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Lee TH, Ahn SH, Chung K, Park W, Cho WK, Kim N, Kim TG, Kim H. Quantitative assessment of breast volume changes after whole-breast irradiation for breast cancer using breast auto-segmentation. Breast Cancer Res Treat 2024; 203:205-214. [PMID: 37833452 DOI: 10.1007/s10549-023-07146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE This study aimed to quantitatively estimate the changes in breast volume associated with radiotherapy in patients undergoing breast-conserving surgery and whole-breast irradiation (WBI). METHODS Pre-WBI simulation computed tomography (CT) scans and post-WBI follow-up chest CT scans from a total of 1,151 breast cancer patients were analyzed using a deep-learning-driven auto-segmentation approach. The CT-based asymmetry index (CTAI) was calculated by dividing the volume of the irradiated breast by the volume of the contralateral breast. Significant breast shrinkage was defined as a CTAI < 0.85. To quantify changes in CTAI over the follow-up period, the CTAI ratio was determined as the post-WBI CTAI divided by the pre-WBI CTAI. A multivariate logistic regression analysis was conducted to identify potential variables associated with post-WBI significant breast shrinkage. RESULTS The median CTAI values for pre- and post-WBI CT scans were 0.973 (interquartile range: 0.887-1.069) and 0.866 (interquartile range: 0.773-0.967), respectively. The difference between them was statistically significant (p < 0.001). Following WBI, there was an increase in the rate of significant breast shrinkage from 16.3 to 44.8%. The CTAI ratio showed a negative association with the time interval (p < 0.001, Pearson r = - 0.310). In the multivariate logistic regression analysis, lower pre-WBI CTAI, younger age, and longer interval between CT scans were found to be significantly associated with a higher occurrence of post-WBI significant breast shrinkage. CONCLUSION Breast volume decreases following WBI, and this decrease is correlated with an increased duration after WBI. These findings highlight the long-term consequences of WBI on breast asymmetry.
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Affiliation(s)
- Tae Hoon Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang Hee Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kwangzoo Chung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Haeyoung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Eber J, Schmitt M, Dehaynin N, Le Fèvre C, Antoni D, Noël G. Evaluation of Cardiac Substructures Exposure of DIBH-3DCRT, FB-HT, and FB-3DCRT in Hypofractionated Radiotherapy for Left-Sided Breast Cancer after Breast-Conserving Surgery: An In Silico Planning Study. Cancers (Basel) 2023; 15:3406. [PMID: 37444516 DOI: 10.3390/cancers15133406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Left-sided breast cancer radiotherapy can lead to late cardiovascular complications, including ischemic events. To mitigate these risks, cardiac-sparing techniques such as deep-inspiration breath-hold (DIBH) and intensity-modulated radiotherapy (IMRT) have been developed. However, recent studies have shown that mean heart dose is not a sufficient dosimetric parameter for assessing cardiac exposure. In this study, we aimed to compare the radiation exposure to cardiac substructures for ten patients who underwent hypofractionated radiotherapy using DIBH three-dimensional conformal radiation therapy (3DCRT), free-breathing (FB)-3DCRT, and FB helical tomotherapy (HT). Dosimetric parameters of cardiac substructures were analyzed, and the results were statistically compared using the Wilcoxon signed-rank test. This study found a significant reduction in the dose to the heart, left anterior descending coronary artery, and ventricles with DIBH-3DCRT and FB-HT compared to FB-3DCRT. While DIBH-3DCRT was very effective in sparing the heart, in some cases, it provided little or no cardiac sparing. FB-HT can be an interesting treatment modality to reduce the dose to major coronary vessels and ventricles and may be of interest for patients with cardiovascular risks who do not benefit from or cannot perform DIBH. These findings highlight the importance of cardiac-sparing techniques for precise delivery of radiation therapy.
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Affiliation(s)
- Jordan Eber
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Martin Schmitt
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Nicolas Dehaynin
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Clara Le Fèvre
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Delphine Antoni
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
| | - Georges Noël
- Department of Radiation Oncology, Institut de Cancérologie Strasbourg Europe (ICANS), 67033 Strasbourg, France
- Centre Paul Strauss, Strasbourg University, CNRS, IPHC UMR 7178, UNICANCER, 67000 Strasbourg, France
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Xie Y, Wang Q, Hu T, Chen R, Wang J, Chang H, Cheng J. Risk Factors Related to Acute Radiation Dermatitis in Breast Cancer Patients After Radiotherapy: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:738851. [PMID: 34912704 PMCID: PMC8667470 DOI: 10.3389/fonc.2021.738851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background Acute radiation dermatitis (ARD) is the most common acute response after adjuvant radiotherapy in breast cancer patients and negatively affects patients’ quality of life. Some studies have reported several risk factors that can predict breast cancer patients who are at a high risk of ARD. This study aimed to identify patient- and treatment-related risk factors associated with ARD. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and WanFang literature databases were searched for studies exploring the risk factors in breast cancer patients. The pooled effect sizes, relative risks (RRs), and 95% CIs were calculated using the random-effects model. Potential heterogeneity and sensitivity analyses by study design, ARD evaluation scale, and regions were also performed. Results A total of 38 studies composed of 15,623 breast cancer patients were included in the analysis. Of the seven available patient-related risk factors, four factors were significantly associated with ARD: body mass index (BMI) ≥25 kg/m2 (RR = 1.11, 95% CI = 1.06–1.16, I2 = 57.1%), large breast volume (RR = 1.02, 95% CI = 1.01–1.03, I2 = 93.2%), smoking habits (RR = 1.70, 95% CI = 1.24–2.34, I2 = 50.7%), and diabetes (RR = 2.24, 95% CI = 1.53–3.27, I2 = 0%). Of the seven treatment-related risk factors, we found that hypofractionated radiotherapy reduced the risk of ARD in patients with breast cancer compared with that in conventional fractionated radiotherapy (RR = 0.28, 95% CI = 0.19–0.43, I2 = 84.5%). Sequential boost and bolus use was significantly associated with ARD (boost, RR = 1.91, 95% CI = 1.34–2.72, I2 = 92.5%; bolus, RR = 1.94, 95% CI = 1.82–4.76, I2 = 23.8%). However, chemotherapy regimen (RR = 1.17, 95% CI = 0.95–1.45, I2 = 57.2%), hormone therapy (RR = 1.35, 95% CI = 0.94–1.93, I2 = 77.1%), trastuzumab therapy (RR = 1.56, 95% CI = 0.18–1.76, I2 = 91.9%), and nodal irradiation (RR = 1.57, 95% CI = 0.98–2.53, I2 = 72.5%) were not correlated with ARD. Sensitivity analysis results showed that BMI was consistently associated with ARD, while smoking, breast volume, and boost administration were associated with ARD depending on study design, country of study, and toxicity evaluation scale used. Hypofractionation was consistently shown as protective. The differences between study design, toxicity evaluation scale, and regions might explain a little of the sources of heterogeneity. Conclusion The results of this systematic review and meta-analysis indicated that BMI ≥ 25 kg/m2 was a significant predictor of ARD and that hypofractionation was consistently protective. Depending on country of study, study design, and toxicity scale used, breast volume, smoking habit, diabetes, and sequential boost and bolus use were also predictive of ARD.
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Affiliation(s)
- Yuxiu Xie
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiong Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Hu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renwang Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jue Wang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyan Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Cheng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Cardiac substructures exposure in left-sided breast cancer radiotherapy: Is the mean heart dose a reliable predictor of cardiac toxicity? Cancer Radiother 2021; 25:229-236. [DOI: 10.1016/j.canrad.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/11/2020] [Accepted: 09/03/2020] [Indexed: 12/31/2022]
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Correlation between toxicity and dosimetric parameters for adjuvant intensity modulated radiation therapy of breast cancer: a prospective study. Sci Rep 2021; 11:3626. [PMID: 33574446 PMCID: PMC7878810 DOI: 10.1038/s41598-021-83159-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
ORCID: 0000–0001-6019–7309. In the treatment of breast cancer, intensity-modulated radiation therapy (IMRT) reportedly reduces the high-dose irradiation of at-risk organs and decreases the frequency of adverse events (AEs). Comparisons with conventional radiotherapy have shown that IMRT is associated with lower frequencies of acute and late-onset AEs. Here, we extended a prospective, observational, single-center study of the safety of IMRT to a second investigating center. Patients scheduled for adjuvant IMRT after partial or total mastectomy were given a dose of 50 Gy (25 fractions of 2 Gy over 5 weeks), with a simultaneous integrated boost in patients having undergone conservative surgery. 300 patients were included in the study, and 288 were analyzed. The median follow-up period was 2.1 years. The 2-year disease-free survival rate [95% CI] was 93.4% [89.2–96.0%]. Most AEs were mild. The most common AEs were skin-related—mainly radiodermatitis [in 266 patients (92.4%)] and hyperpigmentation (in 178 (61.8%)). 35% and 6% of the patients presented with grade 2 acute skin and esophageal toxicity, respectively. Only 4 patients presented with a grade 3 event (radiodermatitis). Smoking (odds ratio) [95% CI] = 2.10 [1.14–3.87]; p = 0.017), no prior chemotherapy (0.52 [0.27–0.98]; p = 0.044), and D98% for subclavicular skin (1.030 [1.001–1.061]; p = 0.045) were associated with grade ≥ 2 acute AEs. In a univariate analysis, the mean dose, (p < 0.0001), D2% (p < 0.0001), D50% (p = 0.037), D95% (p = 0.0005), D98% (p = 0.0007), V30Gy (p < 0.0001), and V45Gy (p = 0.0001) were significantly associated with grade ≥ 1 acute esophageal AEs. In a multivariate analysis, D95% for the skin (p < 0.001), D98% for the subclavicular skin and low D95% for the internal mammary lymph nodes were associated with grade ≥ 1 medium-term AEs. The safety profile of adjuvant IMRT after partial or total mastectomy is influenced by dosimetric parameters. Trial registration: ClinicalTrials.gov NCT02281149.
