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Dhia SB, Schiappa R, Gal J, Ferrero JM, Bahadoran P, Chapellier C, Bondiau PY. In Regard to Bondiau et al. Int J Radiat Oncol Biol Phys 2024; 119:1027-1028. [PMID: 38851261 DOI: 10.1016/j.ijrobp.2024.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Syrine Ben Dhia
- Department of Radiotherapy, Antoine Lacassagne Center, Nice, France
| | - Reneaud Schiappa
- Department of Epidemiology, Biostatistics, and Health Data, Antoine Lacassagne Center, Nice, France
| | - Joyclin Gal
- Department of Epidemiology, Biostatistics, and Health Data, Antoine Lacassagne Center, Nice, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Antoine Lacassagne Center, Nice, France
| | - Philippe Bahadoran
- Department of Dermatology, PASTEUR Neurosciences University Hospital, Nice, France
| | - Claire Chapellier
- Department of Medical Imaging, Antoine Lacassagne Center, Nice, France
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Washington I, Palm RF, White J, Rosenberg SA, Ataya D. The Role of MRI in Breast Cancer and Breast Conservation Therapy. Cancers (Basel) 2024; 16:2122. [PMID: 38893241 PMCID: PMC11171236 DOI: 10.3390/cancers16112122] [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: 04/22/2024] [Revised: 05/19/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Contrast-enhanced breast MRI has an established role in aiding in the detection, evaluation, and management of breast cancer. This article discusses MRI sequences, the clinical utility of MRI, and how MRI has been evaluated for use in breast radiotherapy treatment planning. We highlight the contribution of MRI in the decision-making regarding selecting appropriate candidates for breast conservation therapy and review the emerging role of MRI-guided breast radiotherapy.
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Affiliation(s)
- Iman Washington
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Russell F. Palm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Julia White
- Department of Radiation Oncology, The University of Kansas Medical Center, 4001 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Stephen A. Rosenberg
- Department of Radiation Therapy, H. Lee Moffitt Cancer Center & Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA;
| | - Dana Ataya
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, 10920 N. McKinley Drive, Tampa, FL 33612, USA;
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3
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Moore-Palhares D, Dasgupta A, Saifuddin M, Anzola Pena ML, Prasla S, Ho L, Lu L, Kung J, McNabb E, Sannachi L, Vesprini D, Chen H, Karam I, Soliman H, Szumacher E, Chow E, Gandhi S, Trudeau M, Curpen B, Stanisz GJ, Kolios M, Czarnota GJ. Radiation enhancement using focussed ultrasound-stimulated microbubbles for breast cancer: A Phase 1 clinical trial. PLoS Med 2024; 21:e1004408. [PMID: 38758967 PMCID: PMC11146716 DOI: 10.1371/journal.pmed.1004408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 06/03/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Preclinical studies have demonstrated that tumour cell death can be enhanced 10- to 40-fold when radiotherapy is combined with focussed ultrasound-stimulated microbubble (FUS-MB) treatment. The acoustic exposure of microbubbles (intravascular gas microspheres) within the target volume causes bubble cavitation, which induces perturbation of tumour vasculature and activates endothelial cell apoptotic pathways responsible for the ablative effect of stereotactic body radiotherapy. Subsequent irradiation of a microbubble-sensitised tumour causes rapid increased tumour death. The study here presents the mature safety and efficacy outcomes of magnetic resonance (MR)-guided FUS-MB (MRgFUS-MB) treatment, a radioenhancement therapy for breast cancer. METHODS AND FINDINGS This prospective, single-center, single-arm Phase 1 clinical trial included patients with stages I-IV breast cancer with in situ tumours for whom breast or chest wall radiotherapy was deemed adequate by a multidisciplinary team (clinicaltrials.gov identifier: NCT04431674). Patients were excluded if they had contraindications for contrast-enhanced MR or microbubble administration. Patients underwent 2 to 3 MRgFUS-MB treatments throughout radiotherapy. An MR-coupled focussed ultrasound device operating at 800 kHz and 570 kPa peak negative pressure was used to sonicate intravenously administrated microbubbles within the MR-guided target volume. The primary outcome was acute toxicity per Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Secondary outcomes were tumour response at 3 months and local control (LC). A total of 21 female patients presenting with 23 primary breast tumours were enrolled and allocated to intervention between August/2020 and November/2022. Three patients subsequently withdrew consent and, therefore, 18 patients with 20 tumours were included in the safety and LC analyses. Two patients died due to progressive metastatic disease before 3 months following treatment completion and were excluded from the tumour response analysis. The prescribed radiation doses were 20 Gy/5 fractions (40%, n = 8/20), 30 to 35 Gy/5 fractions (35%, n = 7/20), 30 to 40 Gy/10 fractions (15%, n = 3/20), and 66 Gy/33 fractions (10%, n = 2/20). The median follow-up was 9 months (range, 0.3 to 29). Radiation dermatitis was the most common acute toxicity (Grade 1 in 16/20, Grade 2 in 1/20, and Grade 3 in 2/20). One patient developed grade 1 allergic reaction possibly related to microbubbles administration. At 3 months, 18 tumours were evaluated for response: 9 exhibited complete response (50%, n = 9/18), 6 partial response (33%, n = 6/18), 2 stable disease (11%, n = 2/18), and 1 progressive disease (6%, n = 1/18). Further follow-up of responses indicated that the 6-, 12-, and 24-month LC rates were 94% (95% confidence interval [CI] [84%, 100%]), 88% (95% CI [75%, 100%]), and 76% (95% CI [54%, 100%]), respectively. The study's limitations include variable tumour sizes and dose fractionation regimens and the anticipated small sample size typical for a Phase 1 clinical trial. CONCLUSIONS MRgFUS-MB is an innovative radioenhancement therapy associated with a safe profile, potentially promising responses, and durable LC. These results warrant validation in Phase 2 clinical trials. TRIAL REGISTRATION clinicaltrials.gov, identifier NCT04431674.
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Affiliation(s)
- Daniel Moore-Palhares
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Archya Dasgupta
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | | | - Shopnil Prasla
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Ling Ho
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lin Lu
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Joseph Kung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Evan McNabb
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ewa Szumacher
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Sonal Gandhi
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Maureen Trudeau
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Greg J. Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Department of Biophysics, University of Toronto, Toronto, Canada
- Department of Neurosurgery, Medical University, Lublin, Poland
| | | | - Gregory J. Czarnota
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Department of Biophysics, University of Toronto, Toronto, Canada
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Chua GWY, Li L. Treatment Options for Early Stage Inoperable Breast Cancer: Cryoablation or Radiotherapy? Breast Care (Basel) 2024; 19:106-115. [PMID: 38645759 PMCID: PMC11026071 DOI: 10.1159/000536413] [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: 09/16/2023] [Accepted: 01/18/2024] [Indexed: 04/23/2024] Open
Abstract
Background Surgical removal of the tumour is the gold standard treatment for early stage invasive breast cancer. However, with a global ageing population, a larger number of diagnoses are occurring in women with comorbidities that render them unsuitable for surgery. Hence, it is of interest to explore alternative treatment strategies for this group of women. Summary Our narrative review aims to explore two such techniques, cryoablation and external beam radiotherapy, providing a brief summary of the evidence behind each technique. Following this, we discuss which groups of patients would gain the most benefit from each technique. Factors favouring the use of radiotherapy include patients with larger tumours, more superficial tumours, and those with less well-demarcated tumours where there is uncertainty regarding tumour extent. Meanwhile, patients who may benefit more from cryoablation include those who desire a smaller number of treatment sessions, have concerns regarding cosmesis and skin pigmentation, or who have relative contraindications to radiotherapy such as scleroderma, systemic lupus erythematosus, reduced lung function, or cardiac comorbidities. Key Messages Continued advancements in both cryoablation and radiotherapy technologies are taking place, in tandem with imaging technologies enabling greater certainty in tumour detection and delineation. These factors will help increase local control rates in this group of non-operable early stage breast cancer patients. Through this review, we hope to aid in the clinical decision-making process regarding the selection and referral of patients for each treatment.
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Affiliation(s)
- Gail Wan Ying Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Lucia Li
- Medical Sciences Division, University of Cambridge, Cambridge, UK
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Zabrocka E, Roberson JD, Noldner C, Kim J, Patel R, Ryu S, Stessin A. Stereotactic body radiation therapy (SBRT) for the treatment of primary breast cancer in patients not undergoing surgery. Adv Med Sci 2024; 69:29-35. [PMID: 38306916 DOI: 10.1016/j.advms.2024.01.002] [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: 03/29/2023] [Revised: 09/26/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE The purpose was to explore the role of stereotactic body radiation therapy (SBRT) in providing local control (LC) for primary breast cancer in patients unable to undergo surgery. MATERIALS/METHODS Between 2015 and 2019, 13 non-surgical candidates with 14 lesions were treated with SBRT for primary breast cancer. In 4 cases, SBRT was used after whole breast radiation therapy (WBRT; 40-50 Gy/20-25 fractions). SBRT dose was 30-40 Gy in 5 fractions for patients treated with SBRT alone and 25-32 Gy in 4-5 fractions for those treated with SBRT + WBRT. LC and overall survival (OS) were estimated using Kaplan-Meier curves. Response was also assessed using RECIST guidelines. RESULTS Median follow-up was 32 (range: 3.4-70.4) months. Imaging at median 2.2 (0.6-8.1) months post-SBRT showed median 43.2 % (range: 2-100 %) decrease in the largest diameter and median 68.7 % (range: 27.9-100 %) SUV reduction. There were 3 cases of local progression at 8.7-10.6 months. Estimated LC was 100 % at 6 months and 71.6 % at 12, 24 and 36 months. Estimated median OS was 100 % at 6 months, 76.9 % at 12 months, and 61.5 % at 24 and 36 months. Acute toxicity (n = 13; 92.9 %) included grade (G)1 (n = 8), G2 (n = 4), and G4 (necrosis; n = 1). Late toxicity included G2 edema (n = 1) and G4 necrosis (n = 2, including 1 consequential late effect). Only patients treated with SBRT + WBRT experienced acute/late G4 toxicity, managed with resection or steroids. CONCLUSIONS SBRT to primary breast cancer resulted in good LC in non-surgical/metastatic patients. Although necrosis (n = 2) occurred in the SBRT + WBRT group, it was successfully salvaged.
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Affiliation(s)
- Ewa Zabrocka
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - John D Roberson
- Southeast Radiation Oncology Group, Charlotte, NC, USA; Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Collin Noldner
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Jinkoo Kim
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Rushil Patel
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Alexander Stessin
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA.
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Chen G, Gu X, Xue J, Zhang X, Yu X, Zhang Y, Li A, Zhao Y, He G, Tang M, Xing F, Yin J, Bian X, Han Y, Cao S, Liu C, Jiang X, Zhang K, Xia Y, Li H, Niu N, Liu C. Effects of neoadjuvant stereotactic body radiotherapy plus adebrelimab and chemotherapy for triple-negative breast cancer: A pilot study. eLife 2023; 12:e91737. [PMID: 38131294 PMCID: PMC10746137 DOI: 10.7554/elife.91737] [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: 08/08/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Background Emerging data have supported the immunostimulatory role of radiotherapy, which could exert a synergistic effect with immune checkpoint inhibitors (ICIs). With proven effective but suboptimal effect of ICI and chemotherapy in triple-negative breast cancer (TNBC), we designed a pilot study to explore the efficacy and safety of neoadjuvant stereotactic body radiotherapy (SBRT) plus adebrelimab and chemotherapy in TNBC patients. Methods Treatment-naïve TNBC patients received two cycles of intravenous adebrelimab (20 mg/kg, every 3 weeks), and SBRT (24 Gy/3 f, every other day) started at the second cycle, then followed by six cycles of adebrelimab plus nab-paclitaxel (125 mg/m² on days 1 and 8) and carboplatin (area under the curve 6 mg/mL per min on day 1) every 3 weeks. The surgery was performed within 3-5 weeks after the end of neoadjuvant therapy. Primary endpoint was pathological complete response (pCR, ypT0/is ypN0). Secondary endpoints included objective response rate (ORR), residual cancer burden (RCB) 0-I, and safety. Results 13 patients were enrolled and received at least one dose of therapy. 10 (76.9%) patients completed SBRT and were included in efficacy analysis. 90% (9/10) of patients achieved pCR, both RCB 0-I and ORR reached 100% with three patients achieved complete remission. Adverse events (AEs) of all-grade and grade 3-4 occurred in 92.3% and 53.8%, respectively. One (7.7%) patient had treatment-related serious AEs. No radiation-related dermatitis or death occurred. Conclusions Adding SBRT to adebrelimab and neoadjuvant chemotherapy led to a substantial proportion of pCR with acceptable toxicities, supporting further exploration of this combination in TNBC patients. Funding None. Clinical trial number NCT05132790.
