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Dykstra M, Thompson J, Aldous J, Jiang S, Hughes T, Hayman J, Dragovic A, Shah J, Chang A, Speers C, Sabel M, Dossett L, Schipper M, Jagsi R. The Effect of Wire Versus Magnetic Seed Localization on Lumpectomy Cavity Size. Pract Radiat Oncol 2024; 14:e255-e263. [PMID: 38161002 DOI: 10.1016/j.prro.2023.12.004] [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: 09/08/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Our purpose was to assess whether an association exists between surgical localization technique and lumpectomy cavity size on radiation therapy planning computed tomography (CT) scan. METHODS AND MATERIALS A single-institution retrospective review was conducted of women undergoing breast conserving surgery with wire or magnetic seed guided lumpectomy followed by adjuvant radiation therapy from 2018 to 2021. Patients of a surgeon only performing 1 localization technique or undergoing bracketed localization were excluded. The primary outcome was lumpectomy cavity size on simulation CT. Confounding due to imbalance in patient and tumor factors was addressed with overlap weights derived from a propensity score analysis and used in a weighted multivariable analysis. Secondary outcomes included positive margins, total pathologic volume, boost delivery, and boost modality. RESULTS Of 617 women who received lumpectomy during the study period, 387 were included in final analysis. Tumors of patients undergoing seed localization were more likely unifocal, assessable by ultrasound, and smaller. Seed use rates ranged from 27.7% to 70.7% per surgeon. There was no difference in positive margins (6.4 vs 5.4%, P = .79) or second surgeries (9.4 vs 8.1%, P = .79) between groups. Close margin rates were similar for ductal carcinoma in situ (P = .35) and invasive carcinoma (P = .97). In unadjusted bivariable analyses, wire localization was associated with larger total pathology volume (P = .004), but localization technique showed no association with CT cavity volume (P = .15). After adjusting for potentially confounding variables, multivariable analysis failed to show an association between localization technique and either CT cavity (P = .35) or total path volume (P = .08). There was no difference in indicated-boost delivery (P = .15) or electron boost (P = .14) by localization technique. CONCLUSIONS There was no significant difference in CT cavity size by localization technique, suggesting choice between surgical techniques does not impede radiation therapy boost delivery.
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Affiliation(s)
- Michael Dykstra
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jessica Thompson
- Department of Surgery, Division of Surgical Oncology, Corewell Health Medical Group, Grand Rapids, Michigan
| | - Jessica Aldous
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Shannon Jiang
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Tasha Hughes
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan
| | - James Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Aleksandar Dragovic
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Alfred Chang
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan
| | - Corey Speers
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio
| | - Michael Sabel
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan
| | - Lesly Dossett
- Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
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Jung W, Chung J, Lee J, Kim K. Quantifying radiation-induced breast fibrosis by shear-wave elastography in patients with breast cancer: A 12-months-follow-up data of a prospective study. Clin Transl Radiat Oncol 2024; 46:100773. [PMID: 38590328 PMCID: PMC10999491 DOI: 10.1016/j.ctro.2024.100773] [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: 01/02/2024] [Revised: 03/17/2024] [Accepted: 03/29/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To assess radiation-induced fibrosis (RIF) using shear-wave elastography (SWE) in patients with breast cancer who received radiotherapy (RT) after breast conserving surgery. Methods Forty-one patients were enrolled in a prospective study before RT. SWE and B-mode ultrasonography were performed to measure elasticity. For quantitative measurement, the maximum elasticity value was measured in the tumor bed and non-tumor bed of the treated breast, and contralateral breast before RT and at 3, and 12 months after RT. and RIF was recorded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results The mean ± standard deviation elasticity values for the tumor bed, non-tumor bed, and contralateral breast were 71.2 ± 74.9 kPa, 19.4 ± 9.8 kPa and 20.3 ± 10.0 kPa before RT; 28.7 ± 26.3 kPa, 15.1 ± 7.0 kPa, and 14.7 ± 6.3 kPa at 12 months after RT, respectively. The elasticity values for all three measurement areas before and 12 months after RT were significantly different (p < 0.001 for tumor bed, p = 0.002 for non-tumor bed, p = 0.001 for contralateral breast). At 12 months follow-up, the distribution of grades of RIF evaluated by CTCAE grade was grade 0 in 43.9 %, grade 1 in 48.8 %, and grade 2 in 7.3 %. Conclusion We demonstrated that SWE enables the evaluation of tissue stiffness to provide quantified information for the RIF of breast cancer. Further studies with long-term follow-up should provide more quantitative data.
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Affiliation(s)
- Wonguen Jung
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University College of Medicine, Republic of Korea
| | - Jihae Lee
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Republic of Korea
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Mao Y, Di W, Zong D, Mu Z, He X. Machine learning-based radiomics nomograms to predict number of fields in postoperative IMRT for breast cancer. J Appl Clin Med Phys 2024; 25:e14194. [PMID: 37910655 DOI: 10.1002/acm2.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/26/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Breast cancer is now the most commonly diagnosed cancer in women worldwide. Radiotherapy is an important part of the treatment for breast cancer, while setting proper number of fields dramatically affects the benefits one can receive. Machine learning and radiomics have been widely investigated in the management of breast cancer. This study aims to provide models to predict the best number of fields based on machine learning and improve the prediction performance by adding clinical factors. METHODS Two-hundred forty-two breast cancer patients were retrospectively enrolled for this study, all of whom received postoperative intensity modulated radiation therapy. The patients were randomized into a training set and a validation set at a ratio of 7:3. Radiomics shape features were extracted for eight machine learning algorithms to predict the number of fields. Univariate and multivariable logistic regression were implemented to screen clinical factors. A combined model of rad-score and clinical factors were finally constructed. The area under receiver operating characteristic curve, precision, recall, F1 measure and accuracy were used to evaluate the model. RESULTS Random Forest outperformed from eight machine learning algorithms while predicting the number of fields. Prediction performance of the radiomics model was better than the clinical model, while the predictive nomogram combining the rad-score and clinical factors performed the best. CONCLUSIONS The model combining rad-score and clinical factors performed the best. Nomograms constructed from the combined models can be of reliable references for medical dosimetrists.
