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Wrzeszcz K, Kwiatkowska K, Rhone P, Formanowicz D, Kruszewski S, Ruszkowska-Ciastek B. Traditional Clinicopathological Biomarkers Still Determine Disease-Free and Overall Survival in Invasive Breast Cancer Patients: A Pilot Study. J Clin Med 2024; 13:2021. [PMID: 38610786 PMCID: PMC11012512 DOI: 10.3390/jcm13072021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Molecular classification, tumor diameter, Ki67 expression, and brachytherapy administration still act as the most potent potential predictors of breast cancer recurrence and overall survival. Methods: Over the period of 23 months, we included in the study 92 invasive breast cancer (IBrC) patients initially diagnosed at the Clinical Ward of Breast Cancer and Reconstructive Surgery, Oncology Center in Bydgoszcz, Poland. The probability of disease-free survival (DFS) and overall survival (OS) in relation to potential prognostic factors for the patients were determined using a Kaplan-Meier analysis, and univariate and multivariate Cox regression analyses evaluated the predictive factors of IBrC patients. The investigation of the potential prognostic model's accuracy was analyzed using the ROC curve. Results: Patients with tumor size < 2 cm, Ki67 expression < 20%, luminal-A molecular subtype, and extra-dose brachytherapy boost administration displayed the most favorable prognosis according to breast cancer disease-free survival and overall survival. The estimated 5 year probability of DFS and OS rates in women with tumor diameter < 2 cm were 89% and 90%, respectively. In tumor diameter > 2 cm, the estimated 5 year probability of DFS was 73% and OS was 76%. Interestingly, the tumor diameter of 1.6 cm with a specificity of 60.5% and a sensitivity of 75% occurred as the best threshold point to differentiate patients with cancer recurrence from those without cancer progression. Conclusions: Our study provides essential information on the clinicopathological profile and future outcomes of early stage IBrC patients. Furthermore, the tumor diameter cut-off value of 1.6 cm discriminating between disease recurrence and those without disease progression patients represents an innovative direction for further research.
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Affiliation(s)
- Katarzyna Wrzeszcz
- Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University, Collegium Medicum, 85-094 Bydgoszcz, Poland;
| | - Katarzyna Kwiatkowska
- Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University, Collegium Medicum, 85-094 Bydgoszcz, Poland;
| | - Piotr Rhone
- Clinical Ward of Breast Cancer and Reconstructive Surgery, Oncology Centre Prof. F. Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland;
| | - Dorota Formanowicz
- Poznan University of Medical Sciences, Department of Medical Chemistry and Laboratory Medicine, 60-806 Poznan, Poland;
| | - Stefan Kruszewski
- Biophysics Department, Collegium Medicum of Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland;
| | - Barbara Ruszkowska-Ciastek
- Department of Pathophysiology, Faculty of Pharmacy, Nicolaus Copernicus University, Collegium Medicum, 85-094 Bydgoszcz, Poland;
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Chicheł A, Burchardt WM, Kluska A, Chyrek AJ. Thermally boosted interstitial high-dose-rate brachytherapy in high-risk early-stage breast cancer conserving therapy - large cohort long-term results. Rep Pract Oncol Radiother 2023; 28:661-670. [PMID: 38179295 PMCID: PMC10764043 DOI: 10.5603/rpor.97510] [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: 06/12/2023] [Accepted: 09/18/2023] [Indexed: 01/06/2024] Open
Abstract
Background Early-stage high-risk breast cancer (BC) is standardly treated with breast-conserving therapy (BCT), combined with systemic therapy and radiotherapy (RT) ± tumor bed boost, e.g., with interstitial high-dose-rate brachytherapy (HDR-BT). To improve local recurrence rate (LRR), BT radiosensitization (thermal boost, TB) with interstitial microwave hyperthermia (MWHT) may be an option. The paper aims to report a retrospective single-institutional study on 5- and 10-year local control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS), overall survival (OS), cosmetic outcome (CO), and late toxicity (fibrosis, fat necrosis) after thermally enhanced HDR-BT boost to the BC tumor bed. Materials