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Affiliation(s)
- Guanglei Chen
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical UniversityShenyangChina
- Innovative Cancer Drug Research and Development Engineering Center of Liaoning ProvinceShenyangChina
| | - Xi Gu
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical UniversityShenyangChina
- Innovative Cancer Drug Research and Development Engineering Center of Liaoning ProvinceShenyangChina
| | - Jinqi Xue
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical UniversityShenyangChina
- Innovative Cancer Drug Research and Development Engineering Center of Liaoning ProvinceShenyangChina
| | - Xu Zhang
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Xiaopeng Yu
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Yu Zhang
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Department of Gastrointestinal Surgery, Yantai Affiliated Hospital of Binzhou Medical UniversityYantaiChina
| | - Ailin Li
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Yi Zhao
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Guijin He
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Meiyue Tang
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Fei Xing
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Jianqiao Yin
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Xiaobo Bian
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Ye Han
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Shuo Cao
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
| | - Chao Liu
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical UniversityShenyangChina
- Innovative Cancer Drug Research and Development Engineering Center of Liaoning ProvinceShenyangChina
| | - Xiaofan Jiang
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical UniversityShenyangChina
- Innovative Cancer Drug Research and Development Engineering Center of Liaoning ProvinceShenyangChina
| | - Keliang Zhang
- Liaoning Center for Drug Evaluation and InspectionShenyangChina
| | - Yan Xia
- Jiangsu Hengrui PharmaceuticalsShanghaiChina
| | - Huajun Li
- Jiangsu Hengrui PharmaceuticalsShanghaiChina
| | - Nan Niu
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical UniversityShenyangChina
- Innovative Cancer Drug Research and Development Engineering Center of Liaoning ProvinceShenyangChina
| | - Caigang Liu
- Department of Oncology, Shengjing Hospital of China Medical UniversityShenyangChina
- Cancer Stem Cell and Translational Medicine Laboratory, Shengjing Hospital of China Medical UniversityShenyangChina
- Innovative Cancer Drug Research and Development Engineering Center of Liaoning ProvinceShenyangChina
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7
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De Caluwe A, Romano E, Poortmans P, Gombos A, Agostinetto E, Marta GN, Denis Z, Drisis S, Vandekerkhove C, Desmet A, Philippson C, Craciun L, Veys I, Larsimont D, Paesmans M, Van Gestel D, Salgado R, Sotiriou C, Piccart-Gebhart M, Ignatiadis M, Buisseret L. First-in-human study of SBRT and adenosine pathway blockade to potentiate the benefit of immunochemotherapy in early-stage luminal B breast cancer: results of the safety run-in phase of the Neo-CheckRay trial. J Immunother Cancer 2023; 11:e007279. [PMID: 38056900 PMCID: PMC10711977 DOI: 10.1136/jitc-2023-007279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Luminal B breast cancer (BC) presents a worse prognosis when compared with luminal A BC and exhibits a lower sensitivity to chemotherapy and a lower immunogenicity in contrast to non-luminal BC subtypes. The Neo-CheckRay clinical trial investigates the use of stereotactic body radiation therapy (SBRT) directed to the primary tumor in combination with the adenosine pathway inhibitor oleclumab to improve the response to neo-adjuvant immuno-chemotherapy in luminal B BC. The trial consists of a safety run-in followed by a randomized phase II trial. Here, we present the results of the first-in-human safety run-in. METHODS The safety run-in was an open-label, single-arm trial in which six patients with early-stage luminal B BC received the following neo-adjuvant regimen: paclitaxel q1w×12 → doxorubicin/cyclophosphamide q2w×4; durvalumab (anti-programmed cell death receptor ligand 1 (PD-L1)) q4w×5; oleclumab (anti-CD73) q2w×4 → q4w×3 and 3×8 Gy SBRT to the primary tumor at week 5. Surgery must be performed 2-6 weeks after primary systemic treatment and adjuvant therapy was given per local guidelines, RT boost to the tumor bed was not allowed. Key inclusion criteria were: luminal BC, Ki67≥15% or histological grade 3, MammaPrint high risk, tumor size≥1.5 cm. Primary tumor tissue samples were collected at three timepoints: baseline, 1 week after SBRT and at surgery. Tumor-infiltrating lymphocytes, PD-L1 and CD73 were evaluated at each timepoint, and residual cancer burden (RCB) was calculated at surgery. RESULTS Six patients were included between November 2019 and March 2020. Median age was 53 years, range 37-69. All patients received SBRT and underwent surgery 2-4 weeks after the last treatment. After a median follow-up time of 2 years after surgery, one grade 3 adverse event (AE) was reported: pericarditis with rapid resolution under corticosteroids. No grade 4-5 AE were documented. Overall cosmetical breast evaluation after surgery was 'excellent' in four patients and 'good' in two patients. RCB results were 2/6 RCB 0; 2/6 RCB 1; 1/6 RCB 2 and 1/6 RCB 3. CONCLUSIONS This novel treatment combination was considered safe and is worth further investigation in a randomized phase II trial. TRIAL REGISTRATION NUMBER NCT03875573.
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Affiliation(s)
- Alex De Caluwe
- Radiation Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Emanuela Romano
- Medical Oncology, Center for Cancer Immunotherapy, Institut Curie, Paris, France
| | - Philip Poortmans
- Radiation Oncology, Iridium Network and University of Antwerp, Antwerpen, Belgium
| | - Andrea Gombos
- Medical Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Elisa Agostinetto
- Clinical Trials Support Unit (CTSU), Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Bruxelles, Belgium
| | - Guilherme Nader Marta
- Clinical Trials Support Unit (CTSU), Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Bruxelles, Belgium
| | - Zoe Denis
- Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Bruxelles, Belgium
| | - Stylianos Drisis
- Radiology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Christophe Vandekerkhove
- Medical Physics, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Antoine Desmet
- Radiation Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Catherine Philippson
- Radiation Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Ligia Craciun
- Pathology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Isabelle Veys
- Surgery, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Denis Larsimont
- Pathology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Marianne Paesmans
- Clinical Trials Support Unit (CTSU), Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Bruxelles, Belgium
| | - Dirk Van Gestel
- Radiation Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | | | - Christos Sotiriou
- Medical Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Martine Piccart-Gebhart
- Medical Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Michail Ignatiadis
- Medical Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
| | - Laurence Buisseret
- Medical Oncology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Bruxelles, Belgium
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8
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Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Gerardi MA, Fodor C, Rondi E, Vigorito S, Penco S, Sargenti M, Baratella P, Vicini E, Morigi C, Kahler-Ribeiro-Fontana S, Galimberti VE, Gandini S, De Camilli E, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. A narrative review for radiation oncologists to implement preoperative partial breast irradiation. LA RADIOLOGIA MEDICA 2023; 128:1553-1570. [PMID: 37650981 DOI: 10.1007/s11547-023-01706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
The strategy to anticipate radiotherapy (RT) before surgery, for breast cancer (BC) treatment, has recently generated a renewed interest. Historically, preoperative RT has remained confined either to highly selected patients, in the context of personalized therapy, or to clinical research protocols. Nevertheless, in the recent years, thanks to technological advances and increased tumor biology understanding, RT has undergone great changes that have also impacted the preoperative settings, embracing the modern approach to breast cancer. In particular, the reappraisal of preoperative RT can be viewed within the broader view of personalized and tailored medicine. In fact, preoperative accelerated partial breast irradiation (APBI) allows a more precise target delineation, with less variability in contouring among radiation oncologists, and a smaller treatment volume, possibly leading to lower toxicity and to dose escalation programs. The aim of the present review, which represents a benchmark study for the AIRC IG-23118, is to report available data on different technical aspects of preoperative RT including dosimetric studies, patient's selection and set-up, constraints, target delineation and clinical results. These data, along with the ones that will become available from ongoing studies, may inform the design of the future trials and representing a step toward a tailored APBI approach with the potential to challenge the current treatment paradigm in early-stage BC.Trial registration: The study is registered at clinicaltrials.gov (NCT04679454).
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Affiliation(s)
- Maria Alessia Zerella
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Mattia Zaffaroni
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Giuseppe Ronci
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Damaris Patricia Rojas
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Anna Morra
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | | | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Penco
- Division of Breast Radiology, IRCSS, IEO European Institute of Oncology, Milan, Italy
| | - Manuela Sargenti
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Baratella
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa Vicini
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Consuelo Morigi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Elisa De Camilli
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Renne
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Maria Cristina Leonardi
- Department of Radiation Oncology, European Institute of Oncology IRCCS, 20141, Milan, Italy.
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9
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Masi L, Doro R, Di Cataldo V, Francolini G, Zani M, Visani L, Meattini I, Livi L. Preoperative single fraction breast radiotherapy: Intra-fraction geometric uncertainties and dosimetric implications. Phys Med 2023; 112:102638. [PMID: 37441821 DOI: 10.1016/j.ejmp.2023.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE A preoperative breast robotic radiosurgery trial was concluded in our centre. Purposes of the present study were to evaluate retrospectively over the enrolled patients: i) respiratory patterns ii) tracking uncertainties iii) necessity of respiratory compensation iv) tracking errors dosimetric effects. METHODS 22 patients were treated in 21 Gy single fraction using CyberKnife (CK) respiratory modelling and tracking (SynchronyResp) and data extracted from log-files. Respiratory motion and baseline drifts (BD) were analyzed. SynchronyResp uncertainties were computed and compared with errors simulated for CK fiducial tracking without respiratory compensation. Plans were perturbed by tracking errors and perturbed doses calculated on the planning CT scan in order to simulate the dosimetric consequences of intra-fraction errors. RESULTS After BD correction, respiratory amplitudes were below 5.5 mm except one value of 8 mm. 50% of patients showed BD above 3 mm. Standard deviations of SynchronyResp errors remained within 2.1 mm. Standard deviations of tracking errors without respiratory compensation were comparable and below 2.5 mm. Using a 3 mm PTV margin, perturbed CTV coverage was below 95% (93.7%) just for one patient. The latter case presented a large CTV-Skin interface. Perturbed OAR doses were always judged clinically acceptable. CONCLUSION Intra-fraction geometric uncertainties and their effects were quantified for breast neoadjuvant CK treatments. Data indicated that in the majority of cases respiratory compensation may be disabled without increasing uncertainties and reducing treatment time, provided that fiducial intra-fraction tracking is performed to account for BD. Dosimetric effects are mostly not clinically relevant.
