Acute toxicity outcomes and dosimetric implications from incidental irradiation of adjacent tissues in tangent field hypofractionated breast radiotherapy

Sara R. Alcorn, Lindsey Sloan, Todd R. McNutt, Susan F. Stinson, Fariba Asrari, Victoria J. Croog, Bethlehem Floreza, Arcelia Weaver, Jean L. Wright

Research output: Contribution to journalArticlepeer-review


Purpose: Adjacent tissues-in-beam (TIB) may receive substantial incidental doses within standard tangent fields during hypofractioned whole breast irradiation (HF-WBI). To characterize the impact of dose to TIB, we analyzed dosimetric parameters of TIB and associated acute toxicity. Materials and Methods: Plans prescribed to 40.5 Gy/15 fractions from 4/2016-1/2018 were evaluated. Structures of interest were contoured: (1) TIB: all tissues encompassed by plan 30% isodose lines, (2) breast, (3) non-breast TIB (nTIB): TIB minus contoured breast. Volumes of TIB, breast, and nTIB receiving 100%–107% of prescription dose (V100-V107) were calculated. Twelve patient- and physician-reported acute toxicities were prospectively collected weekly. Correlations between volumetric and dosimetric parameters were assessed. Uni- and multivariable logistic regressions evaluated toxicity grade changes as a function of TIB, breast, and nTIB V100-V107 (in cm3). Results: We evaluated 137 plans. Breast volume was positively correlated with nTIB and nTIB V100 (rho = 0.52, rho = 0.30, respectively, both p < 0.001). V107 > 2 cm3 were noted in 14% of breast and 21% of nTIB volumes. On multivariable analyses, increasing breast and nTIB V100 significantly raised odds of grade 2+ dermatitis and burning/twinging pain, respectively; increasing nTIB V105 elevated odds of hyperpigmentation and burning pain; and increasing nTIB V107 raised odds of burning pain. Threshold volumes for >6-fold odds of developing burning pain were TIB V105 > 100 cm3 and V107 > 5 cm3. Conclusions: For HF-WBI, doses to nTIB over the prescription predicted acute toxicities independent of breast doses. These data support inclusion of TIB as a region of interest in treatment planning and protocol design

Original languageEnglish (US)
Pages (from-to)345-350
Number of pages6
JournalReports of Practical Oncology and Radiotherapy
Issue number3
StatePublished - May 1 2020
Externally publishedYes

Bibliographical note

Funding Information:
Each co-author listed is an employee of the Johns Hopkins University School of Medicine. Dr. Sara Alcorn received grant support from National Institutes of Health KL2 award, 5KL2TR001077. Otherwise, there are no other conflicts of interest to disclose.

Publisher Copyright:
© 2020


  • Acute toxicity
  • Breast irradiation
  • Non-breast tissues

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