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Maria P, Theodoros S, Anna Z, Michael P, Vassilis K, Kalliopi P. Synchronous bilateral chest wall irradiation with regional nodal irradiation: A literature review of techniques and a case study. Phys Med 2022; 101:50-61. [PMID: 35961182 DOI: 10.1016/j.ejmp.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/03/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022] Open
Abstract
The optimal radiotherapy technique for patients requiring both breasts or chest walls simultaneous irradiation with or without regional nodal irradiation is currently under investigation. In the last decade several publications present case reports and case series of patients treated with adjuvant radiotherapy in both breasts or chest walls for synchronous bilateral breast cancer (SBBC) with modern radiotherapy techniques. This article presents a systematic review of relevant literature as well as a case report of a SBBC patient who received bilateral chest wall radiotherapy with regional nodal irradiation at our institution with Truebeam - Edge Linear Accelerator. Solid evidence is provided that the practice of avoiding adjuvant radiotherapy in SBBC out of fear of toxicity with older radiotherapy techniques is outdated. Modern techniques can safely and effectively deliver treatment to patients requiring both sides irradiation and even in mastectomy patients in need of regional nodal irradiation.
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Affiliation(s)
- Protopapa Maria
- Mediterraneo General Hospital, Radiation Oncology and Radiosurgery Department, Ilias st. 8-12, Glyfada, Greece.
| | - Stroumbinis Theodoros
- Mediterraneo General Hospital, Radiation Oncology and Radiosurgery Department, Ilias st. 8-12, Glyfada, Greece
| | - Zygogianni Anna
- National and Kapodistrian University of Athens, Medical School, 1st Dpt of Radiology, RT Unit, Aretaieion University Hospital, Greece
| | - Psarras Michael
- Mediterraneo General Hospital, Radiation Oncology and Radiosurgery Department, Ilias st. 8-12, Glyfada, Greece
| | - Kouloulias Vassilis
- National and Kapodistrian University of Athens, Medical School, 2nd Dpt of Radiology, RT Unit, ATTIKON University Hospital, Greece
| | - Platoni Kalliopi
- National and Kapodistrian University of Athens, Medical School, 2nd Dpt of Radiology, RT Unit, ATTIKON University Hospital, Greece; National and Kapodistrian University of Athens, Medical School, 2nd Dpt of Radiology, Medical Physics Unit, ATTIKON University Hospital, Greece
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202
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Chen X, Yang TX, Xia YX, Shen Q, Hou Y, Wang L, Li L, Chang L, Li WH. Optimal radiotherapy after breast-conserving surgery for early breast cancer: A network meta-analysis of 23,418 patients. Cancer Radiother 2022; 26:1054-1063. [PMID: 36036359 DOI: 10.1016/j.canrad.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/09/2022] [Accepted: 04/08/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In order to explore whether partial breast irradiation can replace hypofractionated whole breast irradiation and whether the former two are superior to conventional fractionated whole breast irradiation, we conducted a network meta-analysis based on the data from the latest randomized controlled trials to evaluate the efficacy of these radiotherapy modalities. MATERIAL AND METHODS Data from eligible studies were analyzed to determine the published events for ipsilateral breast tumor recurrence, distant metastasis, total deaths, and non-breast cancer-related deaths. In the case of low or high heterogeneity, the fixed-effect or random-effect model was used for statistical analysis respectively. NMA was performed by using the node-splitting model for two-category data among three radiotherapies based on a Bayesian method. RESULTS A total of 23,418 patients were included in 16 studies. For ipsilateral breast tumor recurrence, both pairwise (OR=1.9; CI95%: 1.2 -2.8; p<0.05) and indirect (OR=1.7; CI95%: 1.2 -2.4; p<0.05) comparison of three radiotherapies by network meta-analysis showed that conventional fractionated whole breast irradiation was significantly better than partial breast irradiation. Indirect comparison of three radiotherapies by network meta-analysis showed that hypofractionated whole breast irradiation was significantly better than partial breast irradiation (OR=1.6; CI95%: 1.0 -2.5; p<0.05). Network and paired meta-analyses found no significant differences in other endpoints among the three radiotherapies. CONCLUSION Overall, this network meta-analysis showed that partial breast irradiation was related to the increase of ipsilateral breast tumor recurrence compared with hypofractionated or conventional fractionated whole breast irradiation in patients with early-stage breast cancer.
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Affiliation(s)
- X Chen
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China
| | - T-X Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, No. 374 Dian-Mian Avenue, Kunming, Yunnan, 650101, PR China
| | - Y-X Xia
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China
| | - Q Shen
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China
| | - Y Hou
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China
| | - L Wang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China
| | - L Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China
| | - L Chang
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China.
| | - W-H Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, NO. 519 Kunzhou Road, Kunming, Yunnan, 650101, PR China.
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Chua BH, Link EK, Kunkler IH, Whelan TJ, Westenberg AH, Gruber G, Bryant G, Ahern V, Purohit K, Graham PH, Akra M, McArdle O, O'Brien P, Harvey JA, Kirkove C, Maduro JH, Campbell ID, Delaney GP, Martin JD, Vu TTT, Muanza TM, Neal A, Olivotto IA. Radiation doses and fractionation schedules in non-low-risk ductal carcinoma in situ in the breast (BIG 3-07/TROG 07.01): a randomised, factorial, multicentre, open-label, phase 3 study. Lancet 2022; 400:431-440. [PMID: 35934006 DOI: 10.1016/s0140-6736(22)01246-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Whole breast irradiation (WBI) after conservative surgery for ductal carcinoma in situ (DCIS) reduces local recurrence. We investigated whether a tumour bed boost after WBI improved outcomes, and examined radiation dose fractionation sensitivity for non-low-risk DCIS. METHODS The study was an international, randomised, unmasked, phase 3 trial involving 136 participating centres of six clinical trials organisations in 11 countries (Australia, New Zealand, Singapore, Canada, the Netherlands, Belgium, France, Switzerland, Italy, Ireland, and the UK). Eligible patients were women aged 18 years or older with unilateral, histologically proven, non-low-risk DCIS treated by breast-conserving surgery with at least 1 mm of clear radial resection margins. They were assigned to one of four groups (1:1:1:1) of no tumour bed boost versus boost after conventional versus hypofractionated WBI, or randomly assigned to one of two groups (1:1) of no boost versus boost after each centre prespecified conventional or hypofractionated WBI. The conventional WBI used was 50 Gy in 25 fractions, and hypofractionated WBI was 42·5 Gy in 16 fractions. A boost dose of 16 Gy in eight fractions, if allocated, was delivered after WBI. Patients and clinicians were not masked to treatment allocation. The primary endpoint was time to local recurrence. This trial is registered with ClinicalTrials.gov (NCT00470236). FINDINGS Between June 25, 2007, and June 30, 2014, 1608 patients were randomly assigned to have no boost (805 patients) or boost (803 patients). Conventional WBI was given to 831 patients, and hypofractionated WBI was given to 777 patients. Median follow-up was 6·6 years. The 5-year free-from-local-recurrence rates were 92·7% (95% CI 90·6-94·4%) in the no-boost group and 97·1% (95·6-98·1%) in the boost group (hazard ratio 0·47; 0·31-0·72; p<0·001). The boost group had higher rates of grade 2 or higher breast pain (10% [8-12%] vs 14% [12-17%], p=0·003) and induration (6% [5-8%] vs 14% [11-16%], p<0·001). INTERPRETATION In patients with resected non-low-risk DCIS, a tumour bed boost after WBI reduced local recurrence with an increase in grade 2 or greater toxicity. The results provide the first randomised trial data to support the use of boost radiation after postoperative WBI in these patients to improve local control. The international scale of the study supports the generalisability of the results. FUNDING National Health and Medical Research Council of Australia, Susan G Komen for the Cure, Breast Cancer Now, OncoSuisse, Dutch Cancer Society, Canadian Cancer Trials Group.
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Affiliation(s)
- Boon H Chua
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.
| | - Emma K Link
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Ian H Kunkler
- Edinburgh Cancer Research Centre, Institute of Genetic and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Timothy J Whelan
- McMaster University, Department of Oncology, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Guenther Gruber
- Institute for Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
| | - Guy Bryant
- University of Queensland, Brisbane, QLD, Australia
| | - Verity Ahern
- University of Sydney, Sydney, NSW, Australia; Westmead Hospital, Westmead, NSW, Australia
| | - Kash Purohit
- University of Sheffield, Sheffield, UK; Weston Park Hospital, Broomhall, Sheffield, UK
| | - Peter H Graham
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; St George Hospital, Kogarah, NSW, Australia
| | - Mohamed Akra
- University of Manitoba, Winnipeg, MB, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Orla McArdle
- Cancer Trials Ireland, Dublin, Ireland; St Luke's Radiation Oncology Network, Beaumont Hospital, Beaumont, Dublin, Ireland
| | - Peter O'Brien
- University of Newcastle, Newcastle, NSW, Australia; GenesisCare, Gateshead, NSW, Australia
| | - Jennifer A Harvey
- University of Queensland, Brisbane, QLD, Australia; Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Carine Kirkove
- Université Catholique de Louvain, Brussels, Belgium; Cliniques Universitaires St Luc, Bruxelles, Belgium
| | - John H Maduro
- Department of Radiation Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Ian D Campbell
- University of Auckland, Auckland, New Zealand; Waikato Hospital, Hamilton, New Zealand
| | - Geoff P Delaney
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Liverpool Hospital, Liverpool, NSW, Australia
| | - Joseph D Martin
- National University of Ireland, Galway, Ireland; University Hospital Galway, Galway, Ireland
| | - T Trinh T Vu
- Université de Montréal, Montreal, QC, Canada; Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Pfaffendorf C, Vonthein R, Krockenberger-Ziegler K, Dellas K, Schreiber A, Uhlemann D, Dinges S, Würschmidt F, Andreas P, Weinstrauch E, Eilf K, Rades D, Höller U, Combs SE, Kazmierczak R, Fehlauer F, Schreck U, Zimmer J, Dunst J, Krug D. Hypofractionation with simultaneous integrated boost after breast-conserving surgery: Long term results of two phase-II trials. Breast 2022; 64:136-142. [PMID: 35691249 PMCID: PMC9190051 DOI: 10.1016/j.breast.2022.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Methods Results Conclusion Hypofractionated breast radiotherapy with SIB was safe and feasible. The local control rate at 5 years was 99.6%. The rate of late grade 3 toxicity was 0.7%.
