Robotic Stereotactic Radioablation Concomitant With Neo-Adjuvant Chemotherapy for Breast Tumors
Received 12 June 2008; received in revised form 11 December 2008; accepted 11 December 2008. published online 21 April 2009.
Purpose
Robotic stereotactic radioablation (RSR) allows stereotactic irradiation of thoracic tumors; however, it has never been used for breast tumors and may have a real potential. We conducted a Phase I study, including neoadjuvant chemotherapy (NACT), a two-level dose-escalation study (6.5 Gy × 3 fractions and 7.5 Gy × 3 fractions) using RSR and breast-conserving surgery followed by conventional radiotherapy.
Materials and Methods
To define toxicity, we performed a dermatologic exam (DE) including clinical examination by two independent observers and technical examination by colorimetry, dermoscopy, and skin ultrasound. DE was performed before NACT (DE0), at 36 days (DE1), at 56 days (DE2), after the NACT treatment onset, and before surgery (DE3). Surgery was performed 4–8 weeks after the last chemotherapy session. A pathologic examination was also performed.
Results
There were two clinical complete responses and four clinical partial responses at D56 and D85. Maximum tolerable dose was not reached. All patients tolerated RSR with no fatigue; 2 patients presented with mild pain after the third fraction of the treatment. There was no significant toxicity measured with ultrasound and dermoscopy tests. Postoperative irradiation (50 Gy) has been delivered without toxicity.
Conclusion
The study showed the feasibility of irradiation with RSR combined with chemotherapy and surgery for breast tumors. There was no skin toxicity at a dose of 19.5 Gy or 22.5 Gy delivered in three fractions combined with chemotherapy. Lack of toxicity suggested that the dose could be increased further. Pathologic response was acceptable.
Reprint requests to: Pierre-Yves Bondiau, Département de Radiothérapie, Centre Antoine Lacassagne, 33 av de Valombrose, 06189 Nice, France. Tel: +33 4 92 03 12 61; Fax: +33 4 92 03 15 70
ABSTRACT