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Chen CH, Hsieh CC, Chang CS, Chen MF. A Retrospective Analysis of Dose Distribution and Toxicity in Patients with Left Breast Cancer Treated with Adjuvant Intensity-Modulated Radiotherapy: Comparison with Three-Dimensional Conformal Radiotherapy. Cancer Manag Res 2020; 12:9173-9182. [PMID: 33061609 PMCID: PMC7532038 DOI: 10.2147/cmar.s269893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background A better understanding of the organs-at-risk (OAR) dose metrics and the related toxicity induced by radiotherapy (RT) for left breast cancer (BC) will improve the quality of life. This study addressed the issue for left-BC patients treated with intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT). Patients and Methods Between 2012 and 2018, 308 left-BC patients underwent adjuvant RT at our hospital. Before June 2015, 134 patients were treated with 3D-CRT. Thereafter, 174 patients underwent IMRT. The patient’s characteristics in the IMRT group did not significantly different compared to those in the 3D-CRT group. Results Among the total study population, the incidence of ≥grade 2 radiation dermatitis (RID) was 17.3%. Higher volumes receiving 105% (≥5.7%) and 107% (≥1%) of prescribed dose and 3D-CRT technique were associated with a higher risk of RID. Regarding lung toxicity, the mean lung dose (≥10.2Gy) and V20 (≥20%) of ipsilateral lung were significantly associated with the incidence of RT-induced pulmonary changes. By dosimetry analysis, IMRT achieved better dose conformity and delivered lower mean doses to heart and ipsilateral lung compared to 3D-CRT. Furthermore, propensity sore and multivariate analysis showed that IMRT technique helped to reduce RT-induced dermatitis and lung toxicity. Conclusion Our data suggest that the volume of OAR exposed to higher doses is a predictor of RT-induced toxicity. Adjuvant RT with IMRT technique offered better dose conformity and spared high-dose levels to OARs to reduce radiation-related morbidity for BC patients.
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Affiliation(s)
- Chia-Hsin Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ching-Chuan Hsieh
- Department of General Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Shen Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Joseph K, Vos LJ, Gabos Z, Pervez N, Chafe S, Tankel K, Warkentin H, Ghosh S, Amanie J, Powell K, Polkosnik LA, Horsman S, MacKenzie M, Sabri S, Parliament MB, Mackey J, Abdulkarim B. Skin Toxicity in Early Breast Cancer Patients Treated with Field-In-Field Breast Intensity-Modulated Radiotherapy versus Helical Inverse Breast Intensity-Modulated Radiotherapy: Results of a Phase III Randomised Controlled Trial. Clin Oncol (R Coll Radiol) 2020; 33:30-39. [PMID: 32711920 DOI: 10.1016/j.clon.2020.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 11/15/2022]
Abstract
AIMS Skin toxicity is a common adverse effect of breast radiotherapy. We investigated whether inverse-planned intensity-modulated radiotherapy (IMRT) would reduce the incidence of skin toxicity compared with forward field-in-field breast IMRT (FiF-IMRT) in early stage breast cancer. MATERIALS AND METHODS This phase III randomised controlled trial compared whole-breast irradiation with either FiF-IMRT or helical tomotherapy IMRT (HT-IMRT), with skin toxicity as the primary end point. Patients received 50 Gy in 25 fractions and were assessed to compare skin toxicity between treatment arms. RESULTS In total, 177 patients were available for assessment and the median follow-up was 73.1 months. Inverse IMRT achieved more homogeneous coverage than FiF-IMRT; erythema and moist desquamation were higher with FiF-IMRT compared with HT-IMRT (61% versus 34%; P < 0.001; 33% versus 11%; P < 0.001, respectively). Multivariate analysis showed large breast volume, FiF-IMRT and chemotherapy were independent factors associated with worse acute toxicity. There was no difference between treatment arms in the incidence of late toxicities. The 5-year recurrence-free survival was 96.3% for both FiF-IMRT and HT-IMRT and the 5-year overall survival was 96.3% for FiF-IMRT and 97.4% for HT-IMRT. CONCLUSIONS Our study showed significant reduction in acute skin toxicity using HT-IMRT compared with FiF-IMRT, without significant reduction in late skin toxicities. On the basis of these findings, inverse-planned IMRT could be used in routine practice for whole-breast irradiation with careful plan optimisation to achieve the required dose constraints for organs at risk.
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Affiliation(s)
- K Joseph
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - L J Vos
- Alberta Cancer Clinical Trials, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Z Gabos
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - N Pervez
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - S Chafe
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - K Tankel
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - H Warkentin
- Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - S Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - J Amanie
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - K Powell
- Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - L-A Polkosnik
- Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - S Horsman
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - M MacKenzie
- Division of Medical Physics, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - S Sabri
- Division of Experimental Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - M B Parliament
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - J Mackey
- Division of Medical Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada
| | - B Abdulkarim
- Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada.
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Van Hulle H, Vakaet V, Deckmyn K, Monten C, Paelinck L, Van Greveling A, Post G, Schoepen M, Fonteyne A, Speleers B, Deseyne P, Mareel M, De Neve W, Veldeman L. Two-year toxicity of hypofractionated breast cancer radiotherapy in five fractions. Acta Oncol 2020; 59:872-875. [PMID: 32285729 DOI: 10.1080/0284186x.2020.1747638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hans Van Hulle
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Vincent Vakaet
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Kathleen Deckmyn
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Chris Monten
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Giselle Post
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Max Schoepen
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Industrial Systems Engineering and Product Design, Kortrijk, Belgium
| | - Arthur Fonteyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Bruno Speleers
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Pieter Deseyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Marc Mareel
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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CHANG CS, CHEN CH, LIU KC, HO CS, CHEN MF. Selection of patients with left breast cancer for IMRT with deep inspiration breath-hold technique. JOURNAL OF RADIATION RESEARCH 2020; 61:431-439. [PMID: 32123912 PMCID: PMC7299258 DOI: 10.1093/jrr/rraa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/09/2019] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
The deep inspiration breath-hold (DIBH) technique has been utilized to reduce the cardiac dose in left-sided breast cancer (BC) patients undergoing radiotherapy. Further investigation of the parameters for selecting which patients will benefit most from DIBH is essential. We performed dosimetric comparisons for 21 patients with left-sided BC who had both computed tomography (CT)-based free-breathing (FB) and DIBH plans. The doses to the heart and left anterior descending artery (LAD) and any reduction due to the DIBH technique were analysed. Based on CTFB plans, dosimetric analysis revealed that the irradiation doses to the heart and LAD were significantly correlated with the target volume, the ipsilateral lung volume (ILV) and the total lung volume (TLV). When patients had an ILV ≥ 950 cm3 or a TLV ≥ 2200 cm3, the irradiation doses to the heart and LAD were significantly decreased. Furthermore, the reduction in the mean heart dose (MHD) was correlated to the difference in lung volume between FB and DIBH. The difference in ILV between DIBH and FB of 1.8 indicated that the patients obtained more benefit from the DIBH technique. The data suggest that lung volume (ILV and TLV) measured on a CT-simulation scan and the difference between FB and DIBH could be utilized to help select patients for DIBH.
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Affiliation(s)
- Chih-Shen CHANG
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Chia-Hsin CHEN
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Kuo-Chi LIU
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Chia-Sheng HO
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
| | - Miao-Fen CHEN
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Chia-Yi, Putz City, Taiwan
- College of Medicine, Chang Gung University College of Medicine, Taiwan
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Kayali M, Abi Jaoude J, Tfayli A, El Saghir N, Poortmans P, Zeidan YH. Post-mastectomy radiation therapy in breast cancer patients with 1-3 positive lymph nodes: No one size fits all. Crit Rev Oncol Hematol 2020; 147:102880. [PMID: 32045847 DOI: 10.1016/j.critrevonc.2020.102880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/05/2019] [Accepted: 01/17/2020] [Indexed: 01/04/2023] Open
Abstract
Post-mastectomy radiation therapy (PMRT) is standard therapy for advanced breast cancer. However, given the lower risk of recurrence, PMRT administration remains controversial in select patients with limited nodal disease. We performed a review of the literature that focuses on the effect of PMRT in breast cancer patients with 1-3 positive lymph nodes, mainly examining loco-regional recurrence (LRR) and overall survival (OS). Most studies, including a large meta-analysis by the EBCTCG, showed a significant improvement in LRR rates among patients receiving PMRT. While most studies demonstrated a trend towards OS improvement, only few studies showed a statistically significant OS or breast cancer-specific survival benefit for PMRT. As such, individualized treatment decisions are recommended, taking into consideration clinicopathological findings. Future studies with large sample sizes and long follow-up times are still needed to better assess the role of PMRT in patients with limited nodal involvement.
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Affiliation(s)
- Majd Kayali
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Arafat Tfayli
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nagi El Saghir
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Philip Poortmans
- Department of Radiation Oncology, Institut Curie & Paris Sciences & Lettres - PSL University, Paris, France
| | - Youssef H Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
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Chen KW, Hsu HT, Lin JF, Yeh HL, Yeh DC, Lin CY, Chan S, Hsieh HY. Adjuvant whole breast radiotherapy with simultaneous integrated boost to tumor bed with intensity modulated radiotherapy technique in elderly breast cancer patients. Transl Cancer Res 2020; 9:S12-S22. [PMID: 35117944 PMCID: PMC8798908 DOI: 10.21037/tcr.2019.07.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/01/2019] [Indexed: 12/25/2022]
Abstract
Background Adjuvant whole breast radiotherapy is the standard of care for breast cancer patients after partial mastectomy. Intensity-modulated radiation therapy (IMRT) has been reported to reduce acute toxicities compared to conventional radiotherapy. IMRT with simultaneous integrated boost (SIB) technique can deliver higher doses to tumor bed and irradiate whole breast with a lower dose level to shorten overall treatment duration. This study presents the long-term results of adjuvant IMRT with SIB in elderly breast cancer patients who received partial mastectomy. Methods From January 2007 to January 2018, 93 elder breast cancer patients (≥65-year-old) who received IMRT with SIB technique after partial mastectomy were reviewed retrospectively. The axillary areas were managed with either sentinel lymph node biopsies or axillary lymph node dissection. The dose to whole breast was 50.4 Gy in 28 fractions in all patients and the dose to tumor bed was 61.6 to 66.4 Gy in 28 fractions. The primary end point is locoregional control. Secondary end points include: overall survival, breast cancer-specific survival, distant-metastases-free survival, disease-free survival, and acute and chronic toxicities. Results The median follow-up was 56.1 months. One patient had ipsilateral breast tumor recurrence, 3 patients had regional lymph node recurrence, and 9 patients had distant metastases. Death occurred in 5 patients, including 3 patients died of breast cancer progression. Five-year overall survival is 96.3% and 5-year locoregional recurrence-free survival is 96.4%. The 5-year breast cancer specific survival and 5-year distant metastases-free survival is 97.5% and 87.2%, respectively. Seven patients developed second primary cancer after RT. Eighty-one point seven percent patients had acute grade 1 dermatitis while 18.3% suffered from grade 2 dermatitis. The incidence of grade 1 pneumonitis and grade 1 stomatitis was 4.3% and 8.6%, respectively. Conclusions Adjuvant IMRT with SIB technique is a safe and effective treatment strategy for elderly breast cancer patients after partial mastectomy.