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205
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Van Baelen K, Geukens T, Maetens M, Tjan-Heijnen V, Lord CJ, Linn S, Bidard FC, Richard F, Yang WW, Steele RE, Pettitt SJ, Van Ongeval C, De Schepper M, Isnaldi E, Nevelsteen I, Smeets A, Punie K, Voorwerk L, Wildiers H, Floris G, Vincent-Salomon A, Derksen PWB, Neven P, Senkus E, Sawyer E, Kok M, Desmedt C. Current and future diagnostic and treatment strategies for patients with invasive lobular breast cancer. Ann Oncol 2022; 33:769-785. [PMID: 35605746 DOI: 10.1016/j.annonc.2022.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Invasive lobular breast cancer (ILC) is the second most common type of breast cancer after invasive breast cancer of no special type (NST), representing up to 15% of all breast cancers. DESIGN Latest data on ILC are presented, focusing on diagnosis, molecular make-up according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT) guidelines, treatment in the early and metastatic setting and ILC-focused clinical trials. RESULTS At the imaging level, magnetic resonance imaging-based and novel positron emission tomography/computed tomography-based techniques can overcome the limitations of currently used imaging techniques for diagnosing ILC. At the pathology level, E-cadherin immunohistochemistry could help improving inter-pathologist agreement. The majority of patients with ILC do not seem to benefit as much from (neo-)adjuvant chemotherapy as patients with NST, although chemotherapy might be required in a subset of high-risk patients. No differences in treatment efficacy are seen for anti-human epidermal growth factor receptor 2 (HER2) therapies in the adjuvant setting and cyclin-dependent kinases 4 and 6 inhibitors in the metastatic setting. The clinical utility of the commercially available prognostic gene expression-based tests is unclear for patients with ILC. Several ESCAT alterations differ in frequency between ILC and NST. Germline BRCA1 and PALB2 alterations are less frequent in patients with ILC, while germline CDH1 (gene coding for E-cadherin) alterations are more frequent in patients with ILC. Somatic HER2 mutations are more frequent in ILC, especially in metastases (15% ILC versus 5% NST). A high tumour mutational burden, relevant for immune checkpoint inhibition, is more frequent in ILC metastases (16%) than in NST metastases (5%). Tumours with somatic inactivating CDH1 mutations may be vulnerable for treatment with ROS1 inhibitors, a concept currently investigated in early and metastatic ILC. CONCLUSION ILC is a unique malignancy based on its pathological and biological features leading to differences in diagnosis as well as in treatment response, resistance and targets as compared to NST.
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Affiliation(s)
- K Van Baelen
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - T Geukens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - M Maetens
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - V Tjan-Heijnen
- Medical Oncology Department, Maastricht University Medical Center (MUMC), School of GROW, Maastricht, The Netherlands
| | - C J Lord
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Linn
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Medical Oncology, Amsterdam, The Netherlands; Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F-C Bidard
- Department of Medical Oncology, Institut Curie, UVSQ/Paris-Saclav University, Paris, France
| | - F Richard
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | - W W Yang
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - R E Steele
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S J Pettitt
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - C Van Ongeval
- Departments of Radiology, UZ Leuven, Leuven, Belgium
| | - M De Schepper
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium; Pathology, UZ Leuven, Leuven, Belgium
| | - E Isnaldi
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - A Smeets
- Surgical Oncology, UZ Leuven, Leuven, Belgium
| | - K Punie
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - L Voorwerk
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Wildiers
- General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - G Floris
- Pathology, UZ Leuven, Leuven, Belgium
| | | | - P W B Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Neven
- Departments of Gynaecology and Obstetrics, UZ Leuven, Leuven, Belgium
| | - E Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - E Sawyer
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, Guy's Cancer Centre, King's College London, London, UK
| | - M Kok
- Departments of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Tumour Biology and Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Desmedt
- Laboratory for Translational Breast Cancer Research (LTBCR), Department of Oncology, KU Leuven, Leuven, Belgium.
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de Siqueira GS, Hanna SA, de Moura LF, Miranda FA, Carvalho HDA, Marta GN. Moderately hypofractionated radiation therapy for breast cancer: A Brazilian cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100323. [PMID: 36777384 PMCID: PMC9903971 DOI: 10.1016/j.lana.2022.100323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Results from numerous clinical trials have led to a consensus that moderately hypofractionated radiation therapy is the ideal postoperative irradiation treatment plan in patients with breast cancer (BC). However, there are specific situations such as chest wall (with or without breast reconstruction) and regional node irradiation that still face obstacles in its widespread use. There is a lack of evidence supporting the use of moderately hypofractionated irradiation from the Latin American context. This study aims to describe the profile and clinical outcomes of patients treated with moderate hypofractionation for both early-stage (Stage I and II) and locally advanced BC (Stage III) regardless of the type of surgery in a Brazilian Oncology Center. Methods All patients with non-metastatic BC who were treated with moderately hypofractionated schedules of 40Gy in 15 fractions or 42.4Gy in 16 fractions between 2010 to 2019 at Hospital Sírio-Libanês, Brazil were retrospectively analyzed. The rates of local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distance recurrence-free survival (DRFS) and overall survival (OS) were estimated. Acute and late toxicity profiles were accessed for the entire cohort. Findings A total of 670 patients were included. The median age was 57 years and the median follow-up time was 31 months. Most of the patients had stage I and II breast cancer, and 81.6% underwent breast-conserving surgery. Of the 123 women who underwent mastectomy treatment, 29% (n = 37) had immediate reconstruction with implants and 28% (n = 35) with autologous tissue. Seventy-one per cent of the patients presented luminal subtype tumour and 84.3% received adjuvant hormonal therapy. Chemotherapy was administered to almost half of the patients and all 80 patients with Her-2 positive disease received trastuzumab-based systemic therapy. One-third of patients received regional node irradiation; boost was performed in 41.1% of treatments. The 5-year LRFS, RRFS, DRFS and OS was 95.6%, 97.6%,92.2% and 95.9%, respectively. Acute and late side effects profile were mild and only 2.9% of patients developed grade 3 dermatitis. Among patients with breast implants, 11.4% had capsular contracture. Interpretation In this Brazilian institution experience, moderately hypofractionated irradiation to the breast, chest wall (with or without breast reconstruction), and regional lymph nodes was safe and with an acceptable toxicity profile. Funding None.
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Affiliation(s)
| | - Samir A. Hanna
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil
| | | | | | - Heloísa de Andrade Carvalho
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil,Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil,Latin American Cooperative Oncology Group, Porto Alegre, Brazil,Corresponding author at: Department of Radiation Oncology, Hospital Sírio, Libanês, Rua Dona Adma Jafet 91. Sao Paulo, SP. Brazil. 01308-050.
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Chakraborty S, Chatterjee S. HYPORT adjuvant acute toxicity and patient dosimetry quality assurance results - Interim analysis. Radiother Oncol 2022; 174:59-68. [PMID: 35817323 DOI: 10.1016/j.radonc.2022.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND HYPORT adjuvant trial is a randomised phase III open-label noninferiority trial comparing standard moderately hypofractionated 3 week adjuvant radiation therapy in breast cancer with a novel 1-week schedule. The trial was initiated in March 2019 and is open to recruitment with a total sample size of 2100. We report the results of dosimetric quality assurance, acute toxicity and pre planned first interim safety analysis in the first 271 patients. METHODS Stage I-III breast cancer planned for adjuvant radiation therapy to the breast/chest-wall (along with regional nodes as indicated) were randomised to receive 40 Gy/15 fractions/3 weeks or 26 Gy/5 fractions/1 week. For simultaneous integrated boost, the patients in the control arm received 8 Gy/15 fractions/3 weeks, while those in the experimental arm received 6 Gy/5 fractions/1 week (to the tumour bed). For sequential boost, the prescribed dose was 12 Gy/4 fractions/4 days in both arms. Compliance to pre specified dosimetric parameters and acute toxicities were evaluated. RESULT Data of the first 271 patients was analysed of whom 104 patients received tumour bed boost using SIB. All mandatory dosimetric criteria were met apart from one patient with a higher contralateral breast dose due to optimal internal mammary nodal coverage. Overall three patients (1.1%) experienced grade 3 radiation dermatitis (none received SIB), no other Grade 3 or higher toxicities reported. CONCLUSION This acute toxicity interim analysis demonstrates that hypofractionated adjuvant radiotherapy with SIB for patients with breast cancer is feasible, and associated with minimal severe acute toxicities.
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Al-Rashdan A, Deban M, Quan ML, Cao JQ. Locoregional Management of Breast Cancer: A Chronological Review. Curr Oncol 2022; 29:4647-4664. [PMID: 35877229 PMCID: PMC9321012 DOI: 10.3390/curroncol29070369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Locoregional management of breast cancer is founded on evidence generated over a vast time period, much longer than the career span of many practicing physicians. Oncologists rely on specific patient and tumour characteristics to recommend modern-day treatments. However, some of this information may not have been available during prior periods in which the evidence was generated. For example, the comprehensive Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analyses published in the 2000s typically included older trials accruing patients between the 1960s and 1980s. This raises some uncertainty about whether conclusions from studies conducted in prior eras are as relevant or applicable to modern-day patients and treatments. Reviewing the chronological order and details of the evidence can be beneficial to understanding these nuances. This review discusses the evolution of locoregional management through some key clinical trials. We aim to highlight the time period in which the evidence was generated and emphasize the 10-year outcomes for the comparability of results. Evidence supporting surgical management of the breast and axilla, as well as details of radiotherapy are discussed briefly for all stages of breast cancer.
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Affiliation(s)
- Abdulla Al-Rashdan
- Dalhousie University School of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada;
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
| | - Melina Deban
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
- Division of Radiation Oncology, Tom Baker Cancer Centre, 1331 29 St. NW, Calgary, AB T2N 4N2, Canada
| | - May Lynn Quan
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
- Division of Radiation Oncology, Tom Baker Cancer Centre, 1331 29 St. NW, Calgary, AB T2N 4N2, Canada
| | - Jeffrey Q. Cao
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
- Division of Radiation Oncology, Tom Baker Cancer Centre, 1331 29 St. NW, Calgary, AB T2N 4N2, Canada
- Correspondence: or ; Tel.: +1-403-521-3196; Fax: +1-403-283-1651
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Tramacere F, Arcangeli S, Colciago RR, Lucchini R, Pati F, Portaluri M. Outcomes and toxicity following post-operative hypofractionated radiotherapy to the regional nodes and the breast or the chest wall in locally advanced breast cancer. Br J Radiol 2022; 95:20211299. [PMID: 35522785 DOI: 10.1259/bjr.20211299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We aimed to analyze the impact of a 3-week schedule of HypoFractionated (HF) radiotherapy (RT) after axillary dissection and breast surgery, in terms of safety and efficacy in patients with locally advanced breast cancer (BC). METHODS Eligible patients were females with Stage IIA - IIIC BC who underwent axillary dissection and breast surgery, either quadrantectomy or mastectomy. HF RT was delivered in 15 or 16 fractions for a total dose of 40.05 Gy or 42.56 Gy, respectively, to the clavicular nodal region along with the whole breast (HF WBRT) or the chest wall (HF PMRT), according to the type of surgery. Locoregional recurrence (LRR), distant metastases-free survival (DMFS), overall survival (OS) and acute and late treatment-related toxicities were estimated. RESULTS 57 patients with a median age of 60 years (32-85) were retrospectively analyzed. 34 (60%) of patients underwent breast conservative surgery in the form of quadrantectomy and 23 (40%) were offered radical mastectomy. All patients underwent hypofractionated regional nodal irradiation (HF RNI). 34 (60%) of them underwent HF WBRT, while 23 (40%) received HF PMRT.At a median follow-up of 80 months (30-113), the 7-year LRR-free survival was 93% (95% CI, 74%-95%). The same features for DMFS and OS were 76% (95% CI, 52%-78%) and 67% (95% CI, 50%-80%), respectively. Only one (2%) patient experienced G3 acute skin toxicity. No grade ≥2 late toxicity was observed. CONCLUSION Our study shows that HF RNI with HF RT to the whole breast or the chest wall after breast surgery is safe and effective in patients with locally advanced BC. Longer follow-up is needed to strengthen further analyses on late toxicity and clinical outcomes. ADVANCES IN KNOWLEDGE This paper adds to the evidence that post-operative RNI with WBRT or PMRT can be safely and effectively delivered with 3-week HF regimen. Locally advanced BC patients can be offered HF RT to the regional nodes and the breast or the chest wall regardless the type of surgery.
