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Jin K, Luo J, Yu X, Guo X. Hypofractionated radiotherapy with simultaneous tumor bed boost (Hi-RISE) in breast cancer patients receiving upfront breast-conserving surgery: study protocol for a phase III randomized controlled trial. Radiat Oncol 2024; 19:62. [PMID: 38802888 PMCID: PMC11131299 DOI: 10.1186/s13014-024-02449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The effectiveness and safety of moderately hypofractionated radiotherapy (HFRT) in patients undergoing breast-conserving surgery (BCS) has been demonstrated in several pivotal randomized trials. However, the feasibility of applying simultaneous integrated boost (SIB) to the tumor bed and regional node irradiation (RNI) using modern radiotherapy techniques with HFRT needs further evaluation. METHODS This prospective, multi-center, randomized controlled, non-inferiority phase III trial aims to determine the non-inferiority of HFRT combined with SIB (HFRTsib) compared with conventional fractionated radiotherapy with sequential boost (CFRTseq) in terms of five-year locoregional control rate in breast cancer patients undergoing upfront BCS. A total of 2904 participants will be recruited and randomized in a 1:1 ratio into the HFRTsib and CFRTseq groups. All patients will receive whole breast irradiation, and those with positive axillary nodes will receive additional RNI, including internal mammary irradiation. The prescribed dose for the HFRTsib group will be 40 Gy in 15 fractions, combined with a SIB of 48 Gy in 15 fractions to the tumor bed. The CFRTseq group will receive 50 Gy in 25 fractions, with a sequential boost of 10 Gy in 5 fractions to the tumor bed. DISCUSSION This trial intends to assess the effectiveness and safety of SIB combined with HFRT in early breast cancer patients following BCS. The primary endpoint is locoregional control, and the results of this trial are expected to offer crucial evidence for utilizing HFRT in breast cancer patients after BCS. TRIAL REGISTRATION This trial was registered at ClincalTrials.gov (NCT04025164) on July 18, 2019.
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Affiliation(s)
- Kairui Jin
- Department of Radiation Oncology, Department of Oncology, Shanghai Medical College, Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, Shanghai, 200032, China
| | - Jurui Luo
- Department of Radiation Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Department of Oncology, Shanghai Medical College, Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, Shanghai, 200032, China.
| | - Xiaomao Guo
- Department of Radiation Oncology, Department of Oncology, Shanghai Medical College, Shanghai Clinical Research Center for Radiation Oncology, Shanghai Key Laboratory of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, 270 DongAn Road, Shanghai, 200032, China.
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Forster T, Köhler C, Dorn M, Häfner MF, Arians N, König L, Harrabi SB, Schlampp I, Weykamp F, Meixner E, Lang K, Heinrich V, Weidner N, Hüsing J, Wallwiener M, Golatta M, Hennigs A, Heil J, Hof H, Krug D, Debus J, Hörner-Rieber J. Noninferiority of Local Control and Comparable Toxicity of Intensity Modulated Radiation Therapy With Simultaneous Integrated Boost in Breast Cancer: 5-Year Results of the IMRT-MC2 Phase III Trial. Int J Radiat Oncol Biol Phys 2023; 117:857-868. [PMID: 37244626 DOI: 10.1016/j.ijrobp.2023.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The IMRT-MC2 trial was conducted to demonstrate the noninferiority of conventionally fractionated intensity modulated radiation therapy with a simultaneous integrated boost to 3-dimensional conformal radiation therapy with a sequential boost for adjuvant breast radiation therapy. METHODS AND MATERIALS A total of 502 patients were randomized between 2011 and 2015 for the prospective, multicenter, phase III trial (NCT01322854). Five-year results of late toxicity (late effects normal tissue task force-subjective, objective, management, and analytical), overall survival, disease-free survival, distant disease-free survival, cosmesis (Harvard scale), and local control (noninferiority margin at hazard ratio [HR] of 3.5) were analyzed after a median follow-up of 62 months. RESULTS The 5-year local control rate for the intensity modulated radiation therapy with simultaneous integrated boost arm was non-inferior to the control arm (98.7% vs 98.3%, respectively; HR, 0.582; 95% CI, 0.119-2.375; P = .4595). Furthermore, there was no significant difference in overall survival (97.1% vs 98.3%, respectively; HR, 1.235; 95% CI, 0.472-3.413; P = .6697), disease-free survival (95.8% vs 96.1%, respectively; HR, 1.130; 95% CI, 0.487-2.679; P = .7758), and distant disease-free survival (97.0% vs 97.8%, respectively; HR, 1.667; 95% CI, 0.575-5.434; P = .3601). After 5 years, late toxicity evaluation and cosmetic assessment further showed no significant differences between treatment arms. CONCLUSIONS The 5-year results of the IMRT-MC2 trial provide strong evidence that the application of conventionally fractionated simultaneous integrated boost irradiation for patients with breast cancer is both safe and effective, with noninferior local control compared with 3-dimensional conformal radiation therapy with sequential boost.
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Affiliation(s)
- Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Clara Köhler
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Melissa Dorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Felix Häfner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Semi Ben Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Vanessa Heinrich
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Nicola Weidner
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Johannes Hüsing
- Division of Biostatistics, Coordination Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Holger Hof
- Strahlentherapie Rhein-Pfalz, Neustadt, Germany
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Department of Radiation Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium, partner site Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
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Yadav BS, Gupta S, Dahiya D, Gupta A, Oinam AS. Accelerated hypofractionated breast radiotherapy with simultaneous integrated boost: a feasibility study. Radiat Oncol J 2022; 40:127-140. [PMID: 35796116 PMCID: PMC9262700 DOI: 10.3857/roj.2021.01053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To assess the feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) in patients with breast cancer. Materials and Methods A total of 27 patients after breast-conserving surgery were included in this study. Patients were planned on a four-dimensional computerized tomogram, and contouring was done using RTOG guidelines. The dose was 34 Gy/10#/2 week to the breast and 40 Gy/10#/2 week to the tumor bed as SIB with volumetric modulated arc technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs-at-risk were calculated. Toxicities and cosmesis were assessed using RTOG/LENT/SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) were calculated with Kaplan-Meier curves. Results The mean age of the patients was 42 years. Left and right breast cancers were seen in 17 (63%) and 10 (37%) patients, respectively. The mean values of ipsilateral lung V16 and contralateral lung V5 were 16.01% and 3.74%, respectively. The mean heart doses from the left and right breast were 7.25 Gy and 4.37 Gy, respectively. The mean doses to the contralateral breast, oesophagus, and Dmax to brachial plexus were 2.64 Gy, 3.69 Gy, and 26.95 Gy, respectively. The mean value of thyroid V25 was 19.69%. Grade 1 and 2 acute skin toxicities were observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema, and induration were observed in 1 (3.7%), 2 (7.4%), and 4 (14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient. The median follow-up was 51 months (range, 12 to 61 months). At four years, breast induration, edema, and fibrosis were observed in 1 (3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred in 1 (3.7%) and 2 (7.4%) patients, respectively. DFS and OS at four years were 88% and 92%, respectively. Conclusion With this radiotherapy schedule, acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS, and OS were good.
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Affiliation(s)
- Budhi Singh Yadav
- Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shipra Gupta
- Department of Radiation Oncology, National Cancer Institute, Jhajjar, India
| | - Divya Dahiya
- Department of General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ankita Gupta
- Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arun Singh Oinam
- Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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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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Clinical audit of breast cancer patients treated with helical tomotherapy for irradiation of the internal mammary chain. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396921000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
To evaluate efficacy of helical tomotherapy (HT) for treatment of breast cancer with internal mammary lymph node involvement.
Methods:
This is a retrospective clinical audit of planning, dosimetry, toxicity and short-term survival of a cohort of 65 patients. Patients were treated between November 2014 and May 2019. The primary and nodal region was prescribed a dose of 50 Gray (Gy) in 25 fractions, while all cases of breast conserving surgery received a simultaneous integrated boost to a dose of 61 Gy in 25 fractions.
Results:
The 95% coverage for the primary, supraclavicular, internal mammary node and tumour bed was 93·4%, 96·8%, 90·7% and 98·3%, respectively. Mean dose to total lung, heart and contra-lateral breast was 10·6 Gy, 6·92 Gy and 4·32 Gy, respectively. None developed grade III skin or oesophageal toxicity. Twenty-one patients had progression; of which eighteen developed only distant failure while three also had loco-regional recurrence. At a median follow-up of 36 months, the 3-year loco-regional control, disease-free survival and overall survival were 93·5, 73·9 and 85·9%, respectively.
Conclusion:
We report encouraging clinical outcome for patients treated uniformly with HT. The predominant pattern of failure was distant metastases which suggests the need for systemic control intensification.
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Leonardi MC, Kouloura A, Rojas DP, Zaffaroni M, Intra M, Veronesi P, Morra A, Gerardi MA, Fodor CI, Zerella MA, Camarda AM, Cattani F, Luraschi R, Viola A, Riva G, Miglietta E, Orecchia R, Dicuonzo S, Jereczek-Fossa BA. The POLO (Partially Omitted Lobe) approach to safely treat in-breast recurrence after intraoperative radiotherapy with electrons. Br J Radiol 2021; 95:20210405. [PMID: 34919420 DOI: 10.1259/bjr.20210405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate feasibility of salvage 4-week hypofractionated whole breast radiotherapy (WBRT) in patients with in-breast recurrence after receiving intraoperative radiotherapy with electrons (IOERT) for primary breast cancer (BC). METHODS BC patients who had repeated quadrantectomy underwent modified WBRT with intensity-modulated radiotherapy using Helical Tomotherapy to underdose the IOERT region. This approach, called POLO (Partially Omitted Lobe), excluded the IOERT volume from receiving the full prescription dose. RESULTS Nine patients were treated with this approach, receiving 45 Gy in 20 fractions. A simultaneous integrated boost of 2.5 Gy in 20 fractions was delivered in 6/9 patients. Dose constraints and planning objectives were reported. No severe toxicity was reported while local control and overall survival were 100%. CONCLUSION The POLO approach is technically feasible and capable to achieve a significant reduction of radiation dose delivered to the previous treated IOERT area. ADVANCES IN KNOWLEDGE The study demonstrates the technical and dosimetric feasibility of conservative salvage whole breast radiotherapy, while sparing the area already treated with IORT, in patients with in-breast recurrence.