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Affiliation(s)
- Laura Masi
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy.
| | - Raffaela Doro
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Margherita Zani
- Medical Physics Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Luca Visani
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy; Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy; Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi Florence, Italy; Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
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10
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Meattini I, de Oliveira Franco R, Salvestrini V, Hijal T. Special issue. De-escalation of loco-regional treatment in breast cancer: Time to find the balance? Partial breast irradiation. Breast 2023; 69:401-409. [PMID: 37116401 PMCID: PMC10163674 DOI: 10.1016/j.breast.2023.04.007] [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: 11/29/2022] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023] Open
Abstract
Breast cancer is the most common cancer in women worldwide. Over the past few decades, remarkable progress has been made in understanding the biology and pathology of breast cancer. A personalized conservative approach has been currently adopted addressing the patient's individual risk of relapse. After postoperative whole breast irradiation for early-stage breast cancer, a rate of recurrences outside the initial tumour bed lower than 4% was observed. Thus, the highest benefits of breast irradiation seem to result from the dose delivered to the tissue neighbouring the tumour bed. Nonetheless, reducing treatment morbidity while maintaining radiation therapy's ability to decrease local recurrences is an important challenge in treating patients with radiation therapy. In this regard, strategies such as partial-breast irradiation have been developed to reduce toxicity without compromising oncologic outcomes. According to the national and international published guidelines, clinical oncologists can refer to specific dose/fractionation schedules and eligible criteria. However, there are still some areas of open questions. Breast cancer represents a multidisciplinary paradigm; it should be considered a heterogeneous disease where a "one-treatment-fits-all" approach cannot be considered an appropriate option. This is a wide overview on the main partial breast irradiation advantages, risks, timings, techniques, and available recommendations. We aim to provide practical findings to support clinical decision-making, exploring future perspectives, towards a balance for optimisation of breast cancer.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Rejane de Oliveira Franco
- Department of Oncology, McGill University, Montreal, Canada; Division of Radiation Oncology, McGill University Health Centre, Montreal, Canada
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Tarek Hijal
- Department of Oncology, McGill University, Montreal, Canada; Division of Radiation Oncology, McGill University Health Centre, Montreal, Canada
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11
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To NH, Gabelle-Flandin I, Luong TMH, Loganadane G, Ouidir N, Boukhobza C, Grellier N, Verry C, Thiolat A, Cohen JL, Radosevic-Robin N, Belkacemi Y. Pathologic Response to Neoadjuvant Sequential Chemoradiation Therapy in Locally Advanced Breast Cancer: Preliminary, Translational Results from the French Neo-APBI-01 Trial. Cancers (Basel) 2023; 15:cancers15072030. [PMID: 37046691 PMCID: PMC10092968 DOI: 10.3390/cancers15072030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Radiation therapy (RT), a novel approach to boost the anticancer immune response, has been progressively evaluated in the neoadjuvant setting in breast cancer (BC). Purpose: We aimed to evaluate immunity-related indicators of response to neoadjuvant chemoradiation therapy (NACRT) in BC for better treatment personalization. Patients and Methods: We analyzed data of the first 42 patients included in the randomized phase 2 Neo-APBI-01 trial comparing standard neoadjuvant chemotherapy (NACT) and NACRT regimen in locally advanced triple-negative (TN) and luminal B (LB) subtype BC. Clinicopathological parameters, blood counts and the derived parameters, total tumor-infiltrating lymphocytes (TILs) and their subpopulation, as well as TP53 mutation status, were assessed as predictors of response. Results: Twenty-one patients were equally assigned to each group. The pathologic complete response (pCR) was 33% and 38% in the NACT and NACRT groups, respectively, with a dose-response effect. Only one LB tumor reached pCR after NACRT. Numerous parameters associated with response were identified, which differed according to the assigned treatment. In the NACRT group, baseline hemoglobin of ≥13 g/dL and body mass index of <26 were strongly associated with pCR. Higher baseline neutrophils-to-lymphocytes ratio, total TILs, and T-effector cell counts were favorable for pCR. Conclusion: This preliminary analysis identified LB and low-TIL tumors as poor responders to the NACRT protocol, which delivered RT after several cycles of chemotherapy. These findings will allow for amending the selection of patients for the trial and help better design future trials of NACRT in BC.
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12
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Ippolito E, Silipigni S, Pantano F, Matteucci P, Carrafiello S, Marrocco M, Alaimo R, Palumbo V, Fiore M, Orsaria P, D’Angelillo RM, Altomare V, Tonini G, Ramella S. BOMB trial: First results of stereotactic radiotherapy to primary breast tumor in metastatic breast cancer patients. Front Oncol 2023; 13:1062355. [PMID: 37007063 PMCID: PMC10064004 DOI: 10.3389/fonc.2023.1062355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
AimA prospective dose escalation trial was developed to evaluate the maximum tolerated dose of stereotactic body radiotherapy (SABRT) to primary breast cancer in stage IV disease. The aim of the present report was to describe safety and outcome of the first dose level cohort of patients.Material and methodsPatients with histologically confirmed diagnosis of invasive breast carcinoma (biological immuno-histochemical profile: luminal and/or HER2 positive) and distant metastatic disease not progressing after 6 months of systemic therapy with a tumor CT or 5FDG-PET detectable were deemed eligible. The starting dose was 40 Gy in 5 fractions (level 1) because this dose proved to be safe in previous dose-escalation trial on adjuvant stereotactic body radiotherapy. The maximum dose level was chosen as 45 Gy in 5 fractions. Dose limiting toxicity was any grade 3 or worse toxicity according to CTCAE v.4. Time-to-event Keyboard (TITE-Keyboard) design (Lin and Yuan, Biostatistics 2019) was used to find the maximum tolerated dose (MTD). MTD was the dose of radiotherapy associated with a ≤ 20% rate pre-specified treatment-related dose-limiting toxicity (DLT).ResultsTo date 10 patients have been treated at the starting dose level. Median age was 80 years (range 50-89). 7 patients had a luminal disease, while 3 patients had an HER2 positive disease. No patient suspended ongoing systemic treatment. No protocol defined DLTs were observed. Grade 2 skin toxicity occurred in 4 patients with diseases located close to or involving the skin. Median follow-up was 13 months and all 10 patients were evaluable for response: 5 achieved a complete response, 3 achieved a partial response and 2 showed a stable disease, all with a clinical benefit (resolution of skin retraction, bleeding and pain). The mean reduction in the sum of the largest diameters of target lesions was of 61.4% (DS=17.0%).ConclusionsSABR to primary breast cancer seems feasible and is associated with symptoms reduction. Continued accrual to this study is needed to confirm the safety and assess the MTD.Clinical trial registrationClinicalTrials.gov, identifier NCT05229575.
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Affiliation(s)
- Edy Ippolito
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sonia Silipigni
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- *Correspondence: Sonia Silipigni,
| | - Francesco Pantano
- Department of Medical Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, Rome, Italy
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Paolo Matteucci
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sofia Carrafiello
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Maristella Marrocco
- Department of Radiation Oncology, Azienda Sanitaria Locale (ASL) Frosinone, Hospital of Sora, Sora, Italy
| | - Rita Alaimo
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Palumbo
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Michele Fiore
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery (Medicine and Surgery), Università Campus Bio-Medico di Roma, Rome, Italy
- Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rolando Maria D’Angelillo
- Radiation Oncology, Department of Biomedicine and Prevention University of Rome “Tor Vergata”, Rome, Italy
| | - Vittorio Altomare
- Department of Breast Surgery (Medicine and Surgery), Università Campus Bio-Medico di Roma, Rome, Italy
- Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, Rome, Italy
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sara Ramella
- Department of Radiation Oncology (Medicine and Surgery), Università Campus Bio-Medico di Roma, Rome, Italy
- Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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13
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Phase 2 Study of Preoperative SABR for Early-Stage Breast Cancer: Introduction of a Novel Form of Accelerated Partial Breast Radiation Therapy. Int J Radiat Oncol Biol Phys 2023:S0360-3016(22)03689-6. [PMID: 36796498 DOI: 10.1016/j.ijrobp.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 02/17/2023]
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14
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Rong Y, Ding X, Daly ME. Hypofractionation and SABR: 25 years of evolution in medical physics and a glimpse of the future. Med Phys 2023. [PMID: 36756953 DOI: 10.1002/mp.16270] [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: 12/13/2022] [Revised: 12/13/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
As we were invited to write an article for celebrating the 50th Anniversary of Medical Physics journal, on something historically significant, commemorative, and exciting happening in the past decades, the first idea came to our mind is the fascinating radiotherapy paradigm shift from conventional fractionation to hypofractionation and stereotactic ablative radiotherapy (SABR). It is historically and clinically significant since as we all know this RT treatment revolution not only reduces treatment duration for patients, but also improves tumor control and cancer treatment outcomes. It is also commemorative and exciting for us medical physicists since the technology development in medical physics has been the main driver for the success of this treatment regimen which requires high precision and accuracy throughout the entire treatment planning and delivery. This article provides an overview of the technological development and clinical trials evolvement in the past 25 years for hypofractionation and SABR, with an outlook to the future improvement.
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Affiliation(s)
- Yi Rong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California, USA
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15
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Yu CX. Radiotherapy of early‐stage breast cancer. PRECISION RADIATION ONCOLOGY 2023. [DOI: 10.1002/pro6.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Cedric X. Yu
- Radiation Oncology University of Maryland School of Medicine Baltimore Maryland USA
- Xcision Medical Systems Columbia Maryland USA
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16
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Preoperative Radio(Chemo)Therapy in Breast Cancer: Time to Switch the Perspective? Curr Oncol 2022; 29:9767-9787. [PMID: 36547182 PMCID: PMC9777182 DOI: 10.3390/curroncol29120768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
AIM Radiation therapy represents, together with surgery and systemic treatment, the triad on which the current management of patients with breast cancer is based, achieving high control and survival rates. In recent years we have witnessed a (r)evolution in the conception of breast cancer treatment. The classic scheme of surgery followed by systemic treatment and radiotherapy is being subverted and it is becoming more and more frequent to propose the primary administration of systemic treatment before surgery, seeking to maximize its effect and favoring not only the performance of more conservative surgeries but also, in selected cases, increasing the rates of disease-free survival and overall survival. Radiotherapy is also evolving toward a change in perspective: considering preoperative primary administration of radiotherapy may be useful in selected groups. Advances in radiobiological knowledge, together with technological improvements that are constantly being incorporated into clinical practice, support the administration of increasingly reliable, precise, and effective radiotherapy, as well as its safe combination with antitumor drugs or immunotherapy in the primary preoperative context. In this paper, we present a narrative review of the usefulness of preoperative radiotherapy for breast cancer patients and the possibilities for its combination with other therapies.
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Meattini I, Francolini G, Di Cataldo V, Visani L, Becherini C, Scoccimarro E, Salvestrini V, Bellini C, Masi L, Doro R, Di Naro F, Loi M, Salvatore G, Simontacchi G, Greto D, Bernini M, Nori J, Orzalesi L, Bianchi S, Mangoni M, Livi L. Preoperative robotic radiosurgery for early breast cancer: Results of the phase II ROCK trial (NCT03520894). Clin Transl Radiat Oncol 2022; 37:94-100. [PMID: 36177053 PMCID: PMC9513617 DOI: 10.1016/j.ctro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 12/04/2022] Open
Abstract
Preoperative partial breast irradiation treats well-defined target. Stereotactic body radiation therapy have been routinely implemented in clinical practice. No acute toxicity greater than grade 2 was recorded. A single 21 Gy dose preoperative robotic radiosurgery represents a feasible technique.