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Affiliation(s)
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery - University of Milan Bicocca, Milan, Italy
| | - Riccardo Ray Colciago
- Department of Radiation Oncology, School of Medicine and Surgery - University of Milan Bicocca, Milan, Italy
| | - Raffaella Lucchini
- Department of Radiation Oncology, School of Medicine and Surgery - University of Milan Bicocca, Milan, Italy
| | - Francesca Pati
- Department of Radiation Oncology, ASL A. Perrino, Brindisi, Italy
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Yehia ZA, Punglia RS, Wong J. Integration of Radiation and Reconstruction After Mastectomy. Semin Radiat Oncol 2022; 32:237-244. [DOI: 10.1016/j.semradonc.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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211
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Alcorn SR, Corbin KS, Shumway DA. Integrating the Patient's Voice in Toxicity Reporting and Treatment Decisions for Breast Radiotherapy. Semin Radiat Oncol 2022; 32:207-220. [DOI: 10.1016/j.semradonc.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prionas ND, Stephens SJ, Blitzblau RC. Early-stage Breast Cancer: Tailored External Beam Fractionation Approaches for Treatment of the Whole or Partial Breast. Semin Radiat Oncol 2022; 32:245-253. [DOI: 10.1016/j.semradonc.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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213
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Comparison of Heart and Lung Doses According to Tumor Bed Boost Techniques in Early-Stage Left-Sided Breast Cancer: Simultaneous Integrated Boost versus Sequential Boost. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070873. [PMID: 35888592 PMCID: PMC9318371 DOI: 10.3390/medicina58070873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
Background and Objectives: The boost dose to the tumor bed after whole breast irradiation (WBI) can be divided into sequential boost (SEQ) and simultaneous integrated boost (SIB). SIB using modern radiation therapy (RT) techniques, such as volumetric modulated arc therapy, allow the delivery of a highly conformal dose to the target volume and has a salient ability to spare at-risk organs. This study aimed to compare the radiation dose delivered to the heart and lungs according to boost technique and tumor bed location. Materials and Methods: RT planning data of 20 patients with early-stage left-sided breast cancer were used in this study. All patients were treated with volumetric modulated arc therapy after breast-conserving surgery with a sentinel lymph node biopsy. For each patient, two different plans, whole breast irradiation with simultaneous integrated boost (WBI-SIB) and sequential boost after WBI (WBI-SEQ), were generated. To compare the dose received by each organ at risk (OAR), dose-volume histogram data were analyzed. The mean dose (Dmean) and volume of each organ that received x Gy (Vx) were calculated and compared. Results: For the heart, the V10 was lower for the WBI-SIB plan than for the WBI-SEQ plan (5.223 ± 1.947% vs. 6.409 ± 2.545%, p = 0.008). For the left lung, the V5 was lower in the WBI-SIB plan than for the WBI-SEQ plan (27.385 ± 3.871% vs. 32.092 ± 3.545%, p < 0.001). The Dmean for the heart and left lung was lower for the WBI-SIB plan than for the WBI-SEQ plan (heart: 339.745 ± 46.889 cGy vs. 413.030 ± 52.456 cGy, p < 0.001; left lung: 550.445 ± 65.094 cGy vs. 602.270 ± 55.775 cGy, p < 0.001). Conclusions: The WBI-SIB plan delivered lower radiation doses to the heart and left lung than the WBI-SEQ plan in terms of Dmean and low-dose volume in hypofractionated RT of early-stage left-sided breast cancer patients. Furthermore, a large radiation dose per day may be advantageous, considering the radiobiologic aspects of breast cancer. Long-term follow-up data are needed to determine whether the dosimetric advantages of the WBI-SIB plan can lead to clinically improved patient outcomes and reduced late side effects.
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Polgár C, Kahán Z, Ivanov O, Chorváth M, Ligačová A, Csejtei A, Gábor G, Landherr L, Mangel L, Mayer Á, Fodor J. Radiotherapy of Breast Cancer-Professional Guideline 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610378. [PMID: 35832115 PMCID: PMC9272418 DOI: 10.3389/pore.2022.1610378] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022]
Abstract
The international radiotherapy (RT) expert panel has revised and updated the RT guidelines that were accepted in 2020 at the 4th Hungarian Breast Cancer Consensus Conference, based on new scientific evidence. Radiotherapy after breast-conserving surgery (BCS) is indicated in ductal carcinoma in situ (stage 0), as RT decreases the risk of local recurrence (LR) by 50-60%. In early stage (stage I-II) invasive breast cancer RT remains a standard treatment following BCS. However, in elderly (≥70 years) patients with stage I, hormone receptor-positive tumour, hormonal therapy without RT can be considered. Hypofractionated whole breast irradiation (WBI) and for selected cases accelerated partial breast irradiation are validated treatment alternatives to conventional WBI administered for 5 weeks. Following mastectomy, RT significantly decreases the risk of LR and improves overall survival of patients who have 1 to 3 or ≥4 positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes axillary dissection can be substituted with axillary RT. After neoadjuvant systemic treatment (NST) followed by BCS, WBI is mandatory, while after NST followed by mastectomy, locoregional RT should be given in cases of initial stage III-IV and ypN1 axillary status.
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Affiliation(s)
- Csaba Polgár
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Olivera Ivanov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department for Radiation Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Martin Chorváth
- Department of Radiation Oncology, St. Elisabeth Cancer Institute, Slovak Medical University, Bratislava, Slovakia
| | - Andrea Ligačová
- Department of Radiation Oncology, St. Elisabeth Cancer Institute, Slovak Medical University, Bratislava, Slovakia
| | - András Csejtei
- Department of Oncoradiology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Gabriella Gábor
- Oncoradiology Centre, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - László Landherr
- Municipal Oncoradiology Centre, Uzsoki Street Hospital, Budapest, Hungary
| | - László Mangel
- Oncotherapy Institute, University of Pécs, Pécs, Hungary
| | - Árpád Mayer
- Municipal Oncoradiology Centre, Uzsoki Street Hospital, Budapest, Hungary
| | - János Fodor
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
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Clinical Outcomes of Hypofractionated Whole Breast Irradiation in Early-Stage, Biologically High-Risk Breast Cancer. Pract Radiat Oncol 2022; 12:e501-e511. [PMID: 35724921 DOI: 10.1016/j.prro.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Adoption of hypofractionated whole breast irradiation (WBI) for patients with early-stage, biologically high-risk breast cancer remains relatively low. We compared clinical outcomes of conventionally fractionated versus moderately hypofractionated WBI in this patient population. METHODS We queried a prospectively maintained database for patients with early-stage (T1-2, N0, M0) breast cancer who received whole breast irradiation with either conventional fractionation (CWBI) or moderate hypofractionation (HWBI) at a single institution. We included only patients with biologically high-risk tumors (defined as either ER/PR/HER-2 negative, HER-2 amplified, and/or patients with a high-risk multi-gene assay) who received systemic chemotherapy. Inverse probability of treatment weighting (IPTW) was used to compare treatment cohorts and to estimate 5-year time to event endpoints. Hazard ratios (HR) and 95% CI were determined based on Cox Proportional Hazards Model. RESULTS We identified 300 patients, of whom 171 received CWBI and 129 received HWBI. There was a statistically significant difference in median age at diagnosis, 59 years for CWBI vs 63 years for HWBI (p = 0.004), and in median follow-up time, 97 months for CWBI vs 55 months for HWBI (p < 0.001). After accounting for differences in patient and tumor characteristics with IPTW, we found similar 5-year freedom from local recurrence (HR 0.76, 95% CI 0.14-4.1), freedom from regional recurrence (HR 3.3, 95% CI 0.15-69), freedom from distant metastasis (HR 3.9, 95% CI 0.86-17), and disease-free survival (HR 0.84, 95% CI 0.3-2.4), between those treated with CWBI and those treated with HWBI. Results were similar among each of the three high-risk subtypes. CONCLUSION Our data support the use of moderately hypofractionated whole breast irradiation in patients with early-stage, biologically high-risk breast cancer.
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Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, Anderson B, Burstein HJ, Chew H, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Hurvitz SA, Isakoff SJ, Jankowitz RC, Javid SH, Krishnamurthy J, Leitch M, Lyons J, Mortimer J, Patel SA, Pierce LJ, Rosenberger LH, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Wisinski KB, Young JS, Burns J, Kumar R. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:691-722. [PMID: 35714673 DOI: 10.6004/jnccn.2022.0030] [Citation(s) in RCA: 406] [Impact Index Per Article: 203.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The therapeutic options for patients with noninvasive or invasive breast cancer are complex and varied. These NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of ductal carcinoma in situ and the workup and locoregional management of early stage invasive breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.
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Affiliation(s)
| | | | - Jame Abraham
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | - Sara H Javid
- Fred Hutchinson Cancer Research Center/University of Washington
| | | | | | - Janice Lyons
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | | | - John H Ward
- Huntsman Cancer Institute at the University of Utah
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Piras A, Menna S, D’Aviero A, Marazzi F, Mazzini A, Cusumano D, Massaccesi M, Mattiucci GC, Daidone A, Valentini V, Boldrini L. New fractionations in breast cancer: a dosimetric study of 3D-CRT versus VMAT. J Med Radiat Sci 2022; 69:227-235. [PMID: 34551211 PMCID: PMC9163458 DOI: 10.1002/jmrs.530] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/06/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Adjuvant radiation therapy (RT) following primary surgery in women affected by early breast cancer (EBC) plays a central role in reducing local recurrences and overall mortality. The FAST-FORWARD trial recently demonstrated that 1-week hypofractionated adjuvant RT is not inferior to the standard schedule in terms of local relapse, cosmetic outcomes and toxicity. The aim of this in silico study was to evaluate the dosimetric aspects of a 1-week RT course, administered through volumetric modulated arc therapy (VMAT), compared with traditional three-dimensional conformal radiation therapy (3D-CRT) with tangential fields. METHODS Patients affected by left-side EBC undergoing adjuvant RT were selected. ESTRO guidelines for the clinical target volume (CTV) delineation and FAST-FORWARD protocol for CTV to planning target volume (PTV) margin definition were followed. Total prescribed dose was 26 Gy in five fractions. The homogeneity index (HI) and the global conformity index (GCI) were taken into account for planning and dose distribution optimisation purposes. Both 3D-CRT tangential fields and VMAT plans were generated for each patient. RESULTS The analysis included 21 patients. PTV coverage comparison between 3D-CRT and VMAT plans showed significant increases for GCI (P < 0.05) in VMAT technique; no statistically significant differences were observed regarding HI. For organs at risks (OAR), statistically significant increases were observed in terms of skin V103% (P < 0.002) and ipsilateral lung V30% (P < 0.05) with 3D-CRT and of heart V5% (P < 0.05) with VMAT technique. CONCLUSIONS This in silico study showed that both 3D-CRT and VMAT are dosimetrically feasible techniques in the framework of 1-week hypofractionated treatments for left EBC.