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Affiliation(s)
| | - Andriana Kouloura
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Maria Alessia Zerella
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Maria Camarda
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rosa Luraschi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Viola
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Eleonora Miglietta
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Forster T, Hommertgen A, Häfner MF, Arians N, König L, Harrabi SB, Schlampp I, Köhler C, Meixner E, Heinrich V, Weidner N, Hüsing J, Sohn C, Heil J, Golatta M, Hof H, Krug D, Debus J, Hörner-Rieber J. Quality of life after simultaneously integrated boost with intensity-modulated versus conventional radiotherapy with sequential boost for adjuvant treatment of breast cancer: 2-year results of the multicenter randomized IMRT-MC2 trial. Radiother Oncol 2021; 163:165-176. [PMID: 34480960 DOI: 10.1016/j.radonc.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We recently published 2-year results of the prospective, randomized IMRT-MC2 trial, showing non-inferior local control and cosmesis in breast cancer patients after conventionally fractionated intensity-modulated radiotherapy with simultaneously integrated boost (IMRT-SIB), compared to 3D-conformal radiotherapy with sequential boost (3D-CRT-seqB). Here, we report on 2-year quality of life results. PATIENTS AND METHODS 502 patients were enrolled and randomized to IMRT-SIB (50.4 Gy in 1.8 Gy fractions with a 64.4 Gy SIB to the tumor bed) or to 3D-CRT-seqB (50.4 Gy in 1.8 Gy fractions, followed by a sequential boost of 16 Gy in 2 Gy fractions). For quality of life (QoL) assessment, patients completed the QLQ-C30 and QLQ-BR23 questionnaires at baseline, 6 weeks and 2 years after radiotherapy. RESULTS Significant differences between treatment arms were seen 6 weeks after radiotherapy for pain (22.3 points for IMRT vs. 27.0 points for 3D-CRT-seqB; p = 0.033) and arm symptoms (18.1 points for IMRT vs. 23.6 points for 3D-CRT-seqB; p = 0.013), both favoring IMRT-SIB. Compared to baseline values, both arms showed significant improvement in global score (IMRT: p = 0.009; 3D-CRT: p = 0.001) after 2 years, with slight deterioration on the role (IMRT: p = 0.008; 3-D-CRT: p = 0.001) and social functioning (IMRT: p = 0.013, 3D-CRT: p = 0.001) as well as the future perspectives scale (IMRT: p = 0.003; 3D-CRT: p = 0.0034). CONCLUSION This is the first randomized phase III trial demonstrating that IMRT-SIB was associated with slightly superior QoL compared to 3-D-CRT-seqB. These findings further support the clinical implementation of SIB in adjuvant breast cancer treatment.
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Affiliation(s)
- Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Adriane Hommertgen
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Matthias Felix Häfner
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Semi Ben Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Clara Köhler
- Department of Radiation Oncology, Heidelberg University Hospital, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Vanessa Heinrich
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Germany
| | - Nicola Weidner
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Germany
| | - Johannes Hüsing
- Division of Biostatistics, Coordination Centre for Clinical Trials, University of Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Germany
| | - Jörg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Germany
| | - Holger Hof
- Strahlentherapie Rhein-Pfalz, Neustadt, Germany
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Schleswig Holstein, Kiel, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Schleswig Holstein, Kiel, Germany; German Cancer Consortium (DKTK), partner site, Heidelberg, Germany.
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8
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Joseph B, Farooq N, Kumar S, Vijay CR, Puthur KJ, Ramesh C, Lokesh V. Breast-conserving radiotherapy with simultaneous integrated boost; field-in-field three-dimensional conformal radiotherapy versus inverse intensity-modulated radiotherapy - A dosimetric comparison: Do we need intensity-modulated radiotherapy? South Asian J Cancer 2020; 7:163-166. [PMID: 30112330 PMCID: PMC6069338 DOI: 10.4103/sajc.sajc_82_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose: To examine the feasibility of improving breast-conserving radiotherapy with simultaneous integrated boost (SIB) and analyzing the efficiency of forward versus inverse intensity-modulated radiotherapy (IMRT) techniques in providing the same. Materials and Methods: Three-dimensional conformal radiotherapy (3DCRT) field-in-field (FIF) plans with simultaneous and sequential boost and IMRT SIB plans were generated for the datasets of 20 patients who had undergone breast-conserving surgery. The 3 plans were compared dosimetrically for efficiency in terms of planning target volume (PTV) coverage (PTV 95%), homogeneity and conformity, dose delivered to ipsilateral/contralateral lungs (I/L: V10, V20, C/L: Vmean, V5), heart and contralateral breast (Vmean, V30 for heart and Vmean, V1, V5 for C/L breast). Results: The FIF 3DCRT plan with SIB (PLAN B) was more homogeneous than the classical technique with sequential boost (PLAN A). There were less hot spots in terms of Dmax (63.7 ± 1.3) versus Dmax (68.9 ± 1), P < 0.001 and boost V107%, B (0.3 ± 0.7) versus A (3.5 ± 5.99), P = 0.001. The IMRT SIB (PLAN C) did not provide any significant dosimetric advantage over the 3DCRT SIB technique. IMRT SIB plan C was associated with increased dose to contralateral lung in-terms of V5 (10.35 +/- 18.23) vs. (1.13 +/- 4.24), P = 0.04 and Vmean (2.12 ± 2.18) versus Vmean (0.595 ± 0.89), P = 0.008. There was 3-fold greater exposure in terms of Monitor Unit (MU) (1024.9 ± 298.32 versus 281.05 ± 20.23, P < 0.001) and treatment delivery time. Conclusions: FIF 3DCRT SIB provides a dosimetrically acceptable and technically feasible alternative to the classical 3DCRT plan with sequential boost for breast-conserving radiotherapy. It reduces treatment time by 2 weeks. IMRT SIB does not appear to have any dosimetric advantage; it is associated with significantly higher doses to contralateral lung and heart and radiation exposure in terms of MU.
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Affiliation(s)
- Bindhu Joseph
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Nisma Farooq
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Sabari Kumar
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - C R Vijay
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Kurian J Puthur
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - C Ramesh
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Vishwanath Lokesh
- Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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9
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Hörner-Rieber J, Forster T, Hommertgen A, Haefner MF, Arians N, König L, Harrabi SB, Schlampp I, Weykamp F, Lischalk JW, Heinrich V, Weidner N, Hüsing J, Sohn C, Heil J, Hof H, Krug D, Debus J. Intensity Modulated Radiation Therapy (IMRT) With Simultaneously Integrated Boost Shortens Treatment Time and Is Noninferior to Conventional Radiation Therapy Followed by Sequential Boost in Adjuvant Breast Cancer Treatment: Results of a Large Randomized Phase III Trial (IMRT-MC2 Trial). Int J Radiat Oncol Biol Phys 2020; 109:1311-1324. [PMID: 33321192 DOI: 10.1016/j.ijrobp.2020.12.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE In the modern era, improvements in radiation therapy techniques have paved the way for simultaneous integrated boost irradiation in adjuvant breast radiation therapy after breast conservation surgery. Nevertheless, randomized trials supporting the noninferiority of this treatment to historical standards of care approach are lacking. METHODS A prospective, multicenter, randomized phase 3 trial (NCT01322854) was performed to analyze noninferiority of conventional fractionated intensity modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) to 3-D conformal radiation therapy with sequential boost (3-D-CRT-seqB) for breast cancer patients. Primary outcomes were local control (LC) rates at 2 and 5 years (noninferiority margin at hazard ratio [HR] of 3.5) as well as cosmetic results 6 weeks and 2 years after radiation therapy (evaluated via photo documentation calculating the relative breast retraction assessment [pBRA] score [noninferiority margin of 1.25]). RESULTS A total of 502 patients were randomly assigned from 2011 to 2015. After a median follow-up of 5.1 years, the 2-year LC for the IMRT-SIB arm was noninferior to the 3-D-CRT-seqB arm (99.6% vs 99.6%, respectively; HR, 0.602; 95% CI, 0.123-2.452; P = .487). In addition, noninferiority was also shown for cosmesis after IMRT-SIB and 3-D-CRT-seqB at both 6 weeks (median pBRA, 9.1% vs 9.1%) and 2 years (median pBRA, 10.4% vs 9.8%) after radiation therapy (95% CI, -0.317 to 0.107 %; P = .332). Cosmetic assessment according to the Harvard scale by both the patient and the treating physician as well as late-toxicity evaluation with the late effects normal tissues- subjective, objective, management, analytic criteria, a score for the evaluation of long-term adverse effects in normal tissue, revealed no significant differences between treatment arms. In addition, there was no difference in overall survival rates (99.6% vs 99.6%; HR, 3.281; 95% CI: -0.748 to 22.585; P = .148) for IMRT-SIB and 3-D-CRT-seqB, respectively. CONCLUSIONS To our knowledge, this is the first prospective trial reporting the noninferiority of IMRT-SIB versus 3-D-CRT-seqB with respect to cosmesis and LC at 2 years of follow-up. This treatment regimen considerably shortens adjuvant radiation therapy times without compromising clinical outcomes.
