1
|
Bruand M, Salleron J, Guihard S, Crety CM, Liem X, Pasquier D, Lamrani-Ghaouti A, Charra-Brunaud C, Peiffert D, Clavier JB, Desandes E, Faivre JC. Acute skin toxicity of conventional fractionated versus hypofractionated radiotherapy in breast cancer patients receiving regional node irradiation: the real-life prospective multicenter HYPOBREAST cohort. BMC Cancer 2022; 22:1318. [PMID: 36526987 PMCID: PMC9755801 DOI: 10.1186/s12885-022-10402-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Large-scale trials have shown that hypofractionated adjuvant breast radiotherapy was as effective in terms of survival and local control as conventional fractionated radiotherapy, and acute toxicity was reduced with hypofractionated radiotherapy. However, there is a lack of data about the toxicity of breast with regional nodal irradiation (RNI). The aim of this study was to assess the effect of fractionation on radiation-related acute skin toxicity in patients receiving RNI in addition to whole-breast or chest wall irradiation, using real-life data. METHODS We conducted a prospective, multicenter cohort study with systematic computerized data collection integrated into Mosaiq®. Three comprehensive cancer centers used a standardized form to prospectively collect patient characteristics, treatment characteristics and toxicity. RESULTS Between November 2016 and January 2022, 1727 patients were assessed; 1419 (82.2%) and 308 (17.8%) patients respectively received conventional fractionated and hypofractionated radiation therapy. Overall, the incidence of acute grade 2 or higher dermatitis was 28.4% (490 patients). Incidence was lower with hypofractionated than with conventional fractioned radiation therapy (odds ratio (OR) 0.34 [0.29;0.41]). Two prognostic factors were found to increase the risk of acute dermatitis, namely 3D (vs IMRT) and breast irradiation (vs chest wall). CONCLUSION Using real-life data from unselected patients with regional nodal irradiation, our findings confirm the decreased risk of dermatitis previously reported with hypofractionated radiation therapy in clinical trials. Expansion of systematic data collection systems to include additional centers as well as dosimetric data is warranted to further evaluate the short- and long-term effects of fractionation in real life.
Collapse
Affiliation(s)
- Marie Bruand
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France ,grid.29172.3f0000 0001 2194 6418EA 4360 APEMAC, Université de Lorraine, Nancy, France
| | - Julia Salleron
- grid.452436.20000 0000 8775 4825Unité de biostatistiques, Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - Sébastien Guihard
- grid.512000.6Service de Radiothérapie, ICANS - Institut de Cancérologie Strasbourg Europe, 67200 Strasbourg, France
| | - Charles Marchand Crety
- grid.418448.50000 0001 0131 9695Service de Radiothérapie, Institut Jean Godinot, 51100 Reims, France
| | - Xavier Liem
- grid.452351.40000 0001 0131 6312Service de Radiothérapie, Centre Oscar Lambret, 59000 Lille, France
| | - David Pasquier
- grid.452351.40000 0001 0131 6312Service de Radiothérapie, Centre Oscar Lambret, 59000 Lille, France ,grid.503422.20000 0001 2242 6780RIStAL, UMR 9189, Université de Lille, 59000 Lille, France
| | | | - Claire Charra-Brunaud
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France
| | - Didier Peiffert
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France ,grid.29172.3f0000 0001 2194 6418EA 4360 APEMAC, Université de Lorraine, Nancy, France
| | - Jean-Baptiste Clavier
- grid.512000.6Service de Radiothérapie, ICANS - Institut de Cancérologie Strasbourg Europe, 67200 Strasbourg, France
| | - Emmanuel Desandes
- grid.29172.3f0000 0001 2194 6418EA 4360 APEMAC, Université de Lorraine, Nancy, France ,grid.452436.20000 0000 8775 4825Service en Charge des Données de Santé, Institut de Cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - Jean-Christophe Faivre
- grid.452436.20000 0000 8775 4825Academic Department of Radiation Therapy & Brachytherapy, Institut de Cancérologie de Lorraine – Unicancer, 6 avenue de Bourgogne - CS, 30 519 54519 Vandoeuvre-lès-Nancy cedex, France
| |
Collapse
|
2
|
Kim N, Kim YB. Journey to hypofractionation in radiotherapy for breast cancer: critical reviews for recent updates. Radiat Oncol J 2022; 40:216-224. [PMID: 36606299 PMCID: PMC9830038 DOI: 10.3857/roj.2022.00577] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/11/2022] [Indexed: 12/27/2022] Open
Abstract
Historical conventional fractionated radiation therapy (RT) for breast cancer consisted of 1.8-2.0 Gy per fraction with a total dose of 45-60 Gy over 5-7 weeks. Based on radiobiological characteristics, a low α/β is suspected of breast cancer resulting in sensitivity to higher dose per fraction (2.5-3.0 Gy). Over the past 10 years, multiple clinical trials support the application of shorter treatment regimen with hypofractionated RT (HypoRT). Recently, ultra-HypoRT with 5 fractions showed favorable outcomes. Although the safety and efficacy of HypoRT has been supported by high-quality randomized trials, there are still some worries and doubts around HypoRT from radiation oncologists. However, the radiation oncology community have now reached an important timepoint for adopting HypoRT during the COVID-19 pandemic. The aim of this review is to provide an overview of HypoRT in breast cancer based on prospective randomized trials and discuss the special consideration regarding HypoRT.
Collapse
Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea,Correspondence: Yong Bae Kim Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-8095 Fax: +82-2-2227-7823, E-mail:
| |
Collapse
|
3
|
Tramacere F, Arcangeli S, Colciago RR, Lucchini R, Pati F, Portaluri M. Outcomes and toxicity following post-operative hypofractionated radiotherapy to the regional nodes and the breast or the chest wall in locally advanced breast cancer. Br J Radiol 2022; 95:20211299. [PMID: 35522785 DOI: 10.1259/bjr.20211299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We aimed to analyze the impact of a 3-week schedule of HypoFractionated (HF) radiotherapy (RT) after axillary dissection and breast surgery, in terms of safety and efficacy in patients with locally advanced breast cancer (BC). METHODS Eligible patients were females with Stage IIA - IIIC BC who underwent axillary dissection and breast surgery, either quadrantectomy or mastectomy. HF RT was delivered in 15 or 16 fractions for a total dose of 40.05 Gy or 42.56 Gy, respectively, to the clavicular nodal region along with the whole breast (HF WBRT) or the chest wall (HF PMRT), according to the type of surgery. Locoregional recurrence (LRR), distant metastases-free survival (DMFS), overall survival (OS) and acute and late treatment-related toxicities were estimated. RESULTS 57 patients with a median age of 60 years (32-85) were retrospectively analyzed. 34 (60%) of patients underwent breast conservative surgery in the form of quadrantectomy and 23 (40%) were offered radical mastectomy. All patients underwent hypofractionated regional nodal irradiation (HF RNI). 34 (60%) of them underwent HF WBRT, while 23 (40%) received HF PMRT.At a median follow-up of 80 months (30-113), the 7-year LRR-free survival was 93% (95% CI, 74%-95%). The same features for DMFS and OS were 76% (95% CI, 52%-78%) and 67% (95% CI, 50%-80%), respectively. Only one (2%) patient experienced G3 acute skin toxicity. No grade ≥2 late toxicity was observed. CONCLUSION Our study shows that HF RNI with HF RT to the whole breast or the chest wall after breast surgery is safe and effective in patients with locally advanced BC. Longer follow-up is needed to strengthen further analyses on late toxicity and clinical outcomes. ADVANCES IN KNOWLEDGE This paper adds to the evidence that post-operative RNI with WBRT or PMRT can be safely and effectively delivered with 3-week HF regimen. Locally advanced BC patients can be offered HF RT to the regional nodes and the breast or the chest wall regardless the type of surgery.