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Affiliation(s)
- Antonio Piras
- Radioterapia OncologicaVilla Santa TeresaBagheria, PalermoItaly
| | - Sebastiano Menna
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaItaly
| | | | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaItaly
| | | | - Davide Cusumano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaItaly
| | - Mariangela Massaccesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaItaly
| | - Gian Carlo Mattiucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaItaly
- Università Cattolica del Sacro CuoreRomaItaly
| | | | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaItaly
- Università Cattolica del Sacro CuoreRomaItaly
| | - Luca Boldrini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed EmatologiaFondazione Policlinico Universitario Agostino Gemelli IRCCSRomaItaly
- Università Cattolica del Sacro CuoreRomaItaly
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Ivanov O, Milovančev A, Petrović B, Prvulović Bunović N, Ličina J, Bojović M, Koprivica I, Rakin M, Marjanović M, Ivanov D, Lalić N. Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060745. [PMID: 35744008 PMCID: PMC9231223 DOI: 10.3390/medicina58060745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/25/2022]
Abstract
Background and Objectives: Reducing time of treatment during COVID-19 outbreaks has been recommended by the leading Radiation Oncology societies. Still minimizing radiation induced tissue toxicity is one of the most important issues in breast cancer patients. The study aimed to investigate compliance, clinical and dosimetry normal tissue toxicity, and cosmetic results between moderated and ultra-fractionated regimes for breast cancer patients during COVID-19 pandemic. Materials and Methods: This pilot prospective randomized study included 60 patients with early breast cancer after preserving surgery, 27 patients advocated to ultra-hypofractionated whole-breast three dimensional (3D) conformal radiotherapy of 26 Gy in 5 fractions over 1 week and 33 patients with moderate fractionated breast 3D conformal radiotherapy patients between March 2020 and July 2020, during the COVID pandemic outbreak. The compliance to treatment, dosimetric parameters, acute and late skin toxicity, subcutaneous tissue toxicity, cosmetic results and clinical follow up for 18 months for the two regimes were analyzed and compared. Results: When two regimes were compared 5 fraction group had significantly lower prevalence of newly infected cases of SARS-CoV-2 and thus delayed/interrupted treatment (p = 0.05), comparable grade 1 CTCAE v5, acute skin toxicity (p = 0.18), Grade 1 Radiation Morbidity Scoring Scheme (RESS) subcutaneous tissue toxicity (p = 0.18), Grade 1 RESS late skin toxicity (p = 0.88) and cosmetic results (p = 0.46). Dosimetric results reveled that patients in 5 fraction group received significantly lower median ipsilateral lung doses (p < 0.01) in addition to left breast cancer patients that received significantly lower median heart dose (p < 0.01) and median left anterior descending artery (LAD) dose (p < 0.01). Conclusion: Ultra-hypofractionated radiotherapy for breast cancer is comparable to moderate hypofractionation regimen regarding grade 1 acute skin toxicity, grade 1 subcutaneous tissue toxicity, late skin toxicity and cosmetic results. Application of ultra-hypofractionated radiotherapy with significantly lower radiation doses for lung and heart could be crucial in reducing the risk of acute/late pulmonary and heart radiation-induced toxicity.
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Affiliation(s)
- Olivera Ivanov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Department for Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia; (B.P.); (I.K.); (M.M.)
| | - Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Department for Cardiology, Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
- Correspondence:
| | - Borislava Petrović
- Department for Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia; (B.P.); (I.K.); (M.M.)
- Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Nataša Prvulović Bunović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Center for Diagnostic Imaging, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Jelena Ličina
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Department for Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia; (B.P.); (I.K.); (M.M.)
| | - Marko Bojović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Department for Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia; (B.P.); (I.K.); (M.M.)
| | - Ivan Koprivica
- Department for Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia; (B.P.); (I.K.); (M.M.)
| | - Milijana Rakin
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Department for Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia; (B.P.); (I.K.); (M.M.)
| | - Milana Marjanović
- Department for Radiation Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Serbia; (B.P.); (I.K.); (M.M.)
- Faculty of Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Dejan Ivanov
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Department for Abdominal and Endocrine Surgery, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia
| | - Nensi Lalić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (O.I.); (N.P.B.); (J.L.); (M.B.); (M.R.); (D.I.); (N.L.)
- Clinic for Pulmonary Oncology, Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
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Stereotactic Body Radiation in Breast Cancer — Definitive, Oligometastatic, and Beyond. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00447-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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220
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Lertbutsayanukul C, Pitak M, Nantavithya C. Long-term oncological outcomes of hypofractionated versus conventional fractionated whole breast irradiation with simultaneous integrated boost in early-stage breast cancer. Radiat Oncol J 2022; 40:141-150. [PMID: 35796117 PMCID: PMC9262705 DOI: 10.3857/roj.2021.00927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose For patients with early breast cancer who undergo breast-conserving surgery, adjuvant whole breast irradiation (WBI) with simultaneous integrated boost (SIB) results in lower radiotherapy fractions. Published studies have shown that both conventional fraction with SIB (C-SIB) and hypofractionation with SIB (H-SIB) seem to be safe and feasible. In this study, we sought to compare the oncologic outcomes between C-SIB and H-SIB in early-stage breast cancer. Materials and Methods Stage I–II breast cancer patients who received adjuvant WBI with SIB between January 2008 and December 2017 were retrospectively reviewed. The radiation dose in the C-SIB group was 50 Gy and 65 Gy in 25 daily fractions, while in the H-SIB group, it was 43.2 Gy and 52.8 Gy in 16 daily fractions to the whole breast and tumor bed, respectively. Results A total of 188 patients, 103 in the C-SIB group and 85 in the H-SIB group, were included. With a median follow-up time of 87 months, 7-year locoregional control of C-SIB was comparable to H-SIB (95.8% vs. 97.4%, p = 0.964). The 7-year distant metastasis-free survival rates of C-SIB and H-SIB were 89.9% and 95.9% (p = 0.111), while the 7-year disease-free survival rates were 84.2% and 95.4%, respectively (p = 0.176). In multivariate analysis, there was no significant prognostic factor associated with better overall survival. Conclusion H-SIB provided comparable locoregional control to C-SIB. With the advantage of a shorter radiotherapy course, H-SIB could be a favorable option for WBI in early-stage breast cancer.
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Affiliation(s)
- Chawalit Lertbutsayanukul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Manida Pitak
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Chonnipa Nantavithya
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Correspondence: Chonnipa Nantavithya Division of Radiation Oncology, Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873, Rama 4 Rd., Bangkok 10330, Thailand. Tel: +66-2564334 E-mail:
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Abdelkader H, El-Kassas M. Tailored treatment strategies for cancer patients during COVID-19 pandemic. Rep Pract Oncol Radiother 2022; 27:318-330. [PMID: 36299379 PMCID: PMC9591031 DOI: 10.5603/rpor.a2022.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
The global pandemic of respiratory disease caused by the novel human coronavirus (SARS-CoV-2) has caused indefinite global distress, uncertainty, and disturbance. This pandemic has had direct and indirect impacts for the healthcare systems across the world, but certain subgroups of patients have been particularly affected. Among these groups are patients with cancer, who as a result of their immunosuppressed status either from the disease itself or as a consequence of treatment, are at increased risk of severe COVID-19 infection and complications. The pandemic has also led to limited resources as medical services have been primarily directed to emergency care. In this context, physicians and healthcare providers have had to balance the importance of continuing treatment of cancer patients with the risk of virus infection. In this review, we outline the treatment strategies for cancer patients during this pandemic, focusing on tailored treatment in this challenging situation of varying risks and benefits.
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Affiliation(s)
- Haytham Abdelkader
- Clinical Oncology Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
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222
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Sarria GR, Welzel G, Polednik M, Wenz F, Abo-Madyan Y. Prospective Comparison of Hypofractionated Versus Normofractionated Intensity-Modulated Radiotherapy in Breast Cancer: Late Toxicity Results of the Non-Inferiority KOSIMA Trial (ARO2010-3). Front Oncol 2022; 12:824891. [PMID: 35600361 PMCID: PMC9117716 DOI: 10.3389/fonc.2022.824891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/07/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare the late toxicity profile of hypofractionation and normofractionation for whole-breast radiotherapy in breast cancer (BC) patients after conserving surgery. Methods Sixty-year-old or older patients with pTis-pT3, pN0-pN1a, M0 BC were recruited and stratified to hypofractionated (arm R-HF) or normofractionated (arm L-NF) intensity-modulated radiotherapy (IMRT), for right- and left-sided BC, respectively, in this single-center, non-randomized, non-inferiority trial. A boost was allowed if indicated. The primary outcome was the cumulative percentage of patients developing grade III fibrosis, grade I telangiectasia, and/or grade II hyperpigmentation after 2 years, with a pre-specified non-inferiority margin of 15% increase from an expected 2-year toxicity rate of 20%. Results The Median follow-up was 4.93 (0.57-8.65) years for R-HF and 5.02 (0.65-8.72) years for L-NF (p=0.236). The median age was 68 (60-83 and 60-80) years, respectively. In total, 226 patients were recruited (107 for R-HF and 119 for L-NF), with 100 and 117 patients suitable for assessment, respectively. A boost was delivered in 51% and 53% of each arm, respectively. Median PTV volumes were 1013.6 (273-2805) cm3 (R-HF) and 1058.28 (315-2709) cm3 (L-NF, p=0.591). The 2-year primary endpoint rate was 6.1% (95% CI 1.3-11.7, n=5 of 82) and 13.3% (95% CI 7-20.2, n=14 of 105), respectively (absolute difference -7.2%, one-sided 95% CI ∞ to -0.26, favoring R-HF). No local recurrence-free- or overall-survival differences were found. Conclusion In this prospective non-randomized study, hypofractionation did not have higher toxicity than normofractionated whole-breast IMRT.
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Affiliation(s)
- Gustavo R. Sarria
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Radiation Oncology, University Medical Hospital Bonn, University of Bonn, Bonn, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Polednik
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- University Medical Center Freiburg, Medical Faculty Freiburg, Freiburg University, Freiburg, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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223
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Yarnold JR, Brunt AM, Chatterjee S, Somaiah N, Kirby AM. From 25 Fractions to Five: How Hypofractionation has Revolutionised Adjuvant Breast Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:332-339. [PMID: 35318945 DOI: 10.1016/j.clon.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022]
Abstract
There is a sound empirical basis for hypofractionation in radiotherapy for breast cancer. This article reviews the radiobiological implications of hypofractionation in breast cancer derived from a series of clinical trials that began when 50 Gy in 25 fractions over 5 weeks was commonplace. These trials led first to 40 Gy in 15 fractions over 3 weeks and, subsequently, to 26 Gy in five fractions over 1 week being adopted as standards of care for many patients prescribed whole- or partial-breast radiotherapy after primary surgery.
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Affiliation(s)
- J R Yarnold
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - A M Brunt
- School of Medicine, University of Keele, Keele, UK
| | - S Chatterjee
- Department of Radiotherapy, Tata Medical Centre, Kolkata, India
| | - N Somaiah
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - A M Kirby
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, UK.
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224
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Rabinovitch RA. In Regard to Gillespie et al. Pract Radiat Oncol 2022; 12:e241-e242. [PMID: 35512993 DOI: 10.1016/j.prro.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rachel A Rabinovitch
- Department of Radiation Oncology, Comprehensive Cancer Center, University of Colorado, Aurora, Colorado.
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225
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Brand DH, Kirby AM, Yarnold JR, Somaiah N. How Low Can You Go? The Radiobiology of Hypofractionation. Clin Oncol (R Coll Radiol) 2022; 34:280-287. [PMID: 35260319 DOI: 10.1016/j.clon.2022.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 12/25/2022]
Abstract
Hypofractionated radical radiotherapy is now an accepted standard of care for tumour sites such as prostate and breast cancer. Much research effort is being directed towards more profoundly hypofractionated (ultrahypofractionated) schedules, with some reaching UK standard of care (e.g. adjuvant breast). Hypofractionation exerts varying influences on each of the major clinical end points of radiotherapy studies: acute toxicity, late toxicity and local control. This review will discuss these effects from the viewpoint of the traditional 5 Rs of radiobiology, before considering non-canonical radiobiological effects that may be relevant to ultrahypofractionated radiotherapy. The principles outlined here may assist the reader in their interpretation of the wealth of clinical data presented in the tumour site-specific articles in this special issue.
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Affiliation(s)
- D H Brand
- The Institute of Cancer Research, London, UK
| | - A M Kirby
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - J R Yarnold
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - N Somaiah
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
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Cavalcante FP, Abdala E, Weissmann L, Ferreira CEDS, Amorim G, de Oliveira VM, Guilgen G, Landeiro L, Pinho JRR, Pulchinelli Á, Ribeiro H, Souza R, Rosa DD. Impact of COVID-19 Disease in Early Breast Cancer Management: A Summary of the Current Evidence. JCO Glob Oncol 2022; 8:e2100357. [PMID: 35594492 PMCID: PMC9173577 DOI: 10.1200/go.21.00357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
An expert panel on breast cancer and COVID-19 disease was convened to address the impact of the COVID-19 pandemic for early breast cancer (eBC) management.
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Affiliation(s)
| | - Edson Abdala
- Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Leonardo Weissmann
- Emílio Ribas Infectious Disease Institute, São Paulo, SP, Brazil
- Unaerp School of Medicine, Guarujá, SP, Brazil
- Brazilian Society of Infectology, São Paulo, SP, Brazil
| | | | - Gilberto Amorim
- Oncologia D'Or, Rio de Janeiro, RJ, Brazil
- Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, RS, Brazil
| | - Vilmar Marques de Oliveira
- Brazilian Society of Mastology, Rio de Janeiro, RJ, Brazil
- Santa Casa de São Paulo Hospital, São Paulo, SP, Brazil
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
| | - Gisah Guilgen
- Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, RS, Brazil
- Curitiba Cancer and Transplant Institute, Curitiba, PR, Brazil
- Nossa Senhora das Graças Hospital, Curitiba, PR, Brazil
| | - Luciana Landeiro
- Núcleo de Oncologia da Bahia (NOB)—Oncoclínicas Group, Salvador, BA, Brazil
| | - João Renato Rebello Pinho
- Albert Einstein Hospital, São Paulo, SP, Brazil
- Hospital das Clínicas, São Paulo, SP, Brazil
- School of Medicine, Medical Research Laboratories LIM 03/07, University of São Paulo, São Paulo, SP, Brazil
| | - Álvaro Pulchinelli
- Brazilian Society of Clinical Pathology/Laboratory Medicine, Rio de Janeiro, RJ, Brazil
- Fleury Group, São Paulo, SP, Brazil
- School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Heber Ribeiro
- Brazilian Society of Oncology Surgery, Rio de Janeiro, RJ, Brazil
- AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Rafael Souza
- Cancer Treatment Institute (ITC), Campo Grande, MS, Brazil
| | - Daniela Dornelles Rosa
- Brazilian Breast Cancer Study Group (GBECAM), Porto Alegre, RS, Brazil
- Moinhos de Vento Hospital, Porto Alegre, RS, Brazil
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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227
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Accelerated partial breast irradiation (APBI). Clin Transl Oncol 2022; 24:1657-1658. [PMID: 35499601 DOI: 10.1007/s12094-022-02821-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
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228
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Mireştean CC, Iancu RI, Iancu DPT. Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity-A Narrative Review. Front Oncol 2022; 12:862819. [PMID: 35463375 PMCID: PMC9021451 DOI: 10.3389/fonc.2022.862819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Breast cancer is the most common cancer among women worldwide, which is often treated with radiotherapy. Whole breast irradiation (WBI) is one of the most common types of irradiation. Hypo-fractionated WBI (HF-WBI) reduces the treatment time from 5 to 3 weeks. Recent radiobiological and clinical evidence recommended the use of HF-WBI regardless of the age or stage of disease, and it is proven that hypo-fractionation is non-inferior to conventional fractionation regimen irradiation. However, some studies report an increased incidence of heart-related deaths in the case of breast irradiation by hypo-fractionation, especially in patients with pre-existing cardiac risk factors at the time of treatment. Due to the new technical possibilities of radiotherapy techniques, HF-WBI can reduce the risk of cardiac toxicity by controlling the doses received both by the heart and by the anatomical structures of the heart. The radiobiological “double trouble”, in particular “treble trouble”, for hypo-fractionated regimen scan be avoided by improving the methods of heart sparing based on image-guided irradiation (IGRT) and by using respiration control techniques so that late cardiac toxicity is expected to be limited. However, long-term follow-up of patients treated with HF-WBI with modern radiotherapy techniques is necessary considering the progress of systemic therapy, which is associated with long-term survival, and also the cardiac toxicity of new oncological treatments. The still unknown effects of small doses spread in large volumes on lung tissue may increase the risk of second malignancy, but they can also be indirectly involved in the later development of a heart disease. It is also necessary to develop multivariable radiobiological models that include histological, molecular, clinical, and therapeutic parameters to identify risk groups and dosimetric tolerance in order to limit the incidence of late cardiac events. MR-LINAC will be able to offer a new standard for reducing cardiac toxicity in the future, especially in neoadjuvant settings for small tumors.
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Affiliation(s)
- Camil Ciprian Mireştean
- Department of Medical Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, Craiova, Romania.,Department of Surgery, Railways Clinical Hospital, Iasi, Romania
| | - Roxana Irina Iancu
- Oral Pathology Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Clinical Laboratory, St. Spiridon Emergency Hospital, Iaşi, Romania
| | - Dragoş Petru Teodor Iancu
- Department of Medical Oncology and Radiotherapy Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Radiation Oncology, Regional Institute of Oncology, Iasi, Romania
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229
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Dianati-Nasab A, Nasrollahi H, Khoshdel Z, Ghorbani M, Shafiee SM. Overexpression of TIGAR and HO-1 in peripheral blood mononuclear cells (PBMCs) of breast cancer patients treated with radiotherapy. Int J Radiat Biol 2022; 98:1551-1558. [PMID: 35452587 DOI: 10.1080/09553002.2022.2063432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Radiation therapy (RT) is one of the primary treatment choices for breast cancer. In reaction to RT, many metabolic processes in the body are triggered, some of which have a role in counteracting free radicals in cancer cells. As a result, it is important to comprehend the effects of RT on multiple genes, biomarkers and enzymes in the body. METHODS AND MATERIALS Peripheral blood mononuclear cells (PBMCs) were obtained from 83 breast cancer patients in pre-and post- RT (50 Gray (Gy) in 25 fractions). The TIGAR and HO-1 gene expressions were investigated by quantitative real-time PCR (qRT-PCR). Serum bilirubin, total antioxidant capacity (TAC), total protein (TP), alanine aminotransferase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) were assayed in serum patients before and after RT. RESULTS We found that bilirubin (p = 0.001), ALT (p = 0.04), and AST (p = 0.03) were significantly increased, while TAC (p < 0.001) and TP (p = 0.001) were decreased after RT. However, albumin and ALP did not change after RT (p > 0.05 for both). Interestingly, RT led to overexpression of TIGAR (p = 0.004) and HO-1 (p = 0.003) genes in breast cancer patients. CONCLUSIONS The findings of this study showed that RT could overexpress TIGAR and HO-1 in PBMCs of breast cancer patients. More research is required to figure out the mechanisms behind the impacts of RT on increased catabolism and production of bilirubin or increased activity of TIGAR-related pathways and overexpression of TIGAR and HO-1.
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Affiliation(s)
- Aria Dianati-Nasab
- Department of Clinical Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nasrollahi
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khoshdel
- Department of Clinical Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Ghorbani
- Department of Clinical Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Mohammad Shafiee
- Department of Clinical Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Autophagy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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230
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Issoufaly I, Petit C, Guihard S, Eugène R, Jung L, Clavier JB, Servagi Vernat S, Bellefqih S, Verret B, Bonnet N, Deutsch É, Rivera S. Favorable safety profile of moderate hypofractionated over normofractionated radiotherapy in breast cancer patients: a multicentric prospective real-life data farming analysis. Radiat Oncol 2022; 17:80. [PMID: 35443729 PMCID: PMC9019802 DOI: 10.1186/s13014-022-02044-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Moderately hypofractionated whole-breast radiotherapy (HFRT) has proven to be as safe and efficient as normofractionated radiotherapy (NFRT) in randomized trials resulting in major changes in clinical practice. Toxicity rates observed in selected clinical trial patients may differ from those observed in unselected patients with possible comorbidities and frailty in real-life. This study aimed to examine the influence of HFRT versus NFRT on acute toxicity and identify risks factors of dermatitis in real-life patients.
Materials and methods Prospective data from breast cancer patients, treated with locoregional radiotherapy were collected between November 2015 and February 2020 in 3 comprehensive cancer centers. Through a systematic data-farming strategy, acute toxicity evaluation forms (CTCAEv4.0) were prospectively completed and extracted electronically. The results from each center were then anonymously merged into a single database for analysis. A Chi-2 test was used to compare HFRT and NFRT. Furthermore, risk factors of dermatitis were identified in a sub-study (622 patients) by multivariate logistic regression analysis.
Results In total, 3518 T0-4 N0-3 mostly M0 (85.8%) breast cancer patients with a median age of 60.7 (24–96 years old) were analyzed. Acute grade 2–3 dermatitis, grade 1–3 breast oedema, and grade 1–2 hyperpigmentation were less frequent with HFRT versus NFRT: respectively 8.9% versus 35.1% (Chi-2 = 373.7; p < 0.001), 29.0% versus 37.0% (Chi-2 = 23.1; p < 0.001) and 27.0% versus 55.8% (Chi-2 = 279.2; p < 0.001). Fewer patients experienced pain with HFRT versus NFRT: 33.4% versus 53.7% respectively (Chi-2 = 137.1; p < 0.001). Factors such as high BMI (OR = 2.30 [95% CI, 1.28–4.26], p < 0.01), large breast size (OR = 1.88 [95% CI, 1.07–3.28], p < 0.01) and lumpectomy over mastectomy (OR = 0.52 [95% CI, 0.27–0.97], p < 0.05) were associated with greater risk factors of grade 2–3 dermatitis in multivariate analysis regardless of NFRT or HFRT. Conclusion The results of this study suggests that breast HFRT may be a better option even for patients with a high BMI or large breast size. Acute toxicity was low to mild, and lower with HFRT compared to NFRT. Results from real-life data were robust, and support the use of HFRT beyond randomized study populations. Long-term real-life data awaits further investigation.