and methods In 2006-2018, 557 early-stage (I-IIIA) high-risk BC patients were treated with BCT. If indicated, they were administered systemic therapy, then referred for 40.0-50.0 Gy whole breast irradiation (WBI) and 10 Gy interstitial HDR-BT boost (group A). Eligible patients had a single MWHT session preceding BT (group B). Based on present risk factors (RF), medium-risk (1-2 RF) and high-risk subgroups (≥ 3 RF) were formed. Patients were standardly checked, and control mammography (MMG) was performed yearly. Breast cosmesis (Harvard scale) and fibrosis were recorded. LC, DMFS, DFS, and OS were statistically analyzed. Results Out of 557 patients aged 57 years (26-84), 364 (63.4%) had interstitial HDR-BT boost (group A), and 193 (34.6%) were preheated with MWHT (group B). Patients in group B had a higher clinical stage and had more RFs. The median follow-up was 65.9. Estimated 5-year and 10-year LC resulted in 98.5% and 97.5%, respectively. There was no difference in LC, DMFS, DFS, and OS between groups A and B and between extracted high-risk subgroups A and B. Five- and ten-year OS probability was 95.4% and 88.0%, respectively, with no difference between groups A and B. Harvard criteria-based CO assessment revealed good/excellent cosmesis in 74.9-79.1%. Tumor bed hardening was present in 40.1-42.2%. Asymptomatic fat necrosis-related macrocalcifications were detected in 15.6%, more frequently in group B (p = 0.016). Conclusions Thermally boosted or not, HDR-BT was locally highly effective as part of combined treatment. Five- and ten-year LC, DMFS, DFS, and OS were high and equally distributed between the groups, although TB was prescribed in more advanced one with more RFs. TB did not influence CO and fibrosis. TB added to late toxicity regarding asymptomatic fat necrosis detected on MMG.
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Affiliation(s)
- Adam Chicheł
- Brachytherapy Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Wojciech Maria Burchardt
- Brachytherapy Department, Greater Poland Cancer Centre, Poznan, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Kluska
- Brachytherapy Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Artur Jan Chyrek
- Brachytherapy Department, Greater Poland Cancer Centre, Poznan, Poland
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
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González-Hernández LM, Vásquez-Trespalacios E, Gallegos-Téllez EP, Corrales-Cruz LM, Javier-Gallón L, Naranjo AM. Overall Survival and Related Factors of Patients Undergoing Breast-Conserving Surgery with Boost Through Interstitial Brachytherapy in a Cancer Center in Medellin, Colombia. South Asian J Cancer 2023; 12:112-117. [PMID: 37969668 PMCID: PMC10635759 DOI: 10.1055/s-0043-1771382] [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] [Indexed: 11/17/2023] Open
Abstract
Liza María González-HernándezPatients with breast cancer undergoing conservative surgery require management with radiotherapy to decrease the risk of recurrence. Moreover, the use of tumor bed boost in high-risk patients has shown an absolute reduction in the 10-year local recurrence risk from 23.9 to 13.5%. Therefore, this study aimed to estimate the overall survival of a group of patients undergoing conservative surgery with a boost through interstitial brachytherapy at a cancer center in Medellin, Colombia. A retrospective cohort study was performed, and records from 2014 to 2020 of patients with in situ or infiltrating breast cancer treated with a boost through interstitial brachytherapy were included. Univariate analysis was conducted to characterize the study population; median survival was calculated using the Kaplan-Meier method. Moreover, associations concerning survival were calculated with each of the factors independently. A total of 186 patients were included. Their overall survival was 93.5%, with a median survival of 79 months. The presence of negative hormone receptors, having two or more irradiated fields and having a locally advanced stage were factors associated independently with higher mortality. The overall survival of patients with in situ or infiltrating breast cancer was favorable and correlated with studies regarding intervention with a boost through interstitial brachytherapy and the factors associated with higher mortality, such as having a locally advanced stage.