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Affiliation(s)
- Yichen Mao
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Wenyi Di
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Dan Zong
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Zhongde Mu
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
| | - Xia He
- The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research & Jiangsu Cancer Hospital, Nanjing, China
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4
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Jaikuna T, Osorio EV, Azria D, Chang-Claude J, De Santis MC, Gutiérrez-Enríquez S, van Herk M, Hoskin P, Lambrecht M, Lingard Z, Seibold P, Seoane A, Sperk E, Symonds RP, Talbot CJ, Rancati T, Rattay T, Reyes V, Rosenstein BS, de Ruysscher D, Vega A, Veldeman L, Webb A, West CML, Aznar MC. Contouring variation affects estimates of normal tissue complication probability for breast fibrosis after radiotherapy. Breast 2023; 72:103578. [PMID: 37713940 PMCID: PMC10511799 DOI: 10.1016/j.breast.2023.103578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Normal tissue complication probability (NTCP) models can be useful to estimate the risk of fibrosis after breast-conserving surgery (BCS) and radiotherapy (RT) to the breast. However, they are subject to uncertainties. We present the impact of contouring variation on the prediction of fibrosis. MATERIALS AND METHODS 280 breast cancer patients treated BCS-RT were included. Nine Clinical Target Volume (CTV) contours were created for each patient: i) CTV_crop (reference), cropped 5 mm from the skin and ii) CTV_skin, uncropped and including the skin, iii) segmenting the 95% isodose (Iso95%) and iv) 3 different auto-contouring atlases generating uncropped and cropped contours (Atlas_skin/Atlas_crop). To illustrate the impact of contour variation on NTCP estimates, we applied two equations predicting fibrosis grade ≥ 2 at 5 years, based on Lyman-Kutcher-Burman (LKB) and Relative Seriality (RS) models, respectively, to each contour. Differences were evaluated using repeated-measures ANOVA. For completeness, the association between observed fibrosis events and NTCP estimates was also evaluated using logistic regression. RESULTS There were minimal differences between contours when the same contouring approach was followed (cropped and uncropped). CTV_skin and Atlas_skin contours had lower NTCP estimates (-3.92%, IQR 4.00, p < 0.05) compared to CTV_crop. No significant difference was observed for Atlas_crop and Iso95% contours compared to CTV_crop. For the whole cohort, NTCP estimates varied between 5.3% and 49.5% (LKB) or 2.2% and 49.6% (RS) depending on the choice of contours. NTCP estimates for individual patients varied by up to a factor of 4. Estimates from "skin" contours showed higher agreement with observed events. CONCLUSION Contour variations can lead to significantly different NTCP estimates for breast fibrosis, highlighting the importance of standardising breast contours before developing and/or applying NTCP models.
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Affiliation(s)
- Tanwiwat Jaikuna
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom; Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - David Azria
- Department of Radiation Oncology, Montpellier Cancer Institute, Université Montpellier, Inserm, U1194, France
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Germany
| | | | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Marcel van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Peter Hoskin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | | | - Zoe Lingard
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alejandro Seoane
- Medical Physics Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Elena Sperk
- Department of Radiation Oncology, Mannheim Cancer Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - R Paul Symonds
- Leicester Cancer Research Centre, University of Leicester, United Kingdom
| | | | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tim Rattay
- Leicester Cancer Research Centre, University of Leicester, United Kingdom
| | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Barry S Rosenstein
- Department of Radiation Oncology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica, Grupo de Medicina Xenómica (USC), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de, Santiago de Compostela, Spain; Biomedical Network on Rare Diseases (CIBERER), Spain
| | - Liv Veldeman
- Ghent University Hospital, Department of Radiation Oncology, Ghent, Belgium
| | - Adam Webb
- Department of Genetics and Genome Biology, University of Leicester, United Kingdom
| | - Catharine M L West
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Christie NHS Foundation Trust Hospital, Manchester, United Kingdom.