Background and purpose Preoperative partial breast irradiation (PBI) has got the advantage of treating a well-defined target. We report the results of the phase II ROCK trial (NCT03520894), enrolling early breast cancer (BC) patients treated with preoperative robotic radiosurgery (prRS), in terms of acute and early late toxicity, disease control, and cosmesis. Material and methods The study recruited between 2018 and 2021 at our Radiation Oncology Unit. Eligible patients were 50 + years old BC, hormonal receptors positive/human epidermal growth factor receptor 2 negative (HR+/HER2-), sized up to 25 mm. The study aimed to prospectively assess the toxicity and feasibility of a robotic single 21 Gy-fraction prRS in preoperative setting. Results A total of 70 patients were recruited and 22 patients were successfully treated with pRS. Overall, three G1 adverse events (13.6 %) were recorded within 7 days from prRS. Three events (13.6 %) were recorded between 7 and 30 days, one G2 breast oedema and two G1 breast pain. No acute toxicity greater than G2 was recorded. Five patients experienced early late G1 toxicity. One patient reported G2 breast induration. No early late toxicity greater than G2 was observed. At a median follow up of 18 months (range 6–29.8), cosmetic results were scored excellent/good and fair in 14 and 5 patients, respectively, while 3 patients experienced a poor cosmetic outcome. Conclusions ROCK trial showed that a single 21 Gy dose prRS represents a feasible technique for selected patients affected by early BC, showing an acceptable preliminary toxicity profile.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luca Visani
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.,CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Erika Scoccimarro
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Viola Salvestrini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.,CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Chiara Bellini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Laura Masi
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Raffaela Doro
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giulia Salvatore
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Monica Mangoni
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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18
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Takanen S, Pinnarò P, Farina I, Sperati F, Botti C, Vici P, Soriani A, Marucci L, Sanguineti G. Stereotactic partial breast irradiation in primary breast cancer: A comprehensive review of the current status and future directions. Front Oncol 2022; 12:953810. [PMID: 36313648 PMCID: PMC9606691 DOI: 10.3389/fonc.2022.953810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
In selected low-risk breast cancer patients, accelerated partial breast irradiation (APBI) may represent an alternative option to the whole breast irradiation to reduce the volume of irradiated breast and total treatment duration. In the last few years, preliminary data from clinical trials showed that stereotactic partial breast radiotherapy may have the advantage to be less invasive compared to other APBI techniques, with preliminary good results in terms of local toxicity and cosmesis: the use of magnetic resonance, fiducial markers in the tumor bed, and new breast devices support both a precise definition of the target and radiation planning.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257856, identifier CRD42021257856.
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Affiliation(s)
- Silvia Takanen
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Paola Pinnarò
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Ilaria Farina
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Francesca Sperati
- Biostatistics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Soriani
- Physics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Marucci
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
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19
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Zhang Y, Xu Z, Chen H, Sun X, Zhang Z. Survival comparison between postoperative and preoperative radiotherapy for stage I-III non-inflammatory breast cancer. Sci Rep 2022; 12:14288. [PMID: 35995985 PMCID: PMC9395522 DOI: 10.1038/s41598-022-18251-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
To compare the survival benefit between preoperative and postoperative radiotherapy for stage I-III non-inflammatory breast cancer patients, we conducted a retrospective cohort study using surveillance, epidemiology and end results databases. Our study recruited patients who had been diagnosed with stage I-III breast cancer and underwent surgery and radiotherapy. The overall survival was calculated by Kaplan-Meier method. Cox risk model was used to determine the impact of radiotherapy according to stage, molecular subtype and other risk factors. Propensity score matching was used to balance measurable confounding factors. Of all the 411,279 enrolled patients varying from 1975 to 2016, 1712 patients received preoperative radiotherapy, and 409,567 patients received postoperative radiotherapy. Compared with the postoperative radiotherapy group, the preoperative radiotherapy group showed significantly higher risks of overall mortality and breast cancer-specific mortality. Survival differences in treatment sequences were correlated with stage, molecular subtypes and other risk factors. According to the results of this study, preoperative radiotherapy did not show a survival advantage, and postoperative radiotherapy is still the primary treatment. However, preoperative radiotherapy also has some theoretical advantages, such as phase reduction and recurrence reduction. Therefore, it is still worthy of further exploration.
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Affiliation(s)
- Yuxi Zhang
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Zhipeng Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, Jiangsu, China
| | - Hui Chen
- Department of Radiation Oncology, Jiangsu Province Hospital, Nanjing, China
| | - Xinchen Sun
- Department of Radiation Oncology, Jiangsu Province Hospital, Nanjing, China.
| | - Zhaoyue Zhang
- Department of Radiation Oncology, Jiangsu Province Hospital, Nanjing, China.
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20
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Liu Y, Veale C, Hablitz D, Krontiras H, Dalton A, Meyers K, Dobelbower M, Lancaster R, Bredel M, Parker C, Keene K, Thomas E, Boggs D. Feasibility and Short-Term Toxicity of a Consecutively Delivered Five Fraction Stereotactic Body Radiation Therapy Regimen in Early-Stage Breast Cancer Patients Receiving Partial Breast Irradiation. Front Oncol 2022; 12:901312. [PMID: 35880164 PMCID: PMC9307906 DOI: 10.3389/fonc.2022.901312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background For appropriately selected patients with early-stage breast cancer (ESBC), accelerated partial breast irradiation (APBI) yields equivalent rates of ipsilateral breast tumor recurrence with mixed results in patient-rated cosmesis compared with whole-breast radiotherapy depending on the technique utilized. When utilizing external beam radiotherapy for APBI, techniques to reduce target margins and overall treatment volume are potentially important to decrease rates of long-term adverse cosmesis. Stereotactic body radiotherapy (SBRT) is a promising technique to deliver APBI because of its increased accuracy and sparing of uninvolved breast tissue. We report the initial results of a prospective clinical trial investigating feasibility, safety, and cosmetic outcomes of a daily five-fraction SBRT regimen for APBI. Methods Twenty-three patients with ESBC after lumpectomy who met APBI suitability were enrolled. During lumpectomy, a bioabsorbable three-dimensional fixed array tissue marker (BioZorb™, Hologic, Marlborough, MA) was placed for enhanced visualization of the cavity boundaries. Clinical target volume (CTV) was defined as the delineable cavity plus a 1-cm isotropic expansion followed by a 3-mm isotropic planning target volume (PTV) expansion. Patients received 30 Gy delivered in five planned consecutive daily fractions in either prone or supine positioning depending on individual anatomy. Two patients completed the five-fraction treatments in 9-day interval and 11-day interval due to external circumstances. A maximum PTV of 124cc was allowed to minimize incidence of fat necrosis. Plans utilized 10-MV flattening filter–free beams delivered on a Varian Edge linear accelerator. Local control, toxicity, and nurse/patient-scored cosmesis at pre-treatment baseline, 1 month post-treatment, and at subsequent 6-month intervals were recorded. Results Twenty-three patients were accrued at the time of submission with median follow-up of 6 months. No patients experienced grade ≥3 acute toxicity. Of the 10 events reported probably related to SBRT, nine were grade 1 (n = 9/10, 90%). There was no evidence of difference, deterioration, or change in patient or nurse-scored cosmesis from baseline to 1 and 6 months post-treatment. One patient developed nodal failure shortly after APBI. Conclusions Although longer follow-up is needed to assess long-term toxicity and local control, this study demonstrated a five-fraction SBRT regimen delivered over consecutive days is a safe, efficient, well-tolerated, and cosmetically favorable means of delivering APBI in suitable women. Clinical Trial Registration https://www.clinicaltrials.gov/ct2/show/NCT03643861, NCT03643861.
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Affiliation(s)
- Yilan Liu
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christopher Veale
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Diana Hablitz
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Helen Krontiras
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Allison Dalton
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Korie Meyers
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Dobelbower
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rachael Lancaster
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Markus Bredel
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Catherine Parker
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kimberly Keene
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Evan Thomas
- Department of Radiation Oncology, Ohio State University, Columbus, OH, United States
| | - Drexell Boggs
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Drexell Boggs,
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21
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Weinfurtner RJ, Abdalah M, Stringfield O, Ataya D, Williams A, Mooney B, Rosa M, Lee MC, Khakpour N, Laronga C, Czerniecki B, Diaz R, Ahmed K, Washington I, Latifi K, Niell BL, Montejo M, Raghunand N. Quantitative Changes in Intratumoral Habitats on MRI Correlate With Pathologic Response in Early-stage ER/PR+ HER2- Breast Cancer Treated With Preoperative Stereotactic Ablative Body Radiotherapy. JOURNAL OF BREAST IMAGING 2022; 4:273-284. [PMID: 36686407 PMCID: PMC9851176 DOI: 10.1093/jbi/wbac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective To quantitatively evaluate intratumoral habitats on dynamic contrast-enhanced (DCE) breast MRI to predict pathologic breast cancer response to stereotactic ablative body radiotherapy (SABR). Methods Participants underwent SABR treatment (28.5 Gy x3), baseline and post-SABR MRI, and breast-conserving surgery for ER/PR+ HER2- breast cancer. MRI analysis was performed on DCE T1-weighted images. MRI voxels were assigned eight habitats based on high (H) or low (L) maximum enhancement and the sequentially numbered dynamic sequence of maximum enhancement (H1-4, L1-4). MRI response was analyzed by percent tumor volume remaining (%VR = volume post-SABR/volume pre-SABR), and percent habitat makeup (%HM of habitat X = habitat X voxels/total voxels in the segmented volume). These were correlated with percent tumor bed cellularity (%TC) for pathologic response. Results Sixteen patients completed the trial. The %TC ranged 20%-80%. MRI %VR demonstrated strong correlations with %TC (Pearson R = 0.7-0.89). Pre-SABR tumor %HMs differed significantly from whole breasts (P = 0.005 to <0.00001). Post-SABR %HM of tumor habitat H4 demonstrated the largest change, increasing 13% (P = 0.039). Conversely, combined %HM for H1-3 decreased 17% (P = 0.006). This change correlated with %TC (P < 0.00001) and distinguished pathologic partial responders (≤70 %TC) from nonresponders with 94% accuracy, 93% sensitivity, 100% specificity, 100% positive predictive value, and 67% negative predictive value. Conclusion In patients undergoing preoperative SABR treatment for ER/PR+ HER2- breast cancer, quantitative MRI habitat analysis of %VR and %HM change correlates with pathologic response.
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Affiliation(s)
| | - Mahmoud Abdalah
- Moffitt Cancer Center, Quantitative Imaging Core, Tampa, Fl, USA
| | - Olya Stringfield
- Moffitt Cancer Center, Quantitative Imaging Core, Tampa, Fl, USA
| | - Dana Ataya
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Angela Williams
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Blaise Mooney
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Marilin Rosa
- Moffitt Cancer Center, Department of Pathology, Tampa, FL, USA
| | - Marie C Lee
- Moffitt Cancer Center, Department of Surgery, Tampa, FL, USA
| | | | | | | | - Roberto Diaz
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Kamran Ahmed
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Iman Washington
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Kujtim Latifi
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Bethany L Niell
- Moffitt Cancer Center, Department of Radiology, Tampa, FL, USA
| | - Michael Montejo
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
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22
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Zerella MA, Zaffaroni M, Ronci G, Dicuonzo S, Rojas DP, Morra A, Fodor C, Rondi E, Vigorito S, Botta F, Cremonesi M, Garibaldi C, Penco S, Galimberti VE, Intra M, Gandini S, Barberis M, Renne G, Cattani F, Veronesi P, Orecchia R, Jereczek-Fossa BA, Leonardi MC. Single fraction ablative preoperative radiation treatment for early-stage breast cancer: the CRYSTAL study – a phase I/II clinical trial protocol. BMC Cancer 2022; 22:358. [PMID: 35366825 PMCID: PMC8977020 DOI: 10.1186/s12885-022-09305-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Breast-conserving surgery (BCS) and whole breast radiation therapy (WBRT) are the standard of care for early-stage breast cancer (BC). Based on the observation that most local recurrences occurred near the tumor bed, accelerated partial breast irradiation (APBI), consisting of a higher dose per fraction to the tumor bed over a reduced treatment time, has been gaining ground as an attractive alternative in selected patients with low-risk BC. Although more widely delivered in postoperative setting, preoperative APBI has also been investigated in a limited, though increasing, and number of studies. The aim of this study is to test the feasibility, safety and efficacy of preoperative radiotherapy (RT) in a single fraction for selected BC patients. Methods This is a phase I/II, single-arm and open-label single-center clinical trial using CyberKnife. The clinical investigation is supported by a preplanning section which addresses technical and dosimetric issues. The primary endpoint for the phase I study, covering the 1st and 2nd year of the research project, is the identification of the maximum tolerated dose (MTD) which meets a specific target toxicity level (no grade 3–4 toxicity). The primary endpoint for the phase II study (3rd to 5th year) is the evaluation of treatment efficacy measured in terms of pathological complete response rate. Discussion The study will investigate the response of BC to the preoperative APBI from different perspectives. While preoperative APBI represents a form of anticipated boost, followed by WBRT, different are the implications for the scientific community. The study may help to identify good responders for whom surgery could be omitted. It is especially appealing for patients unfit for surgery due to advanced age or severe co-morbidities, in addition to or instead of systemic therapies, to ensure long-term local control. Moreover, patients with oligometastatic disease synchronous with primary BC may benefit from APBI on the intact tumor in terms of tumor progression free survival. The study of response to RT can provide useful information about BC radiobiology, immunologic reactions, genomic expression, and radiomics features, to be tested on a larger scale. Trial registration The study was prospectively registered at clinicaltrials.gov (NCT04679454).
