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Wang K, Yee C, Tam S, Drost L, Chan S, Zaki P, Rico V, Ariello K, Dasios M, Lam H, DeAngelis C, Chow E. Prevalence of pain in patients with breast cancer post-treatment: A systematic review. Breast 2018; 42:113-127. [DOI: 10.1016/j.breast.2018.08.105] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/08/2018] [Accepted: 08/27/2018] [Indexed: 12/12/2022] Open
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Shaitelman SF, Amendola B, Khan A, Beriwal S, Rabinovitch R, Demanes DJ, Kim LH, Cuttino L. American Brachytherapy Society Task Group Report: Long-term control and toxicity with brachytherapy for localized breast cancer. Brachytherapy 2017; 16:13-21. [DOI: 10.1016/j.brachy.2016.04.392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 01/22/2023]
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de Campos TPR, Nogueira LB, Trindade B, Cuperschmid EM. Dosimetric intercomparison of permanent Ho-166 seed's implants and HDR Ir-192 brachytherapy in breast cancer. Rep Pract Oncol Radiother 2016; 21:240-9. [PMID: 27601957 PMCID: PMC5002017 DOI: 10.1016/j.rpor.2015.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/25/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022] Open
Abstract
AIM To provide a comparative dosimetric analysis of permanent implants of Ho(166)-seeds and temporary HDR Ir(192)-brachytherapy through computational simulation. BACKGROUND Brachytherapy with Ir(192)-HDR or LDR based on temporary wires or permanent radioactive seed implants can be used as dose reinforcement for breast radiation therapy. Permanent breast implants have not been a practical clinical routine; although, I(125) and Pd(103)-seeds have already been reported. Biodegradable Ho(166)-ceramic-seeds have been addressed recently. MATERIAL AND METHODS Simulations of implants of nine Ho(166)-seeds and equivalent with HDR Ir(192)-brachytherapy were elaborated in MCNP5, shaped in a computational multivoxel simulator which reproduced a female thorax phantom. Spatial dose rate distributions and dose-volume histograms were generated. Protocol's analysis involving exposure time, seed's activities and dose were performed. RESULTS Permanent Ho(166)-seed implants presented a maximum dose rate per unit of contained activity (MDR) of 1.1601 μGy h(-1) Bq(-1); and, a normalized MDR in standard points (8 mm, equidistant to 03-seeds - SP1, 10 mm - SP2) of 1.0% (SP1) and 0.5% (SP2), respectively. Ir(192)-brachytherapy presented MDR of 4.3945 × 10(-3) μGy h(-1) Bq(-1); and, 30% (SP1), and 20% (SP2). Therefore, seed's implant activities of 333 MBq (Ho(166)) and 259 GBq (Ir(192)) produced prescribed doses of 58 Gy (SP1; 5d) and 56 Gy (SP1, 5 fractions, 6 min), respectively. CONCLUSIONS Breast Ho(166)-implants of 37-111 MBq are attractive due to the high dose rate near 6-10 mm from seeds, equivalent to Ir(192)-brachytherapy of 259 GBq (3 fractions, 6 min) providing similar dose in standard points at a week; however, with spatial dose distribution better confined. The seed positioning can be adjusted for controlling the breast tumor, in stages I and II, in flat and deep tumors, without any breast volumetric limitation.
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Affiliation(s)
- Tarcisio Passos Ribeiro de Campos
- NRI – Nucleo de Radiações Ionizantes, Professor do Departamento de Engenharia Nuclear da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luciana Batista Nogueira
- Departamento de Anatomia e Imagem, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bruno Trindade
- Programa de Ciências e Técnicas Nucleares, Núcleo de Radiações Ionizantes – NRI (Grupo de Pesquisa), UFMG, Brazil
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Clinical Indicators of Psychosocial Distress Predict for Acute Radiation-Induced Fatigue in Patients Receiving Adjuvant Radiation Therapy for Breast Cancer: An Analysis of Patient-Reported Outcomes. Int J Radiat Oncol Biol Phys 2016; 95:946-955. [PMID: 27105720 DOI: 10.1016/j.ijrobp.2016.01.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess the magnitude and predictors of patient-reported fatigue among breast cancer patients receiving radiation therapy (RT). METHODS AND MATERIALS Patients receiving breast RT completed a survey querying fatigue at each weekly on-treatment visit. Patient-reported fatigue severity and interference was assessed on an ordinal scale of 0 to 4, using a validated scoring system. Baseline anxiety and depression scores were also obtained. The kinetics of mean fatigue scores per week and the maximum fatigue scores over the course of the entire treatment were assessed, and clinical predictors were identified by univariate and multivariate regression. RESULTS The average fatigue severity and interference scores were 0.6 and 0.46. The average fatigue scores increased to an equivalent extent from week to week, with expected increases of 0.99 in fatigue severity and 0.85 in interference over 7 weeks. Patients treated with hypofractionated RT (HF-RT) versus conventionally fractionated RT (CF-RT) had significantly fewer maximum fatigue severity or interference scores that were >2 (ie, severe or very severe; 29% vs 10% for severity, and 26% vs 8% for interference, P<.01). Age ≤45 years, presence of psychiatric/pain-related comorbidities, and baseline sadness and anxiety severity were predictive of average and maximum fatigue scores (P<.05), but variables related to treatment intensity (eg, mastectomy vs lumpectomy, chemotherapy use, radiation target volumes) and other host factors (working, children, marital status, proximity to RT facility) were not. CONCLUSION Patient-reported fatigue modestly increases over RT courses, with less maximum fatigue reported with HF-RT. Younger age and baseline sadness, anxiety, and psychiatric/pain-related comorbidities are powerful predictors of fatigue, whereas other factors, such as treatment intensity, are not. Future studies will investigate interventions for patients at high risk for fatigue.
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Kong L, Cheng J, Ding X, Li B, Zhang J, Li H, Huang W, Zhou T, Sun H. Efficacy and Safety of Accelerated Partial Breast Irradiation after Breast-conserving Surgery: A Meta-analysis of Published Comparative Studies. Breast J 2013; 20:116-24. [PMID: 24372818 DOI: 10.1111/tbj.12226] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lingling Kong
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
- Shandong Academy of Medical Sciences; Jinan China
| | - Jian Cheng
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
- Shandong Academy of Medical Sciences; Jinan China
| | - Xiuping Ding
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
| | - Baosheng Li
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
| | - Jian Zhang
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
| | - Hongsheng Li
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
| | - Wei Huang
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
| | - Tao Zhou
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
| | - Hongfu Sun
- Department of Radiation Oncology; Shandong Cancer Hospital; Jinan China
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Vicini FA, Keisch M, Shah C, Goyal S, Khan AJ, Beitsch PD, Lyden M, Haffty BG. Factors associated with optimal long-term cosmetic results in patients treated with accelerated partial breast irradiation using balloon-based brachytherapy. Int J Radiat Oncol Biol Phys 2011; 83:512-8. [PMID: 22079730 DOI: 10.1016/j.ijrobp.2011.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/20/2011] [Accepted: 07/06/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate factors associated with optimal cosmetic results at 72 months for early-stage breast cancer patients treated with Mammosite balloon-based accelerated partial breast irradiation (APBI). METHODS AND MATERIALS A total of 1,440 patients (1,449 cases) with early-stage breast cancer undergoing breast-conserving therapy were treated with balloon-based brachytherapy to deliver APBI (34 Gy in 3.4-Gy fractions). Cosmetic outcome was evaluated at each follow-up visit and dichotomized as excellent/good (E/G) or fair/poor (F/P). Follow-up was evaluated at 36 and 72 months to establish long-term cosmesis, stability of cosmesis, and factors associated with optimal results. RESULTS The percentage of evaluable patients with excellent/good (E/G) cosmetic results at 36 months and more than 72 months were 93.3% (n = 708/759) and 90.4% (n = 235/260). Factors associated with optimal cosmetic results at 72 months included: larger skin spacing (p = 0.04) and T1 tumors (p = 0.02). Using multiple regression analysis, the only factors predictive of worse cosmetic outcome at 72 months were smaller skin spacing (odds ratio [OR], 0.89; confidence interval [CI], 0.80-0.99) and tumors greater than 2 cm (OR, 4.96, CI, 1.53-16.07). In all, 227 patients had both a 36-month and a 72-month cosmetic evaluation. The number of patients with E/G cosmetic results decreased only slightly from 93.4% at 3 years to 90.8% (p = 0.13) at 6 years, respectively. CONCLUSIONS APBI delivered with balloon-based brachytherapy produced E/G cosmetic results in 90.4% of cases at 6 years. Larger tumors (T2) and smaller skin spacing were found to be the two most important independent predictors of cosmesis.
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Affiliation(s)
- Frank A Vicini
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48072, USA.
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Radiobiological rationale and clinical implications of hypofractionated radiation therapy. Cancer Radiother 2011; 15:221-9. [PMID: 21514198 DOI: 10.1016/j.canrad.2010.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 11/18/2010] [Accepted: 12/21/2010] [Indexed: 11/23/2022]
Abstract
Recent clinical trials of hypofractionated radiation treatment have provided critical insights into the safety and efficacy of hypofractionation. However, there remains much controversy in the field, both at the level of clinical practice and in our understanding of the underlying radiobiological mechanisms. In this article, we review the clinical literature on hypofractionated radiation treatment for breast, prostate, and other malignancies. We highlight several ongoing clinical trials that compare outcomes of a hypofractionated approach versus those obtained with a conventional approach. Lastly, we outline some of the preclinical and clinical evidence that argue in favor of differential radiobiological mechanisms underlying hypofractionated radiation treatment. Emerging data from the ongoing studies will help to better define and guide the rational use of hypofractionation in future years.
