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Albendea Roch J, Anchuelo Latorre JT, Galdós Barroso MP, Navarrete Solano P, Rivero Pérez AL, Pinto Guevara F, García Lamela M, Olloqui Urroz J, Díaz de Tuesta M, Mazaira J, Muñoz P, Prada Gómez PJ. Partial-accelerated irradiation with stereotactic radiotherapy at a dose of 30 Gy in 5 fractions in early breast cancer. Clin Transl Oncol 2024; 26:1872-1877. [PMID: 38506978 DOI: 10.1007/s12094-024-03405-8] [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: 12/21/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate feasibility of accelerated partial breast irradiation (APBI) using stereotactic radiotherapy (SBRT) Thirty Gy delivered in 5 fractions for patients with early breast cancer. METHODS Between January 1st, 2018, and December 31s, 2022, we conducted 117 treatments for patients with early-stage breast cancer. All patients underwent conservative surgery followed by APBI using stereotactic external beam radiotherapy. We analyzed local, regional, distant control, overall survival, toxicity, and cosmetic outcomes. RESULTS The average age was 62 years. 21.3% ductal and 78.7% invasive carcinomas. Regarding the PTV volume, the median was 198.8 cc (38-794 cc). Treatments were completed in all cases. The median follow-up period was of 21 months (1-62 months). Regarding acute toxicity, no Grade 3-4 toxicities were recorded. One patient experienced Grade 2 neuropathic pain. One patient developed subacute fibrosis and two patients developed telangiectasia as subacute and chronic toxicity. Cosmetic results were "good" or "very good" in 96.3% of cases. None of the patients relapsed at any level (local, regional, or distant) and overall survival during follow.up was 100%. CONCLUSION APBI with SBRT 30 Gy in 5 fractions in early-stage breast cancer is a feasible technique, very-well tolerated and has excellent oncologic and cosmetic outcome during our follow-up period.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Breast Neoplasms/pathology
- Breast Neoplasms/mortality
- Middle Aged
- Radiosurgery/methods
- Radiosurgery/adverse effects
- Aged
- Feasibility Studies
- Dose Fractionation, Radiation
- Adult
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/mortality
- Aged, 80 and over
- Follow-Up Studies
- Retrospective Studies
- Mastectomy, Segmental
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Pedro Muñoz
- Servicio Cántabro de Salud, Gerencia de Atención Primaria, Santander, Spain
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2
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Eijkelboom AH, Stam MR, van den Bongard DH, Sattler MG, Bantema-Joppe EJ, Siesling S, van Maaren MC. Implementation of ultra-hypofractionated radiotherapy schedules for breast cancer during the COVID-19 pandemic in the Netherlands. Clin Transl Radiat Oncol 2024; 47:100807. [PMID: 38979479 PMCID: PMC11228630 DOI: 10.1016/j.ctro.2024.100807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/31/2024] [Accepted: 06/12/2024] [Indexed: 07/10/2024] Open
Abstract
Background and purpose The COVID-19 pandemic resulted in an accelerated recommendation to use five-fraction radiotherapy schedules, according to the FAST- and FAST-Forward trial. In this study, trends in the use of different radiotherapy schedules in the Netherlands were studied, as well as the likelihood of receiving five fractions. Materials and methods Data from the NABON Breast Cancer Audit-Radiotherapy and Netherlands Cancer Registry was used. Women receiving radiotherapy for their primary invasive breast cancer or DCIS between 01-01-2020 and 31-12-2021 were included. Logistic regression was used to investigate the association between patient-, tumour-, treatment-, and radiotherapy institution-related characteristics and the likelihood of receiving five fractions in tumours meeting the FAST and FAST-Forward criteria. Results Detailed information about radiotherapy treatment was available for 9,392 tumours. Shortly after the start of the COVID-19 pandemic, i.e. April 2020, 19% of the tumours being treated with radiotherapy received five fractions of 5.2 or 5.7 Gray (Gy). While only 3% of the tumours received five fractions in March 2020. The usage of five fractions increased to 26% in December 2021. Partial breast irradiation, compared to whole breast irradiation, was significantly associated with the administration of five fractions, as well as radiotherapy delivered in an academic radiotherapy institution compared to an independent institution. Conclusion The start of the COVID-19 pandemic was associated with the early use of ultra-hypofractionated radiotherapy schedules. After publication of the trials, and mainly after the recommendation by the national radiotherapy society, the implementation further increased. These schedules were not yet used in all patients meeting the eligibility criteria for the FAST- or FAST-Forward trial.
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Affiliation(s)
- Anouk H. Eijkelboom
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Boven Clarenburg 2, 3511 CV, Utrecht, the Netherlands
| | - Marcel R. Stam
- Radiotherapiegroep, Wagnerlaan 47, 6815 AD Arnhem, the Netherlands
| | | | - Margriet G.A. Sattler
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Enja J. Bantema-Joppe
- Department of Radiation Oncology, Radiotherapy Institute Friesland, Borniastraat 36, 8934 AD Leeuwarden, the Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Boven Clarenburg 2, 3511 CV, Utrecht, the Netherlands
| | - Marissa C. van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Boven Clarenburg 2, 3511 CV, Utrecht, the Netherlands
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3
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Wang A, Quint E, Kukeev I, Agassi R, Belochitski O, Barski G, Vaynshtein J. Application of Intraoperative Radiotherapy in Early-Stage Breast Cancer Patients in a Clinical Setting. Int J Breast Cancer 2024; 2024:5551907. [PMID: 38919804 PMCID: PMC11199062 DOI: 10.1155/2024/5551907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 05/25/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Background: Intraoperative radiation therapy (IORT) has gained popularity in recent years as an alternative to external beam whole breast radiation therapy (WBRT) for early-stage breast cancer. Here, we report 43-month recurrence and survival outcomes in a multiethnic cohort treated with IORT in a clinical context. Method: Two hundred and eleven patients with low-risk features were treated with IORT for early-stage breast cancer from 2014 to 2021. Selection criteria were based on Group Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines: preferably unifocal intraductal carcinoma (IDC), aged > 50, tumor size ≤ 2.0 cm, and without lymph node involvement. All patients received 20 Gy of radiation dose during the lumpectomy. Information on patient and tumor characteristics was collected. Results: The mean age of this cohort was 67.5 years; 95.2% of patients are Jewish, and the rest are Bedouins (4.7%). Most tumors were intraductal carcinoma (97.2%) and stage 1 (94.8%). The mean follow-up time was 43.4 months. Bedouins had larger tumor sizes (mean 1.21 vs. 1.13 cm) and were younger at diagnosis than Jewish patients (mean 65.4 vs. 67.6 years), although the differences are not significant. The overall recurrence rate was 1.4%. One case of local recurrence (0.5%) and two cases of metastasis (0.9%) were observed during the study period. One patient died from metastasis. Conclusion: Our findings suggest that IORT in selected low-risk patients can achieve an excellent prognosis with low rates of recurrence and metastasis.
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Affiliation(s)
- Ao Wang
- Medical School for International HealthBen-Gurion University of the Negev, Be'er Sheva 8410501, Israel
| | - Elchanan Quint
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Ivan Kukeev
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Ravit Agassi
- Center Surgical Oncology of BreastSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Olga Belochitski
- Radiation Oncology UnitSoroka University Medical Center, Be'er Sheva, Israel
| | - Gay Barski
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
| | - Julie Vaynshtein
- Department of General Surgery BSoroka University Medical Center, Be'er Sheva 8410101, Israel
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4
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Qadir A, Singh N, Moe AAK, Cahoon G, Lye J, Chao M, Foroudi F, Uribe S. Potential of MRI in Assessing Treatment Response After Neoadjuvant Radiation Therapy Treatment in Breast Cancer Patients: A Scoping Review. Clin Breast Cancer 2024:S1526-8209(24)00136-8. [PMID: 38906720 DOI: 10.1016/j.clbc.2024.05.010] [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: 11/09/2023] [Revised: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 06/23/2024]
Abstract
The objective of this scoping review is to evaluate the potential of Magnetic Resonance Imaging (MRI) and to determine which of the available MRI techniques reported in the literature are the most promising for assessing treatment response in breast cancer patients following neoadjuvant radiotherapy (NRT). Ovid Medline, Embase, CINAHL, and Cochrane databases were searched to identify relevant studies published from inception until March 13, 2023. After primary selection, 2 reviewers evaluated each study using a standardized data extraction template, guided by set inclusion and exclusion criteria. A total of 5 eligible studies were selected. The positive and negative predictive values for MRI predicting pathological complete response across the studies were 67% to 88% and 76% to 85%, respectively. MRI's potential in assessing postradiotherapy tumor sizes was greater for volume measurements than uni-dimensional longest diameter measurements; however, overestimation in surgical tumor sizes was observed. Apparent diffusion coefficient (ADC) values and Time to Enhance (TTE) was seen to increase post-NRT, with a notable difference between responders and nonresponders at 6 months, indicating a potential role in assessing treatment response. In conclusion, this review highlights tumor volume measurements, ADC, and TTE as promising MRI metrics for assessing treatment response post-NRT in breast cancer. However, further research with larger cohorts is needed to confirm their utility. If MRI can accurately identify responders from nonresponders to NRT, it could enable a more personalized and tailored treatment approach, potentially minimizing radiation therapy related toxicity and enhancing cosmetic outcomes.
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Affiliation(s)
- Ayyaz Qadir
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | - Nabita Singh
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Aung Aung Kywe Moe
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Glenn Cahoon
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Jessica Lye
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Michael Chao
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Farshad Foroudi
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia; Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Sergio Uribe
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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Corso G, Fusco N, Guerini-Rocco E, Leonardi MC, Criscitiello C, Zagami P, Nicolò E, Mazzarol G, La Vecchia C, Pesapane F, Zanzottera C, Tarantino P, Petitto S, Bianchi B, Massari G, Boato A, Sibilio A, Polizzi A, Curigliano G, De Scalzi AM, Lauria F, Bonanni B, Marabelli M, Rotili A, Nicosia L, Albini A, Calvello M, Mukhtar RA, Robson ME, Sacchini V, Rennert G, Galimberti V, Veronesi P, Magnoni F. Invasive lobular breast cancer: Focus on prevention, genetics, diagnosis, and treatment. Semin Oncol 2024:S0093-7754(24)00038-1. [PMID: 38897820 DOI: 10.1053/j.seminoncol.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/05/2024] [Accepted: 05/05/2024] [Indexed: 06/21/2024]
Abstract
Invasive lobular cancer (ILC) is the most common of the breast cancer special types, accounting for up to 15% of all breast malignancies. The distinctive biological features of ILC include the loss of the cell adhesion molecule E-cadherin, which drives the tumor's peculiar discohesive growth pattern, with cells arranged in single file and dispersed throughout the stroma. Typically, such tumors originate in the lobules, are more commonly bilateral compared to invasive ductal cancer (IDC) and require a more accurate diagnostic examination through imaging. They are luminal in molecular subtype, and exhibit estrogen and progesterone receptor positivity and HER2 negativity, thus presenting a more unpredictable response to neoadjuvant therapies. There has been a significant increase in research focused on this distinctive breast cancer subtype, including studies on its pathology, its clinical and surgical management, and the high-resolution definition of its genomic profile, as well as the development of new therapeutic perspectives. This review will summarize the heterogeneous pattern of this unique disease, focusing on challenges in its comprehensive clinical management and on future insights and research objectives.
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Affiliation(s)
- Giovanni Corso
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hematology, University of Milano, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Guerini-Rocco
- Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Carmen Criscitiello
- Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Zagami
- Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
| | - Eleonora Nicolò
- Department of Medicine, Division of Hematology-Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Giovanni Mazzarol
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Cristina Zanzottera
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Tarantino
- Department of Oncology and Hematology, University of Milano, Milan, Italy; Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA; Harvard Medical School, Boston, MA
| | - Salvatore Petitto
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Beatrice Bianchi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Giulia Massari
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Anthony Boato
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Andrea Sibilio
- Division of Breast Surgery Forlì (Ravenna), AUSL Romagna, Ravenna, Italy
| | - Andrea Polizzi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hematology, University of Milano, Milan, Italy; Division of New Drugs and Early Drug Development, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Federica Lauria
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Marabelli
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Adriana Albini
- Scientific Directorate, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Mariarosaria Calvello
- Division of Cancer Prevention and Genetics, IEO European Institute of Oncology IRCCS, Milan, Italy; Division of Hematology, Clinica Moncucco, Lugano, Switzerland
| | - Rita A Mukhtar
- Department of Surgery, Division of Surgical Oncology, University of California San Francisco, San Francisco, CA
| | - Mark E Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Virgilio Sacchini
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hematology, University of Milano, Milan, Italy
| | - Gad Rennert
- B. Rappaport Faculty of Medicine, Technion and the Association for Promotion of Research in Precision Medicine (APRPM), Haifa, Israel
| | - Viviana Galimberti
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hematology, University of Milano, Milan, Italy
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy.