Collapse
Affiliation(s)
| | - Stefano Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery - University of Milan Bicocca, Milan, Italy
| | - Riccardo Ray Colciago
- Department of Radiation Oncology, School of Medicine and Surgery - University of Milan Bicocca, Milan, Italy
| | - Raffaella Lucchini
- Department of Radiation Oncology, School of Medicine and Surgery - University of Milan Bicocca, Milan, Italy
| | - Francesca Pati
- Department of Radiation Oncology, ASL A. Perrino, Brindisi, Italy
| | | |
Collapse
|
4
|
Tumor draining lymph nodes, immune response, and radiotherapy: Towards a revisal of therapeutic principles. Biochim Biophys Acta Rev Cancer 2022; 1877:188704. [DOI: 10.1016/j.bbcan.2022.188704] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/06/2022] [Accepted: 02/21/2022] [Indexed: 12/20/2022]
|
5
|
Corrigan KL, Lei X, Ahmad N, Arzu I, Bloom E, Chun SG, Goodman C, Hoffman KE, Joyner M, Mayo L, Mitchell M, Nead KT, Perkins GH, Reed V, Reddy JP, Schlembach P, Shaitelman SF, Stauder MC, Strom EA, Tereffe W, Wiederhold L, Woodward WA, Smith BD. Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer. Adv Radiat Oncol 2022; 7:100877. [PMID: 35387420 PMCID: PMC8977907 DOI: 10.1016/j.adro.2021.100877] [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: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction The first high-quality clinical trial to support ultrahypofractionated whole-breast irradiation (ultra-HF-WBI) for invasive early-stage breast cancer (ESBC) was published in April 2020, coinciding with the beginning of the COVID-19 pandemic. We analyzed adoption of ultra-HF-WBI for ductal carcinoma in situ (DCIS) and ESBC at our institution after primary trial publication. Methods and Materials We evaluated radiation fractionation prescriptions for all patients with DCIS or ESBC treated with WBI from March 2020 to May 2021 at our main campus and regional campuses. Demographic and clinical characteristics were extracted from the electronic medical record. Treating physician characteristics were collected from licensure data. Hierarchical logistic regression models identified factors correlated with adoption of ultra-HF-WBI (26 Gy in 5 daily factions [UK-FAST-FORWARD] or 28.5 Gy in 5 weekly fractions [UK-FAST]). Results Of 665 included patients, the median age was 61.5 years, and 478 patients (71.9%) had invasive, hormone-receptor-positive breast cancer. Twenty-one physicians treated the included patients. In total, 249 patients (37.4%) received ultra-HF-WBI, increasing from 4.3% (2 of 46) in March-April 2020 to a high of 45.5% (45 of 99) in July-August 2020 (P < .001). Patient factors associated with increased use of ultra-HF-WBI included older age (≥50 years old), low-grade WBI without inclusion of the low axilla, no radiation boost, and farther travel distance (P < .03). Physician variation accounted for 21.7% of variance in the outcome, with rate of use of ultra-HF-WBI by the treating physicians ranging from 0% to 75.6%. No measured physician characteristics were associated with use of ultra-HF-WBI. Conclusions Adoption of ultra-HF-WBI at our institution increased substantially after the publication of randomized evidence supporting its use. Ultra-HF-WBI was preferentially used in patients with lower risk disease, suggesting careful selection for this new approach while long-term data are maturing. Substantial physician-level variation may reflect a lack of consensus on the evidentiary standards required to change practice.
Collapse
|
6
|
Fastner G, Krug D, Meattini I, Gruber G, Poortmans P. Expert Discussion: Hypofractionated Radiation Therapy - Standard for All Indications? Breast Care (Basel) 2021; 17:224-231. [PMID: 35707177 PMCID: PMC9149542 DOI: 10.1159/000521552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, Paracelsus Medical University, University Hospital Salzburg, Landeskrankenhaus Salzburg, Salzburg, Austria
- *Gerd Fastner,
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig Holstein, Kiel, Germany
| | - 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
| | - Günther Gruber
- Institute of Radiotherapy, Klinik Hirslanden, Zurich, Switzerland
- University of Berne, Berne, Switzerland
| | - Philip Poortmans
- Iridium Netwerk, Wilrijk-Antwerp, Belgium
- University of Antwerp, Wilrijk-Antwerp, Belgium
| |
Collapse
|
7
|
Accelerated hypofractionated radiotherapy for chest wall and nodal irradiation using hybrid techniques. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
This study compares three different hybrid plans, for left-sided chest wall (CW) and nodal stations irradiation using a hypofractionated dose regimen.
Materials and methods:
Planning target volumes (PTVs) of 25 breast cancer patients that included CW, supraclavicular (SCL) and internal mammary node (IMN) were planned with 3 different hybrid techniques: 3DCRT+IMRT, 3DCRT+VMAT and IMRT+VMAT. All hybrid plans were generated with a hypofractionated dose prescription of 40·5 Gy in 15 fractions. Seventy per cent of the dose was planned with the base-dose component and remaining 30% of the dose was planned with the hybrid component. All plans were evaluated based on the PTVs and organs at risk (OARs) dosimetric parameters.
Results:
The results for PTVs parameters have shown that the 3DCRT+IMRT and 3DCRT+VMAT plans were superior in uniformity index to the IMRT+VMAT plan. The OARs dose parameters were comparable between hybrid plans. The IMRT+VMAT plan provided a larger low dose volume spread to the heart and ipsilateral lung (p < 0·001). The 3DCRT+VMAT plan required less monitor units and treatment time (p = 0·005) than other plans.
Conclusion:
The 3DCRT+VMAT hybrid plan showed superior results with efficient treatment delivery and provide clinical benefit by reducing both low and high dose levels.
Collapse
|
8
|
Krug D, Vonthein R, Schreiber A, Boicev AD, Zimmer J, Laubach R, Weidner N, Dinges S, Hipp M, Schneider R, Weinstrauch E, Martin T, Hörner-Rieber J, Olbrich D, Illen A, Heßler N, König IR, Dellas K, Dunst J. Impact of guideline changes on adoption of hypofractionation and breast cancer patient characteristics in the randomized controlled HYPOSIB trial. Strahlenther Onkol 2020; 197:802-811. [PMID: 33320286 PMCID: PMC8397631 DOI: 10.1007/s00066-020-01730-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
Purpose Hypofractionated radiotherapy is the standard of care for adjuvant whole breast radiotherapy (RT). However, adoption has been slow. The indication for regional nodal irradiation has been expanded to include patients with 0–3 involved lymph nodes. We investigated the impact of the publication of the updated German S3 guidelines in 2017 on adoption of hypofractionation and enrollment of patients with lymph node involvement within a randomized controlled phase III trial. Methods In the experimental arm of the HYPOSIB trial (NCT02474641), hypofractionated RT with simultaneous integrated boost (SIB) was used. In the standard arm, RT could be given as hypofractionated RT with sequential boost (HFseq), normofractionated RT with sequential boost (NFseq), or normofractionated RT with SIB (NFSIB). The cutoff date for the updated German S3 guidelines was December 17, 2017. Temporal trends were analyzed by generalized linear regression models. Multiple logistic regression models were used to investigate the influence of time (prior to/after guideline) and setting (university hospital/other institutions) on the fractionation patterns. Results Enrollment of patients with involved lymph nodes was low throughout the trial. Adoption of HFseq increased over time and when using the guideline publication date as cutoff. Results of the multiple logistic regressions showed an interaction between time and setting. Furthermore, the use of HFseq was significantly more common in university hospitals. Conclusion The use of HFseq in the standard arm increased over the course of the HYPOSIB trial and after publication of the S3 guideline update. This was primarily driven by patients treated in university hospitals. Enrolment of patients with lymph node involvement was low throughout the trial.
Collapse
Affiliation(s)
- David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
| | - Reinhard Vonthein
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Andreas Schreiber
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Alexander D Boicev
- Klinik für Strahlentherapie und Radioonkologie, Heinrich-Braun-Klinikum Zwickau, Zwickau, Germany
| | - Jörg Zimmer
- Praxis für Strahlentherapie Dr. med. Andreas Schreiber, Dresden, Germany
| | - Reinhold Laubach
- Klinik für Radio-Onkologie, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Nicola Weidner
- Klinik für Strahlentherapie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Stefan Dinges
- Klinik für Strahlentherapie & Radioonkologie, Klinikum Lüneburg, Lüneburg, Germany
| | - Matthias Hipp
- Klinik für Strahlentherapie, Klinikum Amberg, Amberg, Germany
| | - Ralf Schneider
- Klinik für Strahlentherapie, Helios-Kliniken Schwerin, Schwerin, Germany
| | - Evelyn Weinstrauch
- Praxis für Radioonkologie, Johanniter-Zentren für Medizinische Versorgung Stendal, Stendal, Germany
| | - Thomas Martin
- Medizinisches Versorgungszentrum Fachbereich RadioOnkologie, Klinikum Bremen-Mitte, Bremen, Germany
| | - Juliane Hörner-Rieber
- RadioOnkologie und Strahlentherapie, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Denise Olbrich
- ZKS Lübeck (Zentrum für klinische Studien Lübeck), Universität zu Lübeck, Lübeck, Germany
| | - Alicia Illen
- ZKS Lübeck (Zentrum für klinische Studien Lübeck), Universität zu Lübeck, Lübeck, Germany
| | - Nicole Heßler
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Inke R König
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Kathrin Dellas
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jürgen Dunst
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| |
Collapse
|
9
|
Harris SR, Tugwell KE. Neurological and Dexterity Assessments in a Woman with Radiation-Induced Brachial Plexopathy After Breast Cancer. Oncologist 2020; 25:e1583-e1585. [PMID: 32525604 DOI: 10.1634/theoncologist.2019-0875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this case report is to inform clinicians about radiation-induced brachial plexopathy, a rare complication that often presents well after treatment with inconsistent symptoms and manifestations. It is often a diagnosis of exclusion when a neoplastic or other cause cannot be identified. Electrodiagnostic testing is particularly useful. Here, the results of a standardized grip and pinch strength assessment and dexterity test are presented in a woman whose symptoms first appeared 20 years after completing treatments for stage IIIA breast cancer.
Collapse
Affiliation(s)
- Susan R Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen E Tugwell
- Physical Therapy Department, St. Paul's Hospital, Vancouver, BC, Canada
| |
Collapse
|
10
|
Yadav BS, Bansal A, Kuttikat PG, Das D, Gupta A, Dahiya D. Late-term effects of hypofractionated chest wall and regional nodal radiotherapy with two-dimensional technique in patients with breast cancer. Radiat Oncol J 2020; 38:109-118. [PMID: 33012154 PMCID: PMC7533408 DOI: 10.3857/roj.2020.00129] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/04/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Hypofractionated radiotherapy (RT) is becoming a new standard in postoperative treatment of patients with early stage breast cancer after breast conservation surgery. However, data on hypofractionation in patients with advanced stage disease who undergo mastectomy followed by local and regional nodal irradiation (RNI) is lacking. In this retrospective study, we report late-term effects of 3 weeks post-mastectomy hypofractionated local and RNI with two-dimensional (2D) technique in patients with stage II and III breast cancer. METHODS Between January 1990 and December 2007, 1,770 women with breast cancer who were given radical treatment with mastectomy, systemic therapy and RT at least 10 years ago were included. RT dose was 35 Gy/15 fractions/3 weeks to chest wall by two tangential fields and 40 Gy in same fractions to supraclavicular fossa (SCF) and internal mammary nodes (IMNs). SCF and IMNs dose was prescribed at dmax and 3 cm depth, respectively. Chemotherapy and hormonal therapy was given in 64% and 74% patients, respectively. Late-term toxicities were assessed with the Radiation Therapy Oncology Group (RTOG) scores and LENT-SOMA scales (the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic scales). RESULTS Mean age was 48 years (range, 19 to 75 years). Median follow-up was 12 years (range, 10 to 27 years). Moderate/marked arm/shoulder pain was reported by 254 (14.3%) patients. Moderate/marked shoulder stiffness was reported by 219 (12.3%) patients. Moderate/marked arm edema was seen in 131 (7.4%) patients. Brachial plexopathy was not seen in any patient. Rib fractures were noted in 6 (0.3%) patients. Late cardiac and lung toxicity was seen in 29 (1.6%) and 23 (1.3%) patients, respectively. Second malignancy developed in 105 (5.9%) patients. CONCLUSION RNI with 40 Gy/15 fractions/3 weeks hypofractionation with 2D technique seems safe and comparable to historical data of conventional fractionation (ClinicalTrial.gov Registration No. XXXX).