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Affiliation(s)
| | | | | | | | - Luis Javier-Gallón
- Especialización en Mastología, Posgrados Clínicos. Universidad CES, Medellín, Colombia
| | - Ana María Naranjo
- Especialización en Mastología, Posgrados Clínicos. Universidad CES, Medellín, Colombia
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Feizi N, Arvandi S, Feli M, Mohammadian F, Zahiri Z, Shamsi A, Bagheri A. Predictors of poor cosmesis in breast cancer patients treated with adjuvant whole breast radiation therapy plus high-dose-rate interstitial brachytherapy boost after breast conservation surgery. J Contemp Brachytherapy 2022; 14:429-437. [PMID: 36478696 PMCID: PMC9720695 DOI: 10.5114/jcb.2022.121403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/29/2022] [Indexed: 09/19/2023] Open
Abstract
Purpose To identify patient, tumor, and treatment-related factors, which predict cosmesis in breast cancer survivors treated with adjuvant whole breast irradiation (WBI) plus high-dose-rate (HDR) multicatheter interstitial brachytherapy (MIBT) boost after breast conservation surgery. Material and methods At least 12 months after completion of radiotherapy, cosmetic outcomes were measured both objectively with BCCT.core software (using a front view digital photograph), and subjectively according to Harvard's criteria. MIBT dose fractionation regimen was 13.6 Gy/4 fractions (bid). To evaluate the correlation between cosmetic scores and dose-volume histogram (DVH) parameters, WBI and MIBT plans were retrospectively analyzed, and ipsilateral skin and breast biologically equivalent dosimetric indices were recorded (α/β = 3 Gy). A multivariate ordinal logistic regression model was used for statistical analysis. Results Twenty-eight consecutive patients were enrolled into this study. The median time from completion of radiation therapy to cosmesis scoring was 18 months. In evaluation with BCCT.core software, no patient was scored as excellent. Cosmesis was good in 18%, fair in 50%, and poor in 32% of patients. According to Harvard's scale, 10.5% of patients had excellent cosmesis, and 43%, 28.5%, and 18% of patients had good, fair, and poor scores, respectively. In univariate analysis, patients with higher absolute MIBT V29Gy (cc), those treated with irradiation of regional lymphatics (odds ratio ≈ 5), and patients with larger breast volumes had statistically significant lower Harvard's scores. In the multivariate model, none of the mentioned factors remained statistically significant, except for a trend for poorer cosmesis in patients with higher absolute MIBT V29Gy (p-value = 0.066). Conclusions Based on the results of this study, MIBT breast V29Gy, regional nodal irradiation, and larger breast volumes are the potential factors, which could predict cosmesis.