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6
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Gimeno-Morales M, Martínez-Monge R, Martinez-Lage A, Jablonska PA, Blanco J, Martínez-Regueira F, Rodriguez-Spiteri N, Olartecoechea B, Ramos L, Insausti LP, Elizalde A, Abengozar M, Cambeiro M. Long-term results of intraoperative multicatheter breast implant (IOMBI) for accelerated partial breast irradiation (APBI) on early breast cancer patients. Radiother Oncol 2024; 194:110193. [PMID: 38432310 DOI: 10.1016/j.radonc.2024.110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND PURPOSE Multicatheter breast brachytherapy is a standard technique for accelerated partial breast irradiation (APBI) in early breast cancer patients. Intraoperative multicatheter breast implant (IOMBI) followed by perioperative high-dose-rate brachytherapy (PHDRBT) offers a novel and advantageous approach. We present long-term oncological, toxicity, and cosmesis outcomes for a well-experienced single institution. MATERIALS AND METHODS Eligible women aged ≥ 40 years with clinically and radiologically confirmed unifocal invasive or in situ ≤ 3 cm breast tumors underwent IOMBI during breast-conserving surgery. Patients meeting APBI criteria by definitive pathologic results received 3.4 Gy × 10fx with PHDRBT. Patients not suitable for APBI received PHDRBT-boost followed by WBRT. RESULTS A total of 171 patients underwent IOMBI during BCS, 120 patients (70.1 %) were suitable for APBI and 51 (29.8 %) for anticipated PHDRBT-boost. The median age was 61 years (range: 40-78), the median tumor size was 1.1 cm (range: 0.2-3.5), with a histological diagnosis of invasive ductal carcinoma in 78.9 % and ductal in situ in 21.1 %. A median of 9 catheters (range: 4-14) were used. For APBI, the median CTV and V100 were 40.8 cc (range: 8.6-99) and 35.4 cc (range: 7.2-94). The median of healthy breast tissue irradiated represents 7.2 % (range: 2.3-28 %) and the median local treatment duration was 10 days (range: 7-16). With a median follow-up of 8.8 years (range: 0.3-16.25), the 8-year local, locoregional, and distant control rates were 99 %, 98.1 %, and 100 %. G1-G2 late-toxicity rate was 53.4 %. Long-term cosmetic evaluation was excellent-good in 90.8 %. CONCLUSION IOMBI&PHDRBT program reports excellent long-term oncological outcomes, with a reduction from unnecessary irradiation exposure which translates into low long-term toxicity and good cosmesis outcomes, especially on well-selected APBI patients.
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Affiliation(s)
- Marta Gimeno-Morales
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain.
| | - Rafael Martínez-Monge
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Adriana Martinez-Lage
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Paola Anna Jablonska
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Javier Blanco
- Medical Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Fernando Martínez-Regueira
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Natalia Rodriguez-Spiteri
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Begoña Olartecoechea
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Luis Ramos
- Departament of Medical Physic, Hospital Arnau de Villanova, Lleida, Spain
| | - Luis Pina Insausti
- Radiology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Arlette Elizalde
- Radiology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Marta Abengozar
- Pathology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Mauricio Cambeiro
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
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7
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Abdul-Latif M, Gal J, Schiappa R, Rizzi Y, Gautier M, Hannoun-Levi JM. Salvage brachytherapy for second ipsilateral breast tumor event: Relating dosimetric analysis to late side effects. Brachytherapy 2024; 23:335-341. [PMID: 38383205 DOI: 10.1016/j.brachy.2023.12.005] [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: 10/04/2023] [Revised: 12/18/2023] [Accepted: 12/31/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE For second ipsilateral breast tumor event (2ndIBTE), conservative treatment (CT) involving wide local excision plus accelerated partial breast reirradiation (APBrI) is increasingly used as an alternative to mastectomy. This study investigates the impact of APBrI technique and multicatheter interstitial high dose-rate brachytherapy (MIB) dosimetry parameters on toxicity and survival in patients with 2ndIBTE. MATERIALS-METHODS Data from patients with 2ndIBTE treated with CT, were analyzed. Inclusion criteria specified 2ndIBTE occurring at least one year after 1st CT for primary breast cancer. Treatment details and dosimetry parameters were recorded. Primary endpoint was late toxicity. Secondary endpoints were late toxicity prognostic factors analysis and oncological outcome. RESULTS From 07/2005 and 07/2023, 201 patients (pts) received 2nd CT. With a median follow-up of 49.6 months (44.9-59.5), tumor size was less than 2 cm (88.1%), with estrogen receptor positive (92.7%). Patients were low (63.7%) or intermediate (29.8%) GEC-ESTRO APBI risk classification. Late toxicities were observed in 34.8% (G1 52.3%, G2 40.7%). Cutaneous fibrosis was the most common toxicity. Cosmetic outcomes were excellent in 64.1%. Dosimetry analysis revealed positive correlations between complications and absolute volumes of CTV, V100, V150, and V200. Volumes requiring higher needle number and lower DNR resulted in fewer complications. 5-year disease-free and overall survival were 88% and 95% respectively. CONCLUSION Second CT for 2ndIBTE showed favorable oncological outcomes and survival rates. Complications were correlated with specific dosimetric parameters, emphasizing the importance of tailored treatment planning. This study provides valuable insights in risk stratification and MIB optimization for APBrI.
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Affiliation(s)
- Mohammed Abdul-Latif
- Department of Radiotherapy, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Jocelyn Gal
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Renaud Schiappa
- Biostatistic Unit, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Yassine Rizzi
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Mathieu Gautier
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France
| | - Jean-Michel Hannoun-Levi
- Department of Radiotherapy, Antoine Lacassagne Cancer Center, University of Cote d'Azur, Nice, France.
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8
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Hannoun-Levi JM, Gimeno Morales M, Gal J, Anchuelo J, Guinot JL, Gaztañaga M, Meszaros N, Polgar C, Strnad V, Schiappa R, Gutierrez C. Very accelerated partial breast irradiation in 1 or 2 days: Late toxicity and early oncological outcome of the GEC-ESTRO VAPBI cohort. Radiother Oncol 2024; 194:110217. [PMID: 38460552 DOI: 10.1016/j.radonc.2024.110217] [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: 01/06/2024] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To analyze late toxicity after very accelerated partial breast irradiation (VAPBI) for low-risk breast cancer. MATERIALS Methods: In this retrospective, observational, international multicenter study (HDH F20220713143949), patients with low-risk breast cancer underwent lumpectomy + vAPBI (high-dose rate multicatheter interstitial brachytherapy-MIBT). VAPBI was performed with 4(4x6.2 Gy/2d), 3(3x7.45 Gy/2d) or 1 fraction (1x16Gy or 1x18Gy/1d). Primary endpoint was late toxicity. Secondary endpoints were cumulative incidence of breast cancer local relapse (LR) and distant metastatic relapse (DMR) and specific (SS) and overall (OS) survivals. Prognostic factors for late toxicity were analyzed. RESULTS From 01/2012 to 06/2022, 516 pts with early breast cancer were enrolled. Median follow-up was 44 months [95 %CI 39-46]. Median age was 71 years [40-100]. Median tumor size was 12 mm [1-35]. VAPBI delivered 1, 3 and 4 fractions for 205pts (39.7 %), 167pts (32.4 %) and 144pts (28 %) respectively. 221 late toxicity events were observed in 168pts (32.6 %) (Fibrosis, dyschromia, pain and telangiectasia). Grade 2 and 3 late toxicities were observed in 7.2 and 0.6 % respectively (no G4) with no difference between 1 and ≥ 2 treatment days. CTV > 50 cc (p = 0.007) and V150 > 40 % (p = 0.027) were prognostic factors for G ≥ 2 late toxicity. Four-year cumulative incidence rates of LR and DMR were 2 % [95 %CI 0-3] and 1 % [95 %CI 0-2] respectively. CONCLUSIONS VAPBI based on 1 or ≥ 2 days of MIBT represents an attractive de-escalation of irradiation approach for low-risk breast cancer. Late toxicity profile appears acceptable while early oncological outcome shows encouraging local control. Longer follow-up is warranted in order to confirm these preliminary results.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University Côte d'Azur, 33 avenue Valombrose, 06189 Nice Cedex 2, Nice, France.
| | - Marta Gimeno Morales
- Department of Radiation Oncology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Jocelyn Gal
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Javier Anchuelo
- Department of Radiation Oncology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jose-Luis Guinot
- Department of Radiation Oncology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Miren Gaztañaga
- Department of Radiation Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - Norbert Meszaros
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Polgar
- National Institute of Oncology and National Tumor Biology Laboratory, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Renaud Schiappa
- Department of Statistics, Antoine Lacassagne Cancer Center - University of Côte d'Azur, Nice, France
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
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9
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Hannoun-Lévi JM, Savignoni A, Féron JG, Malhaire C, Ezzili C, Brédart A, Loap P, Kirova Y. Management of second ipsilateral breast tumor event: An advocacy for a randomized trial. Cancer Radiother 2024; 28:188-194. [PMID: 38216433 DOI: 10.1016/j.canrad.2023.11.001] [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: 09/14/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/14/2024]
Abstract
For a second ipsilateral breast tumor event, salvage mastectomy is the standard of care while second conservative treatment is a possible option. However, level 1 proofs are missing, leading to perform salvage mastectomy for patients who could receive second conservative treatment and consequently avoid psychological/quality of life salvage mastectomy deleterious impacts. A phase 3 randomized trial comparing salvage mastectomy to second conservative treatment is needed. Here we discuss what would be to us the optimal design of such trial to confirm the non-inferiority between the two salvage options, with a focus on methodological aspects in terms of patient characteristics and statistical issues.
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Affiliation(s)
- J-M Hannoun-Lévi
- Department of Radiation Oncology, centre Antoine-Lacassagne, université Côte d'Azur, Nice, France.
| | - A Savignoni
- Department of Biostatistics, institut Curie, Paris, France
| | - J-G Féron
- Department of Breast Surgery, institut Curie, Paris, France
| | - C Malhaire
- Department of Medical Imaging, institut Curie, Paris, France
| | - C Ezzili
- Department of Clinical Research, institut Curie, Paris, France
| | - A Brédart
- Psycho-Oncology Unit, institut Curie, Paris, France
| | - P Loap
- Department of Radiation Oncology, institut Curie, Paris, France
| | - Y Kirova
- Department of Radiation Oncology, institut Curie, Paris, France
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10
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Sfarad HK, Allweis TM. Postoperative Complications Following Lumpectomy With Intraoperative X-Ray Radiation Therapy: A Retrospective Comparative Study. Clin Breast Cancer 2024; 24:237-242. [PMID: 38233254 DOI: 10.1016/j.clbc.2023.12.005] [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: 07/25/2023] [Revised: 10/28/2023] [Accepted: 12/16/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Lumpectomy with intraoperative radiation (IORT) is a relatively new modality for the treatment of early breast cancer. IORT delivers targeted radiation to the tumor bed and obviates the need for external beam radiation (EBRT) in 85% of the cases. IORT is being used increasingly around the world, however information regarding early and late postoperative complications associated with the procedure is limited. AIM To describe and compare complication rates after lumpectomy and IORT with those seen after lumpectomy and EBRT or lumpectomy alone. METHODS Clinical, demographic, and histopathological data were collected from electronic medical records and a retrospectively maintained database. Postoperative complications were compared for patients undergoing lumpectomy with IORT, lumpectomy with EBRT, and lumpectomy alone over the same period. RESULTS A total of 445 patients were included in the study: 113 underwent lumpectomy with IORT, 253 had lumpectomy followed by EBRT, and 79 had Lumpectomy alone. Postoperative seroma was documented in 74 patients (65%) after IORT,87 (34%) after EBRT, and 9 (11%) after lumpectomy alone (P = .000). Surgical site infection requiring antibiotic treatment was diagnosed in 26 patients (23%) after IORT, 38 (15%) after EBRT, and 5 (6%) after lumpectomy alone (P = .013). Postoperative erythema was documented in 39 patients (34%) after IORT, 40 (16%) after EBRT, and 5 (6%) after lumpectomy alone (P = .000). Postoperative minor complications such as scar and breast deformity, edema, Mondor's syndrome, and chronic tenderness, were documented in 62 patients (55%) after IORT, 119 (47%) after EBRT, and 13 (17%) after lumpectomy alone (P = .000). The average follow-up was 14 months. CONCLUSIONS IORT is associated with an increased rate of postoperative complications compared to EBRT or lumpectomy alone. Most complications are minor and transient. We hypothesize that the increased occurrence of complications may also be attributed to overreporting, which is associated with the introduction of a new technology. Educating physicians and patients about potential complications and their course may help establish expectations and improve the management of postoperative complications.