Collapse
Affiliation(s)
- Budhi Singh Yadav
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Anshuma Bansal
- Department of Radiation Oncology, Rajindra Hospital, Patiala, Punjab, India
| | - Philip George Kuttikat
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Deepak Das
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ankita Gupta
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Divya Dahiya
- Department of General Surgery, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
11
|
Chan S, Sutradhar R, Yao Z, Chow E, Lee J, Wan BA, Paszat L. Fractionation in adjuvant radiotherapy for invasive breast cancer and ductal carcinoma in situ in Ontario, Canada from 2009 to 2015. Breast J 2019; 26:602-616. [DOI: 10.1111/tbj.13515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/09/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Stephanie Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre University of Toronto Toronto ON Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences Toronto ON Canada
| | - Zhan Yao
- Institute for Clinical Evaluative Sciences Toronto ON Canada
| | - Edward Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre University of Toronto Toronto ON Canada
| | - Justin Lee
- Odette Cancer Centre, Sunnybrook Health Sciences Centre University of Toronto Toronto ON Canada
| | - Bo Angela Wan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre University of Toronto Toronto ON Canada
| | - Lawrence Paszat
- Odette Cancer Centre, Sunnybrook Health Sciences Centre University of Toronto Toronto ON Canada
- Institute for Clinical Evaluative Sciences Toronto ON Canada
| |
Collapse
|
12
|
Chan TY, Tang JI, Tan PW, Roberts N. Dosimetric evaluation and systematic review of radiation therapy techniques for early stage node-negative breast cancer treatment. Cancer Manag Res 2018; 10:4853-4870. [PMID: 30425577 PMCID: PMC6205528 DOI: 10.2147/cmar.s172818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Radiation therapy (RT) is essential in treating women with early stage breast cancer. Early stage node-negative breast cancer (ESNNBC) offers a good prognosis; hence, late effects of breast RT becomes increasingly important. Recent literature suggests a potential for an increase in cardiac and pulmonary events after RT. However, these studies have not taken into account the impact of newer and current RT techniques that are now available. Hence, this review aimed to evaluate the clinical evidence for each technique and determine the optimal radiation technique for ESNNBC treatment. Currently, six RT techniques are consistently used and studied: 1) prone positioning, 2) proton beam RT, 3) intensity-modulated RT, 4) breath-hold, 5) partial breast irradiation, and 6) intraoperative RT. These techniques show dosimetric promise. However, limited data on late cardiac and pulmonary events exist due to challenges in long-term follow-up. Moving forward, future studies are needed to validate the efficacy and clinical outcomes of these current techniques.
Collapse
Affiliation(s)
- Tabitha Y Chan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Johann I Tang
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Poh Wee Tan
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore,
| | - Neill Roberts
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
13
|
Pazos M, Schönecker S, Reitz D, Rogowski P, Niyazi M, Alongi F, Matuschek C, Braun M, Harbeck N, Belka C, Corradini S. Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer. Breast Care (Basel) 2018; 13:285-291. [PMID: 30319331 DOI: 10.1159/000488189] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Radiation therapy (RT) for breast cancer has dramatically changed over the past years, leading to individualized risk-adapted treatment strategies. Historically, the choice of RT regimen was limited to conventional fractionation protocols using standard tangential fields. Nowadays, technological and technical improvements in modern RT have added a variety of other RT modalities, different fractionation schedules, and individualised treatment volumes to the portfolio of breast RT. This review aims to give a short overview on the main topics which have recently found their way into clinical practice: hypofractionated treatment protocols, accelerated partial breast irradiation (APBI) for low-risk patients, deep inspiration breath hold (DIBH) for maximal heart protection, extent of regional nodal irradiation for high-risk patients, and the implementation of new radiation techniques such as intensity modulated RT (IMRT) and volumetric modulated RT (VMAT).
Collapse
Affiliation(s)
- Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Filippo Alongi
- Department of Radiation Oncology, Sacro Cuore Don Calbria Negrar, Verona, Italy.,University of Brescia, Brescia, Italy
| | - Christiane Matuschek
- Department of Radiation Oncology, Heinrich Heine University, Düsseldorf, Germany
| | - Michael Braun
- Department of Gynecology and Obstetrics, Red Cross Hospital, Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
14
|
Yadav BS, Sharma SC. A Phase 2 Study of 2 Weeks of Adjuvant Whole Breast/Chest Wall and/or Regional Nodal Radiation Therapy for Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2018; 100:874-881. [PMID: 29485066 DOI: 10.1016/j.ijrobp.2017.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/12/2017] [Accepted: 11/23/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the results in terms of feasibility and early toxicity of hypofractionated adjuvant whole breast/chest wall and/or regional nodal radiation therapy for patients with breast cancer. METHODS AND MATERIALS From June 2013 to October 2014, 50 patients with breast cancer after mastectomy or after breast conservation surgery (BCS) were prospectively included. The institutional ethics committee approved the study, which was registered with ClinicalTrials.gov (ClinicalTrials.gov identifier no. NCT02460744). Treatment planning was performed using a simulator with 2 tangential fields to the breast/chest wall and an incident field to the supraclavicular fossa. The radiation dose delivered was 34 Gy in 10 fractions within 2 weeks, followed by a boost of 10 Gy in 5 fractions within 1 week for patients who underwent BCS. Acute skin toxicities were recorded during and after treatment according to the Radiation Therapy Oncology Group acute radiation toxicity scoring criteria. The primary objective was to obtain estimates of the acute toxicity rates and cosmetic outcomes that could be used to design a subsequent phase III comparative study. Acute skin and late toxicities were recorded during and after treatment. Cosmetic outcomes were assessed before and after treatment and during the regular follow-up period. A cost/benefit analysis was also performed and compared with that for standard treatment of 35 Gy in 15 fractions within 3 weeks. RESULTS The median follow-up was 39 months (range 14-48). The mean age was 51 years (range 26-75). A left-sided tumor was present in 25 patients (50%). Total mastectomy with axillary clearance was performed in 40 (80%) and BCS in 10 (20%) patients. Acute grade 2 and 3 skin toxicity was seen in 16 (32%) and 1 (2%) patient, respectively. In the BCS patients, grade 2 skin and subcutaneous toxicity was seen in 2 (20%) and 1 (10%) patient, respectively. Grade 2 edema was seen in 1 patient (10%). The cosmesis was excellent or good in 8 (80%) and fair or poor in 2 (20%) patients. The cost/benefit analysis revealed significantly less financial burden on the patients with 2 weeks of treatment. Disease-free and overall survival at 3 years was 94% and 96%, respectively. CONCLUSIONS Hypofractionated radiation therapy within 2 weeks appears to be feasible for patients with breast cancer and was associated with acute and late skin toxicity profiles similar to those observed with 3 weeks of treatment. The financial burden on the patient and family could be reduced with 2 weeks of treatment. Long-term follow-up data and a prospective comparative study are needed to strengthen these results. Hypofractionation might help radiation centers worldwide to meet the increasing need for radiation for breast cancer, especially in developing countries where resources are limited and patients must travel long distances for treatment.
Collapse
Affiliation(s)
- Budhi Singh Yadav
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Suresh C Sharma
- Department of Radiation Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India; Department of Radiotherapy, Maharishi Markandeshwar Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Mullana-Ambala, India
| |
Collapse
|
15
|
Orecchia R, Rojas DP, Cattani F, Ricotti R, Santoro L, Morra A, Cambria R, Luraschi R, Dicuonzo S, Ronchi S, Surgo A, Dell' Acqua V, Veronesi P, De Lorenzi F, Fodor C, Leonardi MC, Jereczek-Fossa BA. Hypofractionated postmastectomy radiotherapy with helical tomotherapy in patients with immediate breast reconstruction: dosimetric results and acute/intermediate toxicity evaluation. Med Oncol 2018; 35:39. [PMID: 29442173 DOI: 10.1007/s12032-018-1095-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the dosimetry and toxicity of hypofractionation in postmastectomy radiotherapy (PMRT) with intensity-modulated radiotherapy (IMRT) in breast cancer (BC) patients. Stage II-III BC patients with implant-based immediate breast reconstruction received PMRT to the chest wall (CW) and to the infra/supraclavicular nodal region (NR) using a 15-fraction schedule (2.67 Gy/fraction) and helical IMRT (Tomotherapy® System, Accuray Incorporated, Sunnyvale, CA). A score was assigned to each treatment plan in terms of planning target volume (PTV) coverage of CW and NR and the sparing of the organs at risk (OARs). The total score for each plan was calculated. Toxicity was prospectively assessed according to validated scales. Data from 120 consecutive patients treated in the period 2012-2015 were analysed with a median follow-up from the end of radiotherapy of 13.2 months (range 0.0-35 months). 70.8% (85/120) of the plans had high total scores as a result of an optimal coverage of both CW and RN and optimal sparing of all OARs. The maximum acute toxicity was of grade 2 in 36.7% of the cases. Early late toxicity was mild in the majority of cases. In the study population, helical tomotherapy-based IMRT produced optimal treatment plans in most cases. Acute and late toxicity was mild/moderate. Hypofractionated helical IMRT appears to be safe and feasible in the moderate term for PMRT.
Collapse
Affiliation(s)
- Roberto Orecchia
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Damaris Patricia Rojas
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Raffaella Cambria
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosa Luraschi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Samantha Dicuonzo
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Sara Ronchi
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Alessia Surgo
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Veronica Dell' Acqua
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - Francesca De Lorenzi
- Division of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - Maria Cristina Leonardi
- Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiation Oncology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| |
Collapse
|
16
|
Rice L, Goldsmith C, Green MM, Cleator S, Price PM. An effective deep-inspiration breath-hold radiotherapy technique for left-breast cancer: impact of post-mastectomy treatment, nodal coverage, and dose schedule on organs at risk. BREAST CANCER-TARGETS AND THERAPY 2017; 9:437-446. [PMID: 28652810 PMCID: PMC5476442 DOI: 10.2147/bctt.s130090] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background We developed, applied, and prospectively evaluated a novel deep-inspiration breath-hold (DIBH) screening and delivery technique to optimize cardiac sparing in left-breast radiotherapy (RT) at our clinic. The impact of set-up and dose variables upon organs at risk (OAR) dose in DIBH RT was investigated. Methods and materials All patients with left-breast cancer referred between 2011 and 2014 – of all disease stages, set-up variations, and dose prescriptions – were included. Radiographers used simple screening criteria at CT simulation, to systematically assess patients for obvious DIBH benefit and capability. Selected patients received forward-planned intensity-modulated RT (IMRT) based on a DIBH CT scan. A 3D-surface monitoring system with visual feedback assured reproducible DIBH positioning during gated radiation delivery. Patient, target set-up, and OAR dose information were collected at treatment. Results Of 272 patients who were screened, 4 withdrew, 56 showed no obvious advantage, and 56 showed benefit but had suitability issues; 156 patients were selected and successfully completed DIBH treatment. The technique was compatible with complex set-up and optimal target coverage was maintained. Comparison of free-breathing (FB) and DIBH treatment plans in the first five patients enrolled confirmed DIBH reduced heart radiation by ~80% (p = 0.032). Low OAR doses were achieved overall: the mean (95% confidence interval [CI]) heart dose was 1.17 (1.12–1.22) Gy, and the mean ipsilateral lung dose was 5.26 (5.01–5.52) Gy. Patients who underwent a standard radiation schedule (40 Gy/15#) after breast-conserving surgery had the lowest OAR doses: post-mastectomy treatment, simultaneous supraclavicular (SCV) node coverage, and alternative dose schedule (50 Gy/25#) were interrelated variables associated with increased OAR risk and compromised ipsilateral lung dose constraints. Conclusion The DIBH technique was successfully implemented and resulted in optimally low heart radiation. All patients who demonstrate sufficient DIBH technique at planning CT are now offered DIBH RT at our clinic. Patients with more advanced disease, particularly those with additional pulmonary risk factors, warrant additional focus to improve lung sparing.