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Affiliation(s)
- Nasim Feizi
- Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shole Arvandi
- Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Feli
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Mohammadian
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ziba Zahiri
- Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Azin Shamsi
- Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Bagheri
- Interventional Radiotherapy Ward, Department of Radiation Oncology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Chicheł A, Burchardt W, Chyrek AJ, Bielęda G. Thermal Boost Combined with Interstitial Brachytherapy in Early Breast Cancer Conserving Therapy—Initial Group Long-Term Clinical Results and Late Toxicity. J Pers Med 2022; 12:jpm12091382. [PMID: 36143167 PMCID: PMC9504368 DOI: 10.3390/jpm12091382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
(1) In breast-conserving therapy (BCT), adjuvant radiation, including tumor bed boost, is mandatory. Safely delivered thermal boost (TB) based on radio-sensitizing interstitial microwave hyperthermia (MWHT) preceding standard high-dose-rate (HDR) brachytherapy (BT) boost has the potential for local control (LC) improvement. The study is to report the long-term results regarding LC, disease-free survival (DFS), overall survival (OS), toxicity, and cosmetic outcome (CO) of HDR-BT boost ± MWHT for early breast cancer (BC) patients treated with BCT. (2) In the years 2006 and 2007, 57 diverse stages and risk (IA-IIIA) BC patients were treated with BCT ± adjuvant chemotherapy followed by 42.5–50.0 Gy whole breast irradiation (WBI) and 10 Gy HDR-BT boost. Overall, 25 patients (group A; 43.9%) had a BT boost, and 32 (group B; 56.1%) had an additional pre-BT single session of interstitial MWHT on a tumor bed. Long-term LC, DFS, OS, CO, and late toxicity were evaluated. (3) Median follow-up was 94.8 months (range 1.1–185.5). LC was 55/57, or 96.5% (1 LR in each group). DFS was 48/57, or 84.2% (4 failures in group A, 5 in B). OS was 46/57, or 80.7% (6 deaths in group A, 5 in B). CO was excellent in 60%, good in 36%, and satisfactory in 4% (A), and in 53.1%, 34.4%, and 9.4% (B), respectively. One poor outcome was noted (B). Late toxicity as tumor bed hardening occurred in 19/57, or 33.3% of patients (9 in A, 10 in B). In one patient, grade 2 telangiectasia occurred (group A). All differences were statistically insignificant. (4) HDR-BT boost ± TB was feasible, well-tolerated, and highly locally effective. LC, DFS, and OS were equally distributed between the groups. Pre-BT MWHT did not increase rare late toxicity.
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Affiliation(s)
- Adam Chicheł
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
- Correspondence: ; Tel.: +48-618-850-818 or +48-600-687-369
| | - Wojciech Burchardt
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
| | - Artur J. Chyrek
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
| | - Grzegorz Bielęda
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
- Department of Medical Physics, Greater Poland Cancer Center, 61-866 Poznan, Poland
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Yadav BS, Gupta S, Dahiya D, Gupta A, Oinam AS. Accelerated hypofractionated breast radiotherapy with simultaneous integrated boost: a feasibility study. Radiat Oncol J 2022; 40:127-140. [PMID: 35796116 PMCID: PMC9262700 DOI: 10.3857/roj.2021.01053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To assess the feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) in patients with breast cancer. Materials and Methods A total of 27 patients after breast-conserving surgery were included in this study. Patients were planned on a four-dimensional computerized tomogram, and contouring was done using RTOG guidelines. The dose was 34 Gy/10#/2 week to the breast and 40 Gy/10#/2 week to the tumor bed as SIB with volumetric modulated arc technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs-at-risk were calculated. Toxicities and cosmesis were assessed using RTOG/LENT/SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) were calculated with Kaplan-Meier curves. Results The mean age of the patients was 42 years. Left and right breast cancers were seen in 17 (63%) and 10 (37%) patients, respectively. The mean values of ipsilateral lung V16 and contralateral lung V5 were 16.01% and 3.74%, respectively. The mean heart doses from the left and right breast were 7.25 Gy and 4.37 Gy, respectively. The mean doses to the contralateral breast, oesophagus, and Dmax to brachial plexus were 2.64 Gy, 3.69 Gy, and 26.95 Gy, respectively. The mean value of thyroid V25 was 19.69%. Grade 1 and 2 acute skin toxicities were observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema, and induration were observed in 1 (3.7%), 2 (7.4%), and 4 (14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient. The median follow-up was 51 months (range, 12 to 61 months). At four years, breast induration, edema, and fibrosis were observed in 1 (3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred in 1 (3.7%) and 2 (7.4%) patients, respectively. DFS and OS at four years were 88% and 92%, respectively. Conclusion With this radiotherapy schedule, acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS, and OS were good.
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Affiliation(s)
- Budhi Singh Yadav
- Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shipra Gupta
- Department of Radiation Oncology, National Cancer Institute, Jhajjar, India
| | - Divya Dahