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Anderson B, Vicini F, Wazer D, Arthur D. Breast brachytherapy: Building a bright future on the foundation of a rich history of advancement in technology, technique, and patient-centered care. Brachytherapy 2023; 22:368-380. [PMID: 36740541 DOI: 10.1016/j.brachy.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 02/05/2023]
Abstract
For over 20 years, the concept of accelerated partial breast irradiation (APBI) has received considerable attention. Initially concentrating on the appropriateness of APBI as an alternative treatment to whole breast radiotherapy, investigation and innovation evolved towards dose delivery and technique appropriateness. The purpose of this article is to review the pertinent literature that supports the role brachytherapy serves in delivering APBI and the recognized brachytherapy techniques for dose delivery. Publications establishing techniques utilizing multicatheter brachytherapy, single-entry brachytherapy applicators, permanent breast seed implantation brachytherapy, noninvasive breast brachytherapy and electronic brachytherapy are described. The use of brachytherapy for repeat breast conservation therapy is additionally reviewed. A historical perspective and potential direction of future investigation and innovation are presented.
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Affiliation(s)
- Bethany Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - David Wazer
- Department of Radiation Oncology, Tufts Medical Center, Boston, MA
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
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Vicini F, Broughman J, Halima A, Mayo Z, Obi E, Al-Hilli Z, Arthur D, Wazer D, Shah C. Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review. Int J Radiat Oncol Biol Phys 2021; 112:1090-1104. [PMID: 34921906 DOI: 10.1016/j.ijrobp.2021.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/21/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent data have been published supporting the application of ultra-short radiation therapy (RT) regimens for women with early stage breast cancer following breast conserving surgery (BCS). What has remained controversial is whether and how to apply accelerated whole breast irradiation (AWBI) or accelerated partial breast irradiation (APBI) approaches in these patients, as well as the consideration of intraoperative RT (IORT) for this population. METHODS We performed a systematic review of the literature searching for randomized and prospective data published evaluating ultra-short RT delivered in 5-days or less with APBI, AWBI, or IORT. RESULTS We identified two randomized studies applying AWBI (n=5,011 patients) with 5 to 10 year follow up, which supported the use of ultra-short course AWBI (5 fractions in one week) as compared to hypofractionated WBI. We identified six randomized trials evaluating APBI (as compared to WBI) in 5 days or less (n= 8,415) with numerous (n=55) prospective studies as well, with the data supporting short course APBI as compared to WBI. Finally, we identified two randomized trials evaluating IORT; however, both trials demonstrated elevated rates of recurrence with IORT as compared to WBI. CONCLUSIONS The current body of data available for ultra-short adjuvant RT regimens delivered in 5-days or less after BCS overwhelming support their utilization. While data for both exists, APBI regimens have, by far, greater numbers of patients and longer follow-up as compared to AWBI. Also, given increased rates of recurrence seen with IORT with long-term follow-up, this should not be considered a standard approach at this time.
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Affiliation(s)
| | - James Broughman
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmed Halima
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zachary Mayo
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth Obi
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - David Wazer
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Chirag Shah
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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Thill M, Faridi A, Meiré A, Gerber-Schäfer C, Baumann K, Blohmer JU, Mau C, Tofall S, Nolte E, Strittmatter HJ, Ohlinger R, Paepke S. Patient reported outcome and cosmetic evaluation following implant-based breast-reconstruction with a titanized polypropylene mesh (TiLOOP® Bra): A prospective clinical study in 269 patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1484-1490. [PMID: 32336622 DOI: 10.1016/j.ejso.2020.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Implant-based or expander-supported breast reconstruction is an established surgical method after mastectomies due to cancer or to prophylactic reasons. Patient reported outcome (PRO) and cosmetic outcome after breast reconstruction with a synthetic surgical mesh was investigated in a prospective, single-arm, multi-center study. MATERIAL AND METHODS Primary or secondary implant-based breast reconstruction with support of TiLOOP® Bra was performed in 269 patients during the PRO-BRA study. PRO 12 months after breast reconstruction was evaluated using Breast-Q questionnaire. Cosmetic outcome was evaluated by two independent experts by means of pictures taken preoperatively and at the follow-up visits. RESULTS Breast-Q and 12 months FU were completed by 210 women. Patients without adverse event had a significantly higher Breast-Q score for "sexual well-being" (p = 0.001); "psychosocial well-being" was negatively influenced by prior therapies (p < 0.01), and older patients had significantly lower scores at 12 months FU compared to pre-OP for "satisfaction with breasts" (p < 0.01) while the opposite was true for younger patients. Unilateral surgery resulted in reduced "satisfaction with breast" at 12 months FU (p < 0.01). Radiotherapy negatively influenced "satisfaction with breast", "sexual well-being" and "physical well-being chest". The cosmetic evaluation showed a significant difference (p < 0.001) in the evaluation by the patients and experts with the patients' assessment being worse compared to experts' assessment. CONCLUSION Our study showed that two years after implant-based breast reconstruction with support of TiLOOP® Bra PRO is influenced by different factors. This information can be used to improve the decision-making process for women who chose implant-based breast reconstruction.
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Affiliation(s)
- Marc Thill
- Department of Gynecology and Gynecologic Oncology, Agaplesion Markus Hospital, Frankfurt Am Main, Germany.
| | - Andree Faridi
- Center for Breast Diseases, Vivantes Hospital Am Urban, Berlin, Germany
| | | | | | - Kristin Baumann
- Clinic for Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center Charité, Berlin, Germany
| | | | | | | | | | - Ralf Ohlinger
- Clinic for Gynecology and Obstetrics, University Greifswald, Greifswald, Germany
| | - Stefan Paepke
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
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Patient-reported cosmetic satisfaction and the long-term association with quality of life in irradiated breast cancer patients. Breast Cancer Res Treat 2019; 179:479-489. [PMID: 31650347 PMCID: PMC6987082 DOI: 10.1007/s10549-019-05470-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 02/02/2023]
Abstract
Purpose To evaluate patient-reported cosmetic satisfaction in women treated with radiation therapy for breast cancer and to determine the association between dissatisfaction and quality of life (QoL) and depression. Methods Within the prospective UMBRELLA breast cancer cohort, all patients ≥ 1 year after breast conserving treatment or mastectomy with immediate reconstruction were selected. Self-reported cosmetic satisfaction was measured on a 5-point Likert scale. QoL, social functioning, and emotional functioning were measured using EORTC QLQ-C30 and BR23 at 1, 2, and 3 years after inclusion. Mixed model analysis was performed to assess the difference in different domains of QoL between patients with good versus poor self-reported cosmetic satisfaction over time after adjustment for potential confounders. Depression scores were collected by means of the HADS-NL questionnaire. Chi-square test or Fisher's exact test was used to assess the difference in proportions of HADS score ≥ 8, indicating increased depression risk, between satisfied and dissatisfied patients. Results 808 patients were selected for analysis. Respectively one, two, and three years after surgery, 8% (63/808), 7% (45/626), and 8% (31/409) of patients were dissatisfied with their cosmetic outcome. Poor patient-reported cosmetic satisfaction was independently associated with impaired QoL, body image, and lower emotional and social functioning. Scores ≥ 8 on the HADS depression subscale were significantly more common in dissatisfied patients. Conclusions Dissatisfaction with cosmetic outcome was low after breast cancer surgery followed by radiation therapy during 3 years follow-up. Knowing the association between dissatisfaction with cosmetic outcome and QoL and depression could help to improve the preoperative counseling of breast cancer patients.