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Affiliation(s)
- Irfane Issoufaly
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Claire Petit
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | | | | | - Loic Jung
- Radiotherapy, Paul Strauss, Strasbourg, France
| | | | | | | | - Benjamin Verret
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Naïma Bonnet
- Unicancer Radiation and Oncology Group, Paris, France
| | - Éric Deutsch
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France.,UMR 1030, Molecular Radiotherapy and Therapeutic Innovation, INSERM, 94805, Villejuif, France
| | - Sofia Rivera
- Department of Radiotherapy, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France. .,UMR 1030, Molecular Radiotherapy and Therapeutic Innovation, INSERM, 94805, Villejuif, France.
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231
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Chin YS. Extreme hypofractionation in radiation therapy for patients with early breast cancer: what is the optimal technique? J Med Radiat Sci 2022; 69:143-146. [PMID: 35441811 PMCID: PMC9163474 DOI: 10.1002/jmrs.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yaw Sinn Chin
- Department of Radiation Oncology, St. George Hospital, Kogarah, New South Wales, Australia.,St George & Sutherland Clinical School, UNSW Medicine, Sydney, New South Wales, Australia.,Clinical Management Committee, Oncology NSW, GenesisCare, Alexandria, New South Wales, Australia.,Faculty of Radiation Oncology, The Royal Australian & New Zealand College of Radiologists, Sydney, New South Wales, Australia
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232
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Factors Associated with Late Local Radiation Toxicity after Post-Operative Breast Irradiation. Breast J 2022; 2022:6745954. [PMID: 35711897 PMCID: PMC9187272 DOI: 10.1155/2022/6745954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/25/2022]
Abstract
Purpose. To assess determinants associated with late local radiation toxicity in patients treated for breast cancer. Methods. A systematic review was performed. All studies reporting ≥2 variables associated with late local radiation toxicity after treatment with postoperative whole breast irradiation were included. Cohort studies, randomized controlled trials, and cross-sectional studies were eligible designs. Study characteristics and definitions of determinants and outcome measures were extracted. If possible, the measure of association was extracted. Results. Twenty-one studies were included in this review. Six out of seven studies focused on the association between radiotherapy (boost) dose or irradiated breast volume and late radiation toxicity found significant results. Tumor bed boost was associated with late radiation toxicity, fibrosis, and/or edema in six out of twelve studies. Lower age was associated with late breast toxicity in one study, while in another study, higher age was significantly associated with breast fibrosis. Also, no association between age and late radiation toxicity was found in eight out of twelve studies. Similar inconsistent results were found in the association between late radiation toxicity and other patient-related factors (i.e., breast size, diabetes mellitus) and surgical and systemic treatment-related factors (i.e., complications after surgery, chemotherapy, and time between surgery and radiotherapy). Conclusion. In modern 3D radiotherapy, radiotherapy (boost) dose and volume are—like in 2D radiotherapy—associated with late local radiation toxicity, such as breast fibrosis and edema. Treatment de-escalation, for example, partial breast irradiation in selected patients might be important to decrease late local toxicity without compromising locoregional control and survival.
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233
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Amini A, Morris L, Ludmir EB, Movsas B, Jagsi R, VanderWalde NA. Radiation Therapy in Older Adults With Cancer: A Critical Modality in Geriatric Oncology. J Clin Oncol 2022; 40:1806-1811. [PMID: 35417248 DOI: 10.1200/jco.21.02656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Radiation therapy (RT) is a commonly used modality in the treatment of older adults with cancer, and RT represents an attractive oncologic treatment option, providing a noninvasive local therapy with limited systemic side effects. The Journal of Clinical Oncology (JCO) recently published a special series on Geriatric Oncology providing a comprehensive overview of multiple treatment modalities available to older adults with cancer. The purpose of this short review is to highlight the importance of RT in the treatment of older adults and encourage multidisciplinary participation in their care.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Lucinda Morris
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Noam A VanderWalde
- Department of Radiation Oncology, West Cancer Center and Research Institute, Memphis, TN
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234
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Hanson SE, Lei X, Roubaud MS, DeSnyder SM, Caudle AS, Shaitelman SF, Hoffman KE, Smith GL, Jagsi R, Peterson SK, Smith BD. Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction. JAMA Surg 2022; 157:e220631. [PMID: 35416926 PMCID: PMC9008558 DOI: 10.1001/jamasurg.2022.0631] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Treatment options for early breast cancer include breast-conserving surgery with radiation therapy (RT) or mastectomy and breast reconstruction without RT. Despite marked differences in these treatment strategies, little is known with regard to their association with long-term quality of life (QOL). Objective To evaluate the association of treatment with breast-conserving surgery with RT vs mastectomy and reconstruction without RT with long-term QOL. Design, Setting, and Participants This comparative effectiveness research study used data from the Texas Cancer Registry for women diagnosed with stage 0-II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. The study sample was mailed a survey between March 2017 and April 2018. Data were analyzed from August 1, 2018 to October 15, 2021. Exposures Breast-conserving surgery with RT or mastectomy and reconstruction without RT. Main Outcomes and Measures The primary outcome was satisfaction with breasts, measured with the BREAST-Q patient-reported outcome measure. Secondary outcomes included BREAST-Q physical well-being, psychosocial well-being, and sexual well-being; health utility, measured using the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level questionnaire; and local therapy decisional regret. Multivariable linear regression models with weights for treatment, age, and race and ethnicity tested associations of the exposure with outcomes. Results Of 647 patients who responded to the survey (40.0%; 356 had undergone breast-conserving surgery, and 291 had undergone mastectomy and reconstruction), 551 (85.2%) confirmed treatment with breast-conserving surgery with RT (n = 315) or mastectomy and reconstruction without RT (n = 236). Among the 647 respondents, the median age was 53 years (range, 23-85 years) and the median time from diagnosis to survey was 10.3 years (range, 8.4-12.5 years). Multivariable analysis showed no significant difference between breast-conserving surgery with RT (referent) and mastectomy and reconstruction without RT in satisfaction with breasts (effect size, 2.71; 95% CI, -2.45 to 7.88; P = .30) or physical well-being (effect size, -1.80; 95% CI, -5.65 to 2.05; P = .36). In contrast, psychosocial well-being (effect size, -8.61; 95% CI, -13.26 to -3.95; P < .001) and sexual well-being (effect size, -10.68; 95% CI, -16.60 to -4.76; P < .001) were significantly worse with mastectomy and reconstruction without RT. Health utility (effect size, -0.003; 95% CI, -0.03 to 0.03; P = .83) and decisional regret (effect size, 1.32; 95% CI, -3.77 to 6.40; P = .61) did not differ by treatment group. Conclusions and Relevance The findings support equivalence of breast-conserving surgery with RT and mastectomy and reconstruction without RT with regard to breast satisfaction and physical well-being. However, breast-conserving surgery with RT was associated with clinically meaningful improvements in psychosocial and sexual well-being. These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer.
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Affiliation(s)
- Summer E Hanson
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Margaret S Roubaud
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Grace L Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Benjamin D Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Fodor C, Rondi E, Vigorito S, Botta F, Cremonesi M, Garibaldi C, Penco S, Galimberti VE, Intra M, Gandini S, Barberis M, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. Single fraction ablative preoperative radiation treatment for early-stage breast cancer: the CRYSTAL study – a phase I/II clinical trial protocol. BMC Cancer 2022; 22:358. [PMID: 35366825 PMCID: PMC8977020 DOI: 10.1186/s12885-022-09305-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Breast-conserving surgery (BCS) and whole breast radiation therapy (WBRT) are the standard of care for early-stage breast cancer (BC). Based on the observation that most local recurrences occurred near the tumor bed, accelerated partial breast irradiation (APBI), consisting of a higher dose per fraction to the tumor bed over a reduced treatment time, has been gaining ground as an attractive alternative in selected patients with low-risk BC. Although more widely delivered in postoperative setting, preoperative APBI has also been investigated in a limited, though increasing, and number of studies. The aim of this study is to test the feasibility, safety and efficacy of preoperative radiotherapy (RT) in a single fraction for selected BC patients. Methods This is a phase I/II, single-arm and open-label single-center clinical trial using CyberKnife. The clinical investigation is supported by a preplanning section which addresses technical and dosimetric issues. The primary endpoint for the phase I study, covering the 1st and 2nd year of the research project, is the identification of the maximum tolerated dose (MTD) which meets a specific target toxicity level (no grade 3–4 toxicity). The primary endpoint for the phase II study (3rd to 5th year) is the evaluation of treatment efficacy measured in terms of pathological complete response rate. Discussion The study will investigate the response of BC to the preoperative APBI from different perspectives. While preoperative APBI represents a form of anticipated boost, followed by WBRT, different are the implications for the scientific community. The study may help to identify good responders for whom surgery could be omitted. It is especially appealing for patients unfit for surgery due to advanced age or severe co-morbidities, in addition to or instead of systemic therapies, to ensure long-term local control. Moreover, patients with oligometastatic disease synchronous with primary BC may benefit from APBI on the intact tumor in terms of tumor progression free survival. The study of response to RT can provide useful information about BC radiobiology, immunologic reactions, genomic expression, and radiomics features, to be tested on a larger scale. Trial registration The study was prospectively registered at clinicaltrials.gov (NCT04679454).
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Kunkler I. The Evolving Role of Whole Breast Hypofractionation in Older Patients With Early Breast Cancer. Semin Radiat Oncol 2022; 32:155-158. [DOI: 10.1016/j.semradonc.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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237
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Kronfli D, Savla B, Lievers A, Baker K, Eggleston C, Miller R, Bentzen SM, Mohindra P, Vyfhuis MA. Identifying Psychosocial Needs of Cancer Patients Undergoing Curative Radiation Therapy in an Inner-City Academic Center to Address Racial Disparities. Int J Radiat Oncol Biol Phys 2022; 114:185-194. [DOI: 10.1016/j.ijrobp.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/17/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
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Improving the Education of Radiation Oncology Professionals in Geriatric Oncology: Where Are We and Where Should We Be? Semin Radiat Oncol 2022; 32:109-114. [DOI: 10.1016/j.semradonc.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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239
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Marta GN, Riera R, Pacheco RL, Cabrera Martimbianco AL, Meattini I, Kaidar-Person O, Poortmans P. Moderately hypofractionated post-operative radiation therapy for breast cancer: Systematic review and meta-analysis of randomized clinical trials. Breast 2022; 62:84-92. [PMID: 35131647 PMCID: PMC9073333 DOI: 10.1016/j.breast.2022.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction We provide a critical assessment regarding current evidence for the use of moderately hypofractionated irradiation for patients with breast cancer. The aim of the study was to summarize the available evidence regarding outcomes after moderately hypofractionated compared with conventional radiation doses in the post-operative treatment of patients with breast cancer. Material and methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS databases were searched until March 25, 2021. All randomized phase 3 clinical trials that compared moderately hypofractionated with conventional radiation doses in the post-operative treatment of patients with breast cancer were selected. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results Eight clinical trials satisfied the eligibility criteria and were the focus of the analysis. A total of 12,139 breast cancer patients was randomly assigned for moderately hypofractionated compared with conventional irradiation. Meta-analysis of the trials regarding local recurrence, loco-regional recurrence, disease-free survival, and overall survival outcomes did not demonstrate any significant difference between moderately hypofractionated irradiation and conventional radiation doses groups. The rate of severe side effects was low in both groups; acute and late side effects and cosmesis were similar or even tended to be lower after moderately hypofractionated than after conventional irradiation. Conclusions Moderately hypofractionated is at least as effective and safe as conventional radiation irradiation regimens and should be considered as a treatment option for most, if not all, breast cancer patients. Evidence for the use of moderately hypofractionated RT (MHRT) for breast cancer. Meta-analysis of clinical trials. MHRT is at least as safe and effective as conventionally fractionated regimens.