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Affiliation(s)
- Kuan-Wen Chen
- Department of Radiation Oncology, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - Hsiu-Ting Hsu
- Department of Radiation Oncology, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - Jia-Fu Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hui-Ling Yeh
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Dah-Cherng Yeh
- Department of General Surgery, Cheng-Ching Hospital, Chung-Kang Branch, Taichung, Taiwan
| | - Chin-Yao Lin
- Breast Medical Center, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - Siwa Chan
- Department of Medical Imaging, Taichung Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, Taichung, Taiwan
| | - He-Yuan Hsieh
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
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Guo B, Shah C, Xia P. Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality. J Appl Clin Med Phys 2019; 20:87-96. [PMID: 31743598 PMCID: PMC6909113 DOI: 10.1002/acm2.12767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/05/2019] [Accepted: 10/14/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To develop an automated workflow for whole breast irradiation treatment planning using hybrid intensity modulated radiation therapy (IMRT) approach and to demonstrate that this workflow can improve planning quality and efficiency when compared to manual planning. Methods The auto planning framework was built based on scripting with MIM and Pinnacle systems. MIM workflows were developed to automatically segment normal structures and targets, identify landmarks for beam placement, select beam energies, and set beam configurations. Pinnacle scripts were generated from the MIM workflow to create hybrid IMRT plans automatically. Each hybrid IMRT plan included two prescriptions: a three‐dimensional (3D) prescription consisted of two open tangent beams, and an IMRT prescription consisted of two step‐and‐shoot IMRT beams. The 3D prescription delivered a full prescription dose to the maximum dose point, and the IMRT prescription was optimized to deliver a uniform dose to the entire breast while sparing dose to the normal structures. For 30 patients, the auto plans were compared with clinically accepted manual plans using the paired sample t‐test. Results The auto planning process took approximately 8 min to complete. The mean dice coefficients between auto‐segmentation and manual contours were 0.98, 0.94 and 0.88 for the lungs, heart, and PTVeval_Breast, respectively. The MUs of the auto plans was on average 13% higher than that of the manual plans. Auto planning improved plan quality significantly: percentage volume receiving 95% of the prescription dose (V95%) of the PTVeval_Breast increased from 91.5% to 93.2% (P = 0.001), V105% of the PTVeval_Breast decreased from 7.2% to 1.2% (P = 0.013), V20Gy of the ipsilateral lung decreased from 13.1% to 10.4% (P = 0.001) and mean heart dose for left‐sided breast patients decreased from 1.2 Gy to 0.9 Gy (P < 0.001). Conclusion An automated treatment planning process can make the planning process efficient with improved plan quality.
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Affiliation(s)
- Bingqi Guo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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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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Radiodermatitis - review of treatment options. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.2478/sjdv-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Radiation dermatitis is one of the commonest side effects of ionizing radiation which is applied in radiotherapy of carcinoma of all localizations, most frequently of tumors of breast, head and neck region, lungs and soft tissue sarcomas. It usually occurs as a complication of breast radiotherapy and thus it is more often recorded in female patients on the skin in the region of breast subjected to radiation. Clinical manifestations of radiation dermatitis can be divided into four phases: acute phase (erythema, dry desquamation, moist desquamation, ulceration and necrosis with resulting re-epithelialization, residual post-inflammatory hyperpigmentation, reduction and suppression of sebaceous and sweat glands and epilation); subacute phase (hyperpigmentation and hypopigmentation, telangiectasia, skin atrophy, even ulceration); chronic phase (skin atrophy, dermal fibrosis and permanent skin epilation) and late phase (increased risk of skin cancer). In order to prevent radiation dermatitis, skin care products should be applied throughout radiotherapy that will decrease the frequency of skin reactions or block them and thus improve life quality. Although the therapy includes not only topical corticosteroids but numerous other products with active ingredients such as aloe vera, calendula, hyaluronic acid, sucralfat, sorbolene, mineral and olive oil, honey, vitamin C, zinc, antimicrobials and silver, common therapeutic consensus has not been reached on their application in radiation dermatitis. Therefore, the treatment should be conducted according to the basic guidelines but tailor-made for each individual patient.
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Zhu Q, Kirova YM, Cao L, Arsene-Henry A, Chen J. Cardiotoxicity associated with radiotherapy in breast cancer: A question-based review with current literatures. Cancer Treat Rev 2018; 68:9-15. [DOI: 10.1016/j.ctrv.2018.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 12/25/2022]
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Mbah C, De Ruyck K, De Schrijver S, De Sutter C, Schiettecatte K, Monten C, Paelinck L, De Neve W, Thierens H, West C, Amorim G, Thas O, Veldeman L. A new approach for modeling patient overall radiosensitivity and predicting multiple toxicity endpoints for breast cancer patients. Acta Oncol 2018; 57:604-612. [PMID: 29299946 DOI: 10.1080/0284186x.2017.1417633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/03/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Evaluation of patient characteristics inducing toxicity in breast radiotherapy, using simultaneous modeling of multiple endpoints. METHODS AND MATERIALS In 269 early-stage breast cancer patients treated with whole-breast irradiation (WBI) after breast-conserving surgery, toxicity was scored, based on five dichotomized endpoints. Five logistic regression models were fitted, one for each endpoint and the effect sizes of all variables were estimated using maximum likelihood (MLE). The MLEs are improved with James-Stein estimates (JSEs). The method combines all the MLEs, obtained for the same variable but from different endpoints. Misclassification errors were computed using MLE- and JSE-based prediction models. For associations, p-values from the sum of squares of MLEs were compared with p-values from the Standardized Total Average Toxicity (STAT) Score. RESULTS With JSEs, 19 highest ranked variables were predictive of the five different endpoints. Important variables increasing radiation-induced toxicity were chemotherapy, age, SATB2 rs2881208 SNP and nodal irradiation. Treatment position (prone position) was most protective and ranked eighth. Overall, the misclassification errors were 45% and 34% for the MLE- and JSE-based models, respectively. p-Values from the sum of squares of MLEs and p-values from STAT score led to very similar conclusions, except for the variables nodal irradiation and treatment position, for which STAT p-values suggested an association with radiosensitivity, whereas p-values from the sum of squares indicated no association. Breast volume was ranked as the most significant variable in both strategies. DISCUSSION The James-Stein estimator was used for selecting variables that are predictive for multiple toxicity endpoints. With this estimator, 19 variables were predictive for all toxicities of which four were significantly associated with overall radiosensitivity. JSEs led to almost 25% reduction in the misclassification error rate compared to conventional MLEs. Finally, patient characteristics that are associated with radiosensitivity were identified without explicitly quantifying radiosensitivity.
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Affiliation(s)
- Chamberlain Mbah
- a Department of Radiotherapy and Experimental Cancer Research , Ghent University , Ghent , Belgium
- b Department of Mathematical Modelling, Statistics, and Bioinformatics, Faculty of Bioscience Engineering , University of Ghent , Ghent , Belgium
| | - Kim De Ruyck
- c Department of Basic Medical Sciences, Faculty of Health Sciences , University of Ghent , Ghent , Belgium
| | - Silke De Schrijver
- c Department of Basic Medical Sciences, Faculty of Health Sciences , University of Ghent , Ghent , Belgium
| | - Charlotte De Sutter
- a Department of Radiotherapy and Experimental Cancer Research , Ghent University , Ghent , Belgium
| | - Kimberly Schiettecatte
- a Department of Radiotherapy and Experimental Cancer Research , Ghent University , Ghent , Belgium
| | - Chris Monten
- a Department of Radiotherapy and Experimental Cancer Research , Ghent University , Ghent , Belgium
- d Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Leen Paelinck
- d Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Wilfried De Neve
- a Department of Radiotherapy and Experimental Cancer Research , Ghent University , Ghent , Belgium
- d Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
| | - Hubert Thierens
- c Department of Basic Medical Sciences, Faculty of Health Sciences , University of Ghent , Ghent , Belgium
| | - Catharine West
- e Translational Radiobiology Group , Institute of Cancer Sciences Radiotherapy Related Research Christie Hospital NHS Trust , Manchester , UK
| | - Gustavo Amorim
- b Department of Mathematical Modelling, Statistics, and Bioinformatics, Faculty of Bioscience Engineering , University of Ghent , Ghent , Belgium
| | - Olivier Thas
- b Department of Mathematical Modelling, Statistics, and Bioinformatics, Faculty of Bioscience Engineering , University of Ghent , Ghent , Belgium
- f National Institute for Applied Statistics Research Australia (NIASRA), School of Mathematics and Applied Statistics , University of Wollongong , Wollongong , Australia
| | - Liv Veldeman
- d Department of Radiation Oncology , Ghent University Hospital , Ghent , Belgium
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Albuquerque K, Rodgers K, Spangler A, Rahimi A, Willett D. Electronic Medical Record–Based Radiation Oncology Toxicity Recording Instrument Aids Benchmarking and Quality Improvement in the Clinic. J Oncol Pract 2018; 14:e186-e193. [DOI: 10.1200/jop.2017.025163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: The on-treatment visit (OTV) for radiation oncology is essential for patient management. Radiation toxicities recorded during the OTV may be inconsistent because of the use of free text and the lack of treatment site–specific templates. We developed a radiation oncology toxicity recording instrument (ROTOX) in a health system electronic medical record (EMR). Our aims were to assess improvement in documentation of toxicities and to develop clinic toxicity benchmarks. Methods: A ROTOX that was based on National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0) with flow-sheet functionality was developed in the EMR. Improvement in documentation was assessed at various time intervals. High-grade toxicities (ie, grade ≥ 3 by CTCAE) by site were audited to develop benchmarks and to track nursing and physician actions taken in response to these. Results: A random sample of OTV notes from each clinic physician before ROTOX implementation was reviewed and assigned a numerical document quality score (DQS) that was based on completeness and comprehensiveness of toxicity grading. The mean DQS improved from an initial level of 41% to 99% (of the maximum possible DQS) when resampled at 6 months post-ROTOX. This high-level DQS was maintained 3 years after ROTOX implementation at 96% of the maximum. For months 7 to 9 after implementation (during a 3-month period), toxicity grading was recorded in 4,443 OTVs for 698 unique patients; 107 episodes of high-grade toxicity were identified during this period, and toxicity-specific intervention was documented in 95%. Conclusion: An EMR-based ROTOX enables consistent recording of treatment toxicity. In a uniform sample of patients, local population toxicity benchmarks can be developed, and clinic response can be tracked.