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Allali S, Carton M, Everhard S, Rivera S, Ghannam Y, Peignaux K, Guilbert P, De La Lande B, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Cottu P, André F, Kirova Y. CANTO skin: Evaluation of skin toxicity risk factors in patients treated for breast cancer. Int J Cancer 2023; 153:1797-1808. [PMID: 37572223 DOI: 10.1002/ijc.34664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 08/14/2023]
Abstract
Skin reaction is a common toxicity during oncology management, especially followed during the radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients treated for an early breast cancer (BC). We evaluated 8561 patients during their overall management for a BC. We focus on specific skin toxicities: erythema, fibrosis, telangiectasia and changes of skin colour. These toxicities were assessed at the baseline defined as 0-3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months. The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M60, the prevalence of erythema was 2%, while fibrosis remained stable at about 19%. After adjustments, at M0, there was a significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery and the tumour phenotype RH+/HER2+. Concerning fibrosis, a significant association was found, at M12, with the age of the patient, obesity, Charlson score and type of surgery. Concerning the modification of skin colour at M12, we find a link between the age of the patient, obesity, tobacco consumption and alcohol consumption. The prevention of this toxicity is a major issue for the quality of life. Our results allow us to understand the risk of developing skin toxicity in a patient, depending on her intrinsic, tumour or therapeutic characteristics and to implement adapted means of prevention and monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David Pasquier
- Centre Oscar Lambret, Academic Department of Radiation Oncology, Lille, France
- Université de Lille, CHU Lille, CNRS, Centrale Lille, Lille, France
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6
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Allali S, Carton M, Sarrade T, Querel O, Jacquet A, Rivera S, Ghannam Y, Peignaux K, Guilbert P, Chara-Brunaud C, Blanchecotte J, Pasquier D, Racadot S, Bourgier C, Labib A, Geffrelot J, Benyoucef A, Paris F, Cottu P, André F, Kirova Y. CANTO-RT: Skin toxicities evaluation of a multicenter large prospective cohort of irradiated patients for early-stage breast cancer. Int J Cancer 2022; 151:1098-1108. [PMID: 35489021 DOI: 10.1002/ijc.34057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Abstract
Skin damage is the most common and most important toxicity during and after radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major issue in the management of patients irradiated for an early breast cancer CANTO is a prospective clinical cohort study of 10 150 patients with stage I-III BC treated from 2012-2017 in 26 cancer centers. In this study, we used CANTO-RT, a sub-cohort of CANTO, including 3480 patients who received RT. We are focus on specifical skin toxicities: Erythema, fibrosis, telangiectasia, and cutaneous pigmentation The prevalence of toxicities of interest varied over time, so at M3-6, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased respectively while fibrosis remains stable. The prevalence of telangiectasia increases from 1% to 7.1% from M3-6 to M36. After adjustments, we showed an association between the occurrence of skin erythema and obesity; the type of surgery; the presence of axillary dissection; the use of taxane-based CT and the 3DvsIMRT irradiation technique. Regarding fibrosis, an association is found, at M3-6, with age at diagnosis, obesity, tobacco, and the use of boost. Only obesity and the type of surgery received by the patient remained statistically significant at M12 and M36. In this study we identified several risk factors for acute and late skin. The use of a boost was mainly related to the occurrence of fibrosis while the use of IMRT-type technique decreased the occurrence of skin erythema.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - François Paris
- Centre de Recherche en Cancérologie Immunologie Nantes Angers (CRCINA) UMR Inserm 1232, Université de Nantes, Nantes
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7
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Bi S, Zhu R, Dai Z. Dosimetric and radiobiological comparison of simultaneous integrated boost radiotherapy for early stage right side breast cancer between three techniques: IMRT, hybrid IMRT and hybrid VMAT. Radiat Oncol 2022; 17:60. [PMID: 35346264 PMCID: PMC8962055 DOI: 10.1186/s13014-022-02009-2] [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: 06/27/2021] [Accepted: 02/13/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed at evaluating the clinical impact of full intensity-modulated radiotherapy (IMRT), hybrid IMRT (H-IMRT) and hybrid volumetric-modulated arc therapy (H-VMAT) for early-stage breast cancer with simultaneous integrated boost (SIB), in terms of plan quality and second cancer risk (SCR). Methods Three different plans were designed in full IMRT, hybrid IMRT, and hybrid VMAT for each of twenty patients with early-stage breast cancer. Target quality, organs at risk (OARs) sparing, and SCR were compared among the three plans for each case. Results In compared with H-IMRT, IMRT plans showed deterioration in terms of D2% of SIB, V10 of ipsilateral lung, and excess absolute risk (EAR) to contralateral lung (C-Lung) and esophagus. D2% and the homogeneity index (HI) of SIB, V5 of ipsilateral lung (I-Lung), the Dmean of the esophagus, the EAR to C-Lung and the esophagus with hybrid VMAT dramatically increased by 0.63%, 10%, 17.99%, 149.27%, 230.41%, and 135.29%, respectively (p = 0.024; 0.025; 0.046; 0.011; 0.000; 0.014). Dmean of the heart, the EAR to contralateral breast (C-Breast) and C-Lung by full IMRT was significantly decreased in comparison to the H-VMAT (4.67%, p = 0.033, 26.76%, p = 0.018; 48.05%, p = 0.036). Conclusion The results confirmed that H-IMRT could achieve better target quality and OARs sparing than IMRT and H-VMAT for SIB radiotherapy of early-stage right breast cancer. H-IMRT was the best treatment option, while H-VMAT performed the worst among the three plans in terms of SCR to peripheral OARs.
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Affiliation(s)
- Suyan Bi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Rui Zhu
- Department of Oncology, Yunyang County People's Hospital, Chongqing, 404500, China
| | - Zhitao Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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Dicuonzo S, Leonardi MC, Raimondi S, Corrao G, Bagnardi V, Gerardi MA, Morra A, Zerella MA, Zaffaroni M, Pansini F, Cattani F, Luraschi R, Fodor C, Veronesi P, Orecchia R, Rojas DP, Jereczek-Fossa BA. Acute and intermediate toxicity of 3-week radiotherapy with simultaneous integrated boost using TomoDirect: prospective series of 287 early breast cancer patients. Clin Transl Oncol 2021; 23:1415-1428. [PMID: 33537865 DOI: 10.1007/s12094-020-02538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS To report toxicity of a hypofractionated scheme of whole-breast (WB) intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to the tumor bed (TB) using Tomotherapy® with Direct modality. METHODS Patients with early breast cancer, undergoing radiotherapy (RT) in 15 daily fractions to WB (prescription dose 40.05 Gy) and SIB to the TB (48 Gy), between 2013 and 2017, was analyzed. Primary endpoint was acute and intermediate toxicity assessed at the end and within 6 months from RT, according to Radiation Therapy Oncology Group (RTOG) scale. Secondary endpoints included early chronic toxicity at 12-months follow-up, using the Late Effects Normal Tissue Task Subjective, Objective, Management, and Analytic (LENT-SOMA) scale, and cosmesis using Harvard criteria. RESULTS The study population was of 287 patients. Acute and intermediate toxicity was collected among 183 patients with data available at the end of RT and within 6 months, 85 (46%) experienced G2 toxicity and 84 (46%) G1 toxicity, while 14 (8%) did not report toxicity at any time. A significant reduction of any grade toxicity was observed between the two time points, with the majority of patients reporting no clinically relevant toxicity at 6 months. At univariate analysis, age < 40 years, breast volume > 1000 cm3 and Dmax ≤ 115% of prescription dose were predictive factors of clinically relevant acute toxicity (G ≥ 2) at any time. At multivariable analysis, only age and breast volume were confirmed as predictive factors, with Relative Risks (95% Confidence Intervals): 2.02 (1.13-3.63) and 1.84 (1.26-2.67), respectively. At 12-month follow-up, 113 patients had complete information on any toxicity with 53% of toxicity G < 2, while cosmetic evaluation, available for 102 patients, reported a good-excellent result for 86% of patients. CONCLUSIONS Hypofractionated WB IMRT with a SIB to the TB, delivered with TomoDirect modality, is safe and well-tolerated. Most patients reported no toxicity after 6 months and good-excellent cosmesis. Predictive factors of clinically relevant toxicity might be considered during treatment planning in order to further reduce side effects.
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Affiliation(s)
- S Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - M C Leonardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - S Raimondi
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - G Corrao
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - M A Gerardi
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - A Morra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - M A Zerella
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - M Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - F Pansini
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Luraschi
- Unit of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Fodor
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - P Veronesi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R Orecchia
- Scientific Directorate, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - D P Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
| | - B A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, via Ripamonti, 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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9
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Hoekstra N, Habraken S, Swaak-Kragten A, Breedveld S, Pignol JP, Hoogeman M. Reducing the Risk of Secondary Lung Cancer in Treatment Planning of Accelerated Partial Breast Irradiation. Front Oncol 2020; 10:1445. [PMID: 33014782 PMCID: PMC7461936 DOI: 10.3389/fonc.2020.01445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/08/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose: Adjuvant accelerated partial breast irradiation (APBI) results in low local recurrence risks. However, the survival benefit of adjuvant radiotherapy APBI for low-risk breast cancer might partially be offset by the risk of radiation-induced lung cancer. Reducing the lung dose mitigates this risk, but this could result in higher doses to the ipsilateral breast. Different external beam APBI techniques are equally conformal and homogenous, but the intermediate to low dose distribution differs. Thus, the risk of toxicity is different. The purpose of this study is to quantify the trade-off between secondary lung cancer risk and breast dose in treatment planning and to compare an optimal coplanar and non-coplanar technique. Methods: A total of 440 APBI treatment plans were generated using automated treatment planning for a coplanar VMAT beam-setup and a non-coplanar robotic stereotactic radiotherapy beam-setup. This enabled an unbiased comparison of two times 11 Pareto-optimal plans for 20 patients, gradually shifting priority from maximum lung sparing to maximum ipsilateral breast sparing. The excess absolute risks of developing lung cancer and breast fibrosis were calculated using the Schneider model for lung cancer and the Avanzo model for breast fibrosis. Results: Prioritizing lung sparing reduced the mean lung dose from 2.2 Gy to as low as 0.3 Gy for the non-coplanar technique and from 1.9 Gy to 0.4 Gy for the coplanar technique, corresponding to a 7- and 4-fold median reduction of secondary lung cancer risk, respectively, compared to prioritizing breast sparing. The increase in breast dose resulted in a negligible 0.4% increase in fibrosis risk. The use of non-coplanar beams resulted in lower secondary cancer and fibrosis risks (p < 0.001). Lung sparing also reduced the mean heart dose for both techniques. Conclusions: The risk of secondary lung cancer of external beam APBI can be dramatically reduced by prioritizing lung sparing during treatment planning. The associated increase in breast dose did not lead to a relevant increase in fibrosis risk. The use of non-coplanar beams systematically resulted in the lowest risks of secondary lung cancer and fibrosis. Prioritizing lung sparing during treatment planning could increase the overall survival of early-stage breast cancer patients by reducing mortality due to secondary lung cancer and cardiovascular toxicity.
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Affiliation(s)
- Nienke Hoekstra
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Steven Habraken
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Mischa Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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10
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Xu Y, Hu X, Zhou L, Zhao Y. Effect of sequencing of preoperative systemic therapy on patients with locally advanced breast cancer. Breast J 2020; 26:1987-1994. [PMID: 33462826 DOI: 10.1111/tbj.14017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The study aims to perform a clinical trial to evaluate the effect of sequencing of systemic therapy on locally advanced breast cancer (LABC). METHODS LABC patients (n = 733) underwent the combination of external beam radiation therapy, chemotherapy, and breast-conservation surgery with difference sequences. Biopsy followed by histopathological examinations was used to assess treatment responses. The primary end point is ipsilateral local recurrence or death. The secondary end points include the incidence and severity of acute and late side effects, cosmesis, and cumulative incidence of regional recurrence and distant metastasis, and survival. The effects of sequence of therapies on the side effects and treatment outcomes were compared. RESULTS Patients with preoperative systemic treatment, that is, chemotherapy and radiotherapy performed ahead of surgery, had less fibrosis and pain, and showed higher satisfaction regarding the breast conservation. Preoperative systemic treatment also led to better survival of the patients. CONCLUSIONS Preoperative systemic therapy is beneficial to alleviate side effects and improve the breast conservation, treatment outcome, and survival of LABC patients.