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Affiliation(s)
- Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | - Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Adriane Hommertgen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Matthias F Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Semi B Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany
| | - Jonathan W Lischalk
- Perlmutter Cancer Center, Lagone Medical Center, New York University, New York, New York
| | - Vanessa Heinrich
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Nicola Weidner
- Department of Radiation Oncology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Johannes Hüsing
- Division of Biostatistics, Coordination Centre for Clinical Trials, University of Heidelberg, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Jörrg Heil
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Holger Hof
- Strahlentherapie Rhein-Pfalz, Neustadt, Germany
| | - David Krug
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Department of Radiation Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Heidelberg, Germany; National Center for Tumor Diseases, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium, partner site Heidelberg, Germany
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10
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Freedman GM, Taunk NK. Hypofractionated Whole Breast Radiotherapy and Boost in Early-Stage Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer. Radiat Oncol 2020; 15:235. [PMID: 33050920 PMCID: PMC7557053 DOI: 10.1186/s13014-020-01652-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) improves dose homogeneity and late toxicity compared to simple tangential techniques in adjuvant whole-breast radiotherapy for patients with breast cancer. Simultaneous-integrated boost (SIB) radiotherapy shortens the overall treatment time and improves dose homogeneity. However, prospective randomized trials regarding IMRT with SIB for adjuvant radiotherapy in breast cancer are lacking. METHODS The IMRT-MC2 (MINT) trial is a phase III prospective randomized controlled trial comparing IMRT with SIB (Arm A: whole breast 28 × 1.8 Gy, Boost 28 × 2.3 Gy) to 3D-conformal radiotherapy with a sequential boost (Arm B: whole breast 28 × 1.8 Gy, boost 8 × 2 Gy) in patients with breast cancer after BCS. Indication for boost radiotherapy was defined as age < 70 years or age > 70 years with presence of additional risk factors. This is a retrospective analysis of acute toxicity at one of two trial sites. RESULTS Five hundred two patients were randomized, of which 446 patients were eligible for this analysis. There was no statistically significant difference in terms of any grade radiation dermatitis between the two treatment arms at the end of treatment (p = 0.26). However, radiation dermatitis grade 2/3 (29.1% vs. 20.1 and 3.5% vs. 2.3%) occurred significantly more often in Arm A (p = 0.02). Breast/chest wall pain at the first follow-up visit was significantly more common in patients treated on Arm B (p = 0.02). CONCLUSIONS Treatment on both arms was well tolerated, however there were some differences regarding radiodermatitis and breast pain. Further analyses are ongoing. TRIAL REGISTRATION clinicaltrials.gov , NCT01322854 , registered 24th March 2011.
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12
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Onal C, Efe E, Guler OC, Yildirim BA. Dosimetric Comparison of Sequential Versus Simultaneous-integrated Boost in Early-stage Breast Cancer Patients Treated With Breast-conserving Surgery. In Vivo 2020; 33:2181-2189. [PMID: 31662554 DOI: 10.21873/invivo.11720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM To compare simultaneous-integrated boost (SIB) versus sequential-boost (SB) delivered in the context of whole-breast irradiation (WBI) via volumetric-modulated arc therapy (VMAT) and helical-tomotherapy (HT). MATERIALS AND METHODS Planning target-volume (PTV) dosimetric parameters and organs at risk (OAR) were analyzed for SB plan (50 Gy plus 16 Gy boost) and SIB plan (50.4 Gy WBI and 64.4 Gy tumor bed boost) in VMAT and HT techniques. RESULTS Conformity and homogeneity for target-volume doses were better in HT plans compared to VMAT plans. There were no significant differences in ipsilateral lung doses between VMAT and HT plans for SB/SIB techniques, except for a significantly higher lung V5 value with VMAT-SB, and lung V13 value with HT-SIB technique. HT provided a statistically significant decrease in contralateral lung mean V5. CONCLUSION The SIB technique showed better target-volume dose distribution in both HT and VMAT plans, and better sparing heart in HT compared to the SB technique.
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Affiliation(s)
- Cem Onal
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Esma Efe
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Ozan C Guler
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Berna A Yildirim
- Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana, Turkey
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13
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Lee HH, Chen CH, Luo KH, Chuang HY, Huang CJ, Cheng YK, Chen F, Kuo SH, Huang MY. Five-year survival outcomes of intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) using forward IMRT or Tomotherapy for breast cancer. Sci Rep 2020; 10:4342. [PMID: 32152428 PMCID: PMC7063050 DOI: 10.1038/s41598-020-61403-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 02/24/2020] [Indexed: 12/24/2022] Open
Abstract
Intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) reduces overall treatment duration and results in less radiotherapy (RT)-induced dermatitis. However, the use of traditional sequential approach or IMRT-SIB is still under debate since there is not enough evidence of long-term clinical outcomes. The present study investigated 216 patients who underwent breast conserving surgery (BCS) between 2010 and 2013. The median age was 51 years (range, 21-81 years). All patients received IMRT-SIB, 50.4 Gy at 1.8 Gy per fraction to the whole breast and 60.2 Gy at 2.15 Gy per fraction to the tumor bed by integral boost. Among 216 patients, 175 patients received post-operative RT with forward IMRT and 41 patients had Tomotherapy. The median follow-up was 6.4 years. Forty patients (97.6%) in the Tomotherapy arm and 147 patients (84%) in the IMRT arm developed grade 0-1 skin toxicity (P = 0.021). For the entire cohort, the 5-year and 7-year overall survival (OS) rates were 94.4% and 93.1% respectively. The 7-year distant metastasis-free survival rates were 100% vs 89.1% in the Tomotherapy and IMRT arm respectively (P = 0.028). In conclusion, Tomotherapy improved acute skin toxicity compared with forward IMRT-SIB. Chronic skin complication was 1.9%. IMRT-SIB resulted in good long-term survival.
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Affiliation(s)
- Hsin-Hua Lee
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Hau Luo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Yi Chuang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Kai Cheng
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Frank Chen
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hsun Kuo
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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14
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Breast-Conserving Radiotherapy with Simultaneous Integrated Boost—A Dosimetric Comparison of 3DCRT, VMAT and IMRT: Do We Really have a Better Plan? INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0289-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Intensity-modulated radiation therapy with simultaneous integrated boost for locally advanced breast cancer: a prospective study on toxicity and quality of life. Sci Rep 2019; 9:2759. [PMID: 30808911 PMCID: PMC6391390 DOI: 10.1038/s41598-019-39469-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/25/2019] [Indexed: 11/23/2022] Open
Abstract
Radiotherapy after breast conserving surgery and mastectomy with node positive disease has been shown to reduce risk of recurrence and mortality in the treatment of breast cancer. Intensity-modulated radiation therapy (IMRT) after conservative surgery offers several advantages over conventional RT including improved acute and late toxicity and quality of life (QoL). We undertook this study to prospectively evaluate acute (≤90 days after last dose of radiotherapy) and long-term (>90 days) cutaneous, esophageal, and fibrosis toxicity and QoL in breast cancer patients treated by adjuvant IMRT after breast surgery. We included patients with complex volumes for which 3D RT does not allow a good coverage of target volumes and sparing organs at risk. We report here an interim analysis with a median follow-up of 13.1 months (range, 6.5–25.9 months). Most of the acute toxicity was cutaneous (95.9%) and oesophageal (59.6%), and mostly grade 1 and 2. Medium-term cutaneous toxicity rate was 25.6%, and mostly grade 1. Medium-term esophageal toxicity was rare (1.8%). In this series acute oesophageal toxicity was found to be associated with dosimetric factors. QoL was well preserved throughout the study, and aesthetic outcomes were good. Based on these data, tomotherapy may be a favorable alternative to other techniques in patients needing a complex irradiation of the breast and lymph node volumes.
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16
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Kindts I, Defraene G, Laenen A, Petillion S, Van Limbergen E, Depuydt T, Weltens C. Development of a normal tissue complication probability model for late unfavourable aesthetic outcome after breast-conserving therapy. Acta Oncol 2018; 57:916-923. [PMID: 29652212 DOI: 10.1080/0284186x.2018.1461926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE/OBJECTIVES To develop a normal tissue complication probability (NTCP) model for late unfavourable aesthetic outcome (AO) after breast-conserving therapy. MATERIAL AND METHODS The BCCT.core software evaluated the AO using standardized photographs of patients treated between 2009 and 2014. Dose maps in 2 Gy equivalents were calculated assuming α/β = 3.6 Gy. Uni- and multivariable logistic regression analysis was performed to study the predictive value of clinicopathological and dosimetric variables for unfavourable AO. The Lyman Kutcher Burman (LKB) model was fit to the data with dose modifying factors (dmf). Model performance was assessed with the area under the curve (AUC) of the receiver operating characteristic curve and bootstrap sampling. RESULTS Forty-four of the 121 analysed patients (36%) developed unfavourable AO. In the optimal multivariable logistic regression model, a larger breast volume receiving ≥55 Gy (V55), a seroma and an axillary lymph node dissection (ALND) were independently associated with an unfavourable AO, AUC = 0.75 (95%CI 0.64;0.85). Beta-estimates were -2.68 for β0, 0.057 for V55, 1.55 for seroma and 1.20 for ALND. The optimal LKB model parameters were EUD3.6(50) = 63.3 Gy, n = 1.00, m = 0.23, dmf(seroma) = 0.83 and dmf(ALND) = 0.84, AUC = 0.74 (95%CI 0.61;0.83). CONCLUSIONS An NTCP model for late unfavourable AO after breast-conserving therapy was developed including seroma, axillary lymphadenectomy and V55.
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Affiliation(s)
- Isabelle Kindts
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gilles Defraene
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-Biostat), KU Leuven University, Leuven, Belgium
| | - Saskia Petillion
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Depuydt
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Caroline Weltens
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
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17
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Arsene-Henry A, Foy JP, Robilliard M, Xu HP, Bazire L, Peurien D, Poortmans P, Fourquet A, Kirova YM. The use of helical tomotherapy in the treatment of early stage breast cancer: indications, tolerance, efficacy-a single center experience. Oncotarget 2018; 9:23608-23619. [PMID: 29805760 PMCID: PMC5955102 DOI: 10.18632/oncotarget.25286] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/12/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE to evaluate our experience in terms of local control, survival, adverse effects in patients treated by adjuvant helical tomotherapy (HT) for breast cancer (BC). RESULTS We studied 179 consecutive patients with 194 treated breasts with adjuvant HT. Median follow-up was 38.1 months. Median age was 53 years. Chemotherapy was administered to 83% of patients. All 133 hormone receptor positive tumours received hormonal therapy. As concurrent treatment, apart from trastuzumab monotherapy, 6 patients received systemic therapy concomitant to RT. The HT was generally well tolerated with mostly grade 1 and 2 skin reactions and esophagitis. Only 3% grade III early skin reactions. At last follow-up, there were 2 local recurrences, 1 regional lymph node (LN) recurrence and 6 with metastatic progression. The 5-year progression-free survival was 90.5% (95% CI 84.2-97.3). MATERIALS AND METHODS A retrospective study of all patients treated by HT between 2009 and 2015 was done. Patients excluded were those with: breast implants, advanced or metastatic BC, recurrent disease. All patients received breast+/-boost or chest wall irradiation and most received with LN irradiation. Dose constraints for organs at risk were defined using optimization scale developed in our Department. Evaluation of early and late toxicity was done using Common Terminology Adverse Criteria Events v.4.0. CONCLUSIONS HT can be used for a well selected group of breast cancer as bilateral tumours, complex anatomy and target volumes where the conventional radiation therapy techniques cannot ensure an optimal dose distribution. Longer follow-up is necessary to confirm and validate these results.