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A prospective comparison of subjective and objective assessments of cosmetic outcomes following breast brachytherapy. J Contemp Brachytherapy 2019; 11:207-214. [PMID: 31435427 PMCID: PMC6701386 DOI: 10.5114/jcb.2019.85414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose We evaluated agreement between subjective and objective methods of cosmesis scoring in an accelerated partial breast irradiation (APBI) cohort. Material and methods Consecutive women treated with APBI using interstitial brachytherapy reported for clinical follow-up every 6 months. Single cross-sectional assessment of the breast cosmesis was done by a radiation oncologist (subjective method) using Harvard scale and by photographic assessment using BCCT.core (Breast Cancer Conservative Treatment. Cosmetic results, version 3.1) software (objective method) at 18-36 months post-APBI. The agreement between subjective and objective methods for the overall score as well as individual subjective/objective subdomains was computed using kappa statistics. ANOVA was used to test the correlation between objective indices and subjective subdomains. Results The agreement between the subjective (physician) and objective assessment was good with a kappa of 0.673. Overall, 77 (98.7%) patients were satisfied with the overall outcomes of breast conservation therapy. The kappa agreement between physician and patient scoring was 0.457 (95% CI: 0.240-0.674). Among the subjective subdomains, location of the nipple areola complex (NAC) had good agreement with both the overall subjective and objective score, with the kappa of 0.778 and 0.547, respectively. In the objective indices, BCE (breast compliance evaluation), LBC (lower breast contour), and UNR (unilateral nipple retraction) correlated significantly with the subjective subdomains: location of the NAC, breast size, and shape (p < 0.05 for all indices). Conclusions Good agreement exists for overall cosmetic outcomes measured by subjective and objective methods. Location of the NAC, breast size and shape are the most important parameters determining cosmetic outcomes irrespective of the method of assessment.
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Impact of adjuvant systemic chemotherapy on wound healing and cosmetic outcome in 224 women treated with accelerated partial breast irradiation using interstitial brachytherapy. Brachytherapy 2017; 16:935-942. [DOI: 10.1016/j.brachy.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 11/22/2022]
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Altman MB, Mooney KE, Edward S, Garcia-Ramirez JL, Dewees TA, Thomas MA, Zoberi I, Zoberi JE. Efficiency of using the day-of-implant CT for planning of SAVI APBI. Brachytherapy 2017; 17:40-49. [PMID: 28869144 DOI: 10.1016/j.brachy.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to develop an optimized, efficient workflow for using the day-of-implant (DOI) CT for treatment planning of accelerated partial breast irradiation brachytherapy using the strut-adjusted volume implant (SAVI) device. METHODS AND MATERIALS For 62 consecutive SAVI patients, a DOI CT was acquired and used for treatment planning. A "verification" CT was acquired 24-72 h after implant and immediately before the first fraction, then registered to the DOI CT. If the DOI CT-based plan was no longer optimal, a replan was performed. An array of metrics describing the geometry of the device and its relative position in the patient from the DOI CTs for these patients was collected. These metrics from the DOI CT were evaluated to determine what features could predict for the need to replan before the first treatment fraction. Logistical regression analysis including χ2 tests was used to determine if different factors correlated with replanning. RESULTS Twenty-two of 62 patients (35%) required replanning. Only the presence of splayed struts, where splay was toward the skin, and the use of a nine strut ("8-1") SAVI were significantly correlated (p < 0.05) with replanning. Within these individual populations, no additional factors showed a significant statistical correlation for requiring replanning. CONCLUSIONS For strut-based accelerated partial breast irradiation brachytherapy, it was feasible to treat with a plan based on the DOI CT for a majority (65%) of patients. Some factors correlate to needing replanning; recognizing these could be used to optimize treatment workflow for certain patients, increasing clinical efficiency while enhancing the quality of patient care.