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Taunk NK, Haffty BG, Chen S, Khan AJ, Nelson C, Pierce D, Goyal S. Comparison of radiation-induced fatigue across 3 different radiotherapeutic methods for early stage breast cancer. Cancer 2011; 117:4116-24. [PMID: 21365631 DOI: 10.1002/cncr.26013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 01/04/2011] [Accepted: 01/06/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Radiation-induced fatigue is a common side effect of breast cancer radiotherapy (RT). This study compares the induction and persistence of radiation-induced fatigue in accelerated partial breast irradiation (APBI), accelerated hypofractionated RT, and standard whole breast RT. METHODS Eighty patients were treated with a novel, 3-week accelerated regimen with 333 centigrays (cGy) for 15 fractions to 4995 cGy; of these, 45 were treated using APBI, whereas 35 patients were treated using accelerated hypofractionated RT. These patients were matched with patients receiving 200 cGy for 30 fractions using standard whole breast irradiation. Fatigue score, using Common Terminology Criteria for Adverse Events version 4.0, was obtained at 5 time points: consultation before RT, first on-treatment visit, halfway through treatment, last on-treatment visit, and first follow-up. RESULTS Maximum fatigue and average fatigue since treatment were calculated. Maximum fatigue was 1.5, 2.4, and 2.3, and average fatigue was 0.46, 0.81, and 0.92 for the APBI, accelerated hypofractionated RT, and standard whole breast RT groups, respectively. The accelerated schedules did not have significantly less fatigue than standard whole breast RT at first on-treatment visit. Maximum fatigue in APBI was reduced compared with standard whole breast RT. Accelerated hypofractionated RT had fatigue trajectory similar to standard whole breast RT. Multivariate analysis found that increased age and whole breast treatment are associated with more fatigue. Chemotherapy, hormone therapy, race, and T stage were not significant predictors of maximum fatigue. Results were similar for average fatigue, except that magnitudes were smaller. CONCLUSIONS Field sizes and age in breast RT were positively associated with maximum radiation-induced fatigue. Accelerated hypofractionated RT and standard whole breast RT had similar fatigue trajectories compared with APBI, which reduced fatigue at all times.
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Affiliation(s)
- Neil K Taunk
- Department of Radiation Oncology, the Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Guedea F, Venselaar J, Hoskin P, Hellebust TP, Peiffert D, Londres B, Ventura M, Mazeron JJ, Limbergen EV, Pötter R, Kovacs G. Patterns of care for brachytherapy in Europe: Updated results. Radiother Oncol 2010; 97:514-20. [PMID: 20950878 DOI: 10.1016/j.radonc.2010.09.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
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Jeruss JS, Kuerer HM, Beitsch PD, Vicini FA, Keisch M. Update on DCIS outcomes from the American Society of Breast Surgeons accelerated partial breast irradiation registry trial. Ann Surg Oncol 2010; 18:65-71. [PMID: 20577822 DOI: 10.1245/s10434-010-1192-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Indexed: 12/31/2022]
Abstract
BACKGROUND Since the initial reports on use of MammoSite accelerated partial breast irradiation (APBI) for treatment of ductal carcinoma in situ (DCIS), additional follow-up data were collected. We hypothesized that APBI delivered via MammoSite would continue to be well tolerated, associated with a good cosmetic outcome, and carry a low risk for recurrence in patients with DCIS. MATERIALS AND METHODS From 2002-2004, 194 patients with DCIS were enrolled in a registry trial to assess the MammoSite. Follow-up data were available for all 194 patients. Median follow-up was 54.4 months; 63 patients had at least 5 years of follow-up. Data obtained included patient-, tumor-, and treatment-related factors, and recurrence incidence. RESULTS Of the 194 patients, 87 (45%) had the MammoSite placed at lumpectomy; 107 patients (55%) had the device placed postlumpectomy. In the first year of follow-up, 16 patients developed a breast infection, though the method of device placement was not associated with infection risk. Also, 46 patients developed a seroma that was associated with applicator placement at the time of lumpectomy (P = 0.001). For patients with at least 5 years of follow-up, 92% had favorable cosmetic results. There were 6 patients (3.1%) who had an ipsilateral breast recurrence, with 1 (0.5%) experiencing recurrence in the breast and axilla, for a 5-year actuarial local recurrence rate of 3.39%. CONCLUSIONS During an extended follow-up period, APBI delivered via MammoSite continued to be well tolerated for patients with DCIS. Use of this device may make lumpectomy possible for patients who would otherwise choose mastectomy because of barriers associated with standard radiation therapy.
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Affiliation(s)
- Jacqueline S Jeruss
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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