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Briceño Morales X, Briceño Morales C. Implicaciones de la pandemia en la radioterapia para el cáncer de mama. Radioterapia hipofraccionada. REVISTA DE SENOLOGÍA Y PATOLOGÍA MAMARIA 2022. [PMCID: PMC8767944 DOI: 10.1016/j.senol.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
La pandemia por el nuevo coronavirus (SARS-CoV-2) ha puesto a prueba los sistemas de salud de todo el mundo, de una forma tan apremiante que no se veía hace muchos años. Las implicaciones en la atención en salud no afectan únicamente a los pacientes con la COVID-19, sino que son transversales a todas las enfermedades. Específicamente en cáncer de mama, los esquemas de radioterapia hipofraccionada constituyen una alternativa válida y segura que ayuda a disminuir la exposición de las pacientes al nuevo virus, la congestión de las instituciones de salud y los costos propios de los tratamientos oncológicos especializados. En este artículo, se realizó una revisión de la literatura más relevante sobre los regímenes acortados de radioterapia en cáncer de mama: hipofraccionamiento e hipofraccionamiento extremo, y sobre su equivalencia con el fraccionamiento estándar. Al final, se destacan las recomendaciones de diferentes sociedades científicas y expertos internacionales, para considerar esquemas de radioterapia hipofraccionados, a propósito de la contingencia de salud mundial.
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Brada M, Forbes H, Ashley S, Fenwick J. Improving Outcomes in NSCLC: Optimum Dose Fractionation in Radical Radiotherapy Matters. J Thorac Oncol 2022; 17:532-543. [PMID: 35092841 DOI: 10.1016/j.jtho.2022.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We analyzed a comprehensive national radiotherapy data set to compare outcomes of the most frequently used moderate hypofractionation regimen (55 Gy in 20 fractions) and conventional fractionation regimen (60-66 Gy in 30-33 fractions). METHODS A total of 169,863 cases of NSCLC registered in England from January 2012 to December 2016 obtained from the Public Health England were divided into cohort 1 (training set) diagnosed in 2012 to 2013 and cohort 2 (validation set) diagnosed in 2014 to 2016. Radiotherapy data were obtained from the National Radiotherapy Dataset and linked by National Health Service number to survival data from the Office of National Statistics and Hospital Episode Statistics, from which surgical data and Charlson comorbidity index were obtained. Of 73,186 patients with stages I to III NSCLC, 12,898 received radical fractionated radiotherapy (cohort 1-4894; cohort 2-8004). The proportional hazards model was used to investigate overall survival from time of diagnosis. Survival was adjusted for the prognostic factors of age, sex, stage of disease, comorbidity, other radical treatments, and adjuvant chemotherapy, and the difference between the treatment schedules was summarized by hazard ratio (HR) and 95% confidence interval. The significance of any difference was evaluated by the log likelihood test. RESULTS Of patients with stages I to III NSCLC, 17% to 18% received radical fractionated radiotherapy. After adjustment for independent prognostic factors of age, stage, comorbidity, and other radical and adjuvant treatments, patients in cohort 1 treated with the 2.75 Gy per fraction regimen had a median survival of 25 months compared with 29 months for patients treated with the 2 Gy per fraction regimen (HR = 1.16, p = 0.001). Similarly, in cohort 2, the respective median survival values were 25 and 28 months (HR = 1.10, p = 0.02). CONCLUSIONS Big data analysis of a comprehensive national cohort of patients with NSCLC treated in England suggests that compared with a 4-week regimen of 55 Gy in 20 fractions, a 6-week regimen of conventional daily fractionation to a dose of 60 to 66 Gy at 2 Gy per fraction is associated with a survival benefit. Within the limitations of the retrospective big data analysis with potential selection bias and in the absence of randomized trials, the results suggest that conventional fractionation regimens should remain the standard of care.
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Affiliation(s)
- Michael Brada
- Department of Radiation Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom; Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
| | - Helen Forbes
- Department of Radiation Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom; National Clinical Analysis and Specialised Applications Team (NATCANSAT), The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Susan Ashley
- Department of Radiation Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - John Fenwick
- Department of Radiation Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom; Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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Malik D, Singh A, Birajdar MM, Vyas VJ. Feasibility, Tolerance, and Quality of Life for Hypofractionation Versus Conventional Fractionation for Post-mastectomy Radiotherapy in Indian Patients. Cureus 2022; 14:e23497. [PMID: 35494973 PMCID: PMC9038582 DOI: 10.7759/cureus.23497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: The international standard for post-operative radiotherapy for breast cancer delivers hypofractionated radiotherapy. However, many centers in India still follow the longer conventional schedule probably because of paucity of large prospective trials in Indian patients on the same and apprehension regarding tolerance of high dose per fraction in the said population. We aimed to test the feasibility of hypofractionation in our setting and compared the toxicities and the quality of life in patients receiving conventional and hypofractionated radiotherapy. Materials and methods: Eighty histopathologically proven women of non-metastatic carcinoma breast who underwent modified radical mastectomy were assigned to receive 50 Gray/25 fractions/five weeks or 40 Gray/15 fractions/three weeks. Patients were assessed for the following toxicities - radiation dermatitis, radiation pneumonitis, dysphagia, skin fibrosis, lymphedema, shoulder stiffness, and brachial plexopathy, during radiation and at treatment completion and then at first, third, and sixth-month follow-up. Health-related quality of life was assessed using the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) and breast cancer-specific quality of life questionnaire (QLQ-BR23) at treatment completion and then at first, third, and sixth-month follow-up. Results and conclusion: We had a mean follow-up of 12.78 months. All the assessed toxicities and quality of life scores were comparable between the two arms at all time points of evaluation (p>0.05); 40 Gray in 15 fractions over three weeks is feasible and as safe as the five-week schedule with comparable quality of life. Hypofractionation can be practiced as a routine for post-mastectomy breast cancer patients as this shorter radiotherapy schedule is convenient and cheaper for the patients with no compromise on normal tissue toxicity or quality of life.
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Metz G, Snook K, Sood S, Baron-Hay S, Spillane A, Lamoury G, Carroll S. Breast Radiotherapy after Oncoplastic Surgery-A Multidisciplinary Approach. Cancers (Basel) 2022; 14:1685. [PMID: 35406457 PMCID: PMC8996843 DOI: 10.3390/cancers14071685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Oncoplastic breast surgery encompasses a range of techniques used to provide equitable oncological outcomes compared with standard breast surgery while, simultaneously, prioritizing aesthetic outcomes. While the outcomes of oncoplastic breast surgery are promising, it can add an extra complexity to the treatment paradigm of breast cancer and impact on decision-making surrounding adjuvant therapies, like chemotherapy and radiotherapy. As such, early discussions at the multidisciplinary team meeting with surgeons, medical oncologists, and radiation oncologists present, should be encouraged to facilitate best patient care.
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Affiliation(s)
- Gabrielle Metz
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
| | - Kylie Snook
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- Breast and Surgical Oncology, The Poche Centre, Sydney, NSW 2060, Australia
- The Mater Hospital, Sydney, NSW 2060, Australia
| | - Samriti Sood
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- Breast and Surgical Oncology, The Poche Centre, Sydney, NSW 2060, Australia
- The Mater Hospital, Sydney, NSW 2060, Australia
- Breast and Melanoma Surgery Unit, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Sally Baron-Hay
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
| | - Andrew Spillane
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- Breast and Surgical Oncology, The Poche Centre, Sydney, NSW 2060, Australia
- The Mater Hospital, Sydney, NSW 2060, Australia
- Breast and Melanoma Surgery Unit, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Gillian Lamoury
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- The Mater Hospital, Sydney, NSW 2060, Australia
| | - Susan Carroll
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia; (S.S.); (S.B.-H.); (G.L.); (S.C.)
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia; (K.S.); (A.S.)
- The Mater Hospital, Sydney, NSW 2060, Australia
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Ding Z, Zeng Q, Kang K, Xu M, Xiang X, Liu C. Evaluation of Plan Robustness Using Hybrid Intensity-Modulated Radiotherapy (IMRT) and Volumetric Arc Modulation Radiotherapy (VMAT) for Left-Sided Breast Cancer. Bioengineering (Basel) 2022; 9:bioengineering9040131. [PMID: 35447691 PMCID: PMC9028731 DOI: 10.3390/bioengineering9040131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: We aim to evaluate the robustness of multi-field IMRT and VMAT plans to target motion for left-sided BC radiotherapy. Methods: The 7-field hybrid IMRT (7F-H-IMRT) and 2-arc VMAT (2A-VMAT) plans were generated for ten left-sided BC patients. Shifts of 3 mm, 5 mm, and 10 mm in six directions were introduced and the perturbed dose distributions were recalculated. The dose differences (∆D) of the original plan and perturbed plan corresponded to the plan robustness for the structure. Results: Higher ∆D98%, ∆D95%, and ∆Dmean of CTV were observed in 2A-VMAT plans, which induced higher tumor control probability reductions. A higher ∆Dmean of CTV Boost was found in 7F-H-IMRT plans despite lower ∆D98% and ∆D95%. Shifts in the S-I direction exerted the largest effect on CTV and CTV Boost. Regarding OARs, shifts in R, P, and I directions contributed to increasing the received dose. The 2A-VMAT plans performed better dose sparing, but had a higher robustness in a high-dose volume of the left lung and heart. The 2A-VMAT plans decreased the max dose of LAD but exhibited lower robustness. Conclusion: The 2A-VMAT plans showed higher sensitivity to position deviation. Shifts in the S-I direction exerted the largest effect for CTV and CTV Boost.
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Effectiveness and safety of intraoperative radiotherapy (IORT) with low-energy X-rays (INTRABEAM ®) for accelerated partial breast irradiation (APBI). Clin Transl Oncol 2022; 24:1732-1743. [PMID: 35305245 DOI: 10.1007/s12094-022-02823-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate treatment outcomes in patients with early-stage breast cancer (ESBC) treated with targeted intraoperative radiation therapy (IORT) administered as accelerated partial breast irradiation (APBI). METHODS Between December 2014 and May 2019, 50 patients diagnosed with ESBC were treated with a 50 kilovoltage (kV) X-ray source with a single dose of 20 Gy using the Intrabeam® radiotherapy delivery system. All patients were followed prospectively to assess local control (LC), disease-free survival (DFS), cancer-specific survival (CSS), overall survival (OS), radiation-induced toxicity, and cosmetic outcomes. We also evaluated the prognostic implications of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). RESULTS Median follow-up was 53 months. Mean patient age was 70 years. The mean duration of radiation delivery was 22.25 min. Two patients developed a recurrence. One death was recorded. Elevated pretreatment NLR levels were a significant risk factor for mortality (p = 0.0026). The most common treatment-related toxicities were breast induration (30%) and seroma (18%). Five-year LC, DFS, CSS, and OS rates were 97.1%, 93.9%, 100%, and 94.4%, respectively. Cosmesis was excellent or good in most cases (94%). CONCLUSION These findings confirm the effectiveness of a single dose of 20 Gy of IORT with the Intrabeam device as APBI. The toxicity profile was good with excellent cosmesis. These results provide further support for the clinical use of APBI in well-selected patients.