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Affiliation(s)
- Yu Xu
- Department of Abdominal Radiotherapy, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xichi Hu
- Department of Laboratory Medicine, Wuxi Second People's Hospital, Wuxi, China
| | - Leyuan Zhou
- Department of Abdominal Radiotherapy, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yutian Zhao
- Department of Abdominal Radiotherapy, Affiliated Hospital of Jiangnan University, Wuxi, China
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11
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Adjuvant breast inversely planned intensity-modulated radiotherapy with simultaneous integrated boost for early stage breast cancer : Results from a phase II trial. Strahlenther Onkol 2020; 196:764-770. [PMID: 32318767 DOI: 10.1007/s00066-020-01611-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To report early toxicity and 5‑year clinical outcomes of adjuvant breast inversely planned intensity-modulated radiotherapy with simultaneously integrated boost (IMRT-SIB) after breast-conserving surgery for early stage breast cancer patients. PATIENTS AND METHODS In all, 467 patients including 406 invasive breast cancer and 61 ductal carcinoma in situ (DCIS) were enrolled in a single institutional phase II trial. All patients underwent IMRT-SIB treatment to irradiate the whole breast and the tumor bed. Doses to whole breast and surgical bed were 45 and 60 Gy, respectively, delivered in 25 fractions over 5 weeks. The grade of maximum acute skin toxicity during treatment was recorded. Lung toxicity was noted within 6 months and patient-reported cosmetic outcomes were recorded at the 12 month follow-up after the end of radiotherapy. Clinical outcomes were assessed during follow-up. RESULTS Median follow-up time was 5.46 years. Median age was 46 years old (range 22-70 years old). No patient with DCIS had a local recurrence or distant metastasis. Among 406 patients with invasive breast cancer, the unadjusted 5‑year actuarial rate of locoregional control was 98.7% (95% confidence interval [CI] 97.5-100), and distant metastasis-free survival 98.7% (95% CI 97.4-100), respectively. Acute skin toxicity was recorded at grade 0-1 in 76.5% of patients, and grade 2 in 23.5% of patients. None of these patients had grade 3 or more than grade 3 skin toxicity. Grade 1 pneumonitis was found in 25.3% of patients. Assessment of patient reported cosmetic outcomes at the 12 month follow-up showed good or excellent outcome in 86.5% of cases. CONCLUSIONS The use of inversely planned IMRT-SIB as part of breast-conserving therapy results in optimal 5‑year tumor control and minor early toxicities.
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12
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Lee HH, Chen CH, Luo KH, Chuang HY, Huang CJ, Cheng YK, Chen F, Kuo SH, Huang MY. Five-year survival outcomes of intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) using forward IMRT or Tomotherapy for breast cancer. Sci Rep 2020; 10:4342. [PMID: 32152428 PMCID: PMC7063050 DOI: 10.1038/s41598-020-61403-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 02/24/2020] [Indexed: 12/24/2022] Open
Abstract
Intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) reduces overall treatment duration and results in less radiotherapy (RT)-induced dermatitis. However, the use of traditional sequential approach or IMRT-SIB is still under debate since there is not enough evidence of long-term clinical outcomes. The present study investigated 216 patients who underwent breast conserving surgery (BCS) between 2010 and 2013. The median age was 51 years (range, 21-81 years). All patients received IMRT-SIB, 50.4 Gy at 1.8 Gy per fraction to the whole breast and 60.2 Gy at 2.15 Gy per fraction to the tumor bed by integral boost. Among 216 patients, 175 patients received post-operative RT with forward IMRT and 41 patients had Tomotherapy. The median follow-up was 6.4 years. Forty patients (97.6%) in the Tomotherapy arm and 147 patients (84%) in the IMRT arm developed grade 0-1 skin toxicity (P = 0.021). For the entire cohort, the 5-year and 7-year overall survival (OS) rates were 94.4% and 93.1% respectively. The 7-year distant metastasis-free survival rates were 100% vs 89.1% in the Tomotherapy and IMRT arm respectively (P = 0.028). In conclusion, Tomotherapy improved acute skin toxicity compared with forward IMRT-SIB. Chronic skin complication was 1.9%. IMRT-SIB resulted in good long-term survival.
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Affiliation(s)
- Hsin-Hua Lee
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Hung Chen
- Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Hau Luo
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Yi Chuang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Kai Cheng
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Frank Chen
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Hsun Kuo
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Biomarkers and Biotech Drugs, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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13
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A novel technique for treating deep seated breast cavity boosts. Med Dosim 2019; 45:149-152. [PMID: 31548101 DOI: 10.1016/j.meddos.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/06/2019] [Accepted: 08/22/2019] [Indexed: 11/21/2022]
Abstract
Breast boost irradiation is an integral component to the standard of care for early staged breast cancer. The use of reduced tangents is common for deep seating tumor bed; however, reduced tangents result in non-conformal plans delivering prescription dose to large volumes of breast tissue. To improve conformity, a novel technique of integrating a single conformal arc with reduced tangents has been developed. With this technique, a conformal arc was placed between a pair of reduced tangents to better conform the prescription dose to the target volume. This new technique improves the conformity but was also shown to potentially increase max dose to nearby critical structures, such as the heart, due to exit dose from the arc. This tangent and arc technique has been implemented at our clinic in cases where the exit dose is not critical to the heart.