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23
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To NH, Radosevic-Robin N, Belkacemi Y. Neoadjuvant radiotherapy in triple-negative breast cancer: "the past should not steal the present or hide the future". Rep Pract Oncol Radiother 2022; 27:180-181. [PMID: 35402032 PMCID: PMC8989450 DOI: 10.5603/rpor.a2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Nhu Hanh To
- AP-HP, Radiation Oncology Department and Henri Mondor Breast Center, Henri Mondor University Hospital, Créteil, France,INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) team, Mondor Institute of Biomedical Research (IMRB), Créteil, France
| | - Nina Radosevic-Robin
- Department of Pathology, Centre Jean Perrin, University Clermont Auvergne, INSERM U1240, Clermont-Ferrand, France
| | - Yazid Belkacemi
- AP-HP, Radiation Oncology Department and Henri Mondor Breast Center, Henri Mondor University Hospital, Créteil, France,University of Paris-Est Créteil (UPEC), Créteil, France,INSERM Unit 955, Immunoregulation and Biotherapy (I-Biot) team, Mondor Institute of Biomedical Research (IMRB), Créteil, France
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24
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A Novel Approach for the Discovery of Biomarkers of Radiotherapy Response in Breast Cancer. J Pers Med 2021; 11:jpm11080796. [PMID: 34442440 PMCID: PMC8399231 DOI: 10.3390/jpm11080796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023] Open
Abstract
Radiotherapy (RT) is an important treatment modality for the local control of breast cancer (BC). Unfortunately, not all patients that receive RT will obtain a therapeutic benefit, as cancer cells that either possess intrinsic radioresistance or develop resistance during treatment can reduce its efficacy. For RT treatment regimens to become personalised, there is a need to identify biomarkers that can predict and/or monitor a tumour's response to radiation. Here we describe a novel method to identify such biomarkers. Liquid chromatography-mass spectrometry (LC-MS) was used on conditioned media (CM) samples from a radiosensitive oestrogen receptor positive (ER+) BC cell line (MCF-7) to identify cancer-secreted biomarkers which reflected a response to radiation. A total of 33 radiation-induced secreted proteins that had higher (up to 12-fold) secretion levels at 24 h post-2 Gy radiation were identified. Secretomic results were combined with whole-transcriptome gene expression experiments, using both radiosensitive and radioresistant cells, to identify a signature related to intrinsic radiosensitivity. Gene expression analysis assessing the levels of the 33 proteins showed that 5 (YBX3, EIF4EBP2, DKK1, GNPNAT1 and TK1) had higher expression levels in the radiosensitive cells compared to their radioresistant derivatives; 3 of these proteins (DKK1, GNPNAT1 and TK1) underwent in-lab and initial clinical validation. Western blot analysis using CM samples from cell lines confirmed a significant increase in the release of each candidate biomarker from radiosensitive cells 24 h after treatment with a 2 Gy dose of radiation; no significant increase in secretion was observed in the radioresistant cells after radiation. Immunohistochemistry showed that higher intracellular protein levels of the biomarkers were associated with greater radiosensitivity. Intracellular levels were further assessed in pre-treatment biopsy tissues from patients diagnosed with ER+ BC that were subsequently treated with breast-conserving surgery and RT. High DKK1 and GNPNAT1 intracellular levels were associated with significantly increased recurrence-free survival times, indicating that these two candidate biomarkers have the potential to predict sensitivity to RT. We suggest that the methods highlighted in this study could be utilised for the identification of biomarkers that may have a potential clinical role in personalising and optimising RT dosing regimens, whilst limiting the administration of RT to patients who are unlikely to benefit.
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25
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De Caluwé A, Buisseret L, Poortmans P, Van Gestel D, Salgado R, Sotiriou C, Larsimont D, Paesmans M, Craciun L, Stylianos D, Vandekerckhove C, Reyal F, Isabelle V, Eiger D, Piccart M, Romano E, Ignatiadis M. Neo-CheckRay: radiation therapy and adenosine pathway blockade to increase benefit of immuno-chemotherapy in early stage luminal B breast cancer, a randomized phase II trial. BMC Cancer 2021; 21:899. [PMID: 34362344 PMCID: PMC8343924 DOI: 10.1186/s12885-021-08601-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Residual breast cancer after neo-adjuvant chemotherapy (NACT) predicts disease outcome and is a surrogate for survival in aggressive breast cancer (BC) subtypes. Pathological complete response (pCR) rate, however, is lower for luminal B BC in comparison to the triple negative (TNBC) and HER2+ subtypes. The addition of immune checkpoint blockade (ICB) to NACT has the potential to increase pCR rate but is hampered by the lower immunogenicity of luminal B BC. Novel strategies are needed to stimulate the immune response and increase the response rate to ICB in luminal B BC. METHODS The Neo-CheckRay trial is a randomized phase II trial investigating the impact of stereotactic body radiation therapy (SBRT) to the primary breast tumor in combination with an anti-CD73 (oleclumab) to increase response to anti PD-L1 (durvalumab) and NACT. The trial is designed as a three-arm study: NACT + SBRT +/- durvalumab +/- oleclumab. The result at surgery will be evaluated using the residual cancer burden (RCB) index as the primary endpoint. Six patients will be included in a safety run-in, followed by a randomized phase II trial that will include 136 evaluable patients in 3 arms. Inclusion is limited to luminal B breast cancers that are MammaPrint genomic high risk. DISCUSSION combination of ICB with chemotherapy in luminal B BC might benefit from immune priming agents to increase the response rate. As none have been identified so far, this phase II trial will evaluate SBRT and oleclumab as potential immune priming candidates. TRIAL REGISTRATION trial registered on ClinicalTrials.gov ( NCT03875573 ) on March 14th, 2019.
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Affiliation(s)
- Alex De Caluwé
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium.
| | - Laurence Buisseret
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | | | - Dirk Van Gestel
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | | | - Christos Sotiriou
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | - Denis Larsimont
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | - Marianne Paesmans
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | - Ligia Craciun
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | - Drisis Stylianos
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | | | | | - Veys Isabelle
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | - Daniel Eiger
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
| | | | - Michail Ignatiadis
- Institut Jules Bordet, Université Libre de Bruxelles, Rue Héger Bordet 1, 1000, Brussels, Belgium
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26
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Weinfurtner RJ, Raghunand N, Stringfield O, Abdalah M, Niell BL, Ataya D, Williams A, Mooney B, Rosa M, Lee MC, Khakpour N, Laronga C, Czerniecki B, Diaz R, Ahmed K, Washington I, Montejo M. MRI Response to Pre-operative Stereotactic Ablative Body Radiotherapy (SABR) in Early Stage ER/PR+ HER2- Breast Cancer correlates with Surgical Pathology Tumor Bed Cellularity. Clin Breast Cancer 2021; 22:e214-e223. [PMID: 34384695 DOI: 10.1016/j.clbc.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/29/2021] [Accepted: 06/28/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study evaluates breast MRI response of ER/PR+ HER2- breast tumors to pre-operative SABR with pathologic response correlation. METHODS Women enrolled in a phase 2 single institution trial of SABR for ER/PR+ HER2- breast cancer were retrospectively evaluated for radiologic-pathologic correlation of tumor response. These patients underwent baseline breast MRI, SABR (28.5 Gy in 3 fractions), follow-up MRI 5 to 6 weeks post-SABR, and lumpectomy. Tumor size and BI-RADS descriptors on pre and post-SABR breast MRIs were compared to determine correlation with surgical specimen % tumor cellularity (%TC). Reported MRI tumor dimensions were used to calculate percent cubic volume remaining (%VR). Partial MRI response was defined as a BI-RADs descriptor change or %VR ≤ 70%, while partial pathologic response (pPR) was defined as %TC ≤ 70%. RESULTS Nineteen patients completed the trial, and %TC ranged 10% to 80%. For BI-RADS descriptor analysis, 12 of 19 (63%) showed change in lesion or kinetic enhancement descriptors post-SABR. This was associated with lower %TC (29% vs. 47%, P = .042). BI-RADS descriptor change analysis also demonstrated high PPV (100%) and specificity (100%) for predicting pPR to treatment (sensitivity 71%, accuracy 74%), but low NPV (29%). MRI %VR demonstrated strong linear correlation with %TC (R = 0.70, P < .001, Pearson's Correlation) and high accuracy (89%) for predicting pPR (sensitivity 88%, specificity 100%, PPV 100%, and NPV 50%). CONCLUSION Evaluating breast cancer response on MRI using %VR after pre-operative SABR treatment can help identify patients benefiting the most from neoadjuvant radiation treatment of their ER/PR+ HER2- tumors, a group in which pCR to neoadjuvant therapy is rare.
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Affiliation(s)
| | | | - Olya Stringfield
- Post-doctoral Fellow, Quantitative Imaging Core, Moffitt Cancer Center, Tampa, FL
| | - Mahmoud Abdalah
- Post-doctoral Fellow, Quantitative Imaging Core, Moffitt Cancer Center, Tampa, FL
| | - Bethany L Niell
- Associate Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Dana Ataya
- Assistant Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Angela Williams
- Assistant Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Blaise Mooney
- Assosciate Member of Radiology, Moffitt Cancer Center, Tampa, FL
| | - Marilin Rosa
- Associate Member of Pathology, Moffitt Cancer Center, Tampa, FL
| | - Marie C Lee
- Associate Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Nazanin Khakpour
- Senior Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Christine Laronga
- Associate Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Brian Czerniecki
- Associate Member of Breast Surgery, Moffitt Cancer Center, Tampa, FL
| | - Roberto Diaz
- Senior Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Kamran Ahmed
- Assistant Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Iman Washington
- Assistant Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Michael Montejo
- Assistant Member of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
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Abstract
Oligometastatic cancer has been recognized as a distinct clinical entity for over 100 years. For decades surgeons have been devising strategies to identify patients with oligmetastatic cancer that have the potential to be cured by surgically removing the oligometastases ("curative intent metastasectomy"). More recently, several studies have suggested there may be benefits to local therapy in oligometastatic cancer patients that are less likely to be cured. This has transformed the practice of local therapy in this setting away from "curative intent" to a broader purpose of "lesion-specific cytoreduction." As a result, the pool of oligometastatic patients eligible for local therapy has been expanded. However, the boundaries that had previously framed the practice of local therapy in oligometastatic cancer have been obscured. The following is a single surgeon's attempt to align the promise of this expanded role of local therapy, with the principles of risk-benefit deliberation that are intrinsic to the surgical discipline.
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Stereotactic body radiotherapy in Cyberknife® for partial breast irradiation: a review. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s146039692000120x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction:
Partial breast irradiation (PBI) can reduce the volume of treatment and number of treatment sessions in low-risk breast cancer patients. Stereotactic body radiotherapy (SBRT) allows the administration of high doses per fraction thereby reducing the number of fractions and reducing the dose to the surrounding tissues. The objective of this study is to review the literature on the use of SBRT in PBI using the Cyberknife® (CK) unit.
Material and methods:
In this review, we analysed the literature in PubMed and MEDLINE with articles published in the last 10 years. All citations were evaluated for relevant content and validity.
Results:
We include articles in the English language with information about PBI, SBRT in PBI, the use of the CK unit in PBI and other applications of SBRT in breast carcinoma. A total of 68 articles were found and 28 articles were selected for inclusion in this review.
Conclusions:
The treatment of PBI using the CK unit has clear advantages in reducing the treatment volume, and therefore theoretically reducing side effects and good cosmetic results with adequate tumour control. However, the placement of fiducial markers is necessary, requiring an adequate learning curve for the placement of the markers and longer treatment times.