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Affiliation(s)
| | - Tanir M Allweis
- Department of Breast Surgery, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Grimm A, Wollmann E, Sperk E, Weiß C, Sütterlin M, Berlit S, Tuschy B. Intraoperative radiotherapy (IORT) of early breast cancer with low-energy x-rays in breast-conserving surgery : Prospective identification of pre- and intraoperative factors influencing the feasibility of IORT. Strahlenther Onkol 2024; 200:296-305. [PMID: 37792017 DOI: 10.1007/s00066-023-02149-8] [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: 11/23/2022] [Accepted: 08/21/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The aim of this study is to identify pre- and intraoperative factors indicating the feasibility of intraoperative radiotherapy (IORT) during breast-conserving surgery (BCS). MATERIALS AND METHODS From January 2018 to December 2019, a total of 128 women undergoing BCS due to early breast cancer were included in this prospective observational study, independent of whether IORT was planned or not. Patient and tumor characteristics as well as surgical parameters that could potentially influence the feasibility of IORT were recorded for the entire collective. In addition, a preoperative senological assessment was performed and analyzed to assess the feasibility of IORT. Logistic regression was then used to identify relevant preoperative parameters and to generate a formula predicting the feasibility of IORT. RESULTS Of the 128 included women undergoing BCS, 46 were preoperatively rated to be feasible, 20 to be questionably feasible for IORT. Ultimately, IORT was realized in 30 patients. The most frequent reasons for omission of IORT were insufficient tumor-to-skin distance and/or an excessively large tumor cavity. Small clinical tumor size and large tumor-to-skin distance according to preoperative ultrasound were significantly related to accomplishment of IORT. CONCLUSION We observed that preoperative ultrasound-based tumor-skin distance is a significant factor in addition to already known parameters to predict feasibility of IORT. Based on our findings we developed a formula to optimize IORT planning which might serve as an additional tool to improve patient selection for IORT in early breast cancer.
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Affiliation(s)
- Anja Grimm
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Theodor-Kutzer Ufer 1-3, Mannheim, Germany.
| | - Eva Wollmann
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Mannheim Cancer Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sebastian Berlit
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Benjamin Tuschy
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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12
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Shaitelman SF, Anderson BM, Arthur DW, Bazan JG, Bellon JR, Bradfield L, Coles CE, Gerber NK, Kathpal M, Kim L, Laronga C, Meattini I, Nichols EM, Pierce LJ, Poppe MM, Spears PA, Vinayak S, Whelan T, Lyons JA. Partial Breast Irradiation for Patients With Early-Stage Invasive Breast Cancer or Ductal Carcinoma In Situ: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2024; 14:112-132. [PMID: 37977261 DOI: 10.1016/j.prro.2023.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This guideline provides evidence-based recommendations on appropriate indications and techniques for partial breast irradiation (PBI) for patients with early-stage invasive breast cancer and ductal carcinoma in situ. METHODS ASTRO convened a task force to address 4 key questions focused on the appropriate indications and techniques for PBI as an alternative to whole breast irradiation (WBI) to result in similar rates of ipsilateral breast recurrence (IBR) and toxicity outcomes. Also addressed were aspects related to the technical delivery of PBI, including dose-fractionation regimens, target volumes, and treatment parameters for different PBI techniques. The guideline is based on a systematic review provided by the Agency for Healthcare Research and Quality. Recommendations were created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS PBI delivered using 3-dimensional conformal radiation therapy, intensity modulated radiation therapy, multicatheter brachytherapy, and single-entry brachytherapy results in similar IBR as WBI with long-term follow-up. Some patient characteristics and tumor features were underrepresented in the randomized controlled trials, making it difficult to fully define IBR risks for patients with these features. Appropriate dose-fractionation regimens, target volume delineation, and treatment planning parameters for delivery of PBI are outlined. Intraoperative radiation therapy alone is associated with a higher IBR rate compared with WBI. A daily or every-other-day external beam PBI regimen is preferred over twice-daily regimens due to late toxicity concerns. CONCLUSIONS Based on published data, the ASTRO task force has proposed recommendations to inform best clinical practices on the use of PBI.
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Affiliation(s)
- Simona F Shaitelman
- Department of Breast Radiation Oncology, University of Texas MD - Anderson Cancer Center, Houston, Texas.
| | - Bethany M Anderson
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin
| | - Douglas W Arthur
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Jose G Bazan
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jennifer R Bellon
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Naamit K Gerber
- Department of Radiation Oncology, New York University Grossman School of Medicine, New York, New York
| | - Madeera Kathpal
- Department of Radiation Oncology, Duke University Wake County Campus, Raleigh, North Carolina
| | - Leonard Kim
- Department of Radiation Oncology, MD - Anderson Cancer Center at Cooper, Camden, New Jersey
| | - Christine Laronga
- Department of Breast Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Icro Meattini
- Department of Radiation Oncology, University of Florence, Florence, Italy
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lori J Pierce
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Matthew M Poppe
- Department of Radiation Oncology, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Patricia A Spears
- Patient Representative, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shaveta Vinayak
- Department of Medical Oncology, University of Washington, Seattle, Washington
| | - Timothy Whelan
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Janice A Lyons
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
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13
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Hannoun-Levi JM, Gal J, Polgar C, Strnad V, Loessl K, Polat B, Kauer-Domer D, Schiappa R, Gutierrez C. Second Conservative Treatment for Local Recurrence Breast Cancer: A GEC-ESTRO Oncological Outcome and Prognostic Factor Analysis. Int J Radiat Oncol Biol Phys 2023; 117:1200-1210. [PMID: 37459998 DOI: 10.1016/j.ijrobp.2023.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE For second ipsilateral breast tumor event (2nd IBTE), second conservative treatment (2nd CT) combining lumpectomy plus accelerated partial breast reirradiation (APBrI) represents a curative option. The aim of this study was to analyze oncological prognostic factors for patients with a 2nd IBTE treated with 2nd CT. METHODS AND MATERIALS An analysis of clinical practices was conducted across 7 academic hospitals/cancer centers in 6 European countries based on the GEC-ESTRO database. Patients presenting a 2nd IBTE occurring after conservative surgery (lumpectomy + axillary evaluation) and irradiation performed for the primary tumor underwent a 2nd CT with brachytherapy-based APBrI. The main outcome was 5-year cumulative incidence (CI) rate of second local relapse. All analyzed patients were classified according to risk groups for Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) accelerated partial breast irradiation (APBI) and molecular classification and time interval between first and second breast surgery (TIS1S2). Finally, we combined GEC-ESTRO APBI, molecular, and TIS1S2 risk groups, leading to the definition of a new score (named TAM: score based on the combination of time interval [T] between first and second surgery and APBI [A] and molecular [M] classifications) specifically designed for 2nd IBTE oncological outcome analysis. RESULTS From July 1994 to January 2021, a total of 508 patients received a 2nd CT. At the time of 2nd IBTE, median age was 64.6 years (range, 56.2-72.6). With a median follow-up of 60.9 months (56.2-72.6), the 5-year second local relapse CI rate was 4% (95% confidence interval [95% CI], 2%-6%). The 5-year distant metastasis disease CI rate was 7% (95% CI, 4%-10%). Five-year disease-free and overall survival rates were 89% (95% CI, 86%-93%) and 91% (95% CI, 88%-94%), respectively. In multivariate analysis, TAM score was an independent prognostic factor for all the oncological items (P < .001) except disease-specific survival (P = .07) and overall survival (P = .09). The grade ≥3 late toxicity rate was 12.1%. CONCLUSIONS This analysis of 2nd CT combining lumpectomy with APBrI for 2nd IBTE confirmed the excellent oncological results obtained after 2nd CT. Furthermore, the GEC-ESTRO TAM score appears to be an important prognostic factor, assisting patients and physicians in the decision-making process.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France.
| | - Jocelyn Gal
- Department of Epidemiology/Biostatistics, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Csaba Polgar
- Department of Oncology, Semmelweis University, Budapest, Hungary; Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
| | - Vratislav Strnad
- Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany
| | - Kristina Loessl
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Bulent Polat
- Department of Radiation Oncology, Wurzburg University, Wurzburg, Germany
| | - Daniela Kauer-Domer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Renaud Schiappa
- Department of Epidemiology/Biostatistics, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Crisitna Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
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14
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Lyons JA. Second Breast Conserving Therapy: Who, What, When, and How? Int J Radiat Oncol Biol Phys 2023; 117:1211-1212. [PMID: 37980142 DOI: 10.1016/j.ijrobp.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Janice A Lyons
- University Hospitals Seidman Cancer Center, Cleveland, Ohio.
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15
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Petoukhova A, Snijder R, Vissers T, Ceha H, Struikmans H. In vivodosimetry in cancer patients undergoing intraoperative radiation therapy. Phys Med Biol 2023; 68:18TR01. [PMID: 37607566 DOI: 10.1088/1361-6560/acf2e4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/22/2023] [Indexed: 08/24/2023]
Abstract
In vivodosimetry (IVD) is an important tool in external beam radiotherapy (EBRT) to detect major errors by assessing differences between expected and delivered dose and to record the received dose by individual patients. Also, in intraoperative radiation therapy (IORT), IVD is highly relevant to register the delivered dose. This is especially relevant in low-risk breast cancer patients since a high dose of IORT is delivered in a single fraction. In contrast to EBRT, online treatment planning based on intraoperative imaging is only under development for IORT. Up to date, two commercial treatment planning systems proposed intraoperative ultrasound or in-room cone-beam CT for real-time IORT planning. This makes IVD even more important because of the possibility for real-time treatment adaptation. Here, we summarize recent developments and applications of IVD methods for IORT in clinical practice, highlighting important contributions and identifying specific challenges such as a treatment planning system for IORT. HDR brachytherapy as a delivery technique was not considered. We add IVD for ultrahigh dose rate (FLASH) radiotherapy that promises to improve the treatment efficacy, when compared to conventional radiotherapy by limiting the rate of toxicity while maintaining similar tumour control probabilities. To date, FLASH IORT is not yet in clinical use.
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Affiliation(s)
- Anna Petoukhova
- Haaglanden Medical Centre , Department of Medical Physics, Leidschendam, The Netherlands
| | - Roland Snijder
- Haaglanden Medical Centre , Department of Medical Physics, Leidschendam, The Netherlands
| | - Thomas Vissers
- Haaglanden Medical Centre , Medical Library, Leidschendam, The Netherlands
| | - Heleen Ceha
- Haaglanden Medical Centre , Department of Radiation Oncology, Leidschendam, The Netherlands
| | - Henk Struikmans
- Haaglanden Medical Centre , Department of Radiation Oncology, Leidschendam, The Netherlands
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16
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Hanna SA, Bevilacqua JLB, de Barros ACSD, de Andrade FEM, Piato JRM, Pelosi EL, Martella E, da Silva JLF, Carvalho HDA, Jacomo AL. Long-Term Results of Intraoperative Radiation Therapy for Early Breast Cancer Using a Nondedicated Linear Accelerator. Adv Radiat Oncol 2023; 8:101233. [PMID: 37408678 PMCID: PMC10318249 DOI: 10.1016/j.adro.2023.101233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/10/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose To present the long-term results of intraoperative radiation therapy (IORT) for early breast cancer using a nondedicated linear accelerator. Methods and Materials The eligibility criteria were biopsy-proven invasive carcinoma, age ≥40 years, tumor size ≤3 cm, and N0M0. We excluded multifocal lesions and sentinel lymph node involvement. All patients had previously undergone breast magnetic resonance imaging. Breast-conserving surgery with margins and sentinel lymph node evaluation using frozen sections were performed in all cases. If there were no margins or involved sentinel lymph nodes, the patient was transferred from the operative suite to the linear accelerator room, where IORT was delivered (21 Gy). Results A total of 209 patients who were followed up for ≥1.5 years from 2004 to 2019 were included. The median age was 60.3 years (range, 40-88.6), and the mean pT was 1.3 cm (range, 0.2-4). There were 90.5% pN0 cases (7.2% of micrometastases and 1.9% of macrometastases). Ninety-seven percent of the cases were margin free. The rate of lymphovascular invasion was 10.6%. Twelve patients were negative for hormonal receptors, and 28 patients were HER2 positive. The median Ki-67 index was 29% (range, 0.1-85). Intrinsic subtype stratification was as follows: luminal A, 62.7% (n = 131); luminal B, 19.1% (n = 40); HER2 enriched 13.4% (n = 28); and triple negative, 4.8% (n = 10). Within the median follow-up of 145 months (range, 12.8-187.1), the 5-year, 10-year, and 15-year overall survival rates were 98%, 94.7%, and 88%, respectively. The 5-year, 10-year, and 15-year disease-free rates were 96.3%, 90%, and 75.6%, respectively. The 15-year local recurrence-free rate was 76%. Fifteen local recurrences (7.2%) occurred throughout the follow-up period. The mean time to local recurrence was 145 months (range, 12.8-187.1). As a first event, 3 cases of lymph node recurrence, 3 cases of distant metastasis, and 2 cancer-related deaths were recorded. Tumor size >1 cm, grade III, and lymphovascular invasion were identified as risk factors. Conclusions Despite approximately 7% of recurrences, we may infer that IORT may still be a reasonable option for selected cases. However, these patients require a longer follow-up as recurrences may occur after 10 years.
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Affiliation(s)
| | | | | | | | - José Roberto Morales Piato
- Gynecology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Eduardo Martella
- Radiation Oncology Department, Escola Paulista de Medicina, São Paulo, Brazil
| | | | | | - Alfredo Luiz Jacomo
- Surgery Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Sanz J, Eraso A, Ibáñez R, Williams R, Algara M. Tumor Bed Boost Radiotherapy in the Conservative Treatment of Breast Cancer: A Review of Intra-Operative Techniques and Outcomes. Cancers (Basel) 2023; 15:4025. [PMID: 37627053 PMCID: PMC10452620 DOI: 10.3390/cancers15164025] [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: 07/03/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Conservative surgery is the preferred treatment in the management of breast cancer followed by adjuvant whole-breast irradiation. Since the tumor bed is the main site of relapse, boost doses are conveniently administered according to risk factors for local relapse to increase the efficacy of the treatment. The benefit of a radiation boost is well established and it can be performed by several techniques like brachytherapy, external radiation or intraoperative radiotherapy. Greater precision in localizing the tumor cavity, immediacy and increased biological response are the main advantages of intraoperative boost irradiation. This modality of treatment can be performed by means of mobile electron accelerators or low-photon X-ray devices. There is a lot of research and some published series analyzing the results of the use of an intraoperative boost as an adjuvant treatment, after neoadjuvant systemic therapy and in combination with some reconstructive surgeries. This review discusses advantages of intraoperative radiotherapy and presents the main results of a boost in terms of local control, survival, tolerance and cosmesis.
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Affiliation(s)
- Javier Sanz
- Radiation Oncology Department, Hospital del Mar Barcelona, 08003 Barcelona, Spain
- Facultat de Medicina, Campus del Mar, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Arantxa Eraso
- Radiation Oncology Department, Institut Català d’Oncologia, Hospital Trueta, 17007 Girona, Spain;
- Facultat de Medicina, Campus Centre, Universitat de Girona, 17004 Girona, Spain
| | - Reyes Ibáñez
- Radiation Oncology Department, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Rachel Williams
- College of Liberal Arts, Texas A&M University, College Station, TX 77843, USA;
| | - Manuel Algara
- Radiation Oncology Department, Hospital del Mar Barcelona, 08003 Barcelona, Spain
- Facultat de Medicina, Campus del Mar, Universitat Pompeu Fabra, 08002 Barcelona, Spain
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Kim H, Hieken TJ, Abraha F, Jakub JW, Corbin KS, Furutani KM, Boughey JC, Stish BJ, Deufel CL, Degnim AC, Shumway DA, Ahmed SK, Piltin MA, Sandhu NP, Conners AL, Ruddy KJ, Mutter RW, Park SS. Long-term outcomes of intraoperatively-placed applicator brachytherapy for rapid completion of breast conserving treatment: An analysis of a prospective registry data. Clin Transl Radiat Oncol 2023; 41:100639. [PMID: 37251618 PMCID: PMC10212787 DOI: 10.1016/j.ctro.2023.100639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/09/2023] [Accepted: 05/07/2023] [Indexed: 05/31/2023] Open
Abstract
Background and purpose To evaluate the long-term outcome of accelerated partial breast irradiation utilizing intraoperatively placed applicator-based brachytherapy (ABB) in early-stage breast cancer. Materials and methods From our prospective registry, 223 patients with pTis-T2, pN0/pN1mic breast cancer were treated with ABB. The median treatment duration including surgery and ABB was 7 days. The prescribed doses were 32 Gy/8 fx BID (n = 25), 34 Gy/10 fx BID (n = 99), and 21 Gy/3 fx QD (n = 99). Endocrine therapy (ET) adherence was defined as completion of planned ET or ≥ 80% of the follow-up (FU) period. Cumulative incidence of ipsilateral breast tumor recurrence (IBTR) was estimated and influencing factors for IBTR-free survival rate (IBTRFS) were analyzed. Results 218/223 patients had hormone receptor-positive tumors, including 38 (17.0%) with Tis and 185 (83.0%) with invasive cancer. After a median FU of 63 months, 19 (8.5%) patients had recurrence [17 (7.6%) with an IBTR]. Rates of 5-year IBTRFS and DFS were 92.2% and 91.1%, respectively. The 5-year IBTRFS rates were significantly higher for post-menopausal women (93.6% vs. 66.4%, p = 0.04), BMI < 30 kg/m2 (97.4% vs. 88.1%, p = 0.02), and ET-adherence (97.5% vs. 88.6%, p = 0.02). IBTRFS did not differ with dose regimens. Conclusions Postmenopausal status, BMI < 30 kg/m2, and ET- adherence predicted favorable IBTRFS. Our results highlight the importance of careful patient selection for ABB and encouragement of ET compliance.
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Affiliation(s)
- Haeyoung Kim
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University of School of Medicine, Seoul, South Korea
| | | | - Feven Abraha
- Department of Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James W. Jakub
- Department of Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Amy C. Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dean A. Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Mara A. Piltin
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicole P. Sandhu
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amy L. Conners
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert W. Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sean S. Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Hannoun-Levi JM, Gautier M, Rizzi Y, Razzouk K. Workflow optimization of brachytherapy-based very accelerated partial breast irradiation. Brachytherapy 2023; 22:491-495. [PMID: 37164824 DOI: 10.1016/j.brachy.2023.04.005] [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: 03/10/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE For low-risk breast cancer, accelerated partial breast irradiation (APBI) is a level 1 evidence procedure. Brachytherapy based very APBI (vAPBI) makes it possible to perform adjuvant irradiation in 4 to 1 fraction. However, vAPBI organization is critical. The aim of this technical note is to report on its optimization. METHODS AND MATERIALS To offer to low-risk breast cancer patient an efficient, simple, rapid adjuvant irradiation with a reduced number of hospital visits, a new organization of vAPBI based on a single fraction was established, merging all the different steps (from first consultation to irradiation) into a 4-5-consecutive-hour period. This therapeutic program was developed in strong collaboration with radiation oncologists, medical physicists, radiation therapists, and the medical secretary. RESULTS After the validation of adjuvant breast irradiation, the patient was offered a telemedicine consultation with the radiation oncologist. Then, the day of vAPBI, the patient arrived at the brachytherapy unit at 08:00 AM for an in-person consultation followed by a preimplant CT scan (defining catheter number and position). After breast local anesthesia, catheter placement was performed followed by a postimplant CT scan for planning purposes. A total dose of 16 Gy in 1 fraction was delivered before removing the catheters. The patient was discharged from the brachytherapy unit around 12:30 PM with an upcoming surveillance consultation date. CONCLUSIONS VAPBI organization optimization makes it possible to propose a short 5-h procedure from medical consultation to treatment with only one round trip. Strict organization among staff is required.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France.
| | - Mathieu Gautier
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
| | - Yassine Rizzi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Centre, University Cote d'Azur, Nice, France
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20
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Civil YA, Jonker LW, Groot Koerkamp MPM, Duvivier KM, de Vries R, Oei AL, Slotman BJ, van der Velde S, van den Bongard HJGD. Preoperative Partial Breast Irradiation in Patients with Low-Risk Breast Cancer: A Systematic Review of Literature. Ann Surg Oncol 2023; 30:3263-3279. [PMID: 36869253 PMCID: PMC10175515 DOI: 10.1245/s10434-023-13233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/29/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Preoperative instead of standard postoperative partial breast irradiation (PBI) after breast-conserving surgery (BCS) has the advantage of reducing the irradiated breast volume, toxicity, and number of radiotherapy sessions and can allow tumor downstaging. In this review, we assessed tumor response and clinical outcomes after preoperative PBI. PATIENTS AND METHODS We conducted a systematic review of studies on preoperative PBI in patients with low-risk breast cancer using the databases Ovid Medline, Embase.com, Web of Science (Core Collection), and Scopus (PROSPERO registration CRD42022301435). References of eligible manuscripts were checked for other relevant manuscripts. The primary outcome measure was pathologic complete response (pCR). RESULTS A total of eight prospective and one retrospective cohort study were identified (n = 359). In up to 42% of the patients, pCR was obtained and this increased after a longer interval between radiotherapy and BCS (0.5-8 months). After a maximum median follow-up of 5.0 years, three studies on external beam radiotherapy reported low local recurrence rates (0-3%) and overall survival of 97-100%. Acute toxicity consisted mainly of grade 1 skin toxicity (0-34%) and seroma (0-31%). Late toxicity was predominantly fibrosis grade 1 (46-100%) and grade 2 (10-11%). Cosmetic outcome was good to excellent in 78-100% of the patients. CONCLUSIONS Preoperative PBI showed a higher pCR rate after a longer interval between radiotherapy and BCS. Mild late toxicity and good oncological and cosmetic outcomes were reported. In the ongoing ABLATIVE-2 trial, BCS is performed at a longer interval of 12 months after preoperative PBI aiming to achieve a higher pCR rate.
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Affiliation(s)
- Yasmin A Civil
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Lysanne W Jonker
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje P M Groot Koerkamp
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Katya M Duvivier
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Arlene L Oei
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Center for Experimental Molecular Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Berend J Slotman
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Susanne van der Velde
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H J G Desirée van den Bongard
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
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McDonald F, Belka C, Hurkmans C, Alicja Jereczek-Fossa B, Poortmans P, van de Kamer JB, Azizaj E, Franco P. Introducing the ESTRO Guidelines Committee, driving force for the new generation of ESTRO guidelines. Radiother Oncol 2023:109724. [PMID: 37244357 DOI: 10.1016/j.radonc.2023.109724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Fiona McDonald
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich; German Cancer Consortium (DKTK), partner site Munich; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eralda Azizaj
- European Society for Radiotherapy and Oncology, Brussels, Belgium
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, 'Maggiore della Carità' University Hospital, Novara, Italy.
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22
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Civil YA, Oei AL, Duvivier KM, Bijker N, Meijnen P, Donkers L, Verheijen S, van Kesteren Z, Palacios MA, Schijf LJ, Barbé E, Konings IRHM, -van der Houven van Oordt CWM, Westhoff PG, Meijer HJM, Diepenhorst GMP, Thijssen V, Mouliere F, Slotman BJ, van der Velde S, van den Bongard HJGD. Prediction of pathologic complete response after single-dose MR-guided partial breast irradiation in low-risk breast cancer patients: the ABLATIVE-2 trial-a study protocol. BMC Cancer 2023; 23:419. [PMID: 37161377 PMCID: PMC10169374 DOI: 10.1186/s12885-023-10910-6] [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: 01/23/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Partial breast irradiation (PBI) is standard of care in low-risk breast cancer patients after breast-conserving surgery (BCS). Pre-operative PBI can result in tumor downstaging and more precise target definition possibly resulting in less treatment-related toxicity. This study aims to assess the pathologic complete response (pCR) rate one year after MR-guided single-dose pre-operative PBI in low-risk breast cancer patients. METHODS The ABLATIVE-2 trial is a multicenter prospective single-arm trial using single-dose ablative PBI in low-risk breast cancer patients. Patients ≥ 50 years with non-lobular invasive breast cancer ≤ 2 cm, grade 1 or 2, estrogen receptor-positive, HER2-negative, and tumor-negative sentinel node procedure are eligible. A total of 100 patients will be enrolled. PBI treatment planning will be performed using a radiotherapy planning CT and -MRI in treatment position. The treatment delivery will take place on a conventional or MR-guided linear accelerator. The prescribed radiotherapy dose is a single dose of 20 Gy to the tumor, and 15 Gy to the 2 cm of breast tissue surrounding the tumor. Follow-up MRIs, scheduled at baseline, 2 weeks, 3, 6, 9, and 12 months after PBI, are combined with liquid biopsies to identify biomarkers for pCR prediction. BCS will be performed 12 months after radiotherapy or after 6 months, if MRI does not show a radiologic complete response. The primary endpoint is the pCR rate after PBI. Secondary endpoints are radiologic response, toxicity, quality of life, cosmetic outcome, patient distress, oncological outcomes, and the evaluation of biomarkers in liquid biopsies and tumor tissue. Patients will be followed up to 10 years after radiation therapy. DISCUSSION This trial will investigate the pathological tumor response after pre-operative single-dose PBI after 12 months in patients with low-risk breast cancer. In comparison with previous trial outcomes, a longer interval between PBI and BCS of 12 months is expected to increase the pCR rate of 42% after 6-8 months. In addition, response monitoring using MRI and biomarkers will help to predict pCR. Accurate pCR prediction will allow omission of surgery in future patients. TRIAL REGISTRATION The trial was registered prospectively on April 28th 2022 at clinicaltrials.gov (NCT05350722).
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Affiliation(s)
- Yasmin A. Civil
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Arlene L. Oei
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM), Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Department of Radiation Oncology, Amsterdam UMC Location Universiteit van Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Katya M. Duvivier
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Nina Bijker
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Philip Meijnen
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Lorraine Donkers
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Sonja Verheijen
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Zdenko van Kesteren
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Miguel A. Palacios
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Laura J. Schijf
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Ellis Barbé
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Inge R. H. M. Konings
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - C. Willemien Menke -van der Houven van Oordt
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Medical Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Paulien G. Westhoff
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - Hanneke J. M. Meijer
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - Gwen M. P. Diepenhorst
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Victor Thijssen
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM), Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
| | - Florent Mouliere
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Berend J. Slotman
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Susanne van der Velde
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - H. J. G. Desirée van den Bongard
- Department of Radiation Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands
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23
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Gilardi L, Airò Farulla LS, Curigliano G, Corso G, Leonardi MC, Ceci F. FDG and Non-FDG Radiopharmaceuticals for PET Imaging in Invasive Lobular Breast Carcinoma. Biomedicines 2023; 11:biomedicines11051350. [PMID: 37239021 DOI: 10.3390/biomedicines11051350] [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: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most frequent histological type of breast cancer (BC) and includes a heterogeneous spectrum of diseases with unique characteristics, especially the infiltrative growth pattern and metastatic spread. [18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is extensively used in oncology and BC patient evaluation. Its role in ILCs is considered suboptimal due to its low FDG avidity. Therefore, ILCs could benefit from molecular imaging with non-FDG tracers that target other specific pathways, contributing to precision medicine. This narrative review aims to summarize the current literature on the use of FDG-PET/CT in ILC and to discuss future opportunities given by the development of innovative non-FDG radiotracers.
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Affiliation(s)
- Laura Gilardi
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lighea Simona Airò Farulla
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of New Drugs and Early Drug Development, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Division of Breast Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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24
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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: 2] [Impact Index Per Article: 2.0] [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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25
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Merten R, Fischer M, Kopytsia G, Wichmann J, Lange T, Knöchelmann AC, Becker JN, Klapdor R, Hinrichs J, Bremer M. Linac-Based Ultrahypofractionated Partial Breast Irradiation (APBI) in Low-Risk Breast Cancer: First Results of a Monoinstitutional Observational Analysis. Cancers (Basel) 2023; 15:cancers15041138. [PMID: 36831481 PMCID: PMC9954287 DOI: 10.3390/cancers15041138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/15/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Purpose: For adjuvant radiotherapy of low-risk breast cancer after breast-conserving surgery, there have been many trials of hypofractionation and partial breast irradiation (PBI) over the years, with proven mild long-term toxicity. The aim of this study was to introduce a short-course dose-adapted concept, proven in whole breast irradiation (WBI) for use in accelerated partial breast irradiation (APBI), while monitoring dosimetric data and toxicity. Methods: From April 2020 to March 2022, 61 patients with low-risk breast cancer or ductal carcinoma in situ (DCIS) were treated at a single institution with percutaneous APBI of 26 Gy in five fractions every other day after breast-conserving surgery. Dosimetric data for target volume and organs at risk were determined retrospectively. Acute toxicity was evaluated. Results: The target volume of radiotherapy comprised an average of 19% of the ipsilateral mamma. The burden on the heart and lungs was very low. The mean cardiac dose during irradiation of the left breast was only 0.6 Gy. Two out of three patients remained without any acute side effects. Conclusions: Linac-based APBI is an attractive treatment option for patients with low-risk breast cancer in whom neither WBI nor complete omission of radiotherapy appears to be an adequate alternative.
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Affiliation(s)
- Roland Merten
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
- Correspondence:
| | - Mirko Fischer
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Gennadii Kopytsia
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Jörn Wichmann
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Tim Lange
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | | | - Jan-Niklas Becker
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Rüdiger Klapdor
- Clinic for Gynecology and Obstetrics, Hannover Medical School, 30625 Hannover, Germany
| | - Jan Hinrichs
- Institute for Radiology, Hannover Medical School, 30625 Hannover, Germany
| | - Michael Bremer
- Clinic for Radiotherapy, Hannover Medical School, 30625 Hannover, Germany
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26
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Offersen BV, Aznar MC, Bacchus C, Coppes RP, Deutsch E, Georg D, Haustermans K, Hoskin P, Krause M, Lartigau EF, Lee AWM, Löck S, Thwaites DI, van der Kogel AJ, van der Heide U, Valentini V, Overgaard J, Baumann M. The role of ESTRO guidelines in achieving consistency and quality in clinical radiation oncology practice. Radiother Oncol 2023; 179:109446. [PMID: 36566990 DOI: 10.1016/j.radonc.2022.109446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, United Kingdom
| | - Carol Bacchus
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rob P Coppes
- Department of Biomedical Sciences of Cells & Systems, Section Molecular Cell Biology, Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eric Deutsch
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France
| | - Dieter Georg
- Division Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Peter Hoskin
- Mount Vernon Cancer Centre and University of Manchester, United Kingdom
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - Eric F Lartigau
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Anne W M Lee
- Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, University of Hong Kong - Shenzhen Hospital, China
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Australia; Radiotherapy Research Group, St James's Hospital and University of Leeds, United Kingdom
| | - Albert J van der Kogel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Uulke van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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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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Chand-Fouché ME, Colnard C, Gal J, Lam Cham Kee D, Dejean C, Gautier M, Feuillade J, Mana A, Fouché Y, Delpech Y, Dejode M, Gérard JP, Barranger E. Feasibility and early toxicity of intraoperative radiotherapy for breast cancer using the papillon + system: First results. Clin Transl Radiat Oncol 2023; 38:47-52. [DOI: 10.1016/j.ctro.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 10/04/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
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Intraoperative radiation therapy in the management of early stage breast cancer. Brachytherapy 2023; 22:47-52. [PMID: 36207243 DOI: 10.1016/j.brachy.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
Adjuvant radiotherapy (RT) following breast conserving surgery (BCS) is associated with an improvement in local control and a reduction in breast cancer mortality. While traditionally delivered with whole breast irradiation (WBI), novel approaches have looked to reduce the duration, target volume, and toxicity of adjuvant RT. One such approach is intraoperative radiation therapy (IORT), which delivers radiation at the time of surgery with 80-90% of patients not requiring additional WBI. The current review presents IORT techniques and outcomes from modern series evaluating IORT as monotherapy or as a tumor bed boost. Based on two randomized trials (TARGIT-A and ELIOT) with recent updates, concern regarding higher rates of local recurrence with IORT exist, whether using electrons or low-energy techniques. In contrast, data is promising regarding IORT used as a boost, with ongoing studies evaluating its role prospectively. With respect to toxicity, the data suggest IORT is associated with comparable to slightly lower rates of toxicity though there may be a higher risk of seroma requiring aspiration and fat necrosis with IORT. Given current data and guidelines, WBI or other partial breast techniques should remain the standard of care in early stage breast cancer patients, while IORT should not be utilized outside of prospective clinical trials at this time.
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30
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Special Techniques of Adjuvant Breast Carcinoma Radiotherapy. Cancers (Basel) 2022; 15:cancers15010298. [PMID: 36612294 PMCID: PMC9818986 DOI: 10.3390/cancers15010298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Modern radiotherapy techniques are designed to permit reduced irradiation of healthy tissue, resulting in a diminished risk of adverse effects and shortened recovery times. Several randomized studies have demonstrated the benefits of increased dosage to the tumor bed area in combination with whole breast irradiation (WBI). Conventional WBI treatment following breast-conserving procedures, which required 5-7 weeks of daily treatments, has been reduced to 3-4 weeks when using hyperfractionated regimens. The dosage administration improves local control, albeit with poorer cosmesis. The method of accelerated partial breast irradiation (APBI) shortens the treatment period whilst reducing the irradiated volume. APBI can be delivered using intraoperative radiation, brachytherapy, or external beam radiotherapy. Currently available data support the use of external beam partial breast irradiation in selected patients. Modern radiotherapy techniques make it possible to achieve favorable cosmesis in most patients undergoing immediate breast reconstruction surgery, and studies confirm that current methods of external beam radiation allow an acceptable coverage of target volumes both in the reconstructed breast and in the regional lymphatic nodes.
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31
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Offersen BV, Alsner J, Nielsen HM, Jakobsen EH, Nielsen MH, Stenbygaard L, Pedersen AN, Thomsen MS, Yates E, Berg M, Lorenzen EL, Jensen I, Josipovic M, Jensen MB, Overgaard J. Partial Breast Irradiation Versus Whole Breast Irradiation for Early Breast Cancer Patients in a Randomized Phase III Trial: The Danish Breast Cancer Group Partial Breast Irradiation Trial. J Clin Oncol 2022; 40:4189-4197. [PMID: 35930754 DOI: 10.1200/jco.22.00451] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE On the basis of low risk of local recurrence in elderly patients with breast cancer after conservative surgery followed by whole breast irradiation (WBI), the Danish Breast Cancer Group initiated the noninferiority external-beam partial breast irradiation (PBI) trial (ClinicalTrials.gov identifier: NCT00892814). We hypothesized that PBI was noninferior to WBI regarding breast induration. METHODS Patients operated with breast conservation for relatively low-risk breast cancer were randomly assigned to WBI versus PBI, and all had 40 Gy/15 fractions. The primary end point was 3-year grade 2-3 breast induration. RESULTS In total, 865 evaluable patients (434 WBI and 431 PBI) were enrolled between 2009 and 2016. Median follow-up was 5.0 years (morbidity) and 7.6 years (locoregional recurrence). The 3-year rate of induration was 9.7% for WBI and 5.1% for PBI (P = .014). Large breast size was significantly associated with induration with a 3-year incidence of 13% (WBI) and 6% (PBI) for large-breasted patients versus 6% (WBI) and 5% (PBI) for small-breasted patients. PBI showed no increased risk of dyspigmentation, telangiectasia, edema, or pain, and patient satisfaction was high. Letrozole and smoking did not increase the risk of radiation-associated morbidity. Sixteen patients had a locoregional recurrence (six WBI and 10 PBI; P = .28), 20 patients had a contralateral breast cancer, and eight patients had distant failure (five WBI and three PBI). A nonbreast second cancer was detected in 73 patients (8.4%), and there was no difference between groups. CONCLUSION External-beam PBI for patients with low-risk breast cancer was noninferior to WBI in terms of breast induration. Large breast size was a risk factor for radiation-associated induration. Few recurrences were detected and unrelated to PBI.
