Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Patients with large breasts can be a challenge for the delivery of adjuvant radiation therapy:
    • As they have typically had higher acute and late toxicity as well as inferior cosmesis:
      • One potential explanation for this is that they may have larger hot spots of increased radiation dose compared to patients with smaller breasts
  • Several techniques have been devised to reduce these hot spots and thereby reduce toxicity:
    • Intensity-modulated radiation therapy has been shown in randomized trials to reduce acute and chronic toxicity, with institutional data demonstrating reductions in toxicity in women with large breasts by reducing hot spots and improving homogeneity
  • Proton therapy is not widely utilized to deliver WBI as there are no data supporting improvement in toxicity in women with large breasts with WBI
  • Electrons are typically utilized in treating the chest wall or as part of a tumor bed boost, but are not utilized to deliver WBI
  • Neutron therapy is limited in its availability and is not routinely used to deliver WBI
  • References
    • Donovan E, Bleakley N, Denholm E, et al; Breast Technology Group. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007;82(3):254-264.
    • Hille-Betz U, Baske B, Bremer M, et al. Late radiation side effects, cosmetic outcomes, and pain in breast cancer patients after breast-conserving surgery and three-dimensional conformal radiotherapy: risk modifying factors. Strahlenther Onkol. 2016;192(1):8-16.
    • Pignol JP, Olivotto I, Rakovitch E, et al. A multicenter randomized trial of breast intensity modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008;26(13):2085-2092.
    • Shah C, Wobb J, Grills I, Wallace M, Mitchell C, Vicini FA. Use of intensity modulated radiation therapy to reduce acute and chronic toxicities of breast cancer patients treated with traditional and accelerated whole breast irradiation. Pract Radiat Oncol. 2012;2(4):e45-e51.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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