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14
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Dewan A, Chufal KS, Dewan AK, Pahuja A, Mehrotra K, Singh R, Chaudhary RL, Suresh T, Mishra M, Sundari AV, Bommera S, Narang R, Pathak P, Mitra S, Sharma SK, Gairola M. Simultaneous integrated boost by Intensity Modulated Radiotherapy (SIB-IMRT) in patients undergoing breast conserving surgery – A clinical and dosimetric perspective. J Egypt Natl Canc Inst 2018; 30:165-171. [DOI: 10.1016/j.jnci.2018.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/25/2023] Open
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15
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Predictors for poor cosmetic outcome in patients with early stage breast cancer treated with breast conserving therapy: Results of the Young boost trial. Radiother Oncol 2018; 128:434-441. [DOI: 10.1016/j.radonc.2018.06.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/27/2018] [Accepted: 06/12/2018] [Indexed: 11/21/2022]
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16
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Rossi L, Bijman R, Schillemans W, Aluwini S, Cavedon C, Witte M, Incrocci L, Heijmen B. Texture analysis of 3D dose distributions for predictive modelling of toxicity rates in radiotherapy. Radiother Oncol 2018; 129:548-553. [PMID: 30177372 DOI: 10.1016/j.radonc.2018.07.027] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE To explore the use of texture analysis (TA) features of patients' 3D dose distributions to improve prediction modelling of treatment complication rates in prostate cancer radiotherapy. MATERIAL AND METHODS Late toxicity scores, dose distributions, and non-treatment related (NTR) predictors for late toxicity, such as age and baseline symptoms, of 351 patients of the hypofractionation arm of the HYPRO randomized trial were used in this study. Apart from DVH parameters, also TA features of rectum and bladder 3D dose distributions were used for predictive modelling of gastrointestinal (GI) and genitourinary (GU) toxicities. Logistic Normal Tissue Complication Probability (NTCP) models were derived, using only NTR parameters, NTR + DVH, NTR + TA, and NTR + DVH + TA. RESULTS For rectal bleeding, the area under the curve (AUC) for using only NTR parameters was 0.58, which increased to 0.68, and 0.73, when adding DVH or TA parameters respectively. For faecal incontinence, the AUC went up from 0.63 (NTR only), to 0.68 (+DVH) and 0.73 (+TA). For nocturia, adding TA features resulted in an AUC increase from 0.64 to 0.66, while no improvement was seen when including DVH parameters in the modelling. For urinary incontinence, the AUC improved from 0.68 to 0.71 (+DVH) and 0.73 (+TA). For GI, model improvements resulting from adding TA parameters to NTR instead of DVH were statistically significant (p < 0.04). CONCLUSION Inclusion of 3D dosimetric texture analysis features in predictive modelling of GI and GU toxicity rates in prostate cancer radiotherapy improved prediction performance, which was statistically significant for GI.
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Affiliation(s)
- Linda Rossi
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Rik Bijman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Wilco Schillemans
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Shafak Aluwini
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Carlo Cavedon
- Medical Physics Unit, University Hospital of Verona, Italy
| | - Marnix Witte
- Department of Radiation Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ben Heijmen
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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17
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Bautista Hernandez MY, Lujan Castilla PJ, Quézada Bautista AA. Hypofractionation with concomitant boost using intensity-modulated radiation therapy in early-stage breast cancer in Mexico. Rep Pract Oncol Radiother 2018; 23:276-283. [PMID: 30090027 DOI: 10.1016/j.rpor.2018.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022] Open
Abstract
Aim To evaluate whether hypofractionation with integrated boost to the tumour bed using intensity-modulated radiation therapy is an acceptable option and to determine whether this treatment compromises local control, toxicity and cosmesis. Background Retrospective studies have demonstrated that patients who are treated with HF and integrated boost experience adequate local control, a dosimetric benefit, decreased toxicity and acceptable cosmesis compared with conventional fractionation. Materials and methods A retrospective, observational and longitudinal study was conducted from January 2008 to June 2015 and included 34 patients with breast cancer (stage 0-II) who were undergoing conservative surgery.The prescribed doses were 45 Gy in 20 fractions (2.25 Gy/fraction) to the breast and 56 Gy in 20 fractions (2.8 Gy/fraction) to the tumour bed. Results Thirty-four patients were included. The mean follow-up was 49.29 months, and the mean age was 52 years. The mean percentage of PTV from the mammary region that received 100% of the prescribed dose was 97.89% (range 95-100), and the mean PTV percentage of the tumour bed that received 100% of the dose was 98% (95-100).The local control and the overall survival were 100%, and the cosmesis was good in 82% of the patients. Grade 1 acute toxicity was present in 16 patients (47%), and grade 1 chronic toxicity occurred in 6 cases (18%). Conclusion The results of the present study demonstrate that hypofractionation with integrated boost using intensity-modulated radiation therapy is an acceptable option that provides excellent local control and low toxicity.