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Affiliation(s)
- Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne M Nielsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mette H Nielsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Lars Stenbygaard
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Anders N Pedersen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mette S Thomsen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Yates
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Berg
- Department of Medical Physics, Lillebaelt Hospital, Vejle, Denmark
| | - Ebbe L Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ingelise Jensen
- Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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32
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10-year oncological outcome report after second conservative treatment for ipsilateral breast tumor event. Clin Transl Radiat Oncol 2022; 38:71-76. [DOI: 10.1016/j.ctro.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
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33
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Refaat T, Gros SE, Small W. The case for risk-stratified IORT for early breast cancer. Brachytherapy 2022; 21:719-722. [PMID: 36167653 DOI: 10.1016/j.brachy.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Tamer Refaat
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Sebastien E Gros
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL.
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34
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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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Accelerated Partial Breast Irradiation with Intraoperative Radiotherapy Is Effective in Luminal Breast Cancer Patients Aged 60 Years and Older. J Pers Med 2022; 12:jpm12071116. [PMID: 35887613 PMCID: PMC9322635 DOI: 10.3390/jpm12071116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/26/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Adjuvant whole breast irradiation (AWBI) improves local control and survival in breast cancer patients after breast-conserving surgery. Between 2010 and 2017, 823 patients ≥ 60 years with ER-positive, Her-2 negative, clinically N0 breast cancer underwent breast-conserving surgery (BCS) at the West Pomeranian Oncology Center. Intraoperative radiotherapy (IORT) with kV photons was applied to 199 (24.2%) patients according to the IORT protocol, and AWBI only was applied to 624 (75.8%). IORT patients in cases with lymph node metastasis, lobular type presence, extensive in situ components, lymphatic vessel invasion, or resection margin < 2 mm, additionally underwent AWBI. Median follow-up was 74 months. There were two (1%) breast relapses in the IORT protocol group and one (0.2%) in the AWBI-only group. In each group, one axillary lymph node relapse was diagnosed (0.5% and 0.2%, respectively). There were two local relapses in the IORT-only group, and they were treated further with BCS and AWBI. Although locoregional relapse-free survival differed between the AWBI-only and IORT protocol groups (98.5% vs. 99.7%, p = 0.048), the local control, distant metastasis-free survival, and breast cancer-specific survival were similar. IORT is a reasonable option to avoid AWBI in ER-positive, Her-2 negative, cN0 women with breast cancer aged ≥ 60 years.
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36
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Polgár C, Kahán Z, Ivanov O, Chorváth M, Ligačová A, Csejtei A, Gábor G, Landherr L, Mangel L, Mayer Á, Fodor J. Radiotherapy of Breast Cancer—Professional Guideline 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610378. [PMID: 35832115 PMCID: PMC9272418 DOI: 10.3389/pore.2022.1610378] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022]
Abstract
The international radiotherapy (RT) expert panel has revised and updated the RT guidelines that were accepted in 2020 at the 4th Hungarian Breast Cancer Consensus Conference, based on new scientific evidence. Radiotherapy after breast-conserving surgery (BCS) is indicated in ductal carcinoma in situ (stage 0), as RT decreases the risk of local recurrence (LR) by 50–60%. In early stage (stage I-II) invasive breast cancer RT remains a standard treatment following BCS. However, in elderly (≥70 years) patients with stage I, hormone receptor-positive tumour, hormonal therapy without RT can be considered. Hypofractionated whole breast irradiation (WBI) and for selected cases accelerated partial breast irradiation are validated treatment alternatives to conventional WBI administered for 5 weeks. Following mastectomy, RT significantly decreases the risk of LR and improves overall survival of patients who have 1 to 3 or ≥4 positive axillary lymph nodes. In selected cases of patients with 1 to 2 positive sentinel lymph nodes axillary dissection can be substituted with axillary RT. After neoadjuvant systemic treatment (NST) followed by BCS, WBI is mandatory, while after NST followed by mastectomy, locoregional RT should be given in cases of initial stage III–IV and ypN1 axillary status.
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Affiliation(s)
- Csaba Polgár
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Olivera Ivanov
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department for Radiation Oncology, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | - Martin Chorváth
- Department of Radiation Oncology, St. Elisabeth Cancer Institute, Slovak Medical University, Bratislava, Slovakia
| | - Andrea Ligačová
- Department of Radiation Oncology, St. Elisabeth Cancer Institute, Slovak Medical University, Bratislava, Slovakia
| | - András Csejtei
- Department of Oncoradiology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Gabriella Gábor
- Oncoradiology Centre, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - László Landherr
- Municipal Oncoradiology Centre, Uzsoki Street Hospital, Budapest, Hungary
| | - László Mangel
- Oncotherapy Institute, University of Pécs, Pécs, Hungary
| | - Árpád Mayer
- Municipal Oncoradiology Centre, Uzsoki Street Hospital, Budapest, Hungary
| | - János Fodor
- Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
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37
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Nafissi N, Mohammadlou M, Akbari ME, Mahdavi SR, Sheikh M, Borji M, Babaee E, Baharlou R. The impact of intraoperative radiotherapy on breast cancer: focus on the levels of angiogenic factors. World J Surg Oncol 2022; 20:191. [PMID: 35681234 PMCID: PMC9178821 DOI: 10.1186/s12957-022-02653-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Angiogenesis is one of the hallmarks of cancers that is involved in tumor progression. Angiogenic factors induce the formation of new blood vessels and tumor extension, and finally reduce the survival of patients. Intraoperative radiotherapy (IORT), in which radiation is delivered to the tumor bed can kill cells and change tumor microenvironment. Here, we compared the impact of IORT on the levels of angiogenic factors in the blood and surgical wound fluids (SWF) of the breast cancer patients. PATIENTS AND METHODS Three hundred sixty patients, who had undergone breast-conserving surgery between 2013 and 2018, were enrolled in IORT and non-IORT groups non-randomly. Blood and drained wound fluid (WF) samples were collected from the patients before and after surgery, followed by quantification of the amounts of TGF-β, EGF, FGF, VEGF, and DLL4 in the patients using ELISA. RESULTS Our results were indicative of significant differences between the pre-surgery and post-surgery serum levels of EGF, DLL4, and VEGF. Furthermore, ROC analyses showed that TGF-β and DLL4 can differentiate of the early-stage from late-stage of the disease. Interestingly, the rate of the death and recurrence was reduced in IORT group. CONCLUSIONS In summary, IORT is a safe and effective treatment that can affect angiogenic factors and improve the overall- and recurrence-free survival of breast cancer patients.
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Affiliation(s)
- Nahid Nafissi
- Department of Breast, Rasoul Akram Hospital Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Mohammadlou
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Immunology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | | | - Seyed Rabie Mahdavi
- Department of Medical Physics, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Sheikh
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Borji
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Baharlou
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran.
- Department of Immunology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
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38
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Cozzi S, Augugliaro M, Ciammella P, Botti A, Trojani V, Najafi M, Blandino G, Ruggieri MP, Giaccherini L, Alì E, Iori F, Sardaro A, Finocchi Ghersi S, Deantonio L, Gutierrez Miguelez C, Iotti C, Bardoscia L. The Role of Interstitial Brachytherapy for Breast Cancer Treatment: An Overview of Indications, Applications, and Technical Notes. Cancers (Basel) 2022; 14:cancers14102564. [PMID: 35626168 PMCID: PMC9139312 DOI: 10.3390/cancers14102564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Breast cancer is the most common cancer in the female population. Adjuvant radiotherapy has become increasingly important as conservative treatment. Muticatheter interstitial brachytherapy is a type of radiation technique wherein the radioactive sources are directly implanted into or close to the target tissue and may be considered an extremely precise, versatile, and variable radiation technique. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy, with particular focus on the implant description, limits, and advantages of the technique. Abstract Breast cancer represents the second leading cause of cancer-related death in the female population, despite continuing advances in treatment options that have significantly accelerated in recent years. Conservative treatments have radically changed the concept of healing, also focusing on the psychological aspect of oncological treatments. In this scenario, radiotherapy plays a key role. Brachytherapy is an extremely versatile radiation technique that can be used in various settings for breast cancer treatment. Although it is invasive, technically complex, and requires a long learning curve, the dosimetric advantages and sparing of organs at risk are unequivocal. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy, with longer follow-up than new, emerging radiation techniques, whose effectiveness is proven by over 20 years of experience. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy to perform breast lumpectomy boost, breast-conserving accelerated partial breast irradiation, and salvage reirradiation for ipsilateral breast recurrence, with particular focus on the implant description, limits, and advantages of the technique.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
- Correspondence: ; Tel.: +39-329-731-7608
| | - Matteo Augugliaro
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Masoumeh Najafi
- Department of Radiation Oncology, Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran 1997667665, Iran;
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant’Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185 Rome, Italy;
| | - Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, 6500 Lugano, Switzerland;
| | - Cristina Gutierrez Miguelez
- Brachytherapy Unit, Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100 Lucca, Italy;
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Agha A, Wang X, Wang M, Lehrer EJ, Horn SR, Rosenberg JC, Trifiletti DM, Diaz R, Louie AV, Zaorsky NG. Long-Term Risk of Death From Heart Disease Among Breast Cancer Patients. Front Cardiovasc Med 2022; 9:784409. [PMID: 35498020 PMCID: PMC9043135 DOI: 10.3389/fcvm.2022.784409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Most breast cancer patients die of non-cancer causes. The risk of death from heart disease, a leading cause of death, is unknown. The aim of this study is to characterize the long-term risk of fatal heart disease in breast cancer patients. Methods This retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database. Standard mortality ratios (SMR) were calculated for breast cancer patients diagnosed from 1992 to 2014. Patients were stratified by receipt of radiotherapy and/or chemotherapy, disease laterality, and diagnosis era. Hazard ratios (HRs) and odds ratios (ORs) were calculated to compare the risk of death from heart disease among other breast cancer patients. Results There were 1,059,048 patients diagnosed with breast cancer from 1992 to 2014, of which 47,872 (4.6%) died from heart disease. The SMR for death from heart disease at 10+ years for patients who received only radiotherapy was 2.92 (95% CI 2.81–3.04, p < 0.001) and in patients who received only chemotherapy was 5.05 (95% CI 4.57–5.55, p < 0.001). There was no statistically significant difference in SMR for death from heart disease for left-sided vs. right-sided disease. At 10+ years, heart disease made up 28% of deaths from non-primary cancer. HRs and ORs showed that the risk of death from heart disease was highest in patients older than 70 years of age and with longer follow-up. Conclusion The risk of fatal heart disease was highest in older breast cancer patients with longer follow-up (i.e., >5–10 years) and who received chemotherapy. These patients should be referred to cardio-oncology clinics to mitigate this risk.
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Affiliation(s)
- Aya Agha
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States
| | - Xi Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samantha R. Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States
| | - Jennifer C. Rosenberg
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States
| | | | - Roberto Diaz
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Alexander V. Louie
- Department of Radiation Oncology, Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicholas G. Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
- *Correspondence: Nicholas G. Zaorsky,
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Herein A, Stelczer G, Pesznyák C, Fröhlich G, Smanykó V, Mészáros N, Polgár C, Takácsi-Nagy Z, Major T. CyberKnife versus multicatheter interstitial brachytherapy for accelerated partial breast irradiation: a dosimetrical assessment with focus on organs at risk. Rep Pract Oncol Radiother 2022; 27:152-160. [PMID: 35402040 PMCID: PMC8989445 DOI: 10.5603/rpor.a2022.0011] [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: 12/08/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of the study was to dosimetrically compare multicatheter interstitial brachytherapy (MIBT) and stereotactic radiotherapy with CyberKnife (CK) for accelerated partial breast irradiation with special focus on dose to organs at risk (OARs). Materials and methods Treatment plans of thirty-one patients treated with MIBT were selected and additional CK plans were created on the same CT images. The OARs included ipsilateral non-target and contralateral breast, ipsilateral and contralateral lung, skin, ribs, and heart for left sided cases. The fractionation was identical (4 × 6.25 Gy). Dose-volume parameters were calculated for both techniques and compared. Results The D90 of the PTV for MIBT and CK were similar (102.4% vs. 103.6%, p = 0.0654), but in COIN the MIBT achieved lower value (0.75 vs. 0.91, p < 0.001). Regarding the V100 parameter of non-target breast CK performed slightly better than MIBT (V100: 1.1% vs. 1.6%), but for V90, V50 and V25 MIBT resulted in less dose. Every examined parameter of ipsilateral lung, skin, ribs and contralateral lung was significantly smaller for MIBT than for CK. Protection of the heart was slightly better with MIBT, but only the difference of D2cm3 was statistically significant (17.3% vs. 20.4%, p = 0.0311). There were no significant differences among the dose-volume parameters of the contralateral breast. Conclusion The target volume can be properly irradiated by both techniques with high conformity and similar dose to the OARs. MIBT provides more advantageous plans than CK, except for dose conformity and the dosimetry of the heart and contralateral breast. More studies are needed to analyze whether these dosimetrical findings have clinical significance.
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Affiliation(s)
- András Herein
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Budapest University of Technology and Economic, Institute of Nuclear Techniques, Budapest, Hungary
| | - Gábor Stelczer
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Budapest University of Technology and Economic, Institute of Nuclear Techniques, Budapest, Hungary
| | - Csilla Pesznyák
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Budapest University of Technology and Economic, Institute of Nuclear Techniques, Budapest, Hungary
| | - Georgina Fröhlich
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Eötvös Loránd University, Faculty of Science, Budapest, Hungary
| | - Viktor Smanykó
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary
| | - Norbert Mészáros
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Semmelweis University, Department of Oncology, Budapest, Hungary
| | - Csaba Polgár
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Semmelweis University, Department of Oncology, Budapest, Hungary
| | - Zoltán Takácsi-Nagy
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Semmelweis University, Department of Oncology, Budapest, Hungary
| | - Tibor Major
- National Institute of Oncology, Centre of Radiotherapy, Budapest, Hungary.,Semmelweis University, Department of Oncology, Budapest, Hungary
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De-Colle C, Dohm O, Mönnich D, Nachbar M, Weidner N, Heinrich V, Boeke S, Gani C, Zips D, Thorwarth D. Estimation of secondary cancer projected risk after partial breast irradiation at the 1.5 T MR-linac. Strahlenther Onkol 2022; 198:622-629. [PMID: 35412045 PMCID: PMC9217770 DOI: 10.1007/s00066-022-01930-5] [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: 10/11/2021] [Accepted: 03/10/2022] [Indexed: 10/26/2022]
Abstract
PURPOSE For patients treated with partial breast irradiation (PBI), potential long-term treatment-related toxicities are important. The 1.5 T magnetic resonance guided linear accelerator (MRL) offers excellent tumor bed visualization and a daily treatment plan adaption possibility, but MRL-specific electron stream and return effects may cause increased dose deposition at air-tissue interfaces. In this study, we aimed to investigate the projected risk of radiation-induced secondary malignancies (RISM) in patients treated with PBI at the 1.5 T MRL. METHODS Projected excess absolute risk values (EARs) for the contralateral breast, lungs, thyroid and esophagus were estimated for 11 patients treated with PBI at the MRL and compared to 11 patients treated with PBI and 11 patients treated with whole breast irradiation (WBI) at the conventional linac (CTL). All patients received 40.05 Gy in 15 fractions. For patients treated at the CTL, additional dose due to daily cone beam computed tomography (CBCT) was simulated. The t‑test with Bonferroni correction was used for comparison. RESULTS The highest projected risk for a radiation-induced secondary cancer was found for the ipsilateral lung, without significant differences between the groups. A lower contralateral breast EAR was found for MRL-PBI (EAR = 0.89) compared to CTL-PBI (EAR = 1.41, p = 0.01), whereas a lower thyroid EAR for CTL-PBI (EAR = 0.17) compared to MRL-PBI (EAR = 0.33, p = 0.03) and CTL-WBI (EAR = 0.46, p = 0.002) was observed. Nevertheless, when adding the CBCT dose no difference between thyroid EAR for CTL-PBI compared to MRL-PBI was detected. CONCLUSION Better breast tissue visualization and the possibility for daily plan adaption make PBI at the 1.5 T MRL particularly attractive. Our simulations suggest that this treatment can be performed without additional projected risk of RISM.
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Affiliation(s)
- C De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - O Dohm
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - D Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - M Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - N Weidner
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - V Heinrich
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - S Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,partner site Tübingen, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - C Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - D Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,partner site Tübingen, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - D Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany.,partner site Tübingen, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
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Four-fraction ultra-accelerated minimal breast irradiation in early breast cancer: The initial feasibility results of an institutional experience. Brachytherapy 2022; 21:475-486. [PMID: 35396137 DOI: 10.1016/j.brachy.2022.01.008] [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: 11/12/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the feasibility, early toxicity, and clinical outcomes of early-breast cancer patients in a single-arm, phase I/II study of an ultra-accelerated, four-fraction schedule of minimal breast irradiation (4f-AMBI) using a multicatheter, minimally-invasive, intraoperative tumor bed implant (MITBI) during breast-conserving surgery (BCS). METHODS AND MATERIALS Eligible women aged >40 years with clinically and radiologically confirmed, unifocal invasive or in situ ≤3 cm tumors were considered as potential candidates for MITBI during BCS. After the pathology report, patients who met APBI criteria received ultra-accelerated four-fractions irradiation (6.2 Gy BID x 4fx over 2 days) with perioperative HDR-brachytherapy (PHDRBT). Early complications, toxicity, clinical outcomes, and cosmetic results were analyzed. RESULTS Of 89 patients initially implanted, 60(67.4%) were definitively included in the 4f-AMBI-protocol. The median age was 64.4 years; the median CTV was 32.1 cc (6.9-75.4 cc), and the external-V100 was 43.1 cc (12.87-107 cc), representing 5% of the breast tissue irradiated with a median CTV D90 of 6.2 Gy (5.6-6.28 Gy). The entire local treatment (BCS&MITBI-4f-AMBI) was completed at a median of 8 days (4-10 days). The rate of early complications was 11%. There were no major complications. Acute skin-subcutaneous G1 toxicity was reported in 11.7%, and late G1 toxicity on 36.7%. After a median follow-up of 27 months (11-51 months), the local, elsewhere, locoregional and distant-control rates were 100%, 98.3%, 100%, and 100% respectively. The early-cosmetic evaluation was excellent-good in 94.5% of patients evaluated. CONCLUSIONS Ultra-accelerated, four-fraction, minimal breast irradiation (4f-AMBI) using a minimally-invasive tumor bed implant procedure is safe, dosimetrically feasible, and shows small irradiated volumes. This program provides low toxicity rates and excellent short-term clinical and cosmesis outcomes.
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Garduño-Sánchez S, Villanego-Beltrán I, de Las Peñas-Cabrera MD, Jaén-Olasolo J. Response to letter to the Editor. Clin Transl Oncol 2022; 24:1831-1832. [PMID: 35355156 DOI: 10.1007/s12094-022-02828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Sara Garduño-Sánchez
- Department of Radiation Oncology, Puerta del Mar University Hospital, Ana de Viya 21 Avenue, 11009, Cádiz, Spain.
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
| | - Isabel Villanego-Beltrán
- Department of Radiation Oncology, Puerta del Mar University Hospital, Ana de Viya 21 Avenue, 11009, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - María Dolores de Las Peñas-Cabrera
- Department of Radiation Oncology, Puerta del Mar University Hospital, Ana de Viya 21 Avenue, 11009, Cádiz, Spain
- Department of Radiation Oncology, Rey Juan Carlos University Hospital, Gladiolo s/n, 28933, Madrid, Spain
| | - Javier Jaén-Olasolo
- Department of Radiation Oncology, Puerta del Mar University Hospital, Ana de Viya 21 Avenue, 11009, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
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Jacobs DHM, Mast ME, Horeweg N, Speijer G, Petoukhova AL, Straver M, Coerkamp EG, Hazelbag HM, Merkus J, Roeloffzen EMA, Zwanenburg LG, van der Sijp J, Fiocco M, Marijnen CAM, Koper PCM. Accelerated Partial Breast Irradiation using External-Beam or Intraoperative Electron Radiotherapy: 5 year oncological outcomes of a prospective cohort study. Int J Radiat Oncol Biol Phys 2022; 113:570-581. [PMID: 35301990 DOI: 10.1016/j.ijrobp.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE To evaluate the ipsilateral breast tumor recurrence (IBTR) after two accelerated partial breast irradiation (APBI) techniques (intraoperative electron radiotherapy, IOERT and external-beam APBI, EB-APBI) in patients with early stage breast cancer. PATIENTS AND METHODS Between 2011 and 2016, women ≥60 years with breast carcinoma or DCIS of ≤30mm and cN0 undergoing breast conserving therapy were included in a two-armed prospective multi-center cohort study. IOERT (1 × 23.3Gy prescribed at the 100% isodose line) was applied in one hospital and EB-APBI (10 × 3.85Gy daily) in 2 other hospitals. Primary endpoint was IBTR (all recurrences in the ipsilateral breast irrespective of localization) at 5 years after lumpectomy. A competing risk model was used to estimate the cumulative incidences of IBTR, which were compared using Fine and Gray's test. Secondary endpoints were locoregional recurrence rate (LRR), distant recurrence, disease specific survival and overall survival. Univariate Cox-regression models were estimated to identify risk factors for IBTR. Analyses were performed of the intention to treat (ITT) population (IOERT n=305; EB-APBI n=295), and sensitivity analyses were done of the per-protocol population (PP) (IOERT n=270; EB-APBI n=207). RESULTS Median follow up was 5.2 years (IOERT) and 5 years (EB-APBI). Cumulative incidence of IBTR in the ITT population at 5 years after lumpectomy was 10.6% (95% confidence interval 7.0-14.2%) after IOERT and 3.7% (95%CI 1.2-5.9%) after EB-APBI (p=0.002). LRR was significantly higher after IOERT than EB-APBI (12.1% vs 4.5%, p=0.001). There were no differences between groups in other endpoints. Sensitivity analysis showed similar results. For both groups, no significant risk factors for IBTR were identified in the ITT population. In the PP population surgical margin status was the only significant risk factor for developing IBTR in both treatment groups. CONCLUSION Ipsilateral breast tumor recurrences and locoregional recurrence rates were unexpectedly high in patients treated with IOERT, and acceptable in patients treated with EB-APBI.
