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Anderson B, Vicini F, Wazer D, Arthur D. Breast brachytherapy: Building a bright future on the foundation of a rich history of advancement in technology, technique, and patient-centered care. Brachytherapy 2023; 22:368-380. [PMID: 36740541 DOI: 10.1016/j.brachy.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 02/05/2023]
Abstract
For over 20 years, the concept of accelerated partial breast irradiation (APBI) has received considerable attention. Initially concentrating on the appropriateness of APBI as an alternative treatment to whole breast radiotherapy, investigation and innovation evolved towards dose delivery and technique appropriateness. The purpose of this article is to review the pertinent literature that supports the role brachytherapy serves in delivering APBI and the recognized brachytherapy techniques for dose delivery. Publications establishing techniques utilizing multicatheter brachytherapy, single-entry brachytherapy applicators, permanent breast seed implantation brachytherapy, noninvasive breast brachytherapy and electronic brachytherapy are described. The use of brachytherapy for repeat breast conservation therapy is additionally reviewed. A historical perspective and potential direction of future investigation and innovation are presented.
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Affiliation(s)
- Bethany Anderson
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - David Wazer
- Department of Radiation Oncology, Tufts Medical Center, Boston, MA
| | - Douglas Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA.
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2
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Abstract
Breast brachytherapy represents a radiation technique that can be utilized as both monotherapy and as a tumor bed boost following breast conserving surgery. As monotherapy, the rationale for brachytherapy is that the majority of residual disease and therefore recurrences occur in close proximity to the lumpectomy cavity; for boost treatment, brachytherapy represents a technique that provided a more conformal approach prior to 3D treatment planning, and more recently can be used in conjunction with oncoplastic surgery. Multiple guidelines are available to assist clinicians with patient selection for accelerated partial breast irradiation (APBI), and recent guidelines support brachytherapy as an appropriate technique to deliver APBI. Modern breast brachytherapy can be performed with interstitial or applicator-based brachytherapy with multilumen and strut devices offering the ability to provide greater skin, chest wall, and normal breast sparing than previous devices. Novel strategies are being evaluated, including high dose rate perioperative/intraoperative radiotherapy, permanent breast seed implants, and noninvasive breast brachytherapy. Additionally, studies are evaluating shorter courses of brachytherapy. Multiple Level I studies are now available supporting interstitial brachytherapy to deliver APBI while prospective data and the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 trial are available with applicator brachytherapy and provide standardized prescriptions, target volume definitions, and dosimetric goals.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Alvaro Martinez
- 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI
| | - Matthew Kolar
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Frank Vicini
- 21st Century Oncology, Michigan Healthcare Professionals, Farmington Hills, MI.
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Strnad V, Krug D, Sedlmayer F, Piroth MD, Budach W, Baumann R, Feyer P, Duma MN, Haase W, Harms W, Hehr T, Fietkau R, Dunst J, Sauer R. DEGRO practical guideline for partial-breast irradiation. Strahlenther Onkol 2020; 196:749-763. [PMID: 32350554 PMCID: PMC7449998 DOI: 10.1007/s00066-020-01613-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/19/2020] [Indexed: 12/24/2022]
Abstract
Purpose This consensus statement from the Breast Cancer Working Group of the German Society for Radiation Oncology (DEGRO) aims to define practical guidelines for accelerated partial-breast irradiation (APBI). Methods Recent recommendations for relevant aspects of APBI were summarized and a panel of experts reviewed all the relevant literature. Panel members of the DEGRO experts participated in a series of conferences, supplemented their clinical experience, performed a literature review, and formulated recommendations for implementing APBI in clinical routine, focusing on patient selection, target definition, and treatment technique. Results Appropriate patient selection, target definition for different APBI techniques, and basic rules for appropriate APBI techniques for clinical routine outside of clinical trials are described. Detailed recommendations for APBI in daily practice, including dose constraints, are given. Conclusion Guidelines are mandatory to assure optimal results of APBI using different techniques.
