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Montero A, Ciérvide R, Cañadillas C, Álvarez B, García-Aranda M, Alonso R, López M, Chen-Zhao X, Alonso L, Valero J, Sánchez E, Hernando O, García de Acilu P, Fernandez-Letón P, Rubio C. Acute skin toxicity of ultra-hypofractionated whole breast radiotherapy with simultaneous integrated boost for early breast cancer. Clin Transl Radiat Oncol 2023; 41:100651. [PMID: 37388711 PMCID: PMC10300060 DOI: 10.1016/j.ctro.2023.100651] [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: 01/13/2023] [Revised: 05/18/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023] Open
Abstract
Background Whole-breast irradiation (WBI) after breast conserving surgery (BCS) is indicated to improve loco-regional control and survival. Former studies showed that addition of tumor bed boost in all age groups significantly improved local control although no apparent impact on overall survival but with an increased risk of worse cosmetic outcome. Even though shortened regimens in 3 weeks are considered the standard, recent studies have shown the non-inferiority of a treatment regimen of 5 fractions in one-week in both locoregional control and toxicity profile, although simultaneous integrated boost (SIB) in this setting has been scarcely studied. Materials and Methods From March-2020 to March-2022, 383 patients with early breast cancer diagnosis and a median age of 56 years-old (range 30-99)were included in a prospective registry of ultra-hypofractionated WBI up to a total dose of 26 Gy in 5.2 Gy/fraction with a SIB of 29 Gy in 5.8 Gy/fraction in 272 patients (71%), 30-31 Gy in 6-6.2 Gy/fraction in 111 patients (29%) with close/focally affected margins. Radiation treatment was delivered by conformal 3-D technique in 366 patients (95%), VMAT in 16patients (4%) and conformal 3-D with deep inspiration breath hold (DIBH) in 4patients (1%). Ninety-three per cent of patients received endocrine therapy and 43% systemic or targeted chemotherapy. Development of acute skin complications was retrospectively reviewed. Results With a median follow-up of 18 months (range 7-31), all patients are alive without evidence of local, regional or distant relapse. Acute tolerance was acceptable, with null o mild toxicity: 182 (48%) and 15 (4%) patients developed skin toxicity grade 1 and 2 respectively; 9 (2%) and 2 (0.5%) patients breast edema grade 1and 2 respectively. No other acute toxicities were observed. We also evaluated development of early delayed complications and observed grade 1 breast edema in 6 patients (2%); grade 1 hyperpigmentation in 20 patients (5%); and grade 1 and 2 breast induration underneath boost region in 10(3%) and 2 patients (0.5%) respectively. We found a statistically significant correlation between the median PTVWBI and presence of skin toxicity (p = 0.028) as well as a significant correlation between late hyperpigmentation with the median PTVBOOST (p = 0.007) and the ratio PTVBOOST/PTVWBI (p = 0.042). Conclusion Ultra-hypofractionated WBI + SIB in 5 fractions over one-week is feasible and well tolerated, although longer follow-up is necessary to confirm these results.
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Affiliation(s)
- Angel Montero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain
| | - Raquel Ciérvide
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | | | - Beatriz Álvarez
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | | | - Rosa Alonso
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Mercedes López
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Xin Chen-Zhao
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Leyre Alonso
- Department of Medical Physics, HM Hospitales, Madrid, Spain
| | - Jeannete Valero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Emilio Sánchez
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Ovidio Hernando
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | | | | | - Carmen Rubio
- Department of Medical Physics, HM Hospitales, Madrid, Spain
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Abstract
The purpose of this article is to describe the external irradiation process and updated recommendations of the French society for radiation oncology for patient follow-up.