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Affiliation(s)
| | - Jean-Philippe Foy
- University Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon, Lyon, France
| | | | - Hao-Ping Xu
- Department of Radiation Oncology, Institut Curie, Paris, France
- Department of Radiation Oncology, Ruijin Hospital, Shanghai, China
| | - Louis Bazire
- Department of Radiation Oncology, Institut Curie, Paris, France
| | | | | | - Alain Fourquet
- Department of Radiation Oncology, Institut Curie, Paris, France
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The Role of Adjuvant Radiotherapy for a Case of Primary Breast Sarcoma: A Plan Comparison between Three Modern Techniques and a Review of the Literature. Case Rep Med 2018; 2018:4137943. [PMID: 29849658 PMCID: PMC5932497 DOI: 10.1155/2018/4137943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 12/25/2022] Open
Abstract
A 65-year-old woman, affected by a malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma) of the left breast, presented to our department to receive the postoperative radiotherapy. In the absence of prospective and randomized trials and investigations on breast sarcoma irradiation in literature, due to the rarity of this pathology, the role of adjuvant radiotherapy remains unclear. To identify the best radiotherapy technique for this patient, three methods were compared: 3D conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and volumetric arc therapy (VMAT) or RapidArc® (RA). 50 Gy was prescribed to the chest wall and 66 Gy to the tumor bed. Three plans were designed, and target coverage, organs-at-risk sparing, and treatment efficiency were compared. IMRT and RA improved both target coverage and dose uniformity/homogeneity. Planning objective for the lung is always satisfied comparing the different techniques, but the volume receiving 20 Gy drops to 17% by RA compared to 3D-CRT. The heart volume receiving 30 Gy was 10% by IMRT, against 13% and 16% by RA and 3D-CRT. The monitor unit (MU) required by 3D-CRT was 527 MU, followed by RA and IMRT. Treatment time was similar with 3D-CRT and RA but doubled using IMRT. Although all three radiotherapy techniques offered a satisfactory solution, RA and IMRT offer some improvement on target coverage, dose homogeneity, and conformity for this particular case of breast sarcoma.
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19
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How consistent is breast boost radiotherapy practice across the United Kingdom? JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396916000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurposeThe aims of this project were to identify the national range of breast boost radiotherapy doses and variations in treatment practice; determine the factors that potentially cause variations; and examine whether differences between regions are based on clinical evidence or access to technical and financial resources by surveying Therapeutic Radiographers across the United Kingdom to determine current radiotherapy boost practice.MethodsA cross-sectional study design was selected. An electronic questionnaire using the website Survey Monkey® tool was utilised to collect categorical data from practicing Therapeutic Radiographers within the United Kingdom.SettingParticipants were invited to participate from radiotherapy departments across the four countries of the United Kingdom (England, Scotland, Wales and Northern Ireland). There are 52 radiotherapy departments across 12 regions of the United Kingdom.ResultsIn total, 34 Therapeutic Radiographers participated. Their responses were grouped according to their region of practice. Results indicated that there are ten different dose schedules offered to patients nationally for the treatment of breast boost, with 77% of respondents using electrons to deliver boost radiotherapy.ConclusionsThere is no general consensus among Therapeutic Radiographers about whether factors such as age, tumour size, tumour grade or the presence of negative or positive margins, influence the therapeutic doses prescribed for different patients. This may be attributed to the absence of clinical research evidence to support evidence-based practice.
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Calvo-Ortega JF, Moragues S, Pozo M, Casals J. Dosimetric feasibility of an "off-breast isocenter" technique for whole-breast cancer radiotherapy. Rep Pract Oncol Radiother 2016; 21:500-507. [PMID: 27698590 DOI: 10.1016/j.rpor.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/26/2016] [Indexed: 11/17/2022] Open
Abstract
AIM To investigate the viability of placing the treatment isocenter at the patient midline for breast cancer radiotherapy in order to avoid the risk of collisions during image-guided setup and treatment delivery. BACKGROUND The use of kilovoltage orthogonal setup images has spread in last years in breast radiotherapy. There is a potential risk of an imaging system-patient collision when the isocenter is laterally placed. MATERIALS AND METHODS Twenty IMRT plans designed by placing the isocenter within the breast volume ("plan_ref"), were retrospectively replanned by shifting the isocenter at the patient's midline ("plan_off-breast"). An integrated simultaneous boost (SIB) technique was used. Multiple metrics for the planning target volumes (PTVs) and organs at risk (OARs) were compared for both approaches using a paired t test. RESULTS Comparing plan_ref vs. plan_off-breast, no significant differences in PTV coverage (V95%) were found (96.5% vs. 96.2%; p = 0.361 to PTVbreast; 97.0% vs. 97.0%; p = 0.977 to PTVtumor_bed). With regard to OARs, no substantial differences were observed in any analyzed metric: V5Gy (30.3% vs. 31.4%; p = 0.486), V20Gy (10.3% vs. 10.3%; p = 0.903) and mean dose (7.1 Gy vs. 7.1 Gy; p = 0.924) to the ipsilateral lung; V5Gy (11.2% vs. 10.0%; p = 0.459), V30Gy (0.7% vs. 0.6%; p = 0.251) and mean dose (2.3 Gy vs. 2.2 Gy; p = 0.400) to the heart; and average dose to the contralateral breast (0.4 Gy vs. 0.5 Gy; p = 0.107). CONCLUSIONS The off-breast isocenter solution resulted in dosimetrically comparable plans as the reference technique, avoiding the collision risk during the treatment session.
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Affiliation(s)
- Juan-Francisco Calvo-Ortega
- Servicio de Oncología Radioterápica, Hospital Quirón Barcelona, Plaza Alfonso Comín, 5, 08023 Barcelona, Spain
| | - Sandra Moragues
- Servicio de Oncología Radioterápica, Hospital Quirón Barcelona, Plaza Alfonso Comín, 5, 08023 Barcelona, Spain
| | - Miquel Pozo
- Servicio de Oncología Radioterápica, Hospital Quirón Barcelona, Plaza Alfonso Comín, 5, 08023 Barcelona, Spain
| | - Joan Casals
- Servicio de Oncología Radioterápica, Hospital Quirón Barcelona, Plaza Alfonso Comín, 5, 08023 Barcelona, Spain
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Zhao LR, Zhou YB, Sun JG. Comparison of plan optimization for single and dual volumetric-modulated arc therapy versus intensity-modulated radiation therapy during post-mastectomy regional irradiation. Oncol Lett 2016; 11:3389-3394. [PMID: 27123122 DOI: 10.3892/ol.2016.4376] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/28/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate volumetric-modulated arc therapy (VMAT) with single arc (1ARC) and dual arc (2ARC), and intensity-modulated radiation therapy (IMRT), and to evaluate the quality and delivery efficiency of post-mastectomy regional irradiation. A total of 24 female patients who required post-mastectomy regional irradiation were enrolled into the current study, and 1ARC, 2ARC and IMRT plans were designed for each individual patient. The quality of these plans was evaluated by calculating the homogeneity index (HI), conformity index (CI) and specific volume dose to the ipsilateral lung, double lungs, contralateral breast, heart and spinal cord. For the delivery efficiency of these plans, the total treatment time (TTT) and the number of monitor units (MUs) were evaluated. The 1ARC and 2ARC VMAT plans exhibited significantly better HIs and CIs than IMRT. For dose-volume histogram analysis, 1ARC and 2ARC VMAT spared a more specific volume dose to the ipsilateral lung, double lungs, contralateral breast, heart and spinal cord than IMRT (P<0.05). A lower MU per 2.0-Gy fraction was required for 1ARC (539 MU) and 2ARC (608 MU) than for IMRT (1,051 MU). Thus, TTT was correspondingly reduced in 1ARC and 2ARC compared to IMRT (P<0.05). There was no significant dose-volume difference in all the organs at risk (OARs) between the 1ARC and 2ARC plans (P>0.05), and 2ARC VMAT displayed a better HI and CI than 1ARC VMAT (P<0.05). By contrast, 1ARC VMAT was superior to 2ARC VAMT with regard to MU and TTT (P<0.05). The 1ARC and 2ARC VMAT plans demonstrated significantly better dose distribution in a shorter treatment time than IMRT for post-mastectomy regional irradiation, and spared the majority of OARs without compromising target coverage. The results of the present study suggest that 2ARC VMAT may be an alternative to 1ARC in order to obtain a more optimal HI and CI.
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Affiliation(s)
- Li-Rong Zhao
- Cancer Institute of the People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Yi-Bing Zhou
- Cancer Institute of the People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
| | - Jian-Guo Sun
- Cancer Institute of the People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, P.R. China
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Hybrid intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) technique versus three-dimensional (3D) conformal radiotherapy with SIB for breast radiotherapy: a planning comparison. JOURNAL OF RADIOTHERAPY IN PRACTICE 2016. [DOI: 10.1017/s146039691600008x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractAimThis study aims to compare conventional simultaneous integrated boost (SIB) planning technique with a hybrid SIB intensity-modulated radiation therapy (IMRT) technique with varying open tangent to IMRT field dose ratios. Furthermore, we investigated which of the dose ratios proves the most favourable as a class solution across a sample.MethodsIn total, 15 patients with conventional SIB treatment plans were re-planned with hybrid SIB IMRT technique using three differing open field:IMRT dose ratios, that is, 80:20, 70:30 and 60:40. Plans were compared using dosimetric comparison of organs at risk (OARs) and homogeneity and conformity indexes across target structures.ResultsAll hybrid plans reduced dose maximums and showed a reduction of high doses to both lungs but increased lower doses, that is, V5, with similar results discovered for the heart. Contralateral breast dose was shown to decrease V5 and V1 measures by hybrid arms, whereas increasing the V2. Left anterior descending artery dose and non-irradiated structures were reduced by all hybrid arms. The homogeneity and conformity increased across all hybrid arms. Qualitative assessment of all plans also favoured hybrid plans.FindingsHybrid plans produced superior dose conformity, homogeneity, reduced dose maximums and showed an improvement in most OAR parameters. The 70:30 hybrid technique exhibited greater benefits as a class solution to the sample than conventional plans due to superior dose conformity and homogeneity to target volumes.