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18
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Hu JJ, Urbanic JJ, Case LD, Takita C, Wright JL, Brown DR, Langefeld CD, Lively MO, Mitchell SE, Thakrar A, Bryant D, Baglan K, Strasser J, Baez-Diaz L, Lesser GJ, Shaw EG. Association Between Inflammatory Biomarker C-Reactive Protein and Radiotherapy-Induced Early Adverse Skin Reactions in a Multiracial/Ethnic Breast Cancer Population. J Clin Oncol 2018; 36:2473-2482. [PMID: 29989859 DOI: 10.1200/jco.2017.77.1790] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose This study examined an inflammatory biomarker, high-sensitivity C-reactive protein (hsCRP), in radiotherapy (RT)-induced early adverse skin reactions or toxicities in breast cancer. Patients and Methods Between 2011 and 2013, 1,000 patients with breast cancer who underwent RT were evaluated prospectively for skin toxicities through the National Cancer Institute-funded Wake Forest University Community Clinical Oncology Program Research Base. Pre- and post-RT plasma hsCRP levels and Oncology Nursing Society skin toxicity criteria (0 to 6) were used to assess RT-induced skin toxicities. Multivariable logistic regression analyses were applied to ascertain the associations between hsCRP and RT-induced skin toxicities after adjusting for potential confounders. Results The study comprised 623 white, 280 African American, 64 Asian/Pacific Islander, and 33 other race patients; 24% of the patients were Hispanic, and 47% were obese. Approximately 42% and 15% of patients developed RT-induced grade 3+ and 4+ skin toxicities, respectively. The hsCRP levels differed significantly by race and body mass index but not by ethnicity. In multivariable analysis, grade 4+ skin toxicity was significantly associated with obesity (odds ratio [OR], 2.17; 95% CI, 1.41 to 3.34], post-RT hsCRP ≥ 4.11 mg/L (OR, 1.61; 95% CI, 1.07 to 2.44), and both factors combined (OR, 3.65; 95% CI, 2.18 to 6.14). Above-median post-RT hsCRP (OR, 1.93; 95% CI, 1.03 to 3.63), and change in hsCRP (OR, 2.80; 95% CI, 1.42 to 5.54) were significantly associated with grade 4+ skin toxicity in nonobese patients. Conclusion This large prospective study is the first to our knowledge of hsCRP as an inflammatory biomarker in RT-induced skin toxicities in breast cancer. We demonstrate that nonobese patients with elevated RT-related change in hsCRP levels have a significantly increased risk of grade 4+ skin toxicity. The outcomes may help to predict RT responses and guide decision making.
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Affiliation(s)
- Jennifer J Hu
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - James J Urbanic
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - L Doug Case
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Cristiane Takita
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Jean L Wright
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Doris R Brown
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Carl D Langefeld
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Mark O Lively
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Sandra E Mitchell
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Anu Thakrar
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - David Bryant
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Kathy Baglan
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Jon Strasser
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Luis Baez-Diaz
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Glenn J Lesser
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
| | - Edward G Shaw
- Jennifer J. Hu and Cristiane Takita, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL; James J. Urbanic, University of California, San Diego, Encinitas, CA; L. Doug Case, Doris R. Brown, Carl D. Langefeld, Mark O. Lively, Glenn J. Lesser, and Edward G. Shaw, Wake Forest University School of Medicine, Winston-Salem; Sandra E. Mitchell, Randolph Cancer Center Southeast Cancer Control Consortium, Asheboro, NC; Jean L. Wright, Johns Hopkins University, Baltimore, MD; Anu Thakrar, John H Stroger, Jr Hospital of Cook County Minority-Based Community Clinical Oncology Program (MBCCOP), Chicago, IL; David Bryant, Cancer Center of Kansas/Wichita CCOP, Wichita, KS; Kathy Baglan, St Louis-Cape Girardeau CCOP, St Louis, MO; Jon Strasser, Delaware/Christiana Care Health Services CCOP, Newark, DE; and Luis Baez-Diaz, San Juan MBCCOP, San Juan, Puerto Rico
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Kindts I, Defraene G, Laenen A, Petillion S, Van Limbergen E, Depuydt T, Weltens C. Development of a normal tissue complication probability model for late unfavourable aesthetic outcome after breast-conserving therapy. Acta Oncol 2018; 57:916-923. [PMID: 29652212 DOI: 10.1080/0284186x.2018.1461926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE/OBJECTIVES To develop a normal tissue complication probability (NTCP) model for late unfavourable aesthetic outcome (AO) after breast-conserving therapy. MATERIAL AND METHODS The BCCT.core software evaluated the AO using standardized photographs of patients treated between 2009 and 2014. Dose maps in 2 Gy equivalents were calculated assuming α/β = 3.6 Gy. Uni- and multivariable logistic regression analysis was performed to study the predictive value of clinicopathological and dosimetric variables for unfavourable AO. The Lyman Kutcher Burman (LKB) model was fit to the data with dose modifying factors (dmf). Model performance was assessed with the area under the curve (AUC) of the receiver operating characteristic curve and bootstrap sampling. RESULTS Forty-four of the 121 analysed patients (36%) developed unfavourable AO. In the optimal multivariable logistic regression model, a larger breast volume receiving ≥55 Gy (V55), a seroma and an axillary lymph node dissection (ALND) were independently associated with an unfavourable AO, AUC = 0.75 (95%CI 0.64;0.85). Beta-estimates were -2.68 for β0, 0.057 for V55, 1.55 for seroma and 1.20 for ALND. The optimal LKB model parameters were EUD3.6(50) = 63.3 Gy, n = 1.00, m = 0.23, dmf(seroma) = 0.83 and dmf(ALND) = 0.84, AUC = 0.74 (95%CI 0.61;0.83). CONCLUSIONS An NTCP model for late unfavourable AO after breast-conserving therapy was developed including seroma, axillary lymphadenectomy and V55.