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Affiliation(s)
| | - Kellie Rodgers
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Ann Spangler
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Asal Rahimi
- University of Texas Southwestern Medical Center, Dallas, TX
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Jensen KE, Soril LJJ, Stelfox HT, Clement FM, Lin Y, Marshall DA. Side Effects Associated with the Use of Intensity-Modulated Radiation Therapy in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: A Systematic Review and Meta-Analysis. J Med Imaging Radiat Sci 2017; 48:402-413. [PMID: 31047476 DOI: 10.1016/j.jmir.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of the study was to establish the efficacy and safety of breast intensity-modulated radiation therapy (IMRT) compared with non-IMRT standard wedge radiation therapy (RT) for the treatment of adjuvant breast cancer. METHODS A systematic review and meta-analysis were completed using STATA and a random effects model. A total of 1,499 citations were identified from the literature search. Of those, 1,475 were excluded based on abstract review. Full texts of 24 remaining articles were reviewed and 11 articles were included in the final analysis. Side effects were analysed as the primary outcomes of interest. We calculated individual odds ratios and 95% confidence intervals for 17 classifications of side effects reported. The data for eight classifications of side effects were then pooled for meta-analyses to obtain more precise estimates of the relationships between adjuvant RT and a particular side effect. RESULTS The pooled analyses revealed potential protective associations between adjuvant IMRT and two acute side effects: dermatitis and moist desquamation. The remaining pooled estimates suggest that the odds of developing edema, hyperpigmentation, fat necrosis, pain, induration were no worse, nor better among those treated with IMRT compared with those treated with non-IMRT standard wedge RT. CONCLUSION The pooled estimates from this meta-analysis are in line with the existing evidence. When the outcome of interest is reduction of the acute side effects: dermatitis and moist desquamation IMRT is a viable treatment option for women undergoing external beam RT after breast-conserving surgery.
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Affiliation(s)
- Katherine E Jensen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Radiation Oncology, Central Alberta Cancer Center, Alberta Health Services, Red Deer, Alberta, Canada.
| | - Lesley J J Soril
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yongtao Lin
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Krengli M, Pisani C. Could radiotherapy be omitted in elderly patients receiving breast conserving surgery? Curr Med Res Opin 2017; 33:1579-1581. [PMID: 28537491 DOI: 10.1080/03007995.2017.1335190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marco Krengli
- a Division of Radiotherapy , University Hospital Maggiore della Carità , Novara , Italy
| | - Carla Pisani
- b Department of Translational Medicine , University of "Piemonte Orientale" , Novara , Italy
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Nagai A, Shibamoto Y, Yoshida M, Inoda K, Kikuchi Y. Intensity-modulated radiotherapy using two static ports of tomotherapy for breast cancer after conservative surgery: dosimetric comparison with other treatment methods and 3-year clinical results. JOURNAL OF RADIATION RESEARCH 2017; 58:529-536. [PMID: 28339844 PMCID: PMC5570131 DOI: 10.1093/jrr/rrw132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/23/2016] [Indexed: 06/06/2023]
Abstract
This study investigated the differences in dose-volume parameters for the breast and normal tissues during TomoDirectTM (TD) intensity-modulated radiation therapy (IMRT), TD-3D conformal radiotherapy (3DCRT) and 3DCRT plans, all using two beams, and analyzed treatment outcomes of two-beam TD-IMRT for breast cancer after breast-conserving surgery. Between August 2011 and January 2015, 152 patients were treated using two-beam TD-IMRT with 50 Gy/25 fractions. Among them, 20 patients with left-sided breast cancer were randomly chosen, and two-beam TD-IMRT, TD-3DCRT and 3DCRT plans were created for each patient. The homogeneity and conformity indices and various dose-volume parameters for the planning target volume and OARs were evaluated. Clinical outcomes were evaluated at 3 years. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4.0. TD-IMRT and TD-3DCRT showed better whole-breast coverage than 3DCRT (P < 0.001). Most of the mean values of dosimetric endpoints for OARs were better in TD-IMRT than in TD-3DCRT and 3DCRT. Overall survival rates were 97.7% and local control rates were 99.1% at 3 years. Regional control and distant metastasis control rates at 3 years were 98.6% and 96.8%, respectively. Twenty-four of the 152 patients had Grade 2 or higher acute radiation dermatitis. Four patients (4/146 = 2.7%) had Grade 2 radiation pneumonitis. There were no late adverse events of Grade 2 or higher. Two-beam TD-IMRT appeared to yield better dose distribution for whole-breast external-beam radiation therapy than TD-3DCRT and two-beam 3DCRT. The treatment appeared to provide low skin toxicity and acceptable tumor control.
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Affiliation(s)
- Aiko Nagai
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Masanori Yoshida
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan
| | - Koji Inoda
- Department of Radiological Technology, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan
| | - Yuzo Kikuchi
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan
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Chan TY, Tan PW, Tang JI. Intensity-modulated radiation therapy for early-stage breast cancer: is it ready for prime time? BREAST CANCER-TARGETS AND THERAPY 2017; 9:177-183. [PMID: 28360536 PMCID: PMC5365280 DOI: 10.2147/bctt.s127583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Whole breast external beam radiotherapy (WBEBRT) is commonly used as an essential arm in the treatment management of women with early-stage breast cancer. Dosimetry planning for conventional WBEBRT typically involves a pair of tangential fields. Advancement in radiation technology and techniques has the potential to improve treatment outcomes with clinically meaningful long-term benefits. However, this advancement must be balanced with safety and improved efficacy. Intensity-modulated radiation therapy (IMRT) is an advanced technique that shows promise in improving the planning process and radiation delivery. Early data on utilizing IMRT for WBEBRT demonstrate more homogenous dose distribution with reduction in organs at risk doses. This translates to toxicities reduction. The two common descriptors for IMRT are forward-planning "fields in field" and inverse planning. Unlike IMRT for other organs, the aim of IMRT for breast planning is to achieve dose homogeneity and not organ conformality. The aim of this paper was to evaluate whether IMRT is ready for prime time based on these three points: 1) workload impact, 2) the clinical impact on the patient's quality of life, and 3) the appropriateness and applicability to clinical practice.
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Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
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Buwenge M, Cammelli S, Ammendolia I, Tolento G, Zamagni A, Arcelli A, Macchia G, Deodato F, Cilla S, Morganti AG. Intensity modulated radiation therapy for breast cancer: current perspectives. BREAST CANCER-TARGETS AND THERAPY 2017; 9:121-126. [PMID: 28293119 PMCID: PMC5345691 DOI: 10.2147/bctt.s113025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Owing to highly conformed dose distribution, intensity modulated radiation therapy (IMRT) has the potential to improve treatment results of radiotherapy (RT). Postoperative RT is a standard adjuvant treatment in conservative treatment of breast cancer (BC). The aim of this review is to analyze available evidence from randomized controlled trials (RCTs) on IMRT in BC, particularly in terms of reduction of side effects. Methods A literature search of the bibliographic database PubMed, from January 1990 through November 2016, was performed. Only RCTs published in English were included. Results Ten articles reporting data from 5 RCTs fulfilled the selection criteria and were included in our review. Three out of 5 studies enrolled only selected patients in terms of increased risk of toxicity. Three studies compared IMRT with standard tangential RT. One study compared the results of IMRT in the supine versus the prone position, and one study compared standard treatment with accelerated partial breast IMRT. Three studies reported reduced acute and/or late toxicity using IMRT compared with standard RT. No study reported improved quality of life. Conclusion IMRT seems able to reduce toxicity in selected patients treated with postoperative RT for BC. Further analyses are needed to better define patients who are candidates for this treatment modality.