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Eckstein J, Taylor P, Zheng R, Lee L, Chen W, Potters L, Evans C. Implementation of External Beam Five-Fraction Adjuvant Breast Irradiation in a US Center. Cancers (Basel) 2022; 14:1556. [PMID: 35326707 PMCID: PMC8945963 DOI: 10.3390/cancers14061556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 12/04/2022] Open
Abstract
Five-fraction adjuvant whole breast radiation has been shown to be a safe and effective alternative to longer fractionation regimens. Given the lack of international consensus on patient selection for the protocol, we developed a consensus protocol to guide patient selection and facilitate safe and efficient five-fraction radiation in our radiation medicine department. In developing the directive, we surveyed departmental physicians about their choice of adjuvant breast regimen for various clinical scenarios. Patient travel burden was the factor most strongly impacting radiation oncologists’ decision-making when considering prescribing a five-fraction course of adjuvant breast radiation; the length of clinical trial follow-up data and acute and late normal tissue effects also impacted it, along with personal clinical experience and experience of dosimetry and physics personnel. Relative value unit (RVU) reimbursement and financial toxicity to the patient were reported to be less important in decision-making. Physicians were most comfortable using five-fraction radiation in women >50 years of age with low-risk cancer and for patients unable to attend for longer treatment courses. Eight months after implementation, the protocol accounts for 4.7% of breast irradiation delivered in our department.
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Affiliation(s)
- Jacob Eckstein
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY 11042, USA; (J.E.); (P.T.); (R.Z.); (L.L.); (W.C.); (L.P.)
| | - Peter Taylor
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY 11042, USA; (J.E.); (P.T.); (R.Z.); (L.L.); (W.C.); (L.P.)
| | - Ruqin Zheng
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY 11042, USA; (J.E.); (P.T.); (R.Z.); (L.L.); (W.C.); (L.P.)
| | - Lucille Lee
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY 11042, USA; (J.E.); (P.T.); (R.Z.); (L.L.); (W.C.); (L.P.)
- Zucker School of Medicine, Hofstra University, Hempstead, NY 11549, USA
| | - William Chen
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY 11042, USA; (J.E.); (P.T.); (R.Z.); (L.L.); (W.C.); (L.P.)
- Zucker School of Medicine, Hofstra University, Hempstead, NY 11549, USA
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY 11042, USA; (J.E.); (P.T.); (R.Z.); (L.L.); (W.C.); (L.P.)
- Zucker School of Medicine, Hofstra University, Hempstead, NY 11549, USA
| | - Clary Evans
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY 11042, USA; (J.E.); (P.T.); (R.Z.); (L.L.); (W.C.); (L.P.)
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Disease Control After Hypofractionation Versus Conventional Fractionation for Triple Negative Breast Cancer: Comparative Effectiveness in a Large Observational Cohort. Int J Radiat Oncol Biol Phys 2022; 112:853-860. [PMID: 34718094 PMCID: PMC9020566 DOI: 10.1016/j.ijrobp.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Questions remain about whether moderately hypofractionated whole-breast irradiation is appropriate for patients with triple-negative breast cancer. METHODS AND MATERIALS Using the prospective database of a multicenter, collaborative quality improvement consortium, we identified patients with node-negative, triple-negative breast cancer who received whole-breast irradiation with either moderate hypofractionation or conventional fractionation. Using inverse probability of treatment weighting (IPTW), we compared outcomes using the Kaplan-Meier product-limit estimation method with Cox regression models estimating the hazard ratio for time-to-event endpoints between groups. RESULTS The sample included 538 patients treated at 18 centers in 1 state in the United States, of whom 307 received conventionally fractionated whole-breast irradiation and 231 received moderately hypofractionated whole-breast irradiation. The median follow-up time was 5.0 years (95% confidence interval [CI], 4.77-5.15 years). The 5-year IPTW estimates for freedom from local recurrence were 93.6% (95% CI, 87.8%-96.7%) in the moderate hypofractionation group and 94.4% (95% CI, 90.3%-96.8%) in the conventional fractionation group. The hazard ratio was 1.05 (95% CI, 0.51-2.17; P = .89). The 5-year IPTW estimates for recurrence-free survival were 87.8% (95% CI, 81.0%-92.4%) in the moderate hypofractionation group and 88.4% (95% CI 83.2%-92.1%) in the conventional fractionation group. The hazard ratio was 1.02 (95% CI, 0.62-1.67; P = .95). The 5-year IPTW estimates for overall survival were 96.6% (95% CI, 92.0%-98.5%) in the moderate hypofractionation group and 93.4% (95% CI, 88.7%-96.1%) in the conventional fractionation group. The hazard ratio was 0.65 (95% CI, 0.30-1.42; P = .28). CONCLUSIONS Analysis of outcomes in this large observational cohort of patients with triple-negative, node-negative breast cancer treated with whole-breast irradiation revealed no differences by dose fractionation. This adds evidence to support the use of moderate hypofractionation in patients with triple-negative disease.
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Jacobs DHM, Mast ME, Horeweg N, Speijer G, Petoukhova AL, Straver M, Coerkamp EG, Hazelbag HM, Merkus J, Roeloffzen EMA, Zwanenburg LG, van der Sijp J, Fiocco M, Marijnen CAM, Koper PCM. Accelerated Partial Breast Irradiation using External-Beam or Intraoperative Electron Radiotherapy: 5 year oncological outcomes of a prospective cohort study. Int J Radiat Oncol Biol Phys 2022; 113:570-581. [PMID: 35301990 DOI: 10.1016/j.ijrobp.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE To evaluate the ipsilateral breast tumor recurrence (IBTR) after two accelerated partial breast irradiation (APBI) techniques (intraoperative electron radiotherapy, IOERT and external-beam APBI, EB-APBI) in patients with early stage breast cancer. PATIENTS AND METHODS Between 2011 and 2016, women ≥60 years with breast carcinoma or DCIS of ≤30mm and cN0 undergoing breast conserving therapy were included in a two-armed prospective multi-center cohort study. IOERT (1 × 23.3Gy prescribed at the 100% isodose line) was applied in one hospital and EB-APBI (10 × 3.85Gy daily) in 2 other hospitals. Primary endpoint was IBTR (all recurrences in the ipsilateral breast irrespective of localization) at 5 years after lumpectomy. A competing risk model was used to estimate the cumulative incidences of IBTR, which were compared using Fine and Gray's test. Secondary endpoints were locoregional recurrence rate (LRR), distant recurrence, disease specific survival and overall survival. Univariate Cox-regression models were estimated to identify risk factors for IBTR. Analyses were performed of the intention to treat (ITT) population (IOERT n=305; EB-APBI n=295), and sensitivity analyses were done of the per-protocol population (PP) (IOERT n=270; EB-APBI n=207). RESULTS Median follow up was 5.2 years (IOERT) and 5 years (EB-APBI). Cumulative incidence of IBTR in the ITT population at 5 years after lumpectomy was 10.6% (95% confidence interval 7.0-14.2%) after IOERT and 3.7% (95%CI 1.2-5.9%) after EB-APBI (p=0.002). LRR was significantly higher after IOERT than EB-APBI (12.1% vs 4.5%, p=0.001). There were no differences between groups in other endpoints. Sensitivity analysis showed similar results. For both groups, no significant risk factors for IBTR were identified in the ITT population. In the PP population surgical margin status was the only significant risk factor for developing IBTR in both treatment groups. CONCLUSION Ipsilateral breast tumor recurrences and locoregional recurrence rates were unexpectedly high in patients treated with IOERT, and acceptable in patients treated with EB-APBI.
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Affiliation(s)
- Daphne H M Jacobs
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands; Haaglanden Medical Center, Department of Radiation Oncology, Leidschendam, The Netherlands.
| | - Mirjam E Mast
- Haaglanden Medical Center, Department of Radiation Oncology, Leidschendam, The Netherlands.
| | - Nanda Horeweg
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands
| | - Gabrielle Speijer
- Haga Hospital, Department of Radiation Oncology, The Hague, The Netherlands
| | - Anna L Petoukhova
- Haaglanden Medical Center, Department of Radiation Oncology, Leidschendam, The Netherlands
| | - Marieke Straver
- Haaglanden Medical Center, Department of Surgery, Leidschendam, The Netherlands
| | - Emile G Coerkamp
- Haaglanden Medical Center, Department of Radiology, Leidschendam, The Netherlands
| | - Hans-Marten Hazelbag
- Haaglanden Medical Center, Department of Pathology, Leidschendam, The Netherlands
| | - Jos Merkus
- Haga Hospital, Department of Surgery, The Hague, The Netherlands
| | | | | | - Joost van der Sijp
- Haaglanden Medical Center, Department of Surgery, Leidschendam, The Netherlands
| | - Marta Fiocco
- Leiden University Medical Center, Department of Statistics, Leiden, The Netherlands
| | - Corrie A M Marijnen
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands; The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Peter C M Koper
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands
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Hypofractionated Whole Breast Irradiation and Boost-IOERT in Early Stage Breast Cancer (HIOB): First Clinical Results of a Prospective Multicenter Trial (NCT01343459). Cancers (Basel) 2022; 14:cancers14061396. [PMID: 35326548 PMCID: PMC8946807 DOI: 10.3390/cancers14061396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 02/05/2023] Open
Abstract
Background and purpose: To investigate intraoperative electron radiation therapy (IOERT) as a tumor bed boost during breast conserving surgery (BCS) followed by hypofractionated whole breast irradiation (HWBI) on age-correlated in-breast recurrence (IBR) rates in patients with low- to high-risk invasive breast cancer. Material and methods: BCS and IOERT (11.1 Gy) preceded a HWBI (40.5 Gy) in 15 fractions. Five-year IBR-rates were compared by a sequential ratio test (SQRT) with best evidences in three age groups (35−40 y and 41−50 y: 3.6%, >50 y: 2%) in a prospective single arm design. Null hypothesis (H0) was defined to undershoot these benchmarks for proof of superiority. Results: Of 1445 enrolled patients, 326 met exclusion criteria, leaving 1119 as eligible for analysis. After a median follow-up of 50 months (range 0.7−104), we detected two local recurrences, both in the age group >50 y. With no observed IBR, superiority was demonstrated for the patient groups 41−50 and >50 y, respectively. For the youngest group (35−40 y), no appropriate statistical evaluation was yet possible due to insufficient recruitment. Conclusions: In terms of five-year IBR-rates, Boost-IOERT followed by HWBI has been demonstrated to be superior in patients older than 50 and in the age group 41−50 when compared to best published evidence until 2010.
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Synchronous bilateral breast carcinoma irradiation: A comparative investigation between flattened and unflattened beams. Appl Radiat Isot 2022; 181:110079. [DOI: 10.1016/j.apradiso.2021.110079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 12/24/2022]
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