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Ghannam AAEA, Khedr RAEG. An accelerated hypofractionated schedule with a daily concomitant boost after breast conservation surgery: the feasibility and toxicity. J Egypt Natl Canc Inst 2016; 28:39-44. [DOI: 10.1016/j.jnci.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 12/19/2022] Open
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Lee HH, Hou MF, Chuang HY, Huang MY, Tsuei LP, Chen FM, Ou-Yang F, Huang CJ. Intensity modulated radiotherapy with simultaneous integrated boost vs. conventional radiotherapy with sequential boost for breast cancer - A preliminary result. Breast 2015; 24:656-60. [PMID: 26371691 DOI: 10.1016/j.breast.2015.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/19/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE This study was aimed to assess the acute dermatological adverse effect from two distinct RT techniques for breast cancer patients. We compared intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) and conventional radiotherapy followed by sequential boost (CRT-SB). METHODS The study population was composed of 126 consecutive female breast cancer patients treated with breast conserving surgery. Sixty-six patients received IMRT-SIB to 2 dose levels simultaneously. They received 50.4 Gy at 1.8 Gy per fraction to the whole breast and 60.2 Gy at 2.15 Gy per fraction to the tumor bed by integral boost. Sixty patients in the CRT-SB group received 50 Gy in 25 fractions to the whole breast followed by a boost irradiation to tumor bed in 5-7 fractions to a total dose of 60-64 Gy. Acute skin toxicities were documented in agreement with the Common Terminology Criteria for Adverse Events version 3 (CTCAE v.3.0). RESULTS Ninety-eight patients had grade 1 radiation dermatitis while 14 patients had grade 2. Among those with grade 2, there were 3 patients in IMRT-SIB group (4.5%) while 11 in CRT-SB group (18.3%). (P = 0.048) There was no patient with higher than grade 2 toxicity. Three year local control was 99.2%, 3-year disease free survival was 97.5% and 3-year overall survival was 99.2%. CONCLUSIONS A significant reduction in the severity of acute radiation dermatitis from IMRT-SIB comparing with CRT-SB is demonstrated.
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Affiliation(s)
- Hsin-Hua Lee
- Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiation Oncology, Antai Tian-Sheng Memorial Hospital, Pingtung, Taiwan
| | - Ming-Feng Hou
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of General Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; National Sun Yat-Sen University-Kaohsiung Medical University Joint Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hung-Yi Chuang
- Faculty of Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Le-Ping Tsuei
- Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Radiation Oncology, Antai Tian-Sheng Memorial Hospital, Pingtung, Taiwan
| | - Fang-Ming Chen
- Department of General Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fu Ou-Yang
- Department of General Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Jen Huang
- Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Dundas KL, Pogson EM, Batumalai V, Boxer MM, Yap ML, Delaney GP, Metcalfe P, Holloway L. Australian survey on current practices for breast radiotherapy. J Med Imaging Radiat Oncol 2015; 59:736-42. [PMID: 26269376 DOI: 10.1111/1754-9485.12348] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/21/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. METHOD An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. RESULTS Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. CONCLUSION This survey provides insight into the current radiotherapy practice for breast cancer in Australia.
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Affiliation(s)
- Kylie L Dundas
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Elise M Pogson
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Miriam M Boxer
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Lois Holloway
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
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Fiorentino A, Mazzola R, Ricchetti F, Giaj Levra N, Fersino S, Naccarato S, Sicignano G, Ruggieri R, Di Paola G, Massocco A, Gori S, Alongi F. Intensity modulated radiation therapy with simultaneous integrated boost in early breast cancer irradiation. Report of feasibility and preliminary toxicity. Cancer Radiother 2015. [PMID: 26206732 DOI: 10.1016/j.canrad.2015.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the feasibility and tolerance in the use of adjuvant intensity modulated radiation therapy (IMRT) and simultaneous integrated boost in patients with a diagnosis of breast cancer after breast-conserving surgery. PATIENTS AND METHODS Between September 2011 to February 2013, 112 women with a diagnosis of early breast cancer (T1-2, N0-1, M0) were treated with IMRT and simultaneous integrated boost after breast-conserving surgery in our institution. A dose of 50Gy in 25 fractions was prescribed to the whole breast and an additional dose of radiation was prescribed on the tumour bed. A dose prescription of 60Gy in 25 fractions to the tumour bed was used in patients with negative margins after surgery, whereas if the margins were close (<1mm) or positive (without a new surgical resection) a dose of 64Gy was prescribed. All patients were followed with periodic clinical evaluation. Acute and late toxicity were scored using the EORTC/RTOG radiation morbidity score system. Both patient and physician recorded cosmetic outcome evaluation with a subjective judgment scale at the time of scheduled follow-up. RESULTS The median follow-up was 28 months (range 24-40 months). The acute skin grade toxicity during the treatment was grade 0 in 8 patients (7%), grade 1 in 80 (72%), grade 2 in 24 cases (21%). No grade 3 or higher acute skin toxicity was observed. At 12 months, skin toxicity was grade 0 in 78 patients (70%), grade 1 in 34 patients (30%). No toxicity grade 2 or higher was registered. At 24 months, skin toxicity was grade 0 in 79 patients (71%), grade 1 in 33 patients (29%). No case of grade 2 toxicity or higher was registered. The pretreatment variables correlated with skin grade 2 acute toxicity were adjuvant chemotherapy (P=0.01) and breast volume ≥700cm(3) (P=0.001). Patients with an acute skin toxicity grade 2 had a higher probability to develop late skin toxicity (P<0.0001). In the 98% of cases, patients were judged to have a good or excellent cosmetic outcome. The 2-year-overall survival and 2-year-local control were 100%. CONCLUSION These data support the feasibility and safety of IMRT with simultaneous integrated boost in patients with a diagnosis of early breast cancer following breast-conserving surgery with acceptable acute and late treatment-related toxicity. A longer follow-up is needed to define the efficacy on outcomes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Esthetics
- Feasibility Studies
- Female
- Follow-Up Studies
- Humans
- Mastectomy, Segmental
- Middle Aged
- Radiodermatitis/etiology
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Radiotherapy, Intensity-Modulated
- Severity of Illness Index
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Affiliation(s)
- A Fiorentino
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - R Mazzola
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy; Radiation oncology school, university of Palermo, Palermo, Italy.
| | - F Ricchetti
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - N Giaj Levra
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - S Fersino
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - S Naccarato
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - G Sicignano
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - R Ruggieri
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - G Di Paola
- Statistic science faculty, university of Palermo, Palermo, Italy
| | - A Massocco
- Breast surgery, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - S Gori
- Medical oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
| | - F Alongi
- Radiation oncology, Sacro Cuore-Don Calabria hospital, Negrar, Verona, Italy
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Franco P, Cante D, Sciacero P, Girelli G, La Porta MR, Ricardi U. Tumor Bed Boost Integration during Whole Breast Radiotherapy: A Review of the Current Evidence. Breast Care (Basel) 2015; 10:44-9. [PMID: 25960725 DOI: 10.1159/000369845] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Radiation therapy delivered with hypofractionation, which involves the delivery of a higher dose per fraction in fewer fractions (generally with a lower total nominal dose) over a shorter overall treatment time, is an established therapeutic option at least for a selected group of early breast cancer patients after breast-conserving surgery. Optimal delivery of the tumor bed boost dose in terms of timing, fractionation, and total dose whenever a hypofractionated schedule is employed has yet to be established. We herein present a review of the current evidence on the role of boost integration in whole breast radiotherapy.
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Affiliation(s)
| | - Domenico Cante
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Piera Sciacero
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Giuseppe Girelli
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Maria Rosa La Porta
- Radiation Oncology Department, Ivrea Community Hospital, ASLTO4, Ivrea, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Torino, Turin, Italy
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Liu ZM, Ge XL, Chen JY, Wang PP, Zhang C, Yang X, Zhu HC, Liu J, Qin Q, Xu LP, Lu J, Zhan LL, Cheng HY, Sun XC. Adjuvant Radiotherapy after Breast Conserving Treatment for Breast Cancer: A Dosimetric Comparison between Volumetric Modulated Arc Therapy and Intensity Modulated Radiotherapy. Asian Pac J Cancer Prev 2015; 16:3257-65. [PMID: 25921129 DOI: 10.7314/apjcp.2015.16.8.3257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiotherapy is an important treatment of choice for breast cancer patients after breast- conserving surgery, and we compare the feasibility of using dual arc volumetric modulated arc therapy (VMAT2), single arc volumetric modulated arc therapy (VMAT1) and Multi-beam Intensity Modulated Radiotherapy (M-IMRT) on patients after breast-conserving surgery. MATERIALS AND METHODS Thirty patients with breast cancer (half right-sided and half left-sided) treated by conservative lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned with three different radiotherapy techniques: 1) VMAT1; 2) VMAT2; 3) M-IMRT. The distributions for the planning target volume (PTV) and organs at risk (OARs) were compared. Dosimetries for all the techniques were compared. RESULTS All three techniques satisfied the dose constraint well. VMAT2 showed no obvious difference in the homogeneity index (HI) and conformity index (CI) of the PTV with respect to M-IMRT and VMAT1. VMAT2 clearly improved the treatment efficiency and can also decrease the mean dose and V5Gy of the contralateral lung. The mean dose and maximum dose of the spinal cord and contralateral breast were lower for VMAT2 than the other two techniques. The very low dose distribution (V1Gy) of the contralateral breast also showed great reduction in VMAT2 compared with the other two techniques. For the ipsilateral lung of right-sided breast cancer, the mean dose was decreased significantly in VMAT2 compared with VMAT1 and M-IMRT. The V20Gy and V30Gy of the ipsilateral lung of the left- sided breast cancer for VMAT2 showed obvious reduction compared with the other two techniques. The heart statistics of VMAT2 also decreased considerably compared to VMAT1 and M-IMRT. CONCLUSIONS Compared to the other two techniques, the dual arc volumetric modulated arc therapy technique reduced radiation dose exposure to the organs at risk and maintained a reasonable target dose distribution.