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Affiliation(s)
- V Strnad
- University Hospital Erlangen, Erlangen, Germany.
| | - D Krug
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - F Sedlmayer
- Paracelsus Medical University Hospital Salzburg, Salzburg, Austria
| | - M D Piroth
- Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - W Budach
- Heinrich-Heine-University Hospital Düsseldorf, Düsseldorf, Germany
| | - R Baumann
- St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - P Feyer
- Vivantes Hospital Neukoelln, Berlin, Germany
| | - M N Duma
- University Hospital, Jena, Germany
| | - W Haase
- St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - W Harms
- St. Claraspital Basel, Basel, Switzerland
| | - T Hehr
- Marienhospital Stuttgart, Stuttgart, Germany
| | - R Fietkau
- University Hospital Erlangen, Erlangen, Germany
| | - J Dunst
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Sauer
- University Hospital Erlangen, Erlangen, Germany
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Dynamic Modulated Brachytherapy (DMBT) Balloon Applicator for Accelerated Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2019; 104:953-961. [PMID: 30910767 DOI: 10.1016/j.ijrobp.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To propose a novel high-dose-rate brachytherapy applicator for balloon-based dynamic modulated brachytherapy (DMBT) for accelerated partial breast irradiation (APBI) and to demonstrate its dosimetric advantage compared to the widely used Contura applicator. METHODS AND MATERIALS The DMBT balloon device consists of a fixed central channel enabling real-time, in vivo dosimetry and an outer motion-dynamic, adjustable-radius channel capable of moving to any angular position within the balloon. This design allows placement of dwell positions anywhere within the balloon volume, guaranteeing optimal placement and generation of the applicator and treatment plan, respectively. Thirteen clinical treatment plans for patients with early-stage breast cancer receiving APBI after lumpectomy using Contura were retrospectively obtained under institutional review board approval. New treatment plans were created by replacing the Contura with the DMBT device. DMBT plans were limited to 4 angular positions and an outer channel radius of 1.5 cm. The new plans were optimized to limit dose to ribs and skin while maintaining target coverage similar to that of the clinical plan. RESULTS Similar target coverage was obtained for the DMBT plans compared with clinical Contura plans. Across all patients the mean (standard deviation) reductions in D0.1 cc to the ribs and skin were 6.70% (6.28%) and 5.13% (6.54%), respectively. A threshold separation distance between the balloon surface and the organ at risk (OAR), below which dosimetric changes of greater than 5% were obtained, was observed to be 12 mm for ribs and skin. When both OARs were far from the balloon, DMBT plans were of similar quality to Contura plans, as expected. CONCLUSIONS This study demonstrates the superior ability of the APBI DMBT applicator to spare OARs while achieving target coverage comparable to current treatment plans, especially when in close proximity. The DMBT balloon may enable new modes of dynamic high-dose-rate treatment delivery and allow for ultrahypofractionated dose regimens to be safely used.
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Huang YJ, Su FCF, Gaffney DK, Kokeny KE, Zhao H, Rassiah-Szegedi P, Salter BJ, Poppe MM. Skin dose estimation using virtual structures for Contura Multi-Lumen Balloon breast brachytherapy. Brachytherapy 2018; 17:956-965. [PMID: 30236908 DOI: 10.1016/j.brachy.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/12/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To propose a workflow that uses ultrasound (US)-measured skin-balloon distances and virtual structure creations in the treatment planning system to evaluate the maximum skin dose for patients treated with Contura Multi-Lumen Balloon applicators. METHODS AND MATERIALS Twenty-three patients were analyzed in this study. CT and US were used to investigate the interfractional skin-balloon distance variations. Virtual structures were created on the planning CT to predict the maximum skin doses. Fitted curves and its equation can be obtained from the skin-balloon distance vs. maximum skin dose plot using virtual structure information. The fidelity of US-measured skin distance and the skin dose prediction using virtual structures were assessed. RESULTS The differences between CT- and US-measured skin-balloon distances values had an average of -0.5 ± 1.1 mm (95% confidence interval [CI] = -1.0 to 0.1 mm). Using virtual structure created on CT, the average difference between the predicted and the actual dose overlay maximum skin dose was -1.7% (95% CI = -3.0 to -0.4%). Furthermore, when applying the US-measured skin distance values in the virtual structure trendline equation, the differences between predicted and actual maximum skin dose had an average of 0.7 ± 6.4% (95% CI = -2.3% to 3.7%). CONCLUSIONS It is possible to use US to observe interfraction skin-balloon distance variation to replace CT acquisition. With the proposed workflow, based on the creation of virtual structures defined on the planning CT- and US-measured skin-balloon distances, the maximum skin doses can be reasonably estimated.