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Affiliation(s)
- Michael B Altman
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO.
| | - Karen E Mooney
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Sharbacha Edward
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | | | - Todd A Dewees
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
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Hepel JT, Arthur D, Shaitelman S, Polgár C, Todor D, Zoberi I, Kamrava M, Major T, Yashar C, Wazer DE. American Brachytherapy Society consensus report for accelerated partial breast irradiation using interstitial multicatheter brachytherapy. Brachytherapy 2017; 16:919-928. [PMID: 28676428 DOI: 10.1016/j.brachy.2017.05.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/11/2017] [Accepted: 05/28/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To develop a consensus report for the quality practice of accelerated partial breast irradiation (APBI) using interstitial multicatheter brachytherapy (IMB). METHODS AND MATERIALS The American Brachytherapy Society Board appointed an expert panel with clinical and research experience with breast brachytherapy to provide guidance for the current practice of IMB. This report is based on a comprehensive literature review with emphasis on randomized data and expertise of the panel. RESULTS Randomized trials have demonstrated equivalent efficacy of APBI using IMB compared with whole breast irradiation for select patients with early-stage breast cancer. Several techniques for placement of interstitial catheters are described, and importance of three-dimensional planning with appropriate optimization is reviewed. Optimal target definition is outlined. Commonly used dosing schemas include 50 Gy delivered in pulses of 0.6-0.8 Gy/h using pulsed-dose-rate technique and 34 Gy in 10 fractions, 32 Gy in eight fractions, or 30 Gy in seven fractions using high-dose-rate technique. Potential toxicities and strategies for toxicity avoidance are described in detail. Dosimetric constraints include limiting whole breast volume that receives ≥50% of prescription dose to <60%, skin dose to ≤100% of prescription dose (≤60-70% preferred), chest wall dose to ≤125% of prescription dose, Dose Homogeneity Index to >0.75 (>0.85 preferred), V150 < 45 cc, and V200 < 14 cc. Using an optimal implant technique coupled with optimal planning and appropriate dose constraints, a low rate of toxicity and a good-to-excellent cosmetic outcome of ≥90% is expected. CONCLUSIONS IMB is an effective technique to deliver APBI for appropriately selected women with early-stage breast cancer. This consensus report has been created to assist clinicians in the appropriate practice of APBI using IMB.
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Affiliation(s)
- Jaroslaw T Hepel
- Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA.
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Simona Shaitelman
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Csaba Polgár
- Department of Radiation Oncology, National Institute of Oncology, Budapest, Hungary
| | - Dorin Todor
- Department of Radiation Oncology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Mitchell Kamrava
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - Tibor Major
- Department of Radiation Oncology, National Institute of Oncology, Budapest, Hungary
| | - Catheryn Yashar
- Department of Radiation Oncology, University of California San Diego, La Jolla, CA
| | - David E Wazer
- Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, RI; Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, MA
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Pérez M, Schootman M, Hall LE, Jeffe DB. Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life. Breast Cancer Res Treat 2017; 162:329-342. [PMID: 28132391 PMCID: PMC5374079 DOI: 10.1007/s10549-017-4121-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type. METHODS We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤3.0 cm and lymph node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 "not at all" to 5 "all the time") and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors. RESULTS Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up. CONCLUSIONS Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.