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Affiliation(s)
- Zhe-Ming Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China E-mail : ;
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Wojcieszynski AP, Olson AK, Rong Y, Kimple RJ, Yadav P. Acute Toxicity From Breast Cancer Radiation Using Helical Tomotherapy With a Simultaneous Integrated Boost. Technol Cancer Res Treat 2015; 15:257-65. [PMID: 25780060 DOI: 10.1177/1533034615574387] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/29/2015] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate 2 simultaneous integrated boost treatment planning techniques using helical tomotherapy for breast conserving therapy with regard to acute skin toxicity and dosimetry. METHODS Thirty-two patients were studied. The original approach was for 16 patients and incorporated a directional block of the ipsilateral lung and breast. An additional 16 patients were planned for using a modified approach that incorporates a full block of the ipsilateral lung exclusive of 4 cm around the breast. Dose-volume histograms of targets and critical structures were evaluated. Skin toxicity monitoring was performed throughout treatment and follow-up using the Common Terminology Criteria for Adverse Events. RESULTS Treatment was well tolerated with patients receiving a median dose of 59.36 Gy. Of the 16 patients in both groups, 8 had grade 2 erythema immediately after radiation. On 3-week follow-up, 10 and 7 patients in the original and modified groups showed grade 1 erythema. On 3- and 6-month follow-up, both groups had minimal erythema, with all patients having either grade 0 or 1 symptoms. No grade 2 or 3 toxicities were reported. Mean treatment time was 7.5 and 10.4 minutes using the original and modified methods. Adequate dose coverage was achieved using both methods (V95 = 99.5% and 98%). Mean dose to the heart was 10.5 and 1.8 Gy, respectively (P < .01). For right-sided tumors, the original and modified plans yielded a mean of 8.8 and 1.1 Gy (P < .01) versus 11.7 and 2.4 Gy for left-sided tumors (P < .01). The mean dose to the ipsilateral lung was also significantly lower in the modified plans (11.8 vs. 5.0 Gy, P < .01). CONCLUSIONS Tomotherapy is capable of delivering homogeneous treatment plans to the whole breast and lumpectomy cavity using simultaneous integrated boost treatment. Using the treatment methods described herein, extremely low doses to critical structures can be achieved without compromising acute skin toxicity.
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Affiliation(s)
- Andrzej P Wojcieszynski
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Anna K Olson
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA Department of Radiation Oncology, Riverview Hospital, Wisconsin Rapids, WI, USA
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, University of California, Sacramento, CA, USA
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA Department of Radiation Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI, USA
| | - Poonam Yadav
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA Department of Radiation Oncology, Riverview Hospital, Wisconsin Rapids, WI, USA
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Yu JI, Choi DH, Huh SJ, Cho EY, Kim K, Chie EK, Ha SW, Park IA, Ahn SJ, Lee JS, Shin KH, Kwon Y, Kim YB, Suh CO, Koo JS, Kim JH, Jeong BG, Kim IA, Lee JH, Park W. Differences in Prognostic Factors and Failure Patterns Between Invasive Micropapillary Carcinoma and Carcinoma With Micropapillary Component Versus Invasive Ductal Carcinoma of the Breast: Retrospective Multicenter Case-Control Study (KROG 13-06). Clin Breast Cancer 2015; 15:353-61.e1-2. [PMID: 25776197 DOI: 10.1016/j.clbc.2015.01.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/13/2015] [Accepted: 01/31/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE We designed the present study to investigate differences in prognostic factors and failure patterns between patients with invasive micropapillary carcinoma or carcinoma with micropapillary component (IMPC) and randomly matched patients with invasive ductal carcinoma (IDC) of the breast at multiple institutions of the Korean Radiation Oncology Group (KROG). MATERIALS AND METHODS This retrospective multicenter study was performed using subjects treated from January 1999 to November 2011. Female patients who had undergone curative resection for breast cancer without neoadjuvant chemotherapy were considered for this study. Exact matches were made for age (± 3 years), pathologic tumor and node stage, treatment method (surgery with or without radiotherapy), and period when surgery was performed (within 1 year) at the same institution. RESULTS A total of 534 patients were analyzed. The median follow-up period was 59 months in both groups. In the comparison of clinicopathologic characteristics, rates of lymphovascular invasion (LVI) and nuclear grade III were both significantly higher in IMPC than in IDC (P < .001, P = .01, respectively). During the follow-up period, recurrences developed in 40 patients with IMPC (15.0%) and 21 with IDC (7.9%). Locoregional recurrence (LRR) developed in 22 patients with IMPC (8.2%) and 10 with IDC (3.7%). The rate of distant metastasis did not differ between the 2 groups (P = .52). LRR-free survival (P = .03) and recurrence-free survival (P = .007) were significantly different between the 2 groups, but overall survival was not (P = .67). CONCLUSION IMPC is associated with a higher rate of LVI, high nuclear grade, and a propensity for LRR compared to IDC. Modification of the locoregional treatment modality might be needed in this pathologic subtype of breast cancer.
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Affiliation(s)
- Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seung Jae Huh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Yoon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung W Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - In Ae Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Ja Ahn
- Department of Radiation Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Shin Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hwan Shin
- Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Youngmee Kwon
- Center of Breast Cancer, National Cancer Center, Goyang, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Ja Seung Koo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Bae Gwon Jeong
- Department of Radiation Oncology, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Donovan EM, Harris EJ, Mukesh MB, Haviland JS, Titley J, Griffin C, Coles CE, Evans PM. The IMPORT HIGH image-guided radiotherapy study: a model for assessing image-guided radiotherapy. Clin Oncol (R Coll Radiol) 2015; 27:3-5. [PMID: 25445551 DOI: 10.1016/j.clon.2014.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E M Donovan
- Joint Department of Physics at The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - E J Harris
- Joint Department of Physics at The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - M B Mukesh
- Oncology Centre, Colchester Hospital University NHS Trust, Colchester, UK
| | - J S Haviland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - J Titley
- ICR-CTSU, Institute of Cancer Research, Sutton, UK
| | - C Griffin
- ICR-CTSU, Institute of Cancer Research, Sutton, UK
| | - C E Coles
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P M Evans
- Centre for Vision Speech and Signal Processing, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford, UK.
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Breast conserving treatment for breast cancer: dosimetric comparison of sequential versus simultaneous integrated photon boost. BIOMED RESEARCH INTERNATIONAL 2014; 2014:827475. [PMID: 25162031 PMCID: PMC4137720 DOI: 10.1155/2014/827475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/27/2014] [Accepted: 07/06/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast conserving surgery followed by whole breast irradiation is widely accepted as standard of care for early breast cancer. Addition of a boost dose to the initial tumor area further reduces local recurrences. We investigated the dosimetric benefits of a simultaneously integrated boost (SIB) compared to a sequential boost to hypofractionate the boost volume, while maintaining normofractionation on the breast. METHODS For 10 patients 4 treatment plans were deployed, 1 with a sequential photon boost, and 3 with different SIB techniques: on a conventional linear accelerator, helical TomoTherapy, and static TomoDirect. Dosimetric comparison was performed. RESULTS PTV-coverage was good in all techniques. Conformity was better with all SIB techniques compared to sequential boost (P = 0.0001). There was less dose spilling to the ipsilateral breast outside the PTVboost (P = 0.04). The dose to the organs at risk (OAR) was not influenced by SIB compared to sequential boost. Helical TomoTherapy showed a higher mean dose to the contralateral breast, but less than 5 Gy for each patient. CONCLUSIONS SIB showed less dose spilling within the breast and equal dose to OAR compared to sequential boost. Both helical TomoTherapy and the conventional technique delivered acceptable dosimetry. SIB seems a safe alternative and can be implemented in clinical routine.
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Michalski A, Atyeo J, Cox J, Rinks M, Morgia M, Lamoury G. A dosimetric comparison of 3D-CRT, IMRT, and static tomotherapy with an SIB for large and small breast volumes. Med Dosim 2014; 39:163-8. [DOI: 10.1016/j.meddos.2013.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/25/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
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Liem X, Chira C, Fourquet A, Campana F, Peurien D, Fournier-Bidoz N, Kirova Y. Résultats préliminaires d’une tomothérapie hélicoïdale adjuvante avec boost intégré dans le cadre d’un traitement conservateur d’un cancer du sein. Cancer Radiother 2014; 18:15-22. [DOI: 10.1016/j.canrad.2013.07.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/22/2013] [Accepted: 07/03/2013] [Indexed: 12/24/2022]
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Cilla S, Kigula-Mugambe J, Digesù C, Macchia G, Bogale S, Massaccesi M, Dawotola D, Deodato F, Buwenge M, Caravatta L, Piermattei A, Valentini V, Morganti AG. Forward-planned intensity modulated radiation therapy using a cobalt source: A dosimetric study in breast cancer. J Med Phys 2013; 38:125-31. [PMID: 24049319 PMCID: PMC3775036 DOI: 10.4103/0971-6203.116367] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 11/16/2022] Open
Abstract
This analysis evaluates the feasibility and dosimetric results of a simplified intensity-modulated radiotherapy (IMRT) treatment using a cobalt-therapy unit for post-operative breast cancer. Fourteen patients were included. Three plans per patient were produced by a cobalt-60 source: A standard plan with two wedged tangential beams, a standard tangential plan optimized without the use of wedges and a plan based on the forward-planned “field-in-field” IMRT technique (Co-FinF) where the dose on each of the two tangential beams was split into two different segments and the two segments weight was determined with an iterative process. For comparison purposes, a 6-MV photon standard wedged tangential treatment plan was generated. Dmean, D98%, D2%, V95%, V107%, homogeneity, and conformity indices were chosen as parameters for comparison. Co-FinF technique improved the planning target volume dose homogeneity compared to other cobalt-based techniques and reduced maximum doses (D2%) and high-dose volume (V110%). Moreover, it showed a better lung and heart dose sparing with respect to the standard approach. The higher dose homogeneity may encourage the adoption of accelerated-hypofractionated treatments also with the cobalt sources. This approach can promote the spread of breast conservative treatment in developing countries.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
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Is the simultaneously integrated boost (SIB) technique for early breast cancer ready to be adopted for routine adjuvant radiotherapy? Statement of the German and the Austrian Societies of Radiooncology (DEGRO/ÖGRO). Strahlenther Onkol 2013; 189:193-6. [PMID: 23358687 DOI: 10.1007/s00066-012-0300-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Alford SL, Prassas GN, Vogelesang CR, Leggett HJ, Hamilton CS. Adjuvant breast radiotherapy using a simultaneous integrated boost: clinical and dosimetric perspectives. J Med Imaging Radiat Oncol 2013; 57:222-9. [PMID: 23551785 DOI: 10.1111/j.1754-9485.2012.02473.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 08/13/2012] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We sought to assess the cosmetic outcomes and the proportion of patients with late radiotherapy toxicity in a group of women with early-stage breast cancer treated with breast-conserving surgery (BCS) and adjuvant radiotherapy using a simultaneous integrated boost (SIB) technique. METHODS AND MATERIALS Female patients with early-stage breast cancer (pT1-2 N0-1) treated with BCS and radiotherapy using an SIB technique were identified retrospectively from the departmental database. Radiotherapy consisted of 45 Gy in 25 fractions delivered to the whole breast with a simultaneous forward-planned conformal boost to the tumour bed of 60 Gy in 25 fractions. Demographic data, as well as prospectively collected measures of toxicity and cosmesis, were recorded and analysed. RESULTS Fifty-five eligible patients were treated between 2009 and 2011. The median age was 61 years (range, 31 to 81 years). Median follow-up was 13.3 months. Late toxicities (including oedema, pigmentation, telangiectasia, fibrosis, osteonecrosis and pain) were graded using Common Terminology Criteria for Adverse Events v3.0 criteria. Grade 0, 1 and 2 toxicities were assigned to 52.8%, 43.4% and 3.8% of patients, respectively. There were no cases of grade 3 or greater toxicity. Ninety-eight per cent had a good or excellent cosmetic outcome based on independent assessment by both the patient and physician. One patient developed a second primary contralateral breast cancer. There were no cases of local recurrence. CONCLUSION The use of a conformal SIB technique is proposed as a mode of delivering adjuvant radiotherapy in early-stage breast cancer. This schedule is convenient for the patient given the shortened overall treatment time. Additionally, the SIB technique seems to be well tolerated, with minimal toxicity and acceptable cosmetic outcomes. Finally, there are dosimetric benefits with respect to target coverage and reduction of dose and dose per fraction to organs at risk.