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Affiliation(s)
- I Barillot
- Hôpital Bretonneau, CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Université François-Rabelais, 10, boulevard Tonnellé, 37000 Tours, France.
| | - D Azria
- Fédération universitaire d'oncologie radiothérapie Forom, Institut régional du cancer Montpellier (ICM), université de Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France; Institut de recherche en cancérologie de Montpellier (IRCM), Inserm U1194, INCa, DGOS_12553, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - A Lisbona
- Centre René-Gauducheau, Institut de cancérologie de l'ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - M-A Mahé
- Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
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Belkacemi Y, Loaganadane G, Grellier N, Fonteneau G, Zaoui G, Coraggio G, Hadhri A, Adou M, Bendavid J, Boros A, Ghith S, Debbi K, Cadot P, Bak A, Le Bret C, Hassani W, Mahé M, Hervé ML, Colson-Durand L, Hanh TO N, Luo DF, Cherif A. Radiation Therapy Department Reorganization during the Coronavirus Disease 2019 (COVID-19) Outbreak: Keys to Securing Staff and Patients During the First Weeks of the Crisis and Impact on Radiation Therapy Practice from a Single Institution Experience. Adv Radiat Oncol 2020; 5:644-650. [PMID: 32775775 PMCID: PMC7250781 DOI: 10.1016/j.adro.2020.04.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE During the first weeks of the coronavirus disease 2019 (COVID-19) outbreak in France, it was necessary to clearly define organizational priorities in the radiation therapy (RT) departments. In this report, we focus on the urgent measures taken to reduce risk for both our staff and patients by reducing the number of patients receiving treatment. METHODS AND MATERIALS We reviewed the fractionation schemes for all patients in our department, including those receiving treatment and those soon to start treatment. Our goals were to (1) decrease the number of patients coming daily to the hospital for RT, (2) adapt our human resources to continue patients' care in the department, and (3) help to cover understaffed COVID-19 sectors of the hospital. RESULTS We identified 50 patients who were receiving treatment (n = 6), were going to start radiation after CT scan simulation (n = 41), or for whom the CT scan was pending (n = 3). The majority were women (64%) treated for breast cancer (54%). RT was delayed for 22 (44%) patients. The majority were offered hormone therapy as "waiting therapy." Hypofractionation was considered in 21 (42%) patients mainly with breast cancer (18 of 21, 86%). The number of courses initially planned and replanned as a result of the COVID-19 outbreak during the period of March 15 to May 31, 2020, were 1383 and 683, respectively, which represented a reduction of 50% (including delayed sessions) that allowed our reorganization process. CONCLUSIONS To conserve resources during the pandemic, we successfully reduced the number of patients receiving treatment in a proactive fashion and adapted our organization to minimize the risk of COVID-19 contamination. Departments across the world may benefit from this same approach.
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Affiliation(s)
- Yazid Belkacemi
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM), U955 Team 21, and University Paris-Est Creteil (UPEC), Paris, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
- TransAtlantic Radiation Oncology Network (TRONE), Paris, France
| | - Gokoulakrichenane Loaganadane
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM), U955 Team 21, and University Paris-Est Creteil (UPEC), Paris, France
- TransAtlantic Radiation Oncology Network (TRONE), Paris, France
| | - Noémie Grellier
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
| | - Gloria Fonteneau
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Gaël Zaoui
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Gabriele Coraggio
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
| | - Asma Hadhri
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
| | - Marie Adou
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Jerôme Bendavid
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Angela Boros
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Sahar Ghith
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
| | - Kamel Debbi
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
| | - Pauline Cadot
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Adeline Bak
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Cindy Le Bret
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Wissal Hassani
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
| | - Mathilde Mahé
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Marie-Laure Hervé
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Laurianne Colson-Durand
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
| | - Nhu Hanh TO
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM), U955 Team 21, and University Paris-Est Creteil (UPEC), Paris, France
- TransAtlantic Radiation Oncology Network (TRONE), Paris, France
| | - Deng Feng Luo
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- TransAtlantic Radiation Oncology Network (TRONE), Paris, France
| | - Aziz Cherif
- Assistance Publique Hopitaux de Paris (APHP), Department of Radiation Oncology and Henri Mondor Breast Center, Henri Mondor University Hospital, Creteil, France
- Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM), U955 Team 21, and University Paris-Est Creteil (UPEC), Paris, France
- Association of Radiotherapy and Oncology of the Mediterranean Area (AROME), Paris, France
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