGale, P., Taylor, C., Correa, C., Cutter, D., Duane, F., Ewertz, M., and Wang, Y. 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