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Affiliation(s)
| | - Fan-Chi Frances Su
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - David K Gaffney
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Kristine E Kokeny
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Hui Zhao
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | | | - Bill J Salter
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Matthew M Poppe
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
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The American Brachytherapy Society consensus statement for accelerated partial-breast irradiation. Brachytherapy 2018; 17:154-170. [DOI: 10.1016/j.brachy.2017.09.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022]
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Dosimetric impact of source-positioning uncertainty in high-dose-rate balloon brachytherapy of breast cancer. J Contemp Brachytherapy 2015; 7:387-96. [PMID: 26622246 PMCID: PMC4663215 DOI: 10.5114/jcb.2015.55293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/10/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the dosimetric impact of source-positioning uncertainty in high-dose-rate (HDR) balloon brachytherapy of breast cancer. Material and methods For 49 HDR balloon patients, each dwell position of catheter(s) was manually shifted distally (+) and proximally (–) with a magnitude from 1 to 4 mm. Total 392 plans were retrospectively generated and compared to corresponding clinical plans using 7 dosimetric parameters: dose (D95) to 95% of planning target volume for evaluation (PTV_EVAL), and volume covered by 100% and 90% of the prescribed dose (PD) (V100 and V90); skin and rib maximum point dose (Dmax); normal breast tissue volume receiving 150% and 200% of PD (V150 and V200). Results PTV_EVAL dosimetry deteriorated with larger average/maximum reduction (from ± 1 mm to ± 4 mm) for larger source position uncertainty (p value < 0.0001): from 1.0%/2.5%, 3.3%/5.9%, 6.3%/10.0% to 9.8%/14.5% for D95; from 1.0%/2.6%, 3.1%/5.7%, 5.8%/8.9% to 8.7%/12.3% for V100; from 0.2%/1.5%, 1.0%/4.0%, 2.7%/6.8% to 5.1%/10.3% for V90. ≥ ± 3 mm shift reduced average D95 to < 95% and average V100 to < 90%. While skin and rib Dmax change was case-specific, its absolute change (∣Δ(Value)∣) showed that larger shift and high dose group had larger variation compared to smaller and lower dose group (p value < 0.0001), respectively. Normal breast tissue V150 variation was case-specific and small. Average ∣Δ(V150)∣ was 0.2 cc for the largest shift (± 4 mm) with maximum < 1.7 cc. V200 was increased with higher elevation for larger shift: from 6.4 cc/9.8 cc, 7.0 cc/10.1 cc, 8.0 cc/11.3 cc to 9.2 cc/ 13.0 cc. Conclusions The tolerance of ± 2 mm recommended by AAPM TG 56 is clinically acceptable in most clinical cases. However, special attention should be paid to a case where both skin and rib are located proximally to balloon, and the orientation of balloon catheter(s) is vertical to these critical structures. In this case, sufficient dosimetric planning margins are required.
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Shah C, Berry S. Accelerated partial breast irradiation: a review and evaluation of indications for treatment. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Accelerated partial breast irradiation (APBI) represents a well-studied treatment modality for the delivery of adjuvant radiation therapy following breast-conserving surgery. Interstitial APBI represents the APBI technique with the longest follow-up to date; data from randomized trials and matched pair analyses demonstrate equivalent local control to traditional whole-breast irradiation with comparable rates of toxicity and improved cosmesis. While less mature, prospective data support the efficacy and safety of applicator-based brachytherapy with new multilumen applicators offering the potential for improved outcomes. External beam APBI represents a noninvasive technique; however, concerns regarding toxicity with this technique have emerged though newer techniques may mitigate these concerns. Multiple guidelines have been published based on traditional clinical and pathologic criteria to help physicians offer APBI to appropriately selected patients.