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Affiliation(s)
- Daphne H M Jacobs
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands; Haaglanden Medical Center, Department of Radiation Oncology, Leidschendam, The Netherlands.
| | - Mirjam E Mast
- Haaglanden Medical Center, Department of Radiation Oncology, Leidschendam, The Netherlands.
| | - Nanda Horeweg
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands
| | - Gabrielle Speijer
- Haga Hospital, Department of Radiation Oncology, The Hague, The Netherlands
| | - Anna L Petoukhova
- Haaglanden Medical Center, Department of Radiation Oncology, Leidschendam, The Netherlands
| | - Marieke Straver
- Haaglanden Medical Center, Department of Surgery, Leidschendam, The Netherlands
| | - Emile G Coerkamp
- Haaglanden Medical Center, Department of Radiology, Leidschendam, The Netherlands
| | - Hans-Marten Hazelbag
- Haaglanden Medical Center, Department of Pathology, Leidschendam, The Netherlands
| | - Jos Merkus
- Haga Hospital, Department of Surgery, The Hague, The Netherlands
| | | | | | - Joost van der Sijp
- Haaglanden Medical Center, Department of Surgery, Leidschendam, The Netherlands
| | - Marta Fiocco
- Leiden University Medical Center, Department of Statistics, Leiden, The Netherlands
| | - Corrie A M Marijnen
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands; The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Peter C M Koper
- Leiden University Medical Center, Department of Radiation Oncology, Leiden, The Netherlands
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Meattini I, Becherini C, Boersma L, Kaidar-Person O, Marta GN, Montero A, Offersen BV, Aznar MC, Belka C, Brunt AM, Dicuonzo S, Franco P, Krause M, MacKenzie M, Marinko T, Marrazzo L, Ratosa I, Scholten A, Senkus E, Stobart H, Poortmans P, Coles CE. European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer. Lancet Oncol 2022; 23:e21-e31. [PMID: 34973228 DOI: 10.1016/s1470-2045(21)00539-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 12/17/2022]
Abstract
High-quality randomised clinical trials testing moderately fractionated breast radiotherapy have clearly shown that local control and survival is at least as effective as with 2 Gy daily fractions with similar or reduced normal tissue toxicity. Fewer treatment visits are welcomed by patients and their families, and reduced fractions produce substantial savings for health-care systems. Implementation of hypofractionation, however, has moved at a slow pace. The oncology community have now reached an inflection point created by new evidence from the FAST-Forward five-fraction randomised trial and catalysed by the need for the global radiation oncology community to unite during the COVID-19 pandemic and rapidly rethink hypofractionation implementation. The aim of this paper is to support equity of access for all patients to receive evidence-based breast external beam radiotherapy and to facilitate the translation of new evidence into routine daily practice. The results from this European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus state that moderately hypofractionated radiotherapy can be offered to any patient for whole breast, chest wall (with or without reconstruction), and nodal volumes. Ultrafractionation (five fractions) can also be offered for non-nodal breast or chest wall (without reconstruction) radiotherapy either as standard of care or within a randomised trial or prospective cohort. The consensus is timely; not only is it a pragmatic framework for radiation oncologists, but it provides a measured proposal for the path forward to influence policy makers and empower patients to ensure equity of access to evidence-based radiotherapy.
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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.
| | - Carlotta Becherini
- 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
| | - Liesbeth Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Orit Kaidar-Person
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, Netherlands; Sheba Medical Center, Ramat Gan and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gustavo Nader Marta
- Department of Radiation Oncology-Hospital Sírio-Libanês, São Paulo, Brazil; Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Angel Montero
- Department of Radiation Oncology, HM Hospitales, Madrid, Spain
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Department of Oncology, Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Claus Belka
- Department of Radiation Oncology, LMU Klinikum, Ludwig-Maximilians University Munich, Munich, Germany
| | - Adrian Murray Brunt
- School of Medicine, University of Keele, Keele, UK; Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, Maggiore della Carità University Hospital, Novara, Italy
| | - Mechthild Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; National Center for Tumor Diseases, Partner Site Dresden, German Cancer Research Center, Heidelberg, Germany; German Cancer Research Center, Heidelberg and German Cancer Consortium, Dresden, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology, Dresden, Germany
| | | | - Tanja Marinko
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Livia Marrazzo
- Medical Physics Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Astrid Scholten
- Department of Radiotherapy, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
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46
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Chang JS, Chang JH, Kim N, Kim YB, Shin KH, Kim K. Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy in the Treatment of Breast Cancer: An Updated Review. J Breast Cancer 2022; 25:349-365. [DOI: 10.4048/jbc.2022.25.e37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/16/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Nalee Kim
- Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea
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47
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Riberdy V, Ruiz E, Hoekstra N, Struik G, Pignol JP. Comparison of visibility of iodinated hydrogel and gadolinium-modified hyaluronic acid spacer gels on computed tomography and onboard imaging. Phys Imaging Radiat Oncol 2022; 21:48-53. [PMID: 35243031 PMCID: PMC8861832 DOI: 10.1016/j.phro.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background and purpose In accelerated partial breast irradiation (APBI), accurate definition of the tumour bed is crucial to reduce the risk of local recurrence and the volume of healthy tissue irradiated. Recently, hydrogels have been proposed to improve visibility of the lumpectomy cavity for APBI. The aim of this study was to alter two commercially available hyaluronic acid (HA) gels, with gadopentenate dimeglumine (GD), a magnetic resonance imaging (MRI) contrast agent. We hypothesize that after injection in the surgical cavity, the mixtures will be visible with computed tomography (CT) for improved treatment planning, cone-beam CT (CBCT) for improved patient setup and planar kilovoltage (kV) x-ray for real-time tracking during treatment. Materials and methods In this ex vivo study, GD was mixed with the two HA gels, and 1 mL of each mixture was injected into fatty and muscular tissue of a pork phantom. Visibility with CT, CBCT and planar x-ray imaging was assessed. Contrast-to-noise ratios (CNR) were measured and compared to commercially available iodinated polyethylene glycol (PEG). Results The gel mixtures showed increased visibility over HA gels without GD. When comparing CNR of the gel mixtures to that of iodinated PEG on CT, there was a 4-fold increase in muscle for both mixtures and a 1.6-fold to 3.6-fold increase in fat, depending on the HA gel. Gel mixtures showed better visibility with planar kV imaging over iodinated PEG. Conclusion Addition of GD to HA gels increases visibility with CT, CBCT and planar x-ray imaging, indicating potential for improved delineation and positioning in APBI.
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Affiliation(s)
- Vlora Riberdy
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
- Corresponding author at: Department of Medical Physics, 5820 University Ave., Halifax, NS B3H 1V7, Canada.
| | - Ethan Ruiz
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Nienke Hoekstra
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Gerson Struik
- Department of Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jean-Philippe Pignol
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS, Canada
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48
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Meattini I, Palumbo I, Becherini C, Borghesi S, Cucciarelli F, Dicuonzo S, Fiorentino A, Spoto R, Poortmans P, Aristei C, Livi L. The Italian Association for Radiotherapy and Clinical Oncology (AIRO) position statements for postoperative breast cancer radiation therapy volume, dose, and fractionation. LA RADIOLOGIA MEDICA 2022; 127:1407-1411. [PMID: 36201098 PMCID: PMC9747865 DOI: 10.1007/s11547-022-01563-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
Recent advances in non-metastatic breast cancer radiation therapy significantly reshaped our views on modern dose and fractionation schedules. Especially the advent of hypofractionation and partial breast irradiation defined a new concept of treatment optimization, that should strongly include both patient and tumour characteristics in the physician's decision-making process. Unfortunately, hypofractionation for breast cancer radiation therapy needed long time to enter the routine practice during the last decades despite the level-1 evidence published over time. Hereby we present the Italian Association for Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group position statements for postoperative breast cancer radiation therapy volume, dose, and fractionation to harmonically boost routine clinical practice implementation following evidence-based data.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Viale Morgagni 50, 50134, Florence, Italy. .,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 50, 50134, Florence, Italy.
| | - Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 50, 50134 Florence, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo–Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Francesca Cucciarelli
- Radiotherapy Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCSS, Milan, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F.Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Ruggero Spoto
- Department of Radiotherapy, Humanitas Clinical and Research Center, IRCSS, Rozzano, Milan, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium ,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Viale Morgagni 50, 50134 Florence, Italy ,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Viale Morgagni 50, 50134 Florence, Italy
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49
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Leonardi MC, Kouloura A, Rojas DP, Zaffaroni M, Intra M, Veronesi P, Morra A, Gerardi MA, Fodor CI, Zerella MA, Camarda AM, Cattani F, Luraschi R, Viola A, Riva G, Miglietta E, Orecchia R, Dicuonzo S, Jereczek-Fossa BA. The POLO (Partially Omitted Lobe) approach to safely treat in-breast recurrence after intraoperative radiotherapy with electrons. Br J Radiol 2021; 95:20210405. [PMID: 34919420 DOI: 10.1259/bjr.20210405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study is to evaluate feasibility of salvage 4-week hypofractionated whole breast radiotherapy (WBRT) in patients with in-breast recurrence after receiving intraoperative radiotherapy with electrons (IOERT) for primary breast cancer (BC). METHODS BC patients who had repeated quadrantectomy underwent modified WBRT with intensity-modulated radiotherapy using Helical Tomotherapy to underdose the IOERT region. This approach, called POLO (Partially Omitted Lobe), excluded the IOERT volume from receiving the full prescription dose. RESULTS Nine patients were treated with this approach, receiving 45 Gy in 20 fractions. A simultaneous integrated boost of 2.5 Gy in 20 fractions was delivered in 6/9 patients. Dose constraints and planning objectives were reported. No severe toxicity was reported while local control and overall survival were 100%. CONCLUSION The POLO approach is technically feasible and capable to achieve a significant reduction of radiation dose delivered to the previous treated IOERT area. ADVANCES IN KNOWLEDGE The study demonstrates the technical and dosimetric feasibility of conservative salvage whole breast radiotherapy, while sparing the area already treated with IORT, in patients with in-breast recurrence.
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Affiliation(s)
| | - Andriana Kouloura
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Maria Alessia Zerella
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Maria Camarda
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rosa Luraschi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Viola
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Eleonora Miglietta
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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50
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Wang L, Sun M, Yang S, Chen Y, Li T. Intraoperative Radiotherapy Is Not a Better Alternative to Whole Breast Radiotherapy as a Therapeutic Option for Early-Stage Breast Cancer. Front Oncol 2021; 11:737982. [PMID: 34976796 PMCID: PMC8716392 DOI: 10.3389/fonc.2021.737982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Intraoperative radiotherapy (IORT) in early-stage breast cancer has been studied over the years. However, it has not been demonstrated whether IORT is more suitable as a therapeutic option for early-stage breast cancer than whole breast radiotherapy (WBRT). Therefore, we performed a meta-analysis to compare the efficacy and safety of IORT to those of WBRT as therapeutic options for early-stage breast cancer patients receiving breast-conserving surgery (INPLASY2020120008). Methods PubMed, Embase, and Cochrane Library databases were searched from inception to October 2021. Computerized and manual searches were adopted to identify eligible randomized control trials from online databases. Risk ratio (RR) and 95% confidence intervals (CI) were calculated by random-effect models to assess the relative risk. Potential publication bias was quantified by Begg’s and Egger’s tests. Results Based on our inclusion criteria, 10 randomized control trials involving 5,698 patients were included in this meta-analysis. This meta-analysis showed that the IORT group was associated with a higher local recurrence risk (RR = 2.111, 95% CI, 1.130–3.943, p = 0.0191), especially in the long-term follow-up subgroup or published after 2020 subgroup or Caucasian subgroup (RR = 2.404, 95% CI, 1.183–4.885, p = 0.0154). Subgroup analysis showed that the IORT group had a higher recurrence risk than the WBRT group in the polycentric randomized controlled trial subgroup (RR = 1.213, 95% CI, 1.030–1.428, p = 0.0204). Pooled analysis showed that there was no statistically significant difference in overall survival, recurrence-free survival, distant metastasis-free survival, and cancer-specific survival between IORT and WBRT groups. Additionally, the risk of skin toxicity was reduced, but the incidences of fat toxicity, edema, and scar calcification were significantly increased in the patients who underwent IORT in comparison to those who underwent WBRT. Conclusion This meta-analysis revealed that IORT was not a better alternative to WBRT. More large-scale and well-designed clinical trials with longer follow-up periods are encouraged to further investigate the value of IORT. Systematic Review Registration https://inplasy.com/inplasy-2020-12-0008/.
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Affiliation(s)
- Linwei Wang
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors/Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Min Sun
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Shuailong Yang
- Department of Radiation and Medical Oncology, The Central Hospital of Wuhan, Wuhan, China
| | - Yuanyuan Chen
- Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors/Hubei Cancer Clinical Study Center, Zhongnan Hospital, Wuhan University, Wuhan, China
- *Correspondence: Tian Li, ; Yuanyuan Chen,
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi’an, China
- *Correspondence: Tian Li, ; Yuanyuan Chen,
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