AUTHOR=Bazan Jose G. , DiCostanzo Dominic , Hock Karen , Jhawar Sachin , Kuhn Karla , Lindsey Kylee , Tedrick Kayla , Healy Erin , Beyer Sasha , White Julia R. 

TITLE=Analysis of Radiation Dose to the Shoulder by Treatment Technique and Correlation With Patient Reported Outcomes in Patients Receiving Regional Nodal Irradiation

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.617926

DOI=10.3389/fonc.2021.617926

ISSN=2234-943X

ABSTRACT=BACKGROUND/PURPOSE:  Shoulder/arm morbidity is a late complication of breast cancer treatment with surgery and regional nodal irradiation (RNI).  We set to analyze the impact of radiation technique (intensity modulated radiation therapy [IMRT] or 3D conformal radiation therapy [3DCRT]) on radiation dose to the shoulder with a hypothesis that IMRT use results in smaller volume of shoulder receiving radiation. We explored the relationship of treatment technique on long-term patient-reported outcomes using the quick Disabilities of the Arm, Shoulder, and Hand (q-DASH) questionnaire.   

MATERIALS/METHODS: We identified patients treated with adjuvant RNI (50 Gy/25 fractions) from 2013-2018. We retrospectively contoured the shoulder organ-at-risk (OAR) from 2 cm above the ipsilateral supraclavicular (SCL) planning target volume (PTV) to the inferior SCL PTV slice and calculated the absolute volume of shoulder OAR receiving 5-50 Gy (V5-V50). We identified patients that completed a q-DASH questionnaire ≥6 months from the end of RNI. 

RESULTS: We included 410 RNI patients: 54% stage III, 72% mastectomy, 35% treated with IMRT.  IMRT resulted in significant reductions in the shoulder OAR volume receiving 20-50 Gy vs. 3DCRT. In total, 82 patients completed the q-DASH. The mean (SD) q-DASH=25.4 (19.1) and tended to be lower with IMRT vs. 3DCRT: 19.6 (16.4) vs. 27.8 (19.8), p=0.078.

CONCLUSION: We found that IMRT reduces radiation dose to the shoulder and is associated with a trend towards reduced q-DASH scores ≥6 months post-RNI in a subset of our cohort.  These results support prospective evaluation of IMRT as a technique to reduce shoulder morbidity in breast cancer patients receiving RNI.