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Affiliation(s)
- M Pérez
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - M Schootman
- Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA
| | - L E Hall
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - D B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, Missouri, USA
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Acharya S, Fischer-Valuck BW, Mazur TR, Curcuru A, Sona K, Kashani R, Green O, Ochoa L, Mutic S, Zoberi I, Li HH, Thomas MA. Magnetic Resonance Image Guided Radiation Therapy for External Beam Accelerated Partial-Breast Irradiation: Evaluation of Delivered Dose and Intrafractional Cavity Motion. Int J Radiat Oncol Biol Phys 2016; 96:785-792. [PMID: 27788951 DOI: 10.1016/j.ijrobp.2016.08.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 07/08/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To use magnetic resonance image guided radiation therapy (MR-IGRT) for accelerated partial-breast irradiation (APBI) to (1) determine intrafractional motion of the breast surgical cavity; and (2) assess delivered dose versus planned dose. METHODS AND MATERIALS Thirty women with breast cancer (stages 0-I) who underwent breast-conserving surgery were enrolled in a prospective registry evaluating APBI using a 0.35-T MR-IGRT system. Clinical target volume was defined as the surgical cavity plus a 1-cm margin (excluding chest wall, pectoral muscles, and 5 mm from skin). No additional margin was added for the planning target volume (PTV). A volumetric MR image was acquired before each fraction, and patients were set up to the surgical cavity as visualized on MR imaging. To determine the delivered dose for each fraction, the electron density map and contours from the computed tomography simulation were transferred to the pretreatment MR image via rigid registration. Intrafractional motion of the surgical cavity was determined by applying a tracking algorithm to the cavity contour as visualized on cine MR. RESULTS Median PTV volume was reduced by 52% when using no PTV margin compared with a 1-cm PTV margin used conventionally. The mean (± standard deviation) difference between planned and delivered dose to the PTV (V95) was 0.6% ± 0.1%. The mean cavity displacement in the anterior-posterior and superior-inferior directions was 0.6 ± 0.4 mm and 0.6 ± 0.3 mm, respectively. The mean margin required for at least 90% of the cavity to be contained by the margin for 90% of the time was 0.7 mm (5th-95th percentile: 0-2.7 mm). CONCLUSION Minimal intrafractional motion was observed, and the mean difference between planned and delivered dose was less than 1%. Assessment of efficacy and cosmesis of this MR-guided APBI approach is under way.
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Affiliation(s)
- Sahaja Acharya
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Thomas R Mazur
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Austen Curcuru
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Karl Sona
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Rojano Kashani
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Olga Green
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Laura Ochoa
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - H Harold Li
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
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Hamilton DG, Bale R, Jones C, Fitzgerald E, Khor R, Knight K, Wasiak J. Impact of tumour bed boost integration on acute and late toxicity in patients with breast cancer: A systematic review. Breast 2016; 27:126-35. [PMID: 27113229 DOI: 10.1016/j.breast.2016.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/24/2016] [Accepted: 03/11/2016] [Indexed: 01/13/2023] Open
Abstract
The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle-Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques.
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Affiliation(s)
- Daniel George Hamilton
- Epworth Radiation Oncology Research Centre, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia; Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia.
| | | | - Claire Jones
- Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia
| | - Emma Fitzgerald
- Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia
| | - Richard Khor
- Austin Health, Austin Hospital, 145 Studley Road, Heidelberg VIC 3121, Australia
| | - Kellie Knight
- Department of Medical Imaging & Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton VIC 3800, Australia
| | - Jason Wasiak
- Epworth Radiation Oncology Research Centre, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Thomas MA, Ochoa LL, Zygmunt TM, Matesa M, Altman MB, Garcia-Ramirez JL, Esthappan J, Zoberi I. Accelerated Partial Breast Irradiation: A Safe, Effective, and Convenient Early Breast Cancer Treatment Option. MISSOURI MEDICINE 2015; 112:379-384. [PMID: 26606820 PMCID: PMC6167235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Accelerated partial breast irradiation (APBI) is an excellent treatment option for many women with early stage breast cancer. Patient selection criteria include age over 40, status post lumpectomy, breast cancer (invasive or in situ disease) measuring <3 cm, negative margins (at least 2 mm), negative lymph nodes, and no lymphovascular space invasion. APBI is effective, well tolerated, and convenient. Women with early stage breast cancer and theii caregivers should be aware of this potential treatment option.