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Affiliation(s)
- Simone L Alford
- Department of Radiation Oncology, Austin Hospital, Heidelberg, Austrsalia.
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Small K, Kelly C, Beldham-Collins R, Gebski V. Whole breast and excision cavity radiotherapy plan comparison: Conformal radiotherapy with sequential boost versus intensity-modulated radiation therapy with a simultaneously integrated boost. J Med Radiat Sci 2013; 60:16-24. [PMID: 26229603 PMCID: PMC4175795 DOI: 10.1002/jmrs.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 11/29/2012] [Accepted: 12/05/2012] [Indexed: 11/30/2022] Open
Abstract
Introduction A comparative study was conducted comparing the difference between (1) conformal radiotherapy (CRT) to the whole breast with sequential boost excision cavity plans and (2) intensity-modulated radiation therapy (IMRT) to the whole breast with simultaneously integrated boost to the excision cavity. The computed tomography (CT) data sets of 25 breast cancer patients were used and the results analysed to determine if either planning method produced superior plans. Methods CT data sets from 25 past breast cancer patients were planned using (1) CRT prescribed to 50 Gy in 25 fractions (Fx) to the whole-breast planning target volume (PTV) and 10 Gy in 5Fx to the excision cavity and (2) IMRT prescribed to 60 Gy in 25Fx, with 60 Gy delivered to the excision cavity PTV and 50 Gy delivered to the whole-breast PTV, treated simultaneously. In total, 50 plans were created, with each plan evaluated by PTV coverage using conformity indices, plan maximum dose, lung dose, and heart maximum dose for patients with left-side lesions. Results CRT plans delivered the lowest plan maximum doses in 56% of cases (average CRT = 6314.34 cGy, IMRT = 6371.52 cGy). They also delivered the lowest mean lung dose in 68% of cases (average CRT = 1206.64 cGy, IMRT = 1288.37 cGy) and V20 in 88% of cases (average CRT = 20.03%, IMRT = 21.73%) and V30 doses in 92% of cases (average CRT = 16.82%, IMRT = 17.97%). IMRT created more conformal plans, using both conformity index and conformation number, in every instance, and lower heart maximum doses in 78.6% of cases (average CRT = 5295.26 cGy, IMRT = 5209.87 cGy). Conclusion IMRT plans produced superior dose conformity and shorter treatment duration, but a slightly higher planning maximum and increased lung doses. IMRT plans are also faster to treat on a daily basis, with shorter fractionation.
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Affiliation(s)
- Katherine Small
- Nepean Cancer Care Centre Penrith, New South Wales 2750, Australia
| | - Chris Kelly
- Nepean Cancer Care Centre Penrith, New South Wales 2750, Australia ; The Crown Princess Mary Cancer Centre Westmead, New South Wales 2145, Australia
| | - Rachael Beldham-Collins
- Nepean Cancer Care Centre Penrith, New South Wales 2750, Australia ; The Crown Princess Mary Cancer Centre Westmead, New South Wales 2145, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney Sydney, New South Wales 2050, Australia
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Fung E, Hendry J. External beam radiotherapy (EBRT) techniques used in breast cancer treatment to reduce cardiac exposure. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2012.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Freedman GM, White JR, Arthur DW, Allen Li X, Vicini FA. Accelerated fractionation with a concurrent boost for early stage breast cancer. Radiother Oncol 2013; 106:15-20. [DOI: 10.1016/j.radonc.2012.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 11/25/2012] [Accepted: 12/06/2012] [Indexed: 12/18/2022]
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Yang Z, Chen J, Xie J, Zhu C, Pan Z, Yu X, Mei X, Fu X, Guo X. Simultaneous integrated boost in breast conserving radiotherapy: is replanning necessary following tumor bed change? Technol Cancer Res Treat 2012; 12:115-22. [PMID: 23098285 DOI: 10.7785/tcrt.2012.500309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tumor bed (TB) change is often seen during the whole breast irradiation (WBI) in early breast cancer patients. The aims of this study were to evaluate change in seroma volume on repeat CTs and to explore whether replanning is necessary in breast conserving radiotherapy (RT) using the intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB). Thirty patients underwent WBI with 84 CT scans (24 with 3 CTs (CT1, CT2 and CT3) and 6 without CT3) during the 6 weeks of RT were reviewed. TB and other target volumes on all CTs were delineated and compared. IMRT-SIB treatment plans with 50.68 Gy to the whole breast and 64.4 Gy to the boost in 28 fractions were constructed in the CT1. Replan and hybrid plan (without replanning) in the CT2 were reproduced. Dosimetric differences between the replans and hybrid plans were also compared. The mean TB volumes for CT1, CT2 and CT3 were 42.1 cm(3), 20.1 cm(3), 17.0 cm(3), respectively. The mean TB volume reduction was 40.5% from the CT1 to CT2 and 4.3% from the CT2 to CT3. The difference of TB volumes between the CT1 and CT2 was statistically significance (p < 0.001), but not significant between the CT2 and CT3 (p = 1.000). For all patients, target coverage remained adequate with either hybrid plans or replans. However, replanning can significantly decrease the whole breast mean dose (35.2 vs. 35.6 Gy, p = 0.026) and breast volume outside the boost receiving 95% of the boost prescribed dose (39.5 vs. 68.2 cm(3), p < 0.001). In summary, boost volume could irradiate adequately after the significance shrinkage of tumor bed with the fractionated schedule of IMRT-SIB, but replanning on a second CT could avoid the undesired high dose irradiated breast tissue outside boost.
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Affiliation(s)
- ZhaoZhi Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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Donovan EM, James H, Bonora M, Yarnold JR, Evans PM. Second cancer incidence risk estimates using BEIR VII models for standard and complex external beam radiotherapy for early breast cancer. Med Phys 2012; 39:5814-24. [PMID: 23039620 PMCID: PMC3498624 DOI: 10.1118/1.4748332] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To compare organ specific cancer incidence risks for standard and complex external beam radiotherapy (including cone beam CT verification) following breast conservation surgery for early breast cancer. METHOD Doses from breast radiotherapy and kilovoltage cone beam CT (CBCT) exposures were obtained from thermoluminescent dosimeter measurements in an anthropomorphic phantom in which the positions of radiosensitive organs were delineated. Five treatment deliveries were investigated: (i) conventional tangential field whole breast radiotherapy (WBRT), (ii) noncoplanar conformal delivery applicable to accelerated partial beast irradiation (APBI), (iii) two-volume simultaneous integrated boost (SIB) treatment, (iv) forward planned three-volume SIB, and (v) inverse-planned three volume SIB. Conformal and intensity modulated radiotherapy methods were used to plan the complex treatments. Techniques spanned the range from simple methods appropriate for patient cohorts with a low cancer recurrence risk to complex plans relevant to cohorts with high recurrence risk. Delineated organs at risk included brain, salivary glands, thyroid, contralateral breast, left and right lung, esophagus, stomach, liver, colon, and bladder. Biological Effects of Ionizing Radiation (BEIR) VII cancer incidence models were applied to the measured mean organ doses to determine lifetime attributable risk (LAR) for ages at exposure from 35 to 80 yr according to radiotherapy techniques, and included dose from the CBCT imaging. RESULTS All LAR decreased with age at exposure and were lowest for brain, thyroid, liver, and bladder (<0.1%). There was little dependence of LAR on radiotherapy technique for these organs and for colon and stomach. LAR values for the lungs for the three SIB techniques were two to three times those from WBRT and APBI. Uncertainties in the LAR models outweigh any differences in lung LAR between the SIB methods. Constraints in the planning of the SIB methods ensured that contralateral breast doses and LAR were comparable to WBRT, despite their added complexity. The smaller irradiated volume of the ABPI plan contributed to a halving of LAR for contralateral breast compared with the other plan types. Daily image guided radiotherapy (IGRT) for a left breast protocol using kilovoltage CBCT contributed <10% to LAR for the majority of organs, and did not exceed 22% of total organ dose. CONCLUSIONS Phantom measurements and calculations of LAR from the BEIR VII models predict that complex breast radiotherapy techniques do not increase the theoretical risk of second cancer incidence for organs distant from the treated breast, or the contralateral breast where appropriate plan constraints are applied. Complex SIB treatments are predicted to increase the risk of second cancer incidence in the lungs compared to standard whole breast radiotherapy; this is outweighed by the threefold reduction in 5 yr local recurrence risk for patients of high risk of recurrence, and young age, from the use of radiotherapy. APBI may have a favorable impact on risk of second cancer in the contralateral breast and lung for older patients at low risk of recurrence. Intensive use of IGRT increased the estimated values of LAR but these are dominated by the effect of the dose from the radiotherapy, and any increase in LAR from IGRT is much lower than the models' uncertainties.