Collapse
Affiliation(s)
- Lynsey Rice
- Department of Radiation Oncology, The Harley Street Clinic.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christy Goldsmith
- Department of Radiation Oncology, The Harley Street Clinic.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Melanie Ml Green
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Susan Cleator
- Department of Radiation Oncology, The Harley Street Clinic.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Patricia M Price
- Department of Radiation Oncology, The Harley Street Clinic.,Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
17
|
Prades J, Algara M, Espinàs JA, Farrús B, Arenas M, Reyes V, García-Reglero V, Cambra MJ, Rubio E, Anglada L, Eraso A, Pedro A, Fuentes-Raspall MJ, Tuset V, Solà J, Borras JM. Understanding variations in the use of hypofractionated radiotherapy and its specific indications for breast cancer: A mixed-methods study. Radiother Oncol 2017; 123:22-28. [PMID: 28236538 DOI: 10.1016/j.radonc.2017.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/23/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Radiation oncology guidelines favour hypofractionated whole-breast radiotherapy (HWBRT) over more conventional schemes in the conservative treatment of breast cancer, but its adoption still varies in clinical practice. This study assessed the patterns of HWBRT adoption in Catalonia (Spain). MATERIAL AND METHODS We used a mixed-methods approach based on an explanatory sequential design, first collecting and analysing quantitative data on HWBRT use (>2.5Gy per fraction) in 11 public radiotherapy centres (2005-2015) and then performing 25 semi-structured interviews with all department heads and reference radiation oncologist/s. RESULTS Of the 34,859 patients fulfiling the study criteria over the study period, just 12% were hypofractionated, reaching a percentage of 29% in 2015 (p<0.001). Our analysis showed a narrowing age gap between patients receiving conventional fractionation and hypofractionation in centres leading adoption. However, there were important differences in clinicians' interpretation of evidence (e.g. regarding the perceived risk of long-term toxicity) and selection of patients for specific indications, both within and between departments. CONCLUSIONS Differences observed in the rate of adoption of HWBRT could not be tackled only using a rational, evidence-based approach. Factors related to the management of radiotherapy departments play a major role in the diffusion of therapeutic strategies.
Collapse
Affiliation(s)
- Joan Prades
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
| | - Manel Algara
- Department of Radiation Oncology, Parc de Salut Mar. University Pompeu Fabra (UPF). Hospital del Mar Medical Research Institute (IMIM). Barcelona, Spain
| | - Josep A Espinàs
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
| | - Blanca Farrús
- Department of Radiation Oncology, Hospital Clínic, Barcelona, Spain
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Spain; University of Rovira and Virgili (URV), Reus, Spain
| | - Victoria Reyes
- Department of Radiation Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Maria Josep Cambra
- Department of Radiation Oncology, Institut Oncològic del Vallés, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Terrassa, Spain
| | - Esther Rubio
- Department of Radiation Oncology, Institut Oncològic del Vallés, Consorci Sanitari de Terrassa, Spain
| | - Lluis Anglada
- Dept. of Radiation Oncology, Catalan Institut of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Arantxa Eraso
- University of Barcelona (IDIBELL), Spain; Department of Radiation Oncology, Catalan Institute of Oncology, L'Hospitalet, Spain
| | - Agustí Pedro
- Department of Radiation Oncology, Hospital Plató, Barcelona, Spain
| | | | - Victòria Tuset
- Department of Radiation Oncology, ICO Badalona. Hospital Universitari Germans Trias i Pujol; Badalona, Spain
| | - Judit Solà
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain
| | - Josep M Borras
- Catalonian Cancer Strategy, Department of Health, Barcelona, Spain; University of Barcelona (IDIBELL), Spain.
| |
Collapse
|
18
|
Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis. Int J Radiat Oncol Biol Phys 2016; 97:287-295. [PMID: 27986343 DOI: 10.1016/j.ijrobp.2016.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/14/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system. METHODS AND MATERIALS We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population. RESULTS The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model. CONCLUSIONS Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.
Collapse
|
19
|
Kouloulias V, Mosa E, Zygogianni A, Kypraiou E, Georgakopoulos J, Platoni K, Antypas C, Kyrgias G, Tolia M, Papadimitriou C, Psyrri A, Patatoukas G, Dilvoi M, Armpilia C, Theodorou K, Kalogeridi MA, Beli I, Kouvaris J, Kelekis N. A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer. Breast Care (Basel) 2016; 11:328-332. [PMID: 27920625 DOI: 10.1159/000449433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The aim of this analysis was a retrospective evaluation of the efficacy and toxicity of 2 hypofractionated irradiation schedules compared to conventional therapy in post-mastectomy patients. METHODS 3 irradiation schedules were analyzed: 48.30 Gy in 21 fractions (group A, n = 60), 42.56 Gy in 16 fractions (group B, n = 27) and 50 Gy in 25 fractions (group C, n = 30) of the front chest wall. All groups were also treated with a supraclavicular field, with 39.10 Gy in 17 fractions (group A), 37.24 Gy in 14 fractions (group B) or 45 Gy in 25 fractions (group C). RESULTS No local recurrences were noted in any group during 36 months of follow-up. Acute skin toxicity presented in all groups, with 58.3%, 70.4% and 60% of grade I; 35%, 25.9% and 40% of grade II; 6.7%, 3.7% and 0% of grade III being seen in groups A, B and C, respectively. Late skin toxicity was noted only as grade I in 16.7%, 25.9% and 26.7% of groups A, B and C, respectively. No significant difference was noted among all groups for either acute or late skin toxicity, or for radio-pneumonitis (chi2 test, p > 0.05). CONCLUSION All schedules were equally effective with equivalent toxicity. A prospective randomized study is needed to confirm our results.
Collapse
Affiliation(s)
- Vassilis Kouloulias
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece; Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Eftychia Mosa
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Anna Zygogianni
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Efrosini Kypraiou
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - John Georgakopoulos
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Kalliopi Platoni
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Christos Antypas
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - George Kyrgias
- Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Maria Tolia
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece; Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Christos Papadimitriou
- Therapeutics Clinic, Alexandra Hospital, Medical School of Athens, Athens, Greece, Athens, Greece
| | - Amanda Psyrri
- Medical Oncology Unit, ATTIKON University Hospital, Athens, Greece
| | - George Patatoukas
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Maria Dilvoi
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Christina Armpilia
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Kyriaki Theodorou
- Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Maria-Aggeliki Kalogeridi
- Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Ivelina Beli
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - John Kouvaris
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Nikolaos Kelekis
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| |
Collapse
|
20
|
Mishra R, Khurana R, Mishra H, Rastogi M, Hadi R. Retrospective Analysis of Efficacy and Toxicity of Hypo-fractionated Radiotherapy in Breast Carcinoma. J Clin Diagn Res 2016; 10:XC01-XC03. [PMID: 27656543 DOI: 10.7860/jcdr/2016/20769.8350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The conventional dose fractionation of adjuvant radiotherapy (RT) to whole breast is 45-50 Gy in 25 fractions as 1.8-2.0-Gy per fraction. Lumpectomy cavity with a 1.5-2-cm margin receieves additional 10- 16 Gy doseas boost. Alternative dose fraction schedules used in various randomised trials have established the role of hypofractionated radiotherapy (HRT) in early breast cancer. HRT allows time and cost saving thus better patient compliance. However the efficacy and toxicity of HRT in locally advanced breast cancer is still under evaluation. AIM To study the toxicity and efficacy of Hypofractionated Radiotherapy (HRT) as compared to Conventional Radiotherapy (CRT) in breast cancer at our centre. MATERIALS AND METHODS A retrospective analysis of breast cancer patients treated between October 2012- September 2014 with adjuvant radiation therapy as CRT or HRT. The data of these patients was retrieved and analysed regarding demographic profile, stage at presentation, pathological type, extent of surgery, chemotherapy, efficacy and toxicity of HRT. The toxicity assessment was done as per RTOG toxicity criteria. The data were analysed using SPSS software version 20.0. RESULTS A total of 100 patients with carcinoma breast who received radiotherapy over two years were analysed. Age ranged from 18-90 years, mean 49.15 ± 12.7 years. Fifty-five patients were post-menopausal, predominant clinical feature was painless lump in the breast (98%). Early stage (Stage I and II) constituted 41%, locally advanced disease in 59%. Modified radical mastectomy was done in 75%, breast conserving surgery in 25%. A 56 patients received HRT and 44 were treated with CRT. The most common acute toxicity was skin grade I. An 18% patients in HRT arm and 30% patients in conventional arm developed grade II skin toxicity (p=0.23). Dysphagia grade I was seen in 10% cases in CRT arm and 12% in HRT arm. The median follow-up period was 11.3 months with 2 loco-regional failures in each arm. CONCLUSION HRT seems to be equally efficacious and no more toxic than CRT in carcinoma breast even in unselected sub-group of patients.