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Towards real-time 3D ultrasound planning and personalized 3D printing for breast HDR brachytherapy treatment. Radiother Oncol 2015; 114:335-8. [DOI: 10.1016/j.radonc.2015.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/07/2015] [Accepted: 02/08/2015] [Indexed: 01/17/2023]
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Ozmen T, Polat AV, Polat AK, Bonaventura M, Johnson R, Soran A. Factors affecting cosmesis after breast conserving surgery without oncoplastic techniques in an experienced comprehensive breast center. Surgeon 2014; 13:139-44. [PMID: 24529831 DOI: 10.1016/j.surge.2013.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 12/17/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
We aimed to study the factors affecting cosmetic outcome (CO) in breast conserving surgery (BCS) without oncoplastic techniques in our center with a BCS rate higher than 60% in more than 1000 breast cancer surgeries a year. In this study 284 patients who underwent BCS without oncoplastic techniques were included. Surgeries were performed by two experienced breast surgeons with more than 25 years of experience. These patients were followed in our established Wellness Clinic postoperatively. The CO is evaluated according to the "Harvard Breast Cosmesis Grading Scale" by a breast surgeon who did not participate in the patient's surgery. The correlation among patient factors (age, breast volume, menopausal status), tumor factors (size, location, distance to areola) and treatment factors (excision volume, breast skin excision, axillary surgery, adjuvant therapy) and CO were evaluated. The mean age was 57.6 [33-98] years in the successful CO group and 58.1 [34-85] years in the unsuccessful CO group (p > 0.05). The mean follow-up time was 37.9 [24-84] months. The CO was successful in 88.7% (n:252) of the patients. Tumor size, retroareolar location of the tumor, adjuvant chemotherapy administration and whole breast radiation therapy (WBRT) were correlated with a poorer CO (p < 0.05). We were able to attain a successful CO in approximately 90% of our patients. Adding oncoplastic techniques to the surgical management of larger tumors and retroareolar tumors, may increase the percentage of good CO. In selected patients choosing balloon brachytherapy instead of WBRT, may also have positive effects on CO.
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Affiliation(s)
- Tolga Ozmen
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Ahmet Veysel Polat
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ayfer Kamali Polat
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Ronald Johnson
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Atilla Soran
- Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Chang JH, Lee NK, Kim JY, Kim YJ, Moon SH, Kim TH, Kim JY, Kim DY, Cho KH, Shin KH. Phase II trial of proton beam accelerated partial breast irradiation in breast cancer. Radiother Oncol 2013; 108:209-14. [PMID: 23891102 DOI: 10.1016/j.radonc.2013.06.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/04/2013] [Accepted: 06/08/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Here, we report the results of our phase II, prospective study of proton beam accelerated partial breast irradiation (PB-APBI) in patients with breast cancer after breast conserving surgery (BCS). MATERIALS AND METHODS Thirty patients diagnosed with breast cancer were treated with PB-APBI using a single-field proton beam or two fields after BCS. The treatment dose was 30 cobalt gray equivalent (CGE) in six CGE fractions delivered once daily over five consecutive working days. RESULTS All patients completed PB-APBI. The median follow-up time was 59 months (range: 43-70 months). Of the 30 patients, none had ipsilateral breast recurrence or regional or distant metastasis, and all were alive at the last follow-up. Physician-evaluated toxicities were mild to moderate, except in one patient who had severe wet desquamation at 2 months that was not observed beyond 6 months. Qualitative physician cosmetic assessments of good or excellent were noted in 83% and 80% of the patients at the end of PB-APBI and at 2 months, respectively, and decreased to 69% at 3 years. A good or excellent cosmetic outcome was noted in all patients treated with a two-field proton beam at any follow-up time point except for one. For all patients, the mean percentage breast retraction assessment (pBRA) value increased significantly during the follow-up period (p=0.02); however, it did not increase in patients treated with two-field PB-APBI (p=0.3). CONCLUSIONS PB-APBI consisting of 30 CGE in six CGE fractions once daily for five consecutive days can be delivered with excellent disease control and tolerable skin toxicity to properly selected patients with early-stage breast cancer. Multiple-field PB-APBI may achieve a high rate of good-to-excellent cosmetic outcomes. Additional clinical trials with larger patient groups are needed.