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Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Taussig Cancer institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code T28, Cleveland, OH, USA
| | - Sameer Berry
- Department of Radiation Oncology, Taussig Cancer institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code T28, Cleveland, OH, USA
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9
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Dosimetric variations in permanent breast seed implant due to patient arm position. Brachytherapy 2015; 14:979-85. [DOI: 10.1016/j.brachy.2015.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 12/25/2022]
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Comparative dosimetric findings using accelerated partial breast irradiation across five catheter subtypes. Radiat Oncol 2015; 10:160. [PMID: 26227388 PMCID: PMC4521502 DOI: 10.1186/s13014-015-0468-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/17/2015] [Indexed: 11/16/2022] Open
Abstract
Purpose Accelerated partial breast irradiation (APBI) with balloon and strut adjusted volume implants (SAVI) show promising results with excellent tumor control and minimal toxicity. Knowing the factors that contribute to a high skin dose, rib dose, and D95 coverage may reduce toxicity, improve tumor control, and help properly predict patient outcomes following APBI. Methods and materials A retrospective analysis of 594 patients treated with brachytherapy based APBI at a single institution from May 2008 to September 2014 was grouped by applicator subtype. Patients were treated to a total of 34 Gy (3.4 Gy x 10 fractions over 5 days delivered BID) targeting a planning target volume (PTV) 1.0 cm beyond the lumpectomy cavity using a high dose rate source. Results SAVI devices had the lowest statistically significant values of DmaxSkin (81.00 ± 29.83), highest values of D90 (101.50 ± 3.66), and D95 (96.09 ± 4.55). SAVI-mini devices had the lowest statistically significant values of DmaxRib (77.66 ± 32.92) and smallest V150 (18.01 ± 3.39). Multi-lumen balloons were able to obtain the smallest V200 (5.89 ± 2.21). Strut-based applicators were more likely to achieve a DmaxSkin and a DmaxRib less than or equal to 100 %. The effect of PTV on V150 showed a strong positive relationship (p < .001). PTV and DmaxSkin showed a weak negative relationship in multi-lumen applicators (p = .016) and SAVI-mini devices (p < .001). PTV and DmaxRib showed a weak negative relationship in multi-lumen applicators (p = .009), SAVI devices (p < .001), and SAVI-mini devices (p < .001). Conclusion PTV volume is strongly correlated with V150 in all devices and V200 in strut based devices. Larger PTV volumes result in greater V150 and V200, which could help predict potential risks for hotspots and resulting toxicities in these devices. PTV volume is also weakly negatively correlated with max skin dose and max rib dose, meaning that as the PTV volumes increase one can expect slightly smaller max skin and rib doses. Strut based applicators are significantly more effective in keeping skin and rib dose constraints under 125 and 100 % when compared to any balloon based applicator.
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Trifiletti DM, Romano KD, Showalter SL, Reardon KA, Libby B, Showalter TN. Accelerated partial breast irradiation with brachytherapy: patient selection and technique considerations. BREAST CANCER-TARGETS AND THERAPY 2015; 7:211-21. [PMID: 26251627 PMCID: PMC4524268 DOI: 10.2147/bctt.s55860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Accelerated partial breast irradiation (APBI) through breast brachytherapy is a relatively recent development in breast radiotherapy that has gained international favor because of its reduction in treatment duration and normal tissue irradiation while maintaining favorable cancer-specific and cosmetic outcomes. Despite the fact that several large national trials have not reported final results yet, many providers are currently offering APBI to select patients and APBI is listed as a treatment option for selecting patients in the National Comprehensive Cancer Network guidelines. Multiple consensus guidelines exist in selecting patients for APBI, some with conflicting recommendations. In this review, the existing patient selection guidelines are reported, compared, and critiqued, grouping them in helpful subcategories. Unique patient and technical selection factors for APBI with brachytherapy are explored.
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Affiliation(s)
- Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kara D Romano
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Shayna L Showalter
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelli A Reardon
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bruce Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Trifiletti DM, Jones R, Showalter SL, Libby BB, Brenin DR, Schroen A, Morris MM, Reardon KA, Showalter TN. Techniques for intraoperative radiation therapy for early-stage breast carcinoma. Future Oncol 2015; 11:1047-58. [DOI: 10.2217/fon.15.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
ABSTRACT Intraoperative radiation therapy (IORT) is a method of accelerated partial breast irradiation developed to replace other longer courses of radiotherapy with a single radiation session administered at the time of breast-conserving surgery. The purpose of this review is to summarize the advantages and disadvantages of breast IORT techniques that are currently available, as well to consider potential alternative techniques for breast IORT or ultra-short course breast radiotherapy. Furthermore, we highlight the published outcomes for the IORT treatment approaches including: electron therapy, superficial photon therapy and other techniques. Potential future directions of IORT are explored including novel IORT techniques utilizing intraoperative brachytherapy with in-room imaging and rapid treatment planning.
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Affiliation(s)
- Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ryan Jones
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Shayna L Showalter
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bruce B Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David R Brenin
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Anneke Schroen
- Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Monica M Morris
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelli A Reardon
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Han H, Yang S, Lin SG, Xu CS, Han ZH. Effects and mechanism of downregulation of COX‑2 expression by RNA interference on proliferation and apoptosis of human breast cancer MCF‑7 cells. Mol Med Rep 2014; 10:3092-8. [PMID: 25323004 DOI: 10.3892/mmr.2014.2659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 07/09/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the effects of RNA interference with prostaglandin-endoperoxide synthase 2 (COX‑2) gene on the proliferation and apoptosis of breast cancer MCF‑7 cells, as well as the underlying mechanism. The present study constructed the eukaryotic expression vector of the targeted COX‑2 gene, transfected the MCF‑7 cells and screened the stably expressed clone. Changes in the COX‑2 gene expression in breast cancer MCF‑7 cells prior to and following transfection were examined; the proliferation and apoptosis of MCF‑7 cells were analyzed. Furthermore, changes in the protein levels of survivin, B-cell lymphoma 2 (Bcl‑2) and Bcl-2-associated X (Bax) genes were detected. RNA interference mediated by a lentiviral expression vector significantly decreased the protein expression levels of the COX‑2 gene, and therefore, the proliferation and growth of breast cancer MCF‑7 cells was significantly suppressed and the apoptotic rate increased. Of note, the mRNA and protein expression levels of survivin and Bcl‑2 decreased, while those of Bax increased following COX-2 silencing. RNA interference markedly deactivated the COX‑2 gene, suppressed the proliferation of breast cancer MCF‑7 cells, and, to a certain extent, enhanced the induced spontaneous apoptosis, which is regulated by the Bax gene. These results provided evidence for the potential applications of RNA interference of the targeted COX‑2 gene in gene therapy for the treatment of breast cancer.
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Affiliation(s)
- Hui Han
- Department of Breast Surgery, The Union Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Sheng Yang
- Department of Medical Oncology, The Union Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Shun-Guo Lin
- Department of Breast Surgery, The Union Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Chun-Sen Xu
- Department of Breast Surgery, The Union Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Zhong-Hua Han
- Department of Breast Surgery, The Union Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
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Long-term results from the Contura multilumen balloon breast brachytherapy catheter phase 4 registry trial. Int J Radiat Oncol Biol Phys 2014; 90:1025-9. [PMID: 25442036 DOI: 10.1016/j.ijrobp.2014.08.341] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/07/2014] [Accepted: 08/25/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe the long-term outcomes from a completed, multi-institutional phase 4 registry trial using the Contura multilumen balloon (CMLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer. METHODS AND MATERIALS Three hundred forty-two evaluable patients were enrolled by 23 institutions between January 2008 and February 2011. All patients received 34 Gy in 10 fractions, delivered twice daily. Rigorous target coverage and normal tissue dose constraints were observed. RESULTS The median follow-up time was 36 months (range, 1-54 months). For the entire patient cohort of 342 patients, 10 patients experienced an ipsilateral breast tumor recurrence (IBTR). Eight of these IBTR were classified as true recurrences/marginal miss (TRMM), and 2 were elsewhere failures (EF). Local recurrence-free survival was 97.8% at 3 years. For the entire cohort, 88% of patients had good to excellent overall cosmesis. The overall incidence of infection was 8.5%. Symptomatic seroma was reported in only 4.4% of patients. A separate analysis was performed to determine whether improved outcomes would be observed for patients treated at high-volume centers with extensive brachytherapy experience. Three IBTR were observed in this cohort, only 1 of which was classified as a TRMM. Local recurrence-free survival at high-volume centers was 98.1% at 3 years. Overall cosmetic outcome and toxicity were superior in patients treated at high-volume centers. In these patients, 95% had good to excellent overall cosmesis. Infection was observed in only 2.9% of patients, and symptomatic seroma was reported in only 1.9%. CONCLUSION Use of the CMLB for APBI delivery is associated with acceptable long-term local control and toxicity. Local recurrence-free survival was 97.8% at 3 years. Significant (grade 3) toxicity was uncommon, and no grade 4 toxicity was observed. Treatment at high-volume centers was associated with decreased late toxicity.