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Affiliation(s)
- Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Radiation Oncology Center, University of Bologna, S.Orsola-Malpighi Hospital
| | - Silvia Cammelli
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Radiation Oncology Center, University of Bologna, S.Orsola-Malpighi Hospital
| | - Ilario Ammendolia
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Radiation Oncology Center, University of Bologna, S.Orsola-Malpighi Hospital
| | - Giorgio Tolento
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Radiation Oncology Center, University of Bologna, S.Orsola-Malpighi Hospital
| | - Alice Zamagni
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Radiation Oncology Center, University of Bologna, S.Orsola-Malpighi Hospital
| | | | | | | | - Savino Cilla
- Medical Physics Unit, Research and Care Foundation 'Giovanni Paolo II,' Catholic University of Sacred Heart, Campobasso, Italy
| | - Alessio G Morganti
- Department of Experimental, Diagnostic and Specialty Medicine - DIMES, Radiation Oncology Center, University of Bologna, S.Orsola-Malpighi Hospital
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Sakthivel V, Kadirampatti Mani G, Mani S, Boopathy R. Comparison of treatment planning techniques in treatment of carcinoma of left breast: Second cancer perspective. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Chronic radiation dermatitis is a late side effect of skin irradiation, which may deteriorate patients’ quality of life. There is a lack of precise data about its incidence; however, several risk factors may predispose to the development of this condition. It includes radiotherapy dose, fractionation, technique, concurrent systemic therapy, comorbidities, and personal and genetic factors. Chronic radiation dermatitis is mostly caused by the imbalance of proinflammatory and profibrotic cytokines. Clinical manifestation includes changes in skin appearance, wounds, ulcerations, necrosis, fibrosis, and secondary cancers. The most severe complication of irradiation is extensive radiation-induced fibrosis (RIF). RIF can manifest in many ways, such as skin induration and retraction, lymphedema or restriction of joint motion. Diagnosis of chronic radiation dermatitis is usually made by clinical examination. In case of unclear clinical manifestation, a biopsy and histopathological examination are recommended to exclude secondary malignancy. The most effective prophylaxis of chronic radiation dermatitis is the use of proper radiation therapy techniques to avoid unnecessary irradiation of healthy skin. Treatment of chronic radiation dermatitis is demanding. The majority of the interventions are based only on clinical practice. Telangiectasia may be treated with pulse dye laser therapy. Chronic postirradiation wounds need special dressings. In case of necrosis or severe ulceration, surgical intervention may be considered. Management of RIF should be complex. Available methods are rehabilitative care, pharmacotherapy, hyperbaric oxygen therapy, and laser therapy. Future challenges include the assessment of late skin toxicity in modern irradiation techniques. Special attention should be paid on genomics and radiomics that allow scientists and clinicians to select patients who are at risk of the development of chronic radiation dermatitis. Novel treatment methods and clinical trials are strongly needed to provide more efficacious therapies.
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Affiliation(s)
- Mateusz Spałek
- Department of Radiotherapy I, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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25
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Haloua MH, Volders JH, Krekel NMA, Lopes Cardozo AMF, de Roos WK, de Widt-Levert LM, van der Veen H, Rijna H, Bergers E, Jóźwiak K, Meijer S, van den Tol MP. Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT). Ann Surg Oncol 2016; 23:30-7. [PMID: 26486999 PMCID: PMC4695494 DOI: 10.1245/s10434-015-4906-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 01/06/2023]
Abstract
Background Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). Objective The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS). Methods A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either USS (65 patients) or PGS (69 patients). Cosmetic outcomes were assessed by a three-member panel using computerized software Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and by patient self-evaluation, including patient satisfaction. Time points for follow-up were 3, 6, and 12 months after surgery. Overall cosmetic outcome and patient satisfaction were scored on a 4-point Likert scale (excellent, good, fair, or poor), and outcomes were analyzed using a multilevel, mixed effect, proportional odds model for ordinal responses. Results Ultrasound-guided breast-conserving surgery achieved better cosmetic outcomes, with 20 % excellence overall and only 6 % rated as poor, whereas 14 % of PGS outcomes were rated excellent and 13 % as poor. USS also had consistently lower odds for worse cosmetic outcomes (odds ratio 0.55, p = 0.067) than PGS. The chance of having a worse outcome was significantly increased by a larger lumpectomy volume (ptrend = 0.002); a volume >40 cc showed odds 2.78-fold higher for a worse outcome than a volume ≤40 cc. USS resulted in higher patient satisfaction compared with PGS. Conclusion Ultrasound-guided breast-conserving surgery achieved better overall cosmetic outcomes and patient satisfaction than PGS. Lumpectomy volumes >40 cc resulted in significantly worse cosmetic outcomes.
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Affiliation(s)
- Max H. Haloua
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - José H. Volders
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M. A. Krekel
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Wifred K. de Roos
- />Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | | | - Henk van der Veen
- />Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Herman Rijna
- />Department of Surgery, Kennemergasthuis, Haarlem, The Netherlands
| | - Elisabeth Bergers
- />Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Katarzyna Jóźwiak
- />Department of Epidemiology and Biostatistics, NKI-AVL, Amsterdam, The Netherlands
| | - Sybren Meijer
- />Department of Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Techniques d’irradiation du cancer du sein en 2016 : intérêt et indications de la radiothérapie conformationnelle avec modulation d’intensité. Cancer Radiother 2016; 20:572-5. [DOI: 10.1016/j.canrad.2016.07.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022]
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Pignol JP, Truong P, Rakovitch E, Sattler MG, Whelan TJ, Olivotto IA. Ten years results of the Canadian breast intensity modulated radiation therapy (IMRT) randomized controlled trial. Radiother Oncol 2016; 121:414-419. [PMID: 27637858 DOI: 10.1016/j.radonc.2016.08.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/20/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE We report the long-term outcomes in patients enrolled in a multicenter randomized controlled trial comparing Intensity Modulated Radiation Therapy (IMRT) with standard wedge radiotherapy. MATERIALS AND METHODS Trial participants were assessed to compare long-term side effects between treatment arms. The primary endpoint was chronic breast pain assessed by trained observers blinded to treatment allocation. Secondary endpoints included cosmesis and quality of life measures. RESULTS Median follow-up time was 9.8years and 241 patients were available for assessment. There was no significant difference in chronic pain between treatment arms (OR=0.74, range 0.432-1.271). There were also no differences for the secondary endpoints. Univariate and multivariate analyses identified young age (p=0.013) and pain during RT (p<0.001) to be associated with chronic pain. Acute moist desquamation was associated with late subcutaneous fibrosis (p=0.003) and telangiectasia (p=0.039). Pain during RT was associated with a long-term poorer self-assessed cosmetic outcome (p<0.001) and quality of life (p<0.001). CONCLUSIONS Breast IMRT cannot be recommended for all patients to reduce long-term side effects. However, late toxicities were significantly correlated with acute side effects, which are increased in patients having poor dose distribution. Breast IMRT may hence be useful for selected patients.
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Affiliation(s)
- Jean-Philippe Pignol
- Erasmus MC Cancer Institute, Radiation Oncology Department, Rotterdam, The Netherlands.
| | - Pauline Truong
- Vancouver Island Cancer Centre, Radiation Oncology Department, Victoria, Canada
| | - Eileen Rakovitch
- Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences and Radiation Oncology Department, Toronto, Canada
| | - Margriet G Sattler
- Erasmus MC Cancer Institute, Radiation Oncology Department, Rotterdam, The Netherlands
| | - Timothy J Whelan
- Hamilton Health Sciences, Juravinski Cancer Centre, Hamilton, Canada
| | - Ivo A Olivotto
- Tom Baker Cancer Centre, Division of Radiation Oncology, Calgary, Canada
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28
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The 2-Year Cosmetic Outcome of a Randomized Trial Comparing Prone and Supine Whole-Breast Irradiation in Large-Breasted Women. Int J Radiat Oncol Biol Phys 2016; 95:1210-7. [DOI: 10.1016/j.ijrobp.2016.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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Abstract
Ionizing radiation is an important treatment modality for a variety of malignant conditions. However, development of radiation-induced skin changes is a significant adverse effect of radiation therapy (RT). Cutaneous repercussions of RT vary considerably in severity, course, and prognosis. When they do occur, cutaneous changes to RT are commonly graded as acute, consequential-late, or chronic. Acute reactions can have severe sequelae that impact quality of life as well as cancer treatment. Thus, dermatologists should be informed about these adverse reactions, know how to assess their severity and be able to determine course of management. The majority of measures currently available to prevent these acute reactions are proper skin hygiene and topical steroids, which limit the severity and decrease symptoms. Once acute cutaneous reactions develop, they are treated according to their severity. Treatments are similar to those used in prevention, but incorporate wound care management that maintains a moist environment to hasten recovery. Chronic changes are a unique subset of adverse reactions to RT that may develop months to years following treatment. Chronic radiation dermatitis is often permanent, progressive, and potentially irreversible with substantial impact on quality of life. Here, we also review the etiology, clinical manifestations, pathogenesis, prevention, and management of late-stage cutaneous reactions to radiotherapy, including chronic radiation dermatitis and radiation-induced fibrosis.
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30
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Mukesh MB, Qian W, Wah Hak CC, Wilkinson JS, Barnett GC, Moody AM, Wilson C, Coles CE. The Cambridge Breast Intensity-modulated Radiotherapy Trial: Comparison of Clinician- versus Patient-reported Outcomes. Clin Oncol (R Coll Radiol) 2016; 28:354-64. [PMID: 27021931 DOI: 10.1016/j.clon.2016.02.011] [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: 09/11/2015] [Revised: 02/04/2016] [Accepted: 02/23/2016] [Indexed: 11/27/2022]
Abstract
AIMS Breast radiotherapy-associated toxicity is often reported using clinical and photographic assessments. The addition of patient-reported outcome measures (PROMs) is becoming more common. This study investigated the concordance between clinician- and patient-reported outcomes. MATERIALS AND METHODS The Cambridge Breast Intensity-modulated Radiotherapy (IMRT) trial prospectively collected data on clinician assessment and PROMs at 2 and 5 years after breast radiotherapy. Clinician assessment included physical examination and photographic assessment. PROMs included European Organization for Research and Treatment of Cancer (EORTC) BR23 questionnaire and four breast radiotherapy-specific questions. The correlation between patient and clinician scores were analysed on an independent patient basis using percentage agreement, Cohen's kappa coefficient (k) and Bowker's test of symmetry. The analysis was repeated after stratifying patients based on age, baseline Hospital Anxiety and Depression Score (HADS) and baseline body image score. RESULTS At 2 and 5 years, a weak level of concordance was seen between the clinician-based assessment and PROMS for all the five toxicity end points (k = 0.05-0.21), with individual patient-based agreement of 32.9-78.3% and a highly discordant Bowker's test of symmetry (P < 0.001). The most frequently reported moderate-severe toxicity by patients was change in breast appearance (14% at both 2 and 5 years), whereas it was breast induration (36% and 25% at 2 and 5 years, respectively) by the clinicians. The lack of concordance was not affected by patient's age, baseline HADS and baseline body image score. CONCLUSIONS This study found that moderate-severe toxicity reported by patients is low and the overall concordance between clinicians and patients is low. This could be due to methodological limitations or alternatively reflects the subjective nature of PROMs. Incorporation of a patient's perception on treatment-related toxicity will have important implications for treatment decisions and follow-up care.
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Affiliation(s)
- M B Mukesh
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, Colchester Hospital University NHS Foundation Trust, Essex, UK.
| | - W Qian
- Cambridge Cancer Trials Centre, Cambridge Clinical Trials Unit - Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C C Wah Hak
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - J S Wilkinson
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - G C Barnett
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Cancer Research UK Centre for Genetic Epidemiology and Department of Oncology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - A M Moody
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Wilson
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C E Coles
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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31
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Volders JH, Haloua MH, Krekel NMA, Meijer S, van den Tol PM. Current status of ultrasound-guided surgery in the treatment of breast cancer. World J Clin Oncol 2016; 7:44-53. [PMID: 26862490 PMCID: PMC4734937 DOI: 10.5306/wjco.v7.i1.44] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/02/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing “blind” surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast tumours in the search for better oncological and cosmetic outcomes.
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Tyran M, Mailleux H, Tallet A, Fau P, Gonzague L, Minsat M, Moureau-Zabotto L, Resbeut M. Volumetric-modulated arc therapy for left-sided breast cancer and all regional nodes improves target volumes coverage and reduces treatment time and doses to the heart and left coronary artery, compared with a field-in-field technique. JOURNAL OF RADIATION RESEARCH 2015; 56:927-937. [PMID: 26386255 PMCID: PMC4628222 DOI: 10.1093/jrr/rrv052] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 06/05/2023]
Abstract
We compared two intensity-modulated radiotherapy techniques for left-sided breast treatment, involving lymph node irradiation including the internal mammary chain. Inverse planned arc-therapy (VMAT) was compared with a forward-planned multi-segment technique with a mono-isocenter (MONOISO). Ten files were planned per technique, delivering a 50-Gy dose to the breast and 46.95 Gy to nodes, within 25 fractions. Comparative endpoints were planning target volume (PTV) coverage, dose to surrounding structures, and treatment delivery time. PTV coverage, homogeneity and conformality were better for two arc VMAT plans; V95%(PTV-T) was 96% for VMAT vs 89.2% for MONOISO. Homogeneity index (HI)(PTV-T) was 0.1 and HI(PTV-N) was 0.1 for VMAT vs 0.6 and 0.5 for MONOISO. Treatment delivery time was reduced by a factor of two using VMAT relative to MONOISO (84 s vs 180 s). High doses to organs at risk were reduced (V30(left lung) = 14% using VMAT vs 24.4% with MONOISO; dose to 2% of the volume (D2%)(heart) = 26.1 Gy vs 32 Gy), especially to the left coronary artery (LCA) (D2%(LCA) = 34.4 Gy vs 40.3 Gy). However, VMAT delivered low doses to a larger volume, including contralateral organs (mean dose [Dmean](right lung) = 4 Gy and Dmean(right breast) = 3.2 Gy). These were better protected using MONOISO plans (Dmean(right lung) = 0.8 Gy and Dmean(right breast) = 0.4 Gy). VMAT improved PTV coverage and dose homogeneity, but clinical benefits remain unclear. Decreased dose exposure to the LCA may be clinically relevant. VMAT could be used for complex treatments that are difficult with conventional techniques. Patient age should be considered because of uncertainties concerning secondary malignancies.
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Affiliation(s)
- Marguerite Tyran
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Hugues Mailleux
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Agnes Tallet
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Pierre Fau
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Laurence Gonzague
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Mathieu Minsat
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Laurence Moureau-Zabotto
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - Michel Resbeut
- Service de Radiothérapie, Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
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Currey AD, Bergom C, Kelly TR, Wilson JF. Reducing the Human Burden of Breast Cancer: Advanced Radiation Therapy Yields Improved Treatment Outcomes. Breast J 2015; 21:610-20. [PMID: 26412023 DOI: 10.1111/tbj.12495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Radiation therapy is an important modality in the treatment of patients with breast cancer. While its efficacy in the treatment of breast cancer was known shortly after the discovery of x-rays, significant advances in radiation delivery over the past 20 years have resulted in improved patient outcomes. With the development of improved systemic therapy, optimizing local control has become increasingly important and has been shown to improve survival. Better understanding of the magnitude of treatment benefit, as well as patient and biological factors that confer an increased recurrence risk, have allowed radiation oncologists to better tailor treatment decisions to individual patients. Furthermore, significant technological advances have occurred that have reduced the acute and long-term toxicity of radiation treatment. These advances continue to reduce the human burden of breast cancer. It is important for radiation oncologists and nonradiation oncologists to understand these advances, so that patients are appropriately educated about the risks and benefits of this important treatment modality.
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Affiliation(s)
- Adam D Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carmen Bergom
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tracy R Kelly
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - J Frank Wilson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Hahn C, Kavanagh B, Bhatnagar A, Jacobson G, Lutz S, Patton C, Potters L, Steinberg M. Choosing wisely: the American Society for Radiation Oncology's top 5 list. Pract Radiat Oncol 2015; 4:349-55. [PMID: 25407853 DOI: 10.1016/j.prro.2014.06.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/10/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To highlight 5 interventions that patients should question, as part of the Choosing Wisely campaign. This initiative, led by the American Board of Internal Medicine Foundation, fosters conversations between physicians and patients about treatments and tests that may be overused, unnecessary, or potentially harmful. METHODS AND MATERIALS Potential items were initially compiled using an online survey. They were then evaluated and refined by a work group representing the American Society for Radiation Oncology (ASTRO) Clinical Affairs and Quality, Health Policy, and Government Relations Councils. Literature reviews were carried out to support the recommendation and narrative, as well as to provide references for each item. A final list of 5 items was then selected by the ASTRO Board of Directors. RESULTS ASTRO's 5 recommendations for the Choosing Wisely campaign are the following: (1) Don't initiate whole-breast radiation therapy as a part of breast conservation therapy in women age ≥50 with early-stage invasive breast cancer without considering shorter treatment schedules; (2) don't initiate management of low-risk prostate cancer without discussing active surveillance; (3) don't routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases; (4) don't routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry; and (5) don't routinely use intensity modulated radiation therapy to deliver whole-breast radiation therapy as part of breast conservation therapy. CONCLUSIONS The ASTRO list for the Choosing Wisely campaign highlights radiation oncology interventions that should be discussed between physicians and patients before treatment is initiated. These 5 items provide opportunities to offer higher quality and less costly care.
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Affiliation(s)
- Carol Hahn
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Denver, Colorado
| | - Ajay Bhatnagar
- Cancer Treatment Services Arizona, Affiliate of 21st Century Oncology, Casa Grande, Arizona
| | - Geraldine Jacobson
- Department of Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Stephen Lutz
- Blanchard Valley Regional Cancer Center, Findlay, Ohio
| | | | - Louis Potters
- Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York
| | - Michael Steinberg
- Department of Radiation Oncology, David Geffen School of Medicine, University of California Health System, Los Angeles, California
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Fenoglietto P, Bourgier C, Riou O, Lemanski C, Azria D. Impact de la modulation d’intensité dans l’irradiation des aires ganglionnaires du cancer du sein. Cancer Radiother 2015; 19:265-70. [DOI: 10.1016/j.canrad.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 01/18/2023]
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36
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Straub JM, New J, Hamilton CD, Lominska C, Shnayder Y, Thomas SM. Radiation-induced fibrosis: mechanisms and implications for therapy. J Cancer Res Clin Oncol 2015; 141:1985-94. [PMID: 25910988 DOI: 10.1007/s00432-015-1974-6] [Citation(s) in RCA: 373] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/15/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Radiation-induced fibrosis (RIF) is a long-term side effect of external beam radiation therapy for the treatment of cancer. It results in a multitude of symptoms that significantly impact quality of life. Understanding the mechanisms of RIF-induced changes is essential to developing effective strategies to prevent long-term disability and discomfort following radiation therapy. In this review, we describe the current understanding of the etiology, clinical presentation, pathogenesis, treatment, and directions of future therapy for this condition. METHODS A literature review of publications describing mechanisms or treatments of RIF was performed. Specific databases utilized included PubMed and clinicaltrials.gov, using keywords "Radiation-Induced Fibrosis," "Radiotherapy Complications," "Fibrosis Therapy," and other closely related terms. RESULTS RIF is the result of a misguided wound healing response. In addition to causing direct DNA damage, ionizing radiation generates reactive oxygen and nitrogen species that lead to localized inflammation. This inflammatory process ultimately evolves into a fibrotic one characterized by increased collagen deposition, poor vascularity, and scarring. Tumor growth factor beta serves as the primary mediator in this response along with a host of other cytokines and growth factors. Current therapies have largely been directed toward these molecular targets and their associated signaling pathways. CONCLUSION Although RIF is widely prevalent among patients undergoing radiation therapy and significantly impacts quality of life, there is still much to learn about its pathogenesis and mechanisms. Current treatments have stemmed from this understanding, and it is anticipated that further elucidation will be essential for the development of more effective therapies.
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Affiliation(s)
- Jeffrey M Straub
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, 3020A Wahl Hall East, Kansas City, KS, 66160, USA
| | - Jacob New
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Chase D Hamilton
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, 3020A Wahl Hall East, Kansas City, KS, 66160, USA
| | - Chris Lominska
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, 3020A Wahl Hall East, Kansas City, KS, 66160, USA
| | - Sufi M Thomas
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, 3020A Wahl Hall East, Kansas City, KS, 66160, USA. .,Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, 66160, USA. .,Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
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de Oliveira HF, Trevisan FA, Bighetti VM, Guimarães FDS, Amaral LL, Barbi GL, Borges LF, Peria FM. Intensity modulated radiotherapy (IMRT) for patients of the Brazilian unified health system (SUS): an analysis of 508 treatments two years after the technique implementation. Radiol Bras 2015; 47:355-60. [PMID: 25741118 PMCID: PMC4341373 DOI: 10.1590/0100-3984.2013.1905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 05/06/2014] [Indexed: 11/28/2022] Open
Abstract
The Bosniak classification for renal cysts was developed in the late 1980s in an
attempt to standardize the description and management of complex cystic renal
lesions. Alterations were made to such a classification in the 1990s and, the last
one, in 2005. Currently, five categories of cystic renal lesions are defined -
namely, I, II, II-F, III and IV –, according to their degree of complexity and
likelihood of malignancy. Despite being initially described for computed tomography,
this classification has been also utilized with some advantages also for magnetic
resonance imaging. The present article reviews the different phases of this
classification, its diagnostic efficacy and the most controversial features of its
use.
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Affiliation(s)
- Harley Francisco de Oliveira
- PhD, Professor and Coordinator, Service of Radiotherapy at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Felipe Amstalden Trevisan
- PhD, Professor, Collaborator of Fundação de Apoio ao Ensino, Pesquisa e Assistência (Faepa) - Department of Medical Practice, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Viviane Marques Bighetti
- PhD, MD, Radiotherapist, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Flávio da Silva Guimarães
- MD, Radiotherapist, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Leonardo Lira Amaral
- PhD, Medical Physicist, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Gustavo Lázaro Barbi
- Master, Medical Physicist, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Leandro Federiche Borges
- Medical Physicist, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Fernanda Maris Peria
- PhD, Professor and Coordinator, Service of Clinical Oncology, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
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Radiation Treatment Strategies in Patients Undergoing Breast-Conserving Surgery. CURRENT BREAST CANCER REPORTS 2015. [DOI: 10.1007/s12609-014-0171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barsoum M, Mostafa M, El Hossieny H, Nasr A, Mahmoud M, Fouda S. Dosimetric prospective study comparing 2D and 3D planning for irradiation of supraclavicular and infraclavicular regions in breast cancer patients. J Egypt Natl Canc Inst 2015; 27:25-34. [PMID: 25631950 DOI: 10.1016/j.jnci.2014.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/23/2014] [Accepted: 11/23/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this study is to compare 2D plan and 3D plan regarding coverage of the target (supraclavicular and infraclavicular regions) and dose reaching the risk organs (using mean DVH). Depending on the results of this study, modifications can be made to the 2D conventional planning of supraclavicular and infraclavicular regions in order to achieve better coverage of the target tissues. MATERIALS AND METHODS This is a dosimetric study carried out at the radiation oncology department in NCI-Cairo University in the period from January 2012 to October 2012, on 15 patients with breast cancer who are eligible for supraclavicular and infraclavicular irradiation. For All patients, a 2D and a 3D plan were done. RESULTS We found that the coverage of the supraclavicular and infraclavicular regions and the chest wall or breast together with levels I and II axilla (PTV) were significantly better with the 3D technique with less over dose than the 2D technique. That difference was highly significant and was most evident in MRM cases. Also we found that organs at risk received a dose in the 3D technique that was more than that received in the 2D technique, again that difference was highly significant and was also most evident in MRM cases but all doses were still within tolerance. CONCLUSIONS From the present study we concluded that the coverage of the supraclavicular and infraclavicular PTV is significantly worse with the 2D technique using a single oblique field at a fixed depth of 3 cm for all patients despite their different builts.
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Affiliation(s)
- Mohsen Barsoum
- Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Magda Mostafa
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Egypt
| | - Hisham El Hossieny
- Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Azza Nasr
- Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Mohamed Mahmoud
- Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt.
| | - Sally Fouda
- Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt
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Lin Y, Wang B. Dosimetric absorption of intensity-modulated radiotherapy compared with conventional radiotherapy in breast-conserving surgery. Oncol Lett 2014; 9:9-14. [PMID: 25435927 PMCID: PMC4246647 DOI: 10.3892/ol.2014.2704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/01/2014] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to investigate the dosimetric benefits between intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (CR) among patients receiving breast-conserving surgery. A dosimetric comparison of IMRT and CR was evaluated in 20 patients with early-stage breast cancer using a three-dimensional treatment planning system. The prescribed mammary gland dose was completed in 25 fractions with a total dose of 5,000 cGy. Homogeneity of the planning target volume (PTV), irradiation dose and volume of organs at risk (OARs) were evaluated through a dose-volume histogram. For the homogeneity of PTV, the average volume receiving 95% of the prescribed dose in the IMRT plan was similar to that in the CR plan (97 vs. 96%, respectively). With regard to normal tissue sparing in OARs, the ipsilateral lung V20 in the IMRT and CR plans was 27.8 and 20.8%, respectively. The mean dose and V30 of the heart for five patients were 598.4 versus 348.3 cGy and 10.06 versus 5.3%, respectively. The mean dose sparing the heart or lung was markedly reduced in the IMRT plan compared with the CR plan. The results of the current study demonstrated that whole breast IMRT improves PTV dose distribution and improves normal tissue sparing in OARs.
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Affiliation(s)
- Yang Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Benzhong Wang
- Department of Breast Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Automation and Intensity Modulated Radiation Therapy for Individualized High-Quality Tangent Breast Treatment Plans. Int J Radiat Oncol Biol Phys 2014; 90:688-95. [DOI: 10.1016/j.ijrobp.2014.06.056] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/09/2014] [Accepted: 06/20/2014] [Indexed: 11/18/2022]
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Falk AT, Fenoglietto P, Azria D, Bourgier C. [New external radiotherapy technologies for breast cancer]. Cancer Radiother 2014; 18:480-5. [PMID: 25182528 DOI: 10.1016/j.canrad.2014.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
The purpose of new radiotherapy techniques is to better deliver dose conformation in the tumour volume while diminishing organs at risk exposition. Their development is soaring in the breast cancer field in the adjuvant setting with intensity-modulated radiation therapy but also in cerebral and extracerebral oligometastastic presentation. Their usage is still being debated for breast cancer care. The objective of this narrative review is to list and discuss clinical data at our disposal for these news technologies.
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Affiliation(s)
- A T Falk
- Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France; Université de Nice Sophia-Antipolis, BP 2135, 06103 Nice cedex 2, France
| | - P Fenoglietto
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France
| | - D Azria
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, institut de recherche en cancérologie de Montpellier, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Université de Montpellier 1, CS 19044, 34967 Montpellier cedex 2, France
| | - C Bourgier
- Département de radiothérapie oncologique, centre régional de lutte contre le cancer, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Inserm U896, institut de recherche en cancérologie de Montpellier, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 05, France; Université de Montpellier 1, CS 19044, 34967 Montpellier cedex 2, France.
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Haloua MH, Krekel NMA, Meijer S, van den Tol MP. Ultrasound-guided surgery for palpable breast cancer: a historical perspective. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Breast cancer surgery has changed dramatically from the en bloc removal of the breast to the less invasive breast-conserving surgery. The recent COBALT trial comparing ultrasound-guided surgery with palpation-guided surgery for palpable breast cancer showed less margin involvement and decreased excision volumes with ultrasonography, which resulted in less additional therapy and possibly improved cosmetic outcome. Other surgical techniques pursuing these same aims have been developed over the past two decades and are referred to as oncoplastic surgery. Unfortunately oncoplastic surgery lacks sufficient evidence to corroborate its widespread implementation and should thereby solely be applied to selected cases. This review aims to highlight the position of ultrasound-guided surgery from a perspective of breast-conserving surgery in the search for better oncological and cosmetic outcomes.
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Affiliation(s)
- MH Haloua
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - NMA Krekel
- Department of Plastic & Reconstructive Surgery, VU University Medical Center, De Boelelaan 1117, Room 7F-020, 1081 HV Amsterdam, The Netherlands
| | - S Meijer
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - MP van den Tol
- Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Sen S, Wang SY, Soulos PR, Frick KD, Long JB, Roberts KB, Yu JB, Evans SB, Chagpar AB, Gross CP. Response. J Natl Cancer Inst 2014; 106:dju198. [PMID: 25114276 DOI: 10.1093/jnci/dju198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sounok Sen
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Kevin D Frick
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Jessica B Long
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Kenneth B Roberts
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - James B Yu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Suzanne B Evans
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Anees B Chagpar
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, SYW, PRS, JBL, KBR, JBY, SBE, ABC, CPG) and Department of Epidemiology and Public Health (SYW) and Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG) and Department of Therapeutic Radiology (KBR, JBY, SBE) and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF).
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Ozyigit G, Gultekin M. Current role of modern radiotherapy techniques in the management of breast cancer. World J Clin Oncol 2014; 5:425-439. [PMID: 25114857 PMCID: PMC4127613 DOI: 10.5306/wjco.v5.i3.425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/07/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is the most common type of malignancy in females. Advances in systemic therapies and radiotherapy (RT) provided long survival rates in breast cancer patients. RT has a major role in the management of breast cancer. During the past 15 years several developments took place in the field of imaging and irradiation techniques, intensity modulated RT, hypofractionation and partial-breast irradiation. Currently, improvements in the RT technology allow us a subsequent decrease in the treatment-related complications such as fibrosis and long-term cardiac toxicity while improving the loco-regional control rates and cosmetic results. Thus, it is crucial that modern radiotherapy techniques should be carried out with maximum care and efficiency. Several randomized trials provided evidence for the feasibility of modern radiotherapy techniques in the management of breast cancer. However, the role of modern radiotherapy techniques in the management of breast cancer will continue to be defined by the mature results of randomized trials. Current review will provide an up-to-date evidence based data on the role of modern radiotherapy techniques in the management of breast cancer.
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Barnett GC, Thompson D, Fachal L, Kerns S, Talbot C, Elliott RM, Dorling L, Coles CE, Dearnaley DP, Rosenstein BS, Vega A, Symonds P, Yarnold J, Baynes C, Michailidou K, Dennis J, Tyrer JP, Wilkinson JS, Gómez-Caamaño A, Tanteles GA, Platte R, Mayes R, Conroy D, Maranian M, Luccarini C, Gulliford SL, Sydes MR, Hall E, Haviland J, Misra V, Titley J, Bentzen SM, Pharoah PDP, Burnet NG, Dunning AM, West CML. A genome wide association study (GWAS) providing evidence of an association between common genetic variants and late radiotherapy toxicity. Radiother Oncol 2014; 111:178-85. [PMID: 24785509 DOI: 10.1016/j.radonc.2014.02.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/30/2014] [Accepted: 02/17/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE This study was designed to identify common single nucleotide polymorphisms (SNPs) associated with toxicity 2years after radiotherapy. MATERIALS AND METHODS A genome wide association study was performed in 1850 patients from the RAPPER study: 1217 received adjuvant breast radiotherapy and 633 had radical prostate radiotherapy. Genotype associations with both overall and individual endpoints of toxicity were tested via univariable and multivariable regression. Replication of potentially associated SNPs was carried out in three independent patient cohorts who had radiotherapy for prostate (516 RADIOGEN and 862 Gene-PARE) or breast (355 LeND) cancer. RESULTS Quantile-quantile plots show more associations at the P<5×10(-7) level than expected by chance (164 vs. 9 for the prostate cases and 29 vs. 4 for breast cases), providing evidence that common genetic variants are associated with risk of toxicity. Strongest associations were for individual endpoints rather than an overall measure of toxicity in all patients. However, in general, significant associations were not validated at a nominal 0.05 level in the replication cohorts. CONCLUSIONS This largest GWAS to date provides evidence of true association between common genetic variants and toxicity. Associations with toxicity appeared to be tumour site-specific. Future GWAS require higher statistical power, in particular in the validation stage, to test clinically relevant effect sizes of SNP associations with individual endpoints, but the required sample sizes are achievable.
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Affiliation(s)
- Gillian C Barnett
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK; University of Cambridge, Department of Oncology, Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK.
| | - Deborah Thompson
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Laura Fachal
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica, CIBERER, IDIS, Santiago de Compostela, Spain
| | - Sarah Kerns
- Department of Radiation Oncology, Icahn Mount Sinai School of Medicine, NY, USA
| | - Chris Talbot
- Department of Genetics, University of Leicester, UK
| | - Rebecca M Elliott
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, UK
| | - Leila Dorling
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Charlotte E Coles
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK
| | - David P Dearnaley
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Barry S Rosenstein
- Department of Radiation Oncology, Icahn Mount Sinai School of Medicine, NY, USA
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Grupo de Medicina Xenómica, CIBERER, IDIS, Santiago de Compostela, Spain
| | - Paul Symonds
- Department of Cancer Studies and Molecular Medicine, University Hospitals of Leicester, UK
| | - John Yarnold
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Caroline Baynes
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Kyriaki Michailidou
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Jonathan P Tyrer
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | | | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | | | - Radka Platte
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Rebecca Mayes
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Don Conroy
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Mel Maranian
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Craig Luccarini
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Sarah L Gulliford
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Matthew R Sydes
- Cancer and Other Non-Infectious Diseases, MRC Clinical Trials Unit, London, UK
| | - Emma Hall
- Institute of Cancer Research-Clinical Trials and Statistics Unit, Sutton, UK
| | - Joanne Haviland
- Institute of Cancer Research-Clinical Trials and Statistics Unit, Sutton, UK
| | - Vivek Misra
- Department of Clinical Oncology, Christie Hospital, Manchester, UK
| | - Jennifer Titley
- Institute of Cancer Research-Clinical Trials and Statistics Unit, Sutton, UK
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, Greenebaum Cancer Center; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Neil G Burnet
- University of Cambridge, Department of Oncology, Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Catharine M L West
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, UK
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Mukesh MB, Qian W, Wilkinson JS, Dorling L, Barnett GC, Moody AM, Wilson C, Twyman N, Burnet NG, Wishart GC, Coles CE. Patient reported outcome measures (PROMs) following forward planned field-in field IMRT: results from the Cambridge Breast IMRT trial. Radiother Oncol 2014; 111:270-5. [PMID: 24746570 DOI: 10.1016/j.radonc.2014.02.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 02/06/2014] [Accepted: 02/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of intensity-modulated radiotherapy (IMRT) in breast cancer reduces clinician-assessed breast tissue toxicity including fibrosis, telangectasia and sub-optimal cosmesis. Patient reported outcome measures (PROMs) are also important as they provide the patient's perspective. This longitudinal study reports on (a) the effect of forward planned field-in-field IMRT (∼simple IMRT) on PROMs compared to standard RT at 5 years after RT, (b) factors affecting PROMs at 5years after RT and (c) the trend of PROMs over 5 years of follow up. METHODS PROMs were assessed at baseline (pre-RT), 6, 24 and 60 months after completion of RT using global health (EORTC QLQ C30) and 4 breast symptom questions (BR23). Also, 4 breast RT-specific questions were included at 6, 24 and 60 months: change in skin appearance, firmness to touch, reduction in breast size and overall change in breast appearance since RT. The benefits of simple IMRT over standard RT at 5 years after RT were assessed using standard t-test for global health and logistic regression analysis for breast symptom questions and breast RT-specific questions. Clinical factors affecting PROMs at 5 years were investigated using a multivariate analysis. A repeated mixed model was applied to explore the trend over time for each of PROMs. RESULTS (89%) 727/815, 84%, 81% and 61% patients completed questionnaires at baseline, 6, 24 and 60 months respectively. Patients reported worse toxicity for all four BR23 breast symptoms at 6 months, which then improved over time (p<0.0001). They also reported improvement in skin appearance and breast hardness over time (p<0.0001), with no significant change for breast shrinkage (p=0.47) and overall breast appearance (p=0.13). At 5years, PROMs assessments did not demonstrate a benefit for simple IMRT over standard radiotherapy. Large breast volume, young age, baseline surgical cosmesis and post-operative infection were the most important variables to affect PROMs. CONCLUSIONS This study was unable to demonstrate the benefits of IMRT on PROMs at 5years. PROMs are influenced by non-radiotherapy factors and surgical factors should be optimised to improve patients' outcome. Only a small proportion of patients report moderate-severe breast changes post radiotherapy, with most PROMs improving over time. The difference in clinician assessment and PROMs outcome requires further investigation.
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Affiliation(s)
- Mukesh B Mukesh
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK; Department of Oncology, Colchester Hospital University NHS Foundation Trust, Essex, UK.
| | - Wendi Qian
- Cambridge Cancer Trials Centre, Cambridge Clinical Trials Unit - Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Medical Research Council, Biostatistics Unit Hub for Trials Methodology, UK
| | | | - Leila Dorling
- Cancer Research-UK Centre for Genetic Epidemiology & Dept of Oncology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Gillian C Barnett
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK; Cancer Research-UK Centre for Genetic Epidemiology & Dept of Oncology, University of Cambridge, Strangeways Research Laboratory, UK
| | - Anne M Moody
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Charles Wilson
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Nicola Twyman
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Neil G Burnet
- University of Cambridge, Department of Oncology, Oncology Centre, Addenbrooke's Hospital, UK
| | - Gordon C Wishart
- Faculty of Health, Social Care & Education, Anglia Ruskin University, Cambridge, UK
| | - Charlotte E Coles
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, UK
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Sen S, Wang SY, Soulos PR, Frick KD, Long JB, Roberts KB, Yu JB, Evans SB, Chagpar AB, Gross CP. Examining the cost-effectiveness of radiation therapy among older women with favorable-risk breast cancer. J Natl Cancer Inst 2014; 106:dju008. [PMID: 24598714 DOI: 10.1093/jnci/dju008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about the cost-effectiveness of external beam radiation therapy (EBRT) or newer radiation therapy (RT) modalities such as intensity modulated radiation (IMRT) or brachytherapy among older women with favorable-risk breast cancer. METHODS Using a Markov model, we estimated the cost-effectiveness of no RT, EBRT, and IMRT over 10 years. We estimated the incremental cost-effectiveness ratio (ICER) of IMRT compared with EBRT under different scenarios to determine the necessary improvement in effectiveness for newer modalities to be cost-effective. We estimated model inputs using women in the Surveillance, Epidemiology, and End Results-Medicare database fulfilling the Cancer and Leukemia Group B C9343 trial criteria. RESULTS The incremental cost of EBRT compared with no RT was $9500 with an ICER of $44600 per quality-adjusted life year (QALY) gained. The ICERs increased with age, ranging from $38300 (age 70-74 years) to $55800 (age 80 to 94 years) per QALY. The ICERs increased to more than $63800 per QALY for women aged 70 to 74 years with an expected 10-year survival of 25%. Reduction in local recurrence by IMRT compared with EBRT did not have a substantial impact on the ICER of IMRT. IMRT would have to increase the utility of baseline state by 20% to be cost-effective (<$100000 per QALY). CONCLUSIONS EBRT is cost-effective for older women with favorable risk breast cancer, but substantially less cost-effective for women with shorter expected survival. Newer RT modalities would have to be substantially more effective than existing therapies in improving quality of life to be cost-effective.
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Affiliation(s)
- Sounok Sen
- Affiliations of authors: Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center (SS, S-YW, PRS, JBL, KBR, JBY, SBE, ABC, CPG), Department of Epidemiology and Public Health (S-YW), Section of General Internal Medicine, Department of Internal Medicine (PRS, JBL, CPG), Department of Therapeutic Radiology (KBR, JBY, SBE), and Department of Surgery (ABC), Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (KDF)
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Kerns SL, Ostrer H, Rosenstein BS. Radiogenomics: using genetics to identify cancer patients at risk for development of adverse effects following radiotherapy. Cancer Discov 2014; 4:155-65. [PMID: 24441285 DOI: 10.1158/2159-8290.cd-13-0197] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
UNLABELLED Normal-tissue adverse effects following radiotherapy are common and significantly affect quality of life. These effects cannot be accounted for by dosimetric, treatment, or demographic factors alone, and evidence suggests that common genetic variants are associated with radiotherapy adverse effects. The field of radiogenomics has evolved to identify such genetic risk factors. Radiogenomics has two goals: (i) to develop an assay to predict which patients with cancer are most likely to develop radiation injuries resulting from radiotherapy, and (ii) to obtain information about the molecular pathways responsible for radiation-induced normal-tissue toxicities. This review summarizes the history of the field and current research. SIGNIFICANCE A single-nucleotide polymorphism–based predictive assay could be used, along with clinical and treatment factors, to estimate the risk that a patient with cancer will develop adverse effects from radiotherapy. Such an assay could be used to personalize therapy and improve quality of life for patients with cancer.
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Affiliation(s)
- Sarah L Kerns
- Departments of 1Radiation Oncology and 2Dermatology, Preventive Medicine and Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai; 3Department of Radiation Oncology, New York University School of Medicine, New York; Departments of 4Pathology, and 5Genetics and Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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