Collapse
Affiliation(s)
- Ritusha Mishra
- Senior Resident, Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Rohini Khurana
- Associate Professor, Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Himanshu Mishra
- Senior Resident, Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Madhup Rastogi
- Additional Professor, Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Rahat Hadi
- Associate Professor, Department of Radiation Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| |
Collapse
|
21
|
[Hypofractionated whole breast irradiation (WBRT): Results and indications]. Cancer Radiother 2016; 20:567-71. [PMID: 27614516 DOI: 10.1016/j.canrad.2016.07.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022]
Abstract
Breast irradiation after breast-conserving surgery is essential for maximizing local control and overall survival. The increase of breast cancer (BC) incidence, constraints of classical five weeks (w) radiation regimens and scarcity of radiotherapy units have led to test short hypofractionated WBRT schemes. One pilot study and three prospective randomized trials have tested various hypofractionated regimens of WBRT. About 7000 patients were included and follow-up ranged from 5 to 12 years. The conclusion of these trials is similar, showing local control and toxicity equivalent to these of the standard regimens. Three schemes are now clearly validated: 42.5Gy/16fr/3w, 40Gy/15fr/3w, or 42Gy/13fr/5w. However, the majority of included patients had favorable prognostic factors, were treated to the breast only and the boost dose, when indicated, was delivered with a standard fractionation. Therefore, we recommend the regimens preferentially in patients treated to the breast only, and without nodal involvement. These studies did not evaluate the addition of a boost dose with a hypofractionated scheme. If a boost is to be given, a standard fractionation should be used. Particular care should be taken to avoid heterogeneities leading to high fraction doses to organs at risk (lung and heart).
Collapse
|
22
|
Kim KS, Shin KH, Choi N, Lee SW. Hypofractionated whole breast irradiation: new standard in early breast cancer after breast-conserving surgery. Radiat Oncol J 2016; 34:81-7. [PMID: 27306774 PMCID: PMC4938347 DOI: 10.3857/roj.2016.01697] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 01/13/2023] Open
Abstract
Hypofractionated whole breast irradiation (HF-WBI) has been proved effective and safe and even better for late or acute radiation toxicity for early breast cancer. Moreover, it improves patient convenience, quality of life and is expected to be advantageous in the medical care system by reducing overall cost. In this review, we examined key randomized trials of HF-WBI, focusing on adequate patient selection as suggested by the American Society of Therapeutic Radiology and Oncology (ASTRO) guideline and the radiobiologic aspects of HF-WBI in relation to its adoption into clinical settings. Further investigation to identify the current practice pattern or cost effectiveness is warranted under the national health insurance service system in Korea.
Collapse
Affiliation(s)
- Kyung Su Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Noorie Choi
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| |
Collapse
|
23
|
Bernier J, Rossier C, Horiot JC. Recent advances in regional treatment of breast carcinoma. Crit Rev Oncol Hematol 2016; 99:107-14. [PMID: 26718148 DOI: 10.1016/j.critrevonc.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/11/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022] Open
Abstract
Regional treatment is driven by surgery and radiotherapy in early breast cancer patients as sole or combined modalities. Lymph node dissection, performed in patients with positive sentinel lymph nodes accurately identifies malignant spread in the nodal areas and ensures high levels of control in the axilla. At the turn of the century, its real impact on survival indices was nevertheless questioned, also in terms of therapeutic index, by cooperative groups and meta-analyses. As regards radiotherapy, both the indication and extension of regional irradiation remained for a long time open questions, since these issues were never addressed by randomized trials. Recent results of controlled trials investigating the exact impact of nodal surgery or irradiation on survival indices provide useful tools to optimize the regional treatment in patients with early breast cancer. Caution on interpreting some of the key messages from these controlled studies is nevertheless mandatory due to methodological limitations and caveats identified in several of these major trials enrolling patients with positive sentinel nodes.
Collapse
Affiliation(s)
- Jacques Bernier
- Genolier Swiss Medical Network, Department of Radio-Oncology, Breast Unit, Genolier, Geneva, Switzerland.
| | - Christine Rossier
- Genolier Swiss Medical Network, Department of Radio-Oncology, Breast Unit, Genolier, Geneva, Switzerland
| | - Jean-Claude Horiot
- Genolier Swiss Medical Network, Department of Radio-Oncology, Breast Unit, Genolier, Geneva, Switzerland
| |
Collapse
|
24
|
Koulis TA, Phan T, Olivotto IA. Hypofractionated whole breast radiotherapy: current perspectives. BREAST CANCER-TARGETS AND THERAPY 2015; 7:363-70. [PMID: 26604820 PMCID: PMC4629948 DOI: 10.2147/bctt.s81710] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adjuvant radiotherapy (RT) is an important part of breast cancer management but the dose and fractionation schedules used are variable. A total of 50 Gy in 25 daily fractions delivered over 5 weeks is often considered the “standard” adjuvant RT prescription. Hypofractionated regimes such as 42.5 Gy in 16 daily fractions or 40 Gy in 15 daily fractions following breast-conserving surgery have proven to be equally effective and achieve similar or better cosmetic and normal tissue outcomes for both invasive and in situ diseases and when treating the regional nodes. Hypofractionation is more convenient for patients and less costly. However, certain patients at higher risk of RT late effects may benefit from a less intense, even more extended fractionation schedule. This review describes the indications for whole breast hypofractionated adjuvant RT for patients with breast cancer following breast-conserving surgery and proposes that hypofractionation should be the new “standard” for adjuvant breast cancer RT.
Collapse
Affiliation(s)
- Theodora A Koulis
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Tien Phan
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Ivo A Olivotto
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| |
Collapse
|
25
|
Guenzi M, Blandino G, Vidili MG, Aloi D, Configliacco E, Verzanini E, Tornari E, Cavagnetto F, Corvò R. Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity. Radiat Oncol 2015; 10:177. [PMID: 26289040 PMCID: PMC4554321 DOI: 10.1186/s13014-015-0480-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity. Methods From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34–83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59 %), luminal-B 24 pts (24 %), basal-like 10 pts (10 %), Her-2 like 7 pts (7 %). 82 pts (82 %) received hormonal therapy, 9 pts (9 %) neo-adjuvant chemotherapy, 81pts (81 %) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation. Results Within a median follow-up of 50 months (range 19–82), 6 (6 %) pts died, 1 pt (1 %) had local progression disease, 2 pts (2 %) developed distant metastasis and 1 subject (1 %) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27 %) presented lymphedema, but only 10 cases (10 %) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis. Conclusions Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related.
Collapse
Affiliation(s)
- Marina Guenzi
- Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy.
| | - Gladys Blandino
- Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy.
| | | | - Deborah Aloi
- Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy.
| | - Elena Configliacco
- Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy.
| | - Elisa Verzanini
- Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy.
| | - Elena Tornari
- Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy.
| | | | - Renzo Corvò
- Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy.
| |
Collapse
|
26
|
Doré M, Cutuli B, Cellier P, Campion L, Le Blanc M. Hypofractionated irradiation in elderly patients with breast cancer after breast conserving surgery and mastectomy : Analysis of 205 cases. Radiat Oncol 2015; 10:161. [PMID: 26238442 PMCID: PMC4554320 DOI: 10.1186/s13014-015-0448-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 06/26/2015] [Indexed: 01/05/2023] Open
Abstract
Background Several randomized trials and meta-analyses confirmed a wide benefit of radiotherapy (RT), both after breast conserving surgery (BCS) and mastectomy. However, many elderly women don't receive RT. Hypofractionated (HF) RT allows « simplified » and more accessible treatments with equivalent results to classic RT in three large randomized trials. However, there are few available data on HF-RT for nodal irradiation, as well as for the boost. Methods We evaluated patients treated for IBC by HF-RT between 2004 and 2012 in two regional cancer centres. We used an original scheme delivering 45 Gy in 15 fractions three times a week, both after BCS or mastectomy, with or without nodal irradiation. After BCS, a 9 Gy boost in 3 fractions was delivered. Local, regional and distant recurrences were assessed, as well as acute and late cutaneous, cardiac or pulmonary toxicities. Results 205 patients were analysed, 116 after BCS (57 %) and 89 after mastectomy (43 %). Median age was 81 years (range: 52-91); 44 % had axillary nodal involvement (pN+). The Nottingham Prognostic Index (NPI) scored 0, 1, 2 and 3 in 10 %, 27 %, 44 % and 19 % of the cases. A nodal HF-RT was delivered in 65 patients (32 %) and boost in 98 patients (84 % of BCS) by 9 Gy/3 fr scheme. Fifty (24 %) patients underwent chemotherapy and 156 (75 %) hormonal treatment. With a 49-month median follow-up, 3/116 (2.6 %) patients and 4/89 (4.5 %) had local recurrence (LR) after BCS and mastectomy, respectively. The overall 5-year LR rate was 4.4 %. In univariate and multivariate analysis, LR risk factors were: high NPI (HR 5.46; p = 0.028), and triple negative tumour (HR 9.78; p = 0.006). Only 8 (4.5 %) patients had grade III skin toxicity; 29 (14 %) late fibrosis and 16 (8 %) telangiectasia. No pulmonary or cardiac toxicity was observed. Conclusion Our HF-RT scheme (with or without nodal irradiation) confirms in elderly patients the data from randomized trials, both after BCS or mastectomy. Toxicity seems very acceptable but requires a longer follow-up. A larger evaluation is still ongoing in several other centres in France.
Collapse
Affiliation(s)
- Mélanie Doré
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France.
| | - Bruno Cutuli
- Radiation Oncology Department, Institut de Cancérologie de Courlancy, Reims, France.
| | - Patrice Cellier
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Angers, France.
| | - Loïc Campion
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France.
| | - Magali Le Blanc
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France.
| |
Collapse
|
27
|
Shah C, Badiyan S, Berry S, Khan AJ, Goyal S, Schulte K, Nanavati A, Lynch M, Vicini FA. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol 2014; 112:9-16. [PMID: 24813095 DOI: 10.1016/j.radonc.2014.04.009] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/06/2014] [Accepted: 04/18/2014] [Indexed: 12/12/2022]
Abstract
Breast cancer radiotherapy represents an essential component in the overall management of both early stage and locally advanced breast cancer. As the number of breast cancer survivors has increased, chronic sequelae of breast cancer radiotherapy become more important. While recently published data suggest a potential for an increase in cardiac events with radiotherapy, these studies do not consider the impact of newer radiotherapy techniques commonly utilized. Therefore, the purpose of this review is to evaluate cardiac dose sparing techniques in breast cancer radiotherapy. Current options for cardiac protection/avoidance include (1) maneuvers that displace the heart from the field such as coordinating the breathing cycle or through prone patient positioning, (2) technological advances such as intensity modulated radiation therapy (IMRT) or proton beam therapy (PBT), and (3) techniques that treat a smaller volume around the lumpectomy cavity such as accelerated partial breast irradiation (APBI), or intraoperative radiotherapy (IORT). While these techniques have shown promise dosimetrically, limited data on late cardiac events exist due to the difficulties of long-term follow up. Future studies are required to validate the efficacy of cardiac dose sparing techniques and may use surrogates for cardiac events such as biomarkers or perfusion imaging.
Collapse
Affiliation(s)
- Chirag Shah
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Shahed Badiyan
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, St. Louis, United States
| | - Sameer Berry
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Atif J Khan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey & Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey & Rutgers Robert Wood Johnson Medical School, New Brunswick, United States
| | - Kevin Schulte
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Anish Nanavati
- Department of Oncology, Georgetown University School of Medicine, Washington DC United States
| | - Melanie Lynch
- Department of Radiation Oncology, Summa Health System, Akron, United States
| | - Frank A Vicini
- Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, United States.
| |
Collapse
|