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29
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Cao K, Abbassi L, Romano E, Kirova Y. Radiation therapy and immunotherapy in breast cancer treatment: preliminary data and perspectives. Expert Rev Anticancer Ther 2020; 21:501-510. [PMID: 33355024 DOI: 10.1080/14737140.2021.1868993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: The discovery of the major role of the immune system in the tumor process has led to the development of therapeutic strategies with immunotherapy. The potential systemic role of radiotherapy, (RT) used for a long time for its local action, based on its impact on immunity, is now better understood. The combination of immunotherapy and radiation therapy is currently a field of sustained research programs and has shown successful results, in non-small cell lung cancer, for example. Breast cancer (BC) was wrongly considered poorly immunogenic and put aside during accelerating progress in this new area of treatment.Areas covered: This review provides an overview of pre-clinical and clinical rationales to associate immunotherapy with radiation therapy in the management of breast cancer.Expert opinion: Immunotherapy has been used only recently in breast cancer, but clinical trials have yet to determine the place of this treatment. RT may be useful to enhance the response of breast tumors to immunotherapy. This new approach in breast cancer management is currently based on limited data but should be further investigated, especially in triple-negative breast cancer and in the neoadjuvant setting.
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Affiliation(s)
- Kim Cao
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
| | - Louisa Abbassi
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
| | - Emanuela Romano
- Department of Medical Oncology, Institut Curie, PSL Research University, Paris, France.,Center of Cancer Immunotherapy, Institut Curie, PSL Research University, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
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30
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Luke JJ, Onderdonk BE, Bhave SR, Karrison T, Lemons JM, Chang P, Zha Y, Carll T, Krausz T, Huang L, Martinez C, Janisch LA, Hseu RD, Moroney JW, Patel JD, Khodarev NN, Salama JK, Ott PA, Fleming GF, Gajewski TF, Weichselbaum RR, Pitroda SP, Chmura SJ. Improved Survival Associated with Local Tumor Response Following Multisite Radiotherapy and Pembrolizumab: Secondary Analysis of a Phase I Trial. Clin Cancer Res 2020; 26:6437-6444. [PMID: 33028595 PMCID: PMC8561652 DOI: 10.1158/1078-0432.ccr-20-1790] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/13/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Multisite stereotactic body radiotherapy followed by pembrolizumab (SBRT+P) has demonstrated safety in advanced solid tumors (ASTs). However, no studies have examined the relationships between irradiated tumor response, SBRT-induced tumor gene expression, and overall survival (OS). PATIENTS AND METHODS Patients with AST received SBRT (30-50 Gy in 3-5 fractions) to two to four metastases followed by pembrolizumab (200 mg i.v. every 3 weeks). SBRT was prescribed to a maximum tumor volume of 65 mL. Small metastases received the complete prescribed coverage (complete-Rx), while larger metastases received partial coverage (partial-Rx). Treated metastasis control (TMC) was defined as a lack of progression for an irradiated metastasis. Landmark analysis was used to assess the relationship between TMC and OS. Thirty-five biopsies were obtained from 24 patients: 19 pre-SBRT and 16 post-SBRT (11 matched) prior to pembrolizumab and were analyzed via RNA microarray. RESULTS Sixty-eight patients (139 metastases) were enrolled with a median follow-up of 10.4 months. One-year TMC was 89.5% with no difference between complete-Rx or partial-Rx. On multivariable analysis, TMC was independently associated with a reduced risk for death (HR, 0.36; 95% confidence interval, 0.17-0.75; P = 0.006). SBRT increased expression of innate and adaptive immune genes and concomitantly decreased expression of cell cycle and DNA repair genes in the irradiated tumors. Elevated post-SBRT expression of DNASE1 correlated with increased expression of cytolytic T-cell genes and irradiated tumor response. CONCLUSIONS In the context of SBRT+P, TMC independently correlates with OS. SBRT impacts intratumoral immune gene expression associated with TMC. Randomized trials are needed to validate these findings.
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Affiliation(s)
- Jason J Luke
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | - Paul Chang
- University of Chicago Medicine, Chicago, Illinois
| | - Yuanyuan Zha
- University of Chicago Medicine, Chicago, Illinois
| | - Tim Carll
- University of Chicago Medicine, Chicago, Illinois
| | | | - Lei Huang
- University of Chicago Medicine, Chicago, Illinois
| | | | | | - Robyn D Hseu
- University of Chicago Medicine, Chicago, Illinois
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31
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Ho AY, Wright JL, Blitzblau RC, Mutter RW, Duda DG, Norton L, Bardia A, Spring L, Isakoff SJ, Chen JH, Grassberger C, Bellon JR, Beriwal S, Khan AJ, Speers C, Dunn SA, Thompson A, Santa-Maria CA, Krop IE, Mittendorf E, King TA, Gupta GP. Optimizing Radiation Therapy to Boost Systemic Immune Responses in Breast Cancer: A Critical Review for Breast Radiation Oncologists. Int J Radiat Oncol Biol Phys 2020; 108:227-241. [PMID: 32417409 PMCID: PMC7646202 DOI: 10.1016/j.ijrobp.2020.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022]
Abstract
Immunotherapy using immune checkpoint blockade has revolutionized the treatment of many types of cancer. Radiation therapy (RT)-particularly when delivered at high doses using newer techniques-may be capable of generating systemic antitumor effects when combined with immunotherapy in breast cancer. These systemic effects might be due to the local immune-priming effects of RT resulting in the expansion and circulation of effector immune cells to distant sites. Although this concept merits further exploration, several challenges need to be overcome. One is an understanding of how the heterogeneity of breast cancers may relate to tumor immunogenicity. Another concerns the need to develop knowledge and expertise in delivery, sequencing, and timing of RT with immunotherapy. Clinical trials addressing these issues are under way. We here review and discuss the particular opportunities and issues regarding this topic, including the design of informative clinical and translational studies.
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Affiliation(s)
- Alice Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Jean L Wright
- Department of Radiation Oncology, Johns Hopkins Cancer Center, Brooklandville, Maryland
| | - Rachel C Blitzblau
- Department of Radiation Oncology, Duke Cancer Center, Durham, North Carolina
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Dan G Duda
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Larry Norton
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aditya Bardia
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura Spring
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Steven J Isakoff
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan H Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer R Bellon
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Center, Pittsburgh, Pennslyvania
| | - Atif J Khan
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Corey Speers
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Samantha A Dunn
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alastair Thompson
- Department of Surgical Oncology, Baylor College of Medicine Medical Center, Houston, Texas
| | - Cesar A Santa-Maria
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian E Krop
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth Mittendorf
- Department of Surgical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Tari A King
- Department of Surgical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Gaorav P Gupta
- Department of Radiation Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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32
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Veluvolu M, Patel M, Narayanasamy G, Kim T. Definitive single fraction stereotactic ablative radiotherapy for inoperable early-stage breast cancer: A case report. Rep Pract Oncol Radiother 2020; 25:760-764. [PMID: 32742200 PMCID: PMC7387738 DOI: 10.1016/j.rpor.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
We review a case of inoperable early stage breast cancer treated definitively with the use of stereotactic ablative radiotherapy (SABR). A 57-year-old female with a history of decompensated cirrhosis with early stage breast cancer was treated with 25 Gy in one fraction. At her 7-month follow up visit, there was a complete resolution of disease on imaging. This case represents a novel approach for the treatment of breast cancer with SABR when surgery is contraindicated.
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Affiliation(s)
- Manasa Veluvolu
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, United States
| | - Mausam Patel
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, United States
| | - Ganesh Narayanasamy
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, United States
| | - Thomas Kim
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, 60612, United States
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33
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Belkacemi Y, Debbi K, Loganadane G, Ghith S, Hadhri A, Hassani W, Cherif MA, Coraggio G, To NH, Colson-Durand L, Grellier N. [Adjuvant and neoadjuvant radiotherapy in breast cancer: A literaure review and update on the state of the evidence in 2020]. Cancer Radiother 2020; 24:482-492. [PMID: 32839105 DOI: 10.1016/j.canrad.2020.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
Radiation therapy has benefited from many developments over the past 20 years. These developments are mainly linked to the technology, imaging and informatics evolutions which allow better targets definitions, ensure better organs-at-risk sparing and excellent reproducibility of treatments, with a perfect control of patient positioning. In breast cancer radiotherapy, the evolution was marked by the possibility of reducing the duration of treatments from 6-7 to 3-4 weeks by using hypofractionated regimens, or by further reducing the irradiation to one week when treatment is solely focalised to the tumour bed. This concept of accelerated partial breast irradiation has challenged the paradigm of the obligation to irradiate the whole breast after conservative surgery in all patients. In addition, the technical mastery of accelerated partial breast irradiation and the development of stereotactic radiotherapy techniques are currently contributing to the development of research projects in neoadjuvant settings. Thus, numerous ongoing studies are evaluating the impact of high-dose preoperative tumour irradiation, alone or in combination with systemic treatments, on biological tumor changes, on anti-tumour immunity, and on the pathologic complete response, which is considered as predictive of better long-term survival in some molecular breast cancer subtypes. In this review, we discuss all these developments which allow breast radiation therapy to enter the era of personalisation of treatments in oncology.
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Affiliation(s)
- Y Belkacemi
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Centre sein Henri-Mondor, hôpitaux universitaires Henri-Mondor, 94010 Créteil, France; Inserm U955 equipe 21, IMRB, 94010 Créteil, France.
| | - K Debbi
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - G Loganadane
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Inserm U955 equipe 21, IMRB, 94010 Créteil, France
| | - S Ghith
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Centre sein Henri-Mondor, hôpitaux universitaires Henri-Mondor, 94010 Créteil, France
| | - A Hadhri
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - W Hassani
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - M A Cherif
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - G Coraggio
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - N H To
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Inserm U955 equipe 21, IMRB, 94010 Créteil, France
| | - L Colson-Durand
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France
| | - N Grellier
- Service d'oncologie-radiothérapie-AP-HP, hôpitaux universitaires Henri-Mondor et université Paris Est Créteil, 94010 Créteil, France; Centre sein Henri-Mondor, hôpitaux universitaires Henri-Mondor, 94010 Créteil, France
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34
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Hepel JT, Wazer DE. Update on Partial Breast Irradiation. Clin Breast Cancer 2020; 21:96-102. [PMID: 32448706 DOI: 10.1016/j.clbc.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
For early-stage breast cancer, partial breast irradiation (PBI) allows for reduction in the irradiated volume of normal tissues by confining the radiation target to the area surrounding the lumpectomy cavity after breast-conserving surgery. This approach has been supported by phase 2 data. However, widespread adoption of PBI has awaited the results of randomized controlled trials. This review discusses the results of randomized controlled trials comparing whole breast irradiation to PBI, including the recently published National Surgical Adjuvant Breast and Bowel Project (NSABP) B39/Radiotherapy Oncology Group (RTOG) 0413, and the Canadian RAPID trials. PBI techniques, dose/fractionation schedules, and patient selection are also reviewed.