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Affiliation(s)
- E M Donovan
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK.
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Tumor bed segmentation: first step for partial breast irradiation. Clin Transl Oncol 2012; 15:39-45. [PMID: 22855170 DOI: 10.1007/s12094-012-0884-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In breast IMRT simultaneous integrated boost (SIB) treatment and accelerated partial breast irradiation (APBI), proper delineation of the tumor bed is necessary. Conservative oncoplastic surgery causes changes in peritumoral breast tissue that complicates locating the site of the tumor. Nevertheless, there are still centers that do not use surgical clips to delineate the site. This study aims to show how the lack of clips affects the techniques of SIB and APBI in terms of dose distribution and safety margins in the tumor bed. MATERIALS AND METHODS On 30 patients, the defining of the tumor bed obtained from the pre-surgery CT scan to that outlined on the basis of clips on the post-surgery CT was compared. Tumor bed deviation from the original tumor site was quantified. In addition, the margins to the original tumor site necessary to guarantee the coverage of the tumor bed were calculated. RESULTS Variations were detected in the distances between geometric centers of the PTV (minimum 0.5-maximum 3 cm). The maximum margin necessary to include the entire tumor bed was 4.5 cm. Lesions located in the upper outer quadrant required the widest margins. If margins are not added, the tumor bed volume defined with clips will be underdosed. CONCLUSIONS The definition of the tumor bed based on studies before surgery does not have the necessary accuracy. Clips need to be placed in the surgical bed to identify the changes occurring after the restorative mammoplasty. Without clips, SIB and APBI are not safe.
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Mukesh M, Harris E, Jena R, Evans P, Coles C. Relationship between irradiated breast volume and late normal tissue complications: a systematic review. Radiother Oncol 2012; 104:1-10. [PMID: 22682540 DOI: 10.1016/j.radonc.2012.04.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/29/2012] [Accepted: 04/30/2012] [Indexed: 12/25/2022]
Abstract
The concept of radiation dose-volume effect has been exploited in breast cancer as boost treatment for high risk patients and more recently in trials of Partial Breast Irradiation for low risk patients. However, there appears to be paucity of published data on the dose-volume effect of irradiation on breast tissue including the recently published report on Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC). This systematic review looks at the current literature for relationship between irradiated breast volume and normal tissue complications and introduces the concept of dose modulation.
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Affiliation(s)
- Mukesh Mukesh
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
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Hurkmans CW, Dijckmans I, Reijnen M, van der Leer J, van Vliet-Vroegindeweij C, van der Sangen M. Adaptive radiation therapy for breast IMRT-simultaneously integrated boost: three-year clinical experience. Radiother Oncol 2012; 103:183-7. [PMID: 22280808 DOI: 10.1016/j.radonc.2011.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 12/15/2011] [Accepted: 12/19/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE It has been shown that seroma volumes decrease during breast conserving radiotherapy in a significant percentage of patients. We report on our experience with an adaptive radiation therapy (ART) strategy involving rescanning and replanning patients to take this reduction into account during a course of intensity-modulated radiation therapy with simultaneously integrated boost (IMRT-SIB). MATERIALS From April 2007 till December 2009, 1274 patients eligible for SIB treatment were enrolled into this protocol. Patients for which the time between the initial planning CT (CT(1)) and lumpectomy was less than 30 days and who had an initial seroma volume >30 cm(3) were rescanned at day 10 of treatment (CT(2)) and replanned when significant changes were observed by the radiation oncologist. Patients received 28 fractions of 1.81 Gy to the breast and 2.30 Gy to the boost volume. RESULTS Nine percent (n=113) of the 1274 patients enrolled met the criteria and were rescanned. Of this group, 77% (n=87) of treatment plans were adapted. Time between surgery and CT(1) (20 days versus 20 days for adapted and non-adapted plans, p=0.89) and time between CT(1) and CT(2) (21 days versus 22 days for adapted and non-adapted plans, p=0.43) revealed no procedural differences which might have biased our results. In the adapted plans, seroma decreased significantly from 60 to 27 cm(3) (p<0.001), TBV from 70 to 45 cm(3) (p<0.001) and PTV(boost) from 277 to 220 cm(3) (p<0.001). The volume receiving more than 95% of the boost dose (V(95%(total-dose))) could be reduced by 19% (linear fit, R(2)=0.73) from on average 360 to 292 cm(3) (p<0.001). Delay in treatment and the use of a prolonged treatment schedule with different fractionation for patients with seroma could thus be prevented. CONCLUSION The adaptive radiation therapy IMRT-SIB procedure has proven to be efficient and effective, leading to a clinically significant reduction of the high dose volume. Seroma present in a subgroup of patients referred for breast radiation therapy does not hamper the introduction of highly conformal IMRT-SIB techniques.
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Affiliation(s)
- Coen W Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands.
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Boersma LJ, Janssen T, Elkhuizen PHM, Poortmans P, van der Sangen M, Scholten AN, Hanbeukers B, Duppen JC, Hurkmans C, van Vliet C. Reducing interobserver variation of boost-CTV delineation in breast conserving radiation therapy using a pre-operative CT and delineation guidelines. Radiother Oncol 2012; 103:178-82. [PMID: 22265730 DOI: 10.1016/j.radonc.2011.12.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 12/09/2011] [Accepted: 12/19/2011] [Indexed: 11/17/2022]
Abstract
AIMS To investigate whether using a pre-operative CT scan (Preop-CT) (1) decreases interobserver variation of boost-CTV delineation in breast conserving therapy (BCT), and (2) influences the size of the delineated volumes. PATIENTS AND METHODS Thirty cT1-2N0-1 breast cancer patients underwent a CT-scan in radiation treatment position, prior to and after lumpectomy. Five observers delineated a boost-CTV, both with and without access to the Preop-CT. For each patient and for each observer pair, the conformity index (CI) and the distance between the centres of mass (COMd) for both boost volumes were calculated. In addition, all delineated volumes including the standard deviation (SD) with respect to the median delineation were calculated. RESULTS Using a Preop-CT reduced the mean COMd of the boost-CTV from 1.1cm to 1.0 cm (p<0.001). No effect was seen on the CI, but the boost-CTV volume reduced from 42 cc to 36 cc (p=0.005), implying a reduction of interobserver variation. We saw no significant change in the SD. CONCLUSION Use of a Preop-CT in BCT results in a modest but statistically significant reduction in interobserver variation of the boost-CTV delineations and in a significant reduction in the boost-CTV volume.
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Affiliation(s)
- Liesbeth J Boersma
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
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Teh AYM, Walsh L, Purdie TG, Mosseri A, Xu W, Levin W, Koch CA, Fyles A, Liu FF, Cho BJ. Concomitant intensity modulated boost during whole breast hypofractionated radiotherapy – A feasibility and toxicity study. Radiother Oncol 2012; 102:89-95. [DOI: 10.1016/j.radonc.2011.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 10/18/2011] [Accepted: 10/20/2011] [Indexed: 10/15/2022]
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Topolnjak R, de Ruiter P, Remeijer P, van Vliet-Vroegindeweij C, Rasch C, Sonke JJ. Image-Guided Radiotherapy for Breast Cancer Patients: Surgical Clips as Surrogate for Breast Excision Cavity. Int J Radiat Oncol Biol Phys 2011; 81:e187-95. [DOI: 10.1016/j.ijrobp.2010.12.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 12/15/2010] [Accepted: 12/17/2010] [Indexed: 01/18/2023]
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Sethi RA, No HS, Jozsef G, Ko JP, Formenti SC. Comparison of three-dimensional versus intensity-modulated radiotherapy techniques to treat breast and axillary level III and supraclavicular nodes in a prone versus supine position. Radiother Oncol 2011; 102:74-81. [PMID: 21993404 DOI: 10.1016/j.radonc.2011.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 09/08/2011] [Accepted: 09/10/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND AND PURPOSE To determine the optimal method of targeting breast and regional nodes in selected breast cancer patients after axillary dissection, we compared the results of IMRT versus no IMRT, and CT-informed versus clinically-placed fields, in supine and prone positions. MATERIALS AND METHODS Twelve consecutive breast cancer patients simulated both prone and supine provided the images for this study. Four techniques were used to target breast, level III axilla, and supraclavicular fossa in either position: a traditional three-field three-dimensional conformal radiotherapy (3DCRT) plan, a four-field 3DCRT plan using a posterior axillary boost field, and two techniques using a CT-informed target volume consisting of an optimized 3DCRT plan (CT-planned 3D) and an intensity-modulated radiotherapy (IMRT) plan. The prescribed dose was 50 Gy in 25 fractions. RESULTS CT-planned 3D and IMRT techniques improved nodal PTV coverage. Supine, mean nodal PTV V50 was 50% (3-field), 59% (4-field), 92% (CT-planned 3D), and 94% (IMRT). Prone, V50 was 29% (3-field), 42% (4-field), 97% (CT-planned 3D), and 95% (IMRT). Prone positioning, compared to supine, and IMRT technique, compared to 3D, lowered ipsilateral lung V20. CONCLUSIONS Traditional 3DCRT plans provide inadequate nodal coverage. Prone IMRT technique resulted in optimal target coverage and reduced ipsilateral lung V20.
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Affiliation(s)
- Rajni A Sethi
- Department of Radiation Oncology, New York University Langone Medical Center, New York, USA
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Cante D, Rosa La Porta M, Casanova-Borca V, Sciacero P, Girelli G, Pasquino M, Franco P, Ozzello F. Accelerated Hypofractionated Adjuvant Whole Breast Radiotherapy with Concomitant Photon Boost after Conserving Surgery for Early Stage Breast Cancer: A Prospective Evaluation on 463 Patients. Breast J 2011; 17:586-93. [DOI: 10.1111/j.1524-4741.2011.01159.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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