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Peer-reviewedCC BY 4.0Strahlentherapie Und Onkologie

Hypofractionated and conventionally fractionated radiotherapy for synchronous bilateral breast cancer: clinical and dosimetric outcomes

  • Bahar Cepni1,2,3
  • Line Hoeltgen1,2,3,4
  • David Neugebauer1,2
  • Vania Batista1,2
  • Nathalie Arians1,2,3,4
  • Jakob Liermann1,2,3,4
  • Lars Wessel1,2,3
  • Maria Vinsensia1,2,3
  • Semi Harrabi1,2,3,4
  • Hanna Waldsperger1,2,3,4
  • Thomas Tessonnier1,2,3,4
  • Juliane Hörner-Rieber1,5
2 more authors
  • Jürgen Debus1,2,3,4,6
  • Eva Meixner1,2,3,4
6 affiliations
  1. 1Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
  2. 2Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
  3. 3National Center for Tumor diseases (NCT), Heidelberg, Germany
  4. 4Heidelberg Ion Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
  5. 5Department of Radiation Oncology, University Hospital Düsseldorf, Düsseldorf, Germany
  6. 6German Cancer Research Center (DKFZ), Clinical Cooperation Unit Radiation Oncology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
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Abstract

Background: 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.

Methods: Bilateral breast cancer patients treated with moderately hypofractionated and conventionally fractionated radiotherapy were identified to evaluate dosimetric parameters, toxicity, and oncologic outcomes.

Results: 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).

Conclusion: 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.

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Cite

BibTeXRIS
BibTeX
@article{cepni2026hypofractionated,
  title = {{Hypofractionated and conventionally fractionated radiotherapy for synchronous bilateral breast cancer: clinical and dosimetric outcomes}},
  author = {Bahar Cepni and Line Hoeltgen and David Neugebauer and Vania Batista and Nathalie Arians and Jakob Liermann and Lars Wessel and Maria Vinsensia and Semi Harrabi and Hanna Waldsperger and Thomas Tessonnier and Juliane Hörner-Rieber and Jürgen Debus and Eva Meixner},
  journal = {Strahlentherapie Und Onkologie},
  year = {2026},
  month = jun,
  doi = {10.1007/s00066-026-02558-5},
  url = {https://doi.org/10.1007/s00066-026-02558-5},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Hypofractionated and conventionally fractionated radiotherapy for synchronous bilateral breast cancer: clinical and dosimetric outcomes
AU  - Bahar Cepni
AU  - Line Hoeltgen
AU  - David Neugebauer
AU  - Vania Batista
AU  - Nathalie Arians
AU  - Jakob Liermann
AU  - Lars Wessel
AU  - Maria Vinsensia
AU  - Semi Harrabi
AU  - Hanna Waldsperger
AU  - Thomas Tessonnier
AU  - Juliane Hörner-Rieber
AU  - Jürgen Debus
AU  - Eva Meixner
PY  - 2026
DA  - 2026/06/11
JO  - Strahlentherapie Und Onkologie
DO  - 10.1007/s00066-026-02558-5
UR  - https://doi.org/10.1007/s00066-026-02558-5
AB  - Background: 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.  Methods: Bilateral breast cancer patients treated with moderately hypofractionated and conventionally fractionated radiotherapy were identified to evaluate dosimetric parameters, toxicity, and oncologic outcomes.  Results: 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).  Conclusion: 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.
SN  - 0179-7158
SN  - 1439-099X
ER  -