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Affiliation(s)
- Jaroslaw T Hepel
- Department of Radiation Oncology, Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, RI.
| | - David E Wazer
- Department of Radiation Oncology, Lifespan Cancer Institute, Alpert Medical School of Brown University, Providence, RI
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35
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Palma DA, Nguyen TK, Louie AV, Malthaner R, Fortin D, Rodrigues GB, Yaremko B, Laba J, Kwan K, Gaede S, Lee T, Ward A, Warner A, Inculet R. Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer: A Phase 2 Clinical Trial. JAMA Oncol 2020; 5:681-688. [PMID: 30789648 DOI: 10.1001/jamaoncol.2018.6993] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Stereotactic ablative radiotherapy (SABR) is a standard treatment option in patients with medically inoperable early-stage non-small cell lung cancer (NSCLC), yet the pathologic complete response (pCR) rate after SABR is unknown. Neoadjuvant SABR in patients with cancer who are fit for resection has been hypothesized to improve local control and induce antitumor immune activity, potentially leading to better outcomes. Objectives To determine the pCR rate after SABR and to assess oncologic and toxicity outcomes after a combined approach of neoadjuvant SABR followed by surgery. Design, Setting, and Participants A phase 2, single-arm trial, with patient accrual from September 30, 2014, to August 15, 2017 (median follow-up, 19 months), was performed at a tertiary academic cancer center. Patients 18 years or older with T1T2N0M0 NSCLC and good performance status, with adequate pulmonary reserve to undergo surgical resection, were studied. Interventions Patients underwent neoadjuvant SABR using a risk-adapted fractionation scheme followed by surgery 10 weeks later. Main Outcomes and Measures The pCR rate as determined by hematoxylin-eosin staining. Results Forty patients (mean [SD] age, 68 [8] years; 23 [58%] female) were enrolled. Thirty-five patients underwent surgery and were evaluable for the primary end point. The pCR rate was 60% (95% CI, 44%-76%). The 30- and 90-day postoperative mortality rates were both 0%. Grade 3 or 4 toxic effects occurred in 7 patients (18%). In patients receiving surgery, 2-year overall survival was 77% (95% CI, 48%-91%), local control was 100% (95% CI, not defined), regional control was 53% (95% CI, 22%-76%), and distant control was 76% (95% CI, 45%-91%). Quality of life did not decline after treatment, with no significant changes in mean Functional Assessment of Cancer Therapy for Lung-Trial Outcome Index score during the first year of follow-up. Conclusions and Relevance The pCR rate after SABR for early-stage NSCLC was 60%, lower than hypothesized. The combined approach had toxic effects comparable to series of surgery alone, and there was no perioperative mortality. Further studies are needed to evaluate this combined approach compared with surgical resection alone. Trial Registration ClinicalTrials.gov identifier: NCT02136355.
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Affiliation(s)
- David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Currently with Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada.,Currently with Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard Malthaner
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Dalilah Fortin
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - George B Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Brian Yaremko
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Joanna Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, Ontario, Canada
| | - Stewart Gaede
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Physics and Engineering, Western University, London, Ontario, Canada
| | - Ting Lee
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Aaron Ward
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
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36
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Preoperative radiotherapy: A paradigm shift in the treatment of breast cancer? A review of literature. Crit Rev Oncol Hematol 2019; 141:102-111. [PMID: 31272045 DOI: 10.1016/j.critrevonc.2019.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/12/2019] [Accepted: 06/03/2019] [Indexed: 12/31/2022] Open
Abstract
The standard of care for early-stage breast cancer (BC) consists of breast-conserving surgery followed by postoperative irradiation. Recently, the concept of changing the usual sequence of treatment components in BC RT has been investigated. Potential advantages of preoperative RT in BC include a possible tumor downstaging with improved surgical cosmetic outcomes, accurate tumor site identification and better target volume delineation. Furthermore, preoperative RT could serve as a tool for treatment stratification for de-escalation of treatments in the event of pathological complete response. The present literature review analyzed the available clinical data regarding the potential impact of preoperative RT. Overall, available clinical evidence of preoperative RT in BC remains limited, deriving mostly from retrospective case series. Nevertheless, the experiences prove the feasibility of the preoperative RT approach and confirm the efficacy in almost all analyzed studies, including experiences using higher prescription RT doses or RT in combination with systemic therapy.
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37
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Bondiau PY, Gal J, Chapellier C, Haudebourg J, Courdi A, Levy J, Gerard A, Sumodhee S, Maurin M, Château Y, Barranger E, Ferrero JM, Thariat J. Robotic Stereotactic Boost in Early Breast Cancer, a Phase 2 Trial. Int J Radiat Oncol Biol Phys 2019; 103:374-380. [PMID: 30612961 DOI: 10.1016/j.ijrobp.2018.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility and toxicity of a single-fraction 8-Gy stereotactic boost after whole-breast irradiation in early breast cancer. The primary aim of this phase 2 study was to evaluate cutaneous breast toxicity using National Cancer Institute Common Terminology Criteria for Adverse Events (version 4) 3 months after the boost. Secondary objectives were local control, survival, and patient-reported quality of life using the European Organisation for Research and Treatment of Cancer QLQ-C30 and breast-specific European Organisation for Research and Treatment of Cancer QLQ-BR 23 questionnaires. METHODS AND MATERIALS Patients with invasive ductal or lobular pT1-2 breast cancer treated with lumpectomy with clear margins and pN0 were included. Patients requiring chemotherapy were excluded. RESULTS Twenty-eight eligible patients received the planned boost, and 26 had hormonal therapy. The procedure was technically successful without procedural complications. A median of 3 fiducials were tracked, and 115 beams were used. There were 22 acute grade 1 breast skin toxicities, including fibrosis, pain, erythema, or pigmentation. There were 2 acute grade 2 erythemas. Median skin boost dose was inversely correlated with acute skin toxicity (P = .028). QLQ-C30 scores revealed acute dyspnea and arm symptoms without correlation to the boost dose. Breast symptom QLQ-BR23 scores did not deteriorate, although upset with hair loss and systemic side effects of hormonal therapy were observed. After a median follow-up of 38 months, 1 patient had in-boost-field relapse, and there were 5 late grade 1 and 1 grade 2 skin toxicities. CONCLUSIONS Single-fraction stereotactic boost after conventional whole-breast irradiation in early breast cancer is feasible with minor toxicities. Quality of life and specific breast items showed excellent patient acceptance.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/psychology
- Breast Neoplasms/radiotherapy
- Carcinoma, Ductal, Breast/psychology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Lobular/psychology
- Carcinoma, Lobular/radiotherapy
- Feasibility Studies
- Female
- Fibrosis
- Humans
- Mastectomy, Segmental/methods
- Middle Aged
- Neoplasm Recurrence, Local
- Prospective Studies
- Quality of Life
- Radiosurgery/methods
- Robotic Surgical Procedures/methods
- Severity of Illness Index
- Skin/radiation effects
- Surveys and Questionnaires
- Tomography, X-Ray Computed
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Affiliation(s)
| | - Jocelyn Gal
- Department of Biostatistics, Centre Antoine Lacassagne, Nice, France
| | | | | | - Adel Courdi
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Johan Levy
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Anais Gerard
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Shakeel Sumodhee
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France
| | - Maeva Maurin
- Department of Clinical Research, Centre Antoine Lacassagne, Nice, France
| | - Yann Château
- Department of Clinical Research, Centre Antoine Lacassagne, Nice, France
| | | | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Juliette Thariat
- Department of Radiotherapy, Centre Antoine Lacassagne, Nice, France; Department of Radiation Oncology, Centre François Baclesse, Caen, France - Unicaen - Normandie Universite
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38
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Personalizing Radiation Treatment Delivery in the Management of Breast Cancer. Int J Breast Cancer 2018; 2018:6729802. [PMID: 29984003 PMCID: PMC6015692 DOI: 10.1155/2018/6729802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
Long-term data establishes the efficacy of radiotherapy in the adjuvant management of breast cancer. New dose and fractionation schemas have evolved and are available, each with unique risks and rewards. Current efforts are ongoing to tailor radiotherapy to the unique biology of breast cancer. In this review, we discuss our efforts to personalize radiotherapy dosing using genomic data and the implications for future clinical trials. We also explore immune mechanisms that may contribute to a tumor's unique radiation sensitivity or resistance.
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Gao RW, Park SS, Jakub JW, Hieken TJ, Conners AL, Neal L, Pruthi S, Corbin KS, Yan ES, Mutter RW, Stish BJ. Durable response of early-stage breast cancer to bilateral definitive SBRT in a medically inoperable patient. Pract Radiat Oncol 2018; 8:361-365. [PMID: 29699894 DOI: 10.1016/j.prro.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/04/2018] [Accepted: 03/11/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Robert W Gao
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Amy L Conners
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
| | - Lonzetta Neal
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
| | - Sandhya Pruthi
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth S Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
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Ikegwuonu T, Haddow G, Tait J, Murray AF, Kunkler IH. Horizon scanning implanted biosensors in personalising breast cancer management: First pilot study of breast cancer patients views. Health Sci Rep 2018; 1:30. [PMID: 30613798 PMCID: PMC6266376 DOI: 10.1002/hsr2.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/24/2017] [Accepted: 01/25/2018] [Indexed: 12/13/2022] Open
Abstract
AIMS This study aimed to explore breast cancer patients' understanding and acceptability of implanted biosensors (BS) within the primary tumour to personalise adjuvant radiotherapy, and to determine optimal design and number of BS, and evaluate potential clinical benefits as well as concerns about tolerance, toxicity, dwell time, and confidentiality of data. PATIENTS AND METHODS A total of 32 patients treated by surgery (29 breast conserving, 3 mastectomy), postoperative radiotherapy and systemic therapy for early breast cancer, were recruited from a posttreatment radiotherapy clinic at a cancer centre. Patients participated in semistructured interviews. Interview transcripts were analysed using qualitative methods. RESULTS Participants were aged 39 to 87 years, with a median age of 62 years. Most (N = 23[72%]) were unfamiliar with biosensors. The majority (N = 29[90.6%]) were supportive of the technology's potential use in future breast cancer treatment and were willing to accept biosensors (N = 28[88%]) if they were endorsed by their breast cancer consultant. Only 3 patients expressed concerns, predominantly about uncertainties on their role in the diagnostic and treatment pathway. Patients were flexible about the size and shape of BS, but had a preference for small size (N = 28 [87.5%]). Most (N = 22[69%]) would accept implantation of more than 5 BS and were flexible (N = 22[69%]) about indefinite dwell time. Patients had a strong preference for wireless powering of the BS (N = 28[87.5%]). Few had concerns about loss of confidentiality of data collected. All patients considered biosensors to be potentially of important clinical benefit. CONCLUSIONS While knowledge of biosensors was limited, patients were generally supportive of biosensors implanted within the primary tumour to collect data that might personalise and improve breast cancer radiotherapy in future.
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Affiliation(s)
| | - Gill Haddow
- Science, Technology and Innovation StudiesThe University of EdinburghEdinburghScotland
| | - Joyce Tait
- Innogen InstituteThe University of EdinburghEdinburghScotland
| | - Alan F. Murray
- Institute for Bioengineering, School of EngineeringUniversity of EdinburghEdinburghScotland
| | - Ian H. Kunkler
- Edinburgh Cancer Research Centre, Institute of Genetic and Molecular MedicineWestern General HospitalEdinburghScotland
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Barry A, Fyles A. Establishing the Role of Stereotactic Ablative Body Radiotherapy in Early-Stage Breast Cancer. Int J Breast Cancer 2018; 2018:2734820. [PMID: 29484211 PMCID: PMC5816843 DOI: 10.1155/2018/2734820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/24/2017] [Indexed: 11/17/2022] Open
Abstract
Stereotactic ablative body radiotherapy (SABR) has a role as definitive therapy in many tumor sites; however, its role in the treatment of breast cancer is less well explored. Currently, SABR has been investigated in the neoadjuvant and adjuvant setting with a number of ongoing feasibility studies. However, its use comes with a number of radiobiological and technical challenges that require further evaluation. We have learned much from other extracranial disease sites such as lung, brain, and spine, where definitive treatment with SABR has shown encouraging outcomes. In women with breast cancer, SABR may eliminate the need for invasive surgery, reducing healthcare costs and hospital stays and providing an additional curative option for early-stage disease. This poses the following question: is there a role for SABR as a definitive therapy in breast cancer?
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Affiliation(s)
- Aisling Barry
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON, Canada
| | - Anthony Fyles
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON, Canada
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Snider JW, Mutaf Y, Nichols E, Hall A, Vadnais P, Regine WF, Feigenberg SJ. Projected Improvements in Accelerated Partial Breast Irradiation Using a Novel Breast Stereotactic Radiotherapy Device: A Dosimetric Analysis. Technol Cancer Res Treat 2017; 16:1031-1037. [PMID: 28705082 PMCID: PMC5762064 DOI: 10.1177/1533034617718961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Accelerated partial breast irradiation has caused higher than expected rates of poor cosmesis. At our institution, a novel breast stereotactic radiotherapy device has demonstrated dosimetric distributions similar to those in brachytherapy. This study analyzed comparative dose distributions achieved with the device and intensity-modulated radiation therapy accelerated partial breast irradiation. Nine patients underwent computed tomography simulation in the prone position using device-specific immobilization on an institutional review board–approved protocol. Accelerated partial breast irradiation target volumes (planning target volume_10mm) were created per the National Surgical Adjuvant Breast and Bowel Project B-39 protocol. Additional breast stereotactic radiotherapy volumes using smaller margins (planning target volume_3mm) were created based on improved immobilization. Intensity-modulated radiation therapy and breast stereotactic radiotherapy accelerated partial breast irradiation plans were separately generated for appropriate volumes. Plans were evaluated based on established dosimetric surrogates of poor cosmetic outcomes. Wilcoxon rank sum tests were utilized to contrast volumes of critical structures receiving a percentage of total dose (Vx). The breast stereotactic radiotherapy device consistently reduced dose to all normal structures with equivalent target coverage. The ipsilateral breast V20-100 was significantly reduced (P < .05) using planning target volume_10mm, with substantial further reductions when targeting planning target volume_3mm. Doses to the chest wall, ipsilateral lung, and breast skin were also significantly lessened. The breast stereotactic radiotherapy device’s uniform dosimetric improvements over intensity-modulated accelerated partial breast irradiation in this series indicate a potential to improve outcomes. Clinical trials investigating this benefit have begun accrual.
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Affiliation(s)
- James W Snider
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Yildirim Mutaf
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea Hall
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Patrick Vadnais
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - William F Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Steven J Feigenberg
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
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Preoperative Radiotherapy Is Not Associated with Increased Post-mastectomy Short-term Morbidity: Analysis of 77,902 Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1108. [PMID: 28458959 PMCID: PMC5404430 DOI: 10.1097/gox.0000000000001108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/12/2016] [Indexed: 01/04/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Neoadjuvant radiotherapy (NRT) enhances breast-conserving surgery outcomes, reducing local recurrence of breast cancer and increasing median survival. However, its effect on postoperative morbidity remains under-studied. We sought to assess the impact of NRT on 30-day postoperative morbidity after mastectomy. Methods: We analyzed data from women undergoing mastectomy (with or without immediate reconstruction) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) 2005–2011 datasets. ACS-NSQIP is a prospective, risk-adjusted, outcomes-based registry. Data included demographic and perioperative factors. Outcomes studied included surgical site (wound and prosthesis/flap complications), systemic (cardiac, respiratory, neurological, urinary, and venous thromboembolism events), and overall morbidity. Logistic regression was used to estimate the unadjusted odds ratio (uOR) and adjusted odds ratio (aOR) between NRT and postoperative 30-day morbidity. Results: The study population included 77,902 women, of which 61,039 (78.4%) underwent mastectomy only and 16,863 (21.6%) underwent mastectomy with immediate breast reconstruction. NRT was administered to 266 (0.4%) mastectomy-only and 75 (0.4%) immediate breast reconstruction patients. In the mastectomy-only group, there were no significant differences in the rates of postoperative surgical site morbidity (aOR = 1.41; 95% confidence interval (CI): 0.76–2.63; P = 0.276), systemic morbidity (aOR = 0.72; 95% CI: 0.40–1.26; P = 0.252), and overall morbidity (aOR = 0.85; 95% CI: 0.54–1.33; P = 0.477) between NRT and control groups. Similarly, no significant differences were found for these three outcomes in the immediate breast reconstruction population. Statistical power for every comparison was >80%. Conclusions: This study suggests that NRT is not associated with significantly higher 30-day postoperative complications among breast cancer patients undergoing mastectomy with or without immediate breast reconstruction.
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New Techniques for Irradiating Early Stage Breast Cancer: Stereotactic Partial Breast Irradiation. Semin Radiat Oncol 2017; 27:279-288. [PMID: 28577835 DOI: 10.1016/j.semradonc.2017.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Several improvements in breast cancer radiation delivery have been realized using new techniques over the past several decades. As an example, for early stage disease, there has been active investigation of partial breast irradiation (PBI) vs whole breast irradiation. Although still investigational, PBI reduces the treatment volumes, doses to organs at risk, and may improve cosmesis. Over the past 2 decades PBI has been delivered via interstitial brachytherapy, intracavitary brachytherapy, intraoperative radiation therapy, or 3-dimensional external beam radiation therapy. More recently, there has been growing evidence that supports stereotactic body radiation therapy as a safe and effective new treatment for early stage breast cancer. This article describes this new treatment opportunity and reviews the emerging data of stereotactic partial breast irradiation.
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Nichols E, Kesmodel SB, Bellavance E, Drogula C, Tkaczuk K, Cohen RJ, Citron W, Morgan M, Staats P, Feigenberg S, Regine WF. Preoperative Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer: Preliminary Results of a Prospective, Phase 2 Trial. Int J Radiat Oncol Biol Phys 2016; 97:747-753. [PMID: 28244410 DOI: 10.1016/j.ijrobp.2016.11.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 11/07/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the feasibility of utilizing 3-dimensional conformal accelerated partial-breast irradiation (APBI) in the preoperative setting followed by standard breast-conserving therapy. PATIENTS AND METHODS This was a prospective trial testing the feasibility of preoperative APBI followed by lumpectomy for patients with early-stage invasive ductal breast cancer. Eligible patients had T1-T2 (<3 cm), N0 tumors. Patients received 38.5 Gy in 3.85-Gy fractions delivered twice daily. Surgery was performed >21 days after radiation therapy. Adjuvant therapy was given as per standard of care. RESULTS Twenty-seven patients completed treatment. With a median follow-up of 3.6 years (range, 0.5-5 years), there have been no local or regional failures. A complete pathologic response according to hematoxylin and eosin stains was seen in 4 patients (15%). There were 4 grade 3 seromas. Patient-reported cosmetic outcome was rated as good to excellent in 79% of patients after treatment. CONCLUSIONS Preoperative 3-dimensional conformal radiation therapy-APBI is feasible and well tolerated in select patients with early-stage breast cancer, with no reported local recurrences and good to excellent cosmetic results. The pathologic response rates associated with this nonablative APBI dose regimen are particularly encouraging and support further exploration of this paradigm.
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Affiliation(s)
- Elizabeth Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Susan B Kesmodel
- Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Emily Bellavance
- Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Cynthia Drogula
- Department of Surgical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Katherine Tkaczuk
- Department of Medical Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Randi J Cohen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Wendla Citron
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michelle Morgan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Paul Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Steven Feigenberg
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - William F Regine
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
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46
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Mondal D, Sharma DN. External beam radiation techniques for breast cancer in the new millennium: New challenging perspectives. J Egypt Natl Canc Inst 2016; 28:211-218. [PMID: 27595191 DOI: 10.1016/j.jnci.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/26/2016] [Accepted: 08/01/2016] [Indexed: 11/17/2022] Open
Abstract
Radiation therapy in breast cancer has evolved dramatically over the past century. It has traveled a long path touching different milestones and taking unprecedented turns. At the end, a fine tune of clinical understanding, skill, technological advancement and translation of radiobiological understanding to clinical outcome has taken place. What all these have given is better survival with quality survivorship. It is thus prudent to understand breast irradiation in a new perspective suitable for the current millennium.
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Affiliation(s)
- Dodul Mondal
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi 110029, India
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47
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Abstract
The purpose of this work is to determine, using Monte Carlo simulation and a realistic patient model, the characteristics of the resultant absorbed dose distributions when breast tumors are irradiated using small-field stereotactic body radiation therapy (SBRT) with kilovoltage x-ray beams instead of the standard megavoltage energies currently in use. The Rensselaer Polytechnic Institute (RPI) female phantom was used to model a pair of small-field SBRT breast treatments: in one treatment the tumor at depth and another one with the tumor located close to the breast surface. Each treatment consisted of 300 circular beams aimed at the tumor from a plurality of positions. The PENELOPE Monte Carlo code was used to determine the absorbed dose distribution for each beam and subsequently an optimization algorithm determined each beam weight according to a set of prescription goals. Both kilo- and megavoltage beam treatments were modeled, the latter to be used as a reference. Cumulative dose-volume histograms for eleven structures were used to compare the kilovoltage and reference treatments. Integral dose values are also reported. Absorbed dose distributions for the target volumes as well as the organs at risk were within the parameters reported in a clinical trial for both treatments. While for the ipsilateral healthy breast tissue the megavoltage treatment does offer an advantage in terms of less volume irradiated to intermediate doses, for the contralateral structures, breast and lung, the low penetration ability of the kilovoltage treatment results in a lower maximum dose. Skin dose is higher for the kilovoltage treatment but still well within the tolerance limits reported in the clinical trial.
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Affiliation(s)
- H M Garnica-Garza
- Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Monterrey, Vía del Conocimiento 201 Parque PIIT, Apodaca Nuevo León 66600, Mexico
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48
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Khan AJ, Ahlawat S, Goyal S. Novel and Highly Compressed Schedules for the Treatment of Breast Cancer. Semin Radiat Oncol 2015; 26:45-50. [PMID: 26617209 DOI: 10.1016/j.semradonc.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our thinking about radiotherapy (RT) for early-stage breast cancer has evolved considerably over the last several years. Increasingly patients and physicians together are making the decision to use altered fractionation rather than standard 6-7 weeks of conventional whole breast treatment plus lumpectomy bed boost. Adjuvant hypofractionated whole breast irradiation is now viewed as a preferred strategy for many eligible women, and can be completed in 3-4 weeks. Adjuvant accelerated partial breast irradiation is another alternative that is typically delivered in 8-10 fractions over 4-5 days. With improvements in delivery techniques, there has been renewed interest in shortening treatment times even further, with novel intraoperative approaches and ultrashort courses of external beam RT. This article provides a summary of the status and future directions in intraoperative and ultrashort course RT schedules used in the treatment of breast cancer. Outlined are the benefits as well as the drawbacks of these techniques for abbreviated breast RT.
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Affiliation(s)
- Atif J Khan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Stuti Ahlawat
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sharad Goyal
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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49
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Guidolin K, Lock M, Yaremko B, Gelman N, Gaede S, Kornecki A, Moiseenko V, Cao J, Scott L, Brackstone M. A phase II trial to evaluate single-dose stereotactic body radiation therapy (SBRT) prior to surgery for early-stage breast carcinoma: SIGNAL (stereotactic image-guided neoadjuvant ablative radiation then lumpectomy) trial. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13566-015-0227-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Garnica-Garza HM. Robotic stereotactic radioablation of breast tumors: Influence of beam size on the absorbed dose distributions. Appl Radiat Isot 2015; 107:64-70. [PMID: 26432061 DOI: 10.1016/j.apradiso.2015.09.011] [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: 03/20/2015] [Revised: 07/30/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022]
Abstract
Robotic stereotactic radioablation (RSR) therapy for breast tumors has been shown to be an effective treatment strategy when applied concomitantly with chemotherapy, with the purpose of reducing the tumor volume thus making it more amenable for breast conserving surgery. In this paper we used Monte Carlo simulation within a realistic patient model to determine the influence that the variation in beam collimation radius has on the resultant absorbed dose distributions for this type of treatment. Separate optimized plans were obtained for treatments using 300 circular beams with radii of 0.5 cm, 0.75 cm, 1.0 cm and 1.5 cm. Cumulative dose volume histograms were obtained for the gross, clinical and planning target volumes as well as for eight organs and structures at risk. Target coverage improves as the collimator size is increased, at the expense of increasing the volume of healthy tissue receiving mid-level absorbed doses. Interestingly, it is found that the maximum dose imparted to the skin is highly dependent on collimator size, while the dosimetry of other structures, such as both the ipsilateral and contralateral lung tissue are basically unaffected by a change in beam size.
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Affiliation(s)
- H M Garnica-Garza
- Centro de Investigación y de Estudios Avanzados del IPN Unidad Monterrey, Mexico.
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