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Dosimetric comparison of 192Ir high-dose-rate brachytherapy vs. 50 kV x-rays as techniques for breast intraoperative radiation therapy: Conceptual development of image-guided intraoperative brachytherapy using a multilumen balloon applicator and in-room CT imaging. Brachytherapy 2014; 13:502-7. [DOI: 10.1016/j.brachy.2014.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/18/2014] [Accepted: 04/20/2014] [Indexed: 11/19/2022]
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Jagsi R. Progress and controversies: radiation therapy for invasive breast cancer. CA Cancer J Clin 2014; 64:135-52. [PMID: 24357525 DOI: 10.3322/caac.21209] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 01/29/2023] Open
Abstract
Radiation therapy is a critical component of the multidisciplinary management of invasive breast cancer. In appropriately selected patients, radiation not only improves local control, sparing patients the morbidity and distress of local recurrence, but it also improves survival by preventing seeding and reseeding of distant metastases from persistent reservoirs of locoregional disease. In recent years, considerable progress has been made toward improving our ability to select patients most likely to benefit from radiotherapy and to administer treatment in ways that maximize clinical benefit while minimizing toxicity and burden. This article reviews the role of radiation therapy in invasive breast cancer management, both after breast-conserving surgery and after mastectomy. It focuses particularly on emerging evidence that helps to define the clinical situations in which radiotherapy is indicated, the appropriate targets of treatment, and optimal approaches for minimizing both the toxicity and the burden of treatment, all in the context of the evolving surgical and systemic management of this common disease. It includes a discussion of new approaches in breast cancer radiotherapy, including hypofractionation and intensity modulation, as well as a discussion of promising avenues for future research.
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Affiliation(s)
- Reshma Jagsi
- Associate Professor, Department of Radiation Oncology, Research Investigator, Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, MI
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Vargo JA, Verma V, Kim H, Kalash R, Heron DE, Johnson R, Beriwal S. Extended (5-year) Outcomes of Accelerated Partial Breast Irradiation Using MammoSite Balloon Brachytherapy: Patterns of Failure, Patient Selection, and Dosimetric Correlates for Late Toxicity. Int J Radiat Oncol Biol Phys 2014; 88:285-91. [DOI: 10.1016/j.ijrobp.2013.05.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/13/2013] [Accepted: 05/21/2013] [Indexed: 11/27/2022]
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Can we improve the dose distribution for single or multi-lumen breast balloons used for Accelerated Partial Breast Irradiation? J Contemp Brachytherapy 2013; 5:134-8. [PMID: 24143147 PMCID: PMC3797409 DOI: 10.5114/jcb.2013.37776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/10/2013] [Accepted: 09/26/2013] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of the study was to verify dose distribution parameters for multi-lumen, and artificially created single-lumen balloon applicator used for the same patient with two optimization algorithms: inverse planning simulated annealing (IPSA) and dose point optimization with distance option. Material and methods Group of 24 patients with multi-lumen balloon applied were investigated. Each patient received 10 fractions of 3.4 Gy (2 fractions daily). For every patient, four treatment plans were prepared. Firstly, for five-lumen balloon optimized with IPSA algorithm and optimization parameters adjusted for each case. Secondly, for the same applicator optimized with dose point optimization and distant option. Two other plans were prepared for single-lumen applicator, created by removing four peripheral lumens, optimized with both algorithms. Results The highest D95 parameter was obtained for plans optimized with IPSA algorithm, mean value 99.3 percent of prescribed dose, and it was significantly higher than plans optimized with dose point algorithm (mean = 83.50%, p < 0.0001), IPSA single-lumen balloon plan (mean = 83.50%, p = 0.0037) and optimized to dose point single-lumen balloon (mean = 85.51%, p < 0.0001). There were no statistically significant differences concerning maximum doses distributed to skin surface for neither application nor optimization method. Volumes receiving 200% of prescribed dose in PTV were higher for multi-lumen balloon dose point optimized plans (mean = 8.78%), than for other plans (IPSA multi-lumen balloon plan: mean = 7.37%, p < 0.0001, single-lumen IPSA: mean = 7.20%, p < 0.0001, single-lumen dose point: mean = 7.19%, p < 0.0001). Conclusions Basing on performed survey, better dose distribution parameters are obtained for patients with multi-lumen balloon applied and optimized using IPSA algorithm with individualized optimization parameters.
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