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Affiliation(s)
- Isabelle Kindts
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gilles Defraene
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-Biostat), KU Leuven University, Leuven, Belgium
| | - Saskia Petillion
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Depuydt
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Caroline Weltens
- Department of Oncology, Experimental Radiation Oncology, KU Leuven – University of Leuven, Leuven, Belgium
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
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20
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Christopherson KM, Smith BD. How Does MR Imaging Help Care for My Breast Cancer Patient? Perspective of a Radiation Oncologist. Magn Reson Imaging Clin N Am 2018; 26:295-302. [PMID: 29622135 DOI: 10.1016/j.mric.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Radiation therapy is used in many cases of both early and late breast cancer. The authors examine the role of MR imaging as it pertains to radiotherapy planning and treatment approaches for patients with breast cancer. MR imaging can assist the radiation oncologist in determining the best radiation approach and in creating treatment planning volumes. MR imaging may be useful in the setting of accelerated partial breast irradiation. Radiation oncologists should attend to MR breast images, when obtained, to ensure that these imaging findings are taken into consideration when developing a radiation therapy plan.
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Affiliation(s)
- Kaitlin M Christopherson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Boone Pickens Academic Tower (FCT6.5075), 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1202, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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21
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Jerome NP, Boult JKR, Orton MR, d'Arcy JA, Nerurkar A, Leach MO, Koh DM, Collins DJ, Robinson SP. Characterisation of fibrosis in chemically-induced rat mammary carcinomas using multi-modal endogenous contrast MRI on a 1.5T clinical platform. Eur Radiol 2018; 28:1642-1653. [PMID: 29038934 PMCID: PMC5834566 DOI: 10.1007/s00330-017-5083-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/25/2017] [Accepted: 09/14/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine the ability of multi-parametric, endogenous contrast MRI to detect and quantify fibrosis in a chemically-induced rat model of mammary carcinoma. METHODS Female Sprague-Dawley rats (n=18) were administered with N-methyl-N-nitrosourea; resulting mammary carcinomas underwent nine-b-value diffusion-weighted (DWI), ultrashort-echo (UTE) and magnetisation transfer (MT) magnetic resonance imaging (MRI) on a clinical 1.5T platform, and associated quantitative MR parameters were calculated. Excised tumours were histologically assessed for degree of necrosis, collagen, hypoxia and microvessel density. Significance level adjusted for multiple comparisons was p=0.0125. RESULTS Significant correlations were found between MT parameters and degree of picrosirius red staining (r > 0.85, p < 0.0002 for ka and δ, r < -0.75, p < 0.001 for T1 and T1s, Pearson), indicating that MT is sensitive to collagen content in mammary carcinoma. Picrosirius red also correlated with the DWI parameter fD* (r=0.801, p=0.0004) and conventional gradient-echo T2* (r=-0.660, p=0.0055). Percentage necrosis correlated moderately with ultrashort/conventional-echo signal ratio (r=0.620, p=0.0105). Pimonidazole adduct (hypoxia) and CD31 (microvessel density) staining did not correlate with any MR parameter assessed. CONCLUSIONS Magnetisation transfer MRI successfully detects collagen content in mammary carcinoma, supporting inclusion of MT imaging to identify fibrosis, a prognostic marker, in clinical breast MRI examinations. KEY POINTS • Magnetisation transfer imaging is sensitive to collagen content in mammary carcinoma. • Magnetisation transfer imaging to detect fibrosis in mammary carcinoma fibrosis is feasible. • IVIM diffusion does not correlate with microvessel density in preclinical mammary carcinoma.
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Affiliation(s)
- Neil P Jerome
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Jessica K R Boult
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Matthew R Orton
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
| | - James A d'Arcy
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Ashutosh Nerurkar
- Department of Histopathology, Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Martin O Leach
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Dow-Mu Koh
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, SM2 5PT, UK
| | - David J Collins
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Simon P Robinson
- CR-UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, SM2 5NG, UK.
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22
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Sarsenov D, Aktepe F, Özmen V. Radiation Fibrosis Syndrome Imitating Breast Cancer Recurrence; A Case Report. THE JOURNAL OF BREAST HEALTH 2017; 13:40-42. [PMID: 28331767 DOI: 10.5152/tjbh.2016.3351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/27/2022]
Abstract
Nowadays, surgery, radiotherapy and chemotherapy are the most frequently used modalities in the treatment of breast cancer. It is very well-known that some severe complications may result from after these treatments. Early and late complications of radiotherapy are well known. The complications of radiation therapy may be seen in (early) or after three months (late-delayed) of periods. These complications may be related with direct or indirect effect of radiation. The radiation fibrosis syndrome is a progressive fibrotic tissue sclerosis together with various clinical symptoms in the irradiation field. It is usually a late finding of radiation therapy and may be seen weeks or even years after the treatment. Many systems such as musculo-skeletal, soft tissue, neural tissue and cardiopulmonary system may be affected. In this report, we present a case of a breast cancer treated with breast conserving surgery and radiation therapy twelve years ago. The patient had ipsilateral lymphedema, right axillary mass, and pain during arm and shoulder mobilization. Her physical examination and radiologic findings revealed a big mass invading right thoracic wall, thoracic cavity and the axilla. Histopathological evaluation performed after tru-cut and open biopsy from the mass showed fibrosis resulting from radiation therapy.
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Affiliation(s)
- Dauren Sarsenov
- Department of General Surgery, İstanbul Florence Nigtingale Hospital, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, İstanbul Florence Nigtingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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