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Affiliation(s)
- Ji Hyun Chang
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Republic of Korea
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Olivotto IA, Whelan TJ, Parpia S, Kim DH, Berrang T, Truong PT, Kong I, Cochrane B, Nichol A, Roy I, Germain I, Akra M, Reed M, Fyles A, Trotter T, Perera F, Beckham W, Levine MN, Julian JA. Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol 2013; 31:4038-45. [PMID: 23835717 DOI: 10.1200/jco.2013.50.5511] [Citation(s) in RCA: 275] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To report interim cosmetic and toxicity results of a multicenter randomized trial comparing accelerated partial-breast irradiation (APBI) using three-dimensional conformal external beam radiation therapy (3D-CRT) with whole-breast irradiation (WBI). PATIENTS AND METHODS Women age > 40 years with invasive or in situ breast cancer ≤ 3 cm were randomly assigned after breast-conserving surgery to 3D-CRT APBI (38.5 Gy in 10 fractions twice daily) or WBI (42.5 Gy in 16 or 50 Gy in 25 daily fractions ± boost irradiation). The primary outcome was ipsilateral breast tumor recurrence (IBTR). Secondary outcomes were cosmesis and toxicity. Adverse cosmesis was defined as a fair or poor global cosmetic score. After a planned interim cosmetic analysis, the data, safety, and monitoring committee recommended release of results. There have been too few IBTR events to trigger an efficacy analysis. RESULTS Between 2006 and 2011, 2,135 women were randomly assigned to 3D-CRT APBI or WBI. Median follow-up was 36 months. Adverse cosmesis at 3 years was increased among those treated with APBI compared with WBI as assessed by trained nurses (29% v 17%; P < .001), by patients (26% v 18%; P = .0022), and by physicians reviewing digital photographs (35% v 17%; P < .001). Grade 3 toxicities were rare in both treatment arms (1.4% v 0%), but grade 1 and 2 toxicities were increased among those who received APBI compared with WBI (P < .001). CONCLUSION 3D-CRT APBI increased rates of adverse cosmesis and late radiation toxicity compared with standard WBI. Clinicians and patients are cautioned against the use of 3D-CRT APBI outside the context of a controlled trial.
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Affiliation(s)
- Ivo A Olivotto
- Ivo A. Olivotto, Tanya Berrang, Pauline T. Truong, Alan Nichol, Melanie Reed, and Wayne Beckham, British Columbia Cancer Agency; Ivo A. Olivotto, Tanya Berrang, and Pauline T. Truong, University of British Columbia; Wayne Beckham, University of Victoria, Victoria; Alan Nichol, University of British Columbia, Vancouver; Melanie Reed, University of British Columbia, Kelowna, British Columbia; Timothy J. Whelan, Do-Hoon Kim, Iwa Kong, and Mark N. Levine, Juravinski Cancer Centre; Timothy J. Whelan, Sameer Parpia, Do-Hoon Kim, Iwa Kong, Brandy Cochrane, Mark N. Levine, and Jim A. Julian, McMaster University; Timothy J. Whelan, Sameer Parpia, Brandy Cochrane, Mark N. Levine, and Jim A. Julian, Ontario Clinical Oncology Group, Hamilton; Anthony Fyles, Princess Margaret Hospital, University of Toronto, Toronto; Francisco Perera, London Regional Cancer Centre, University of Western Ontario, London, Ontario; Isabelle Roy, Hôpital Notre-Dame, University of Montreal, Montreal; Isabelle Germain, Hôtel-Dieu de Quebec, Laval University, Quebec City, Quebec; Mohamed Akra, Cancer Care Manitoba, University of Manitoba, Winnipeg, Manitoba; and Theresa Trotter, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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Brachytherapy-based partial breast irradiation is associated with low rates of complications and excellent cosmesis. Brachytherapy 2013; 12:278-84. [DOI: 10.1016/j.brachy.2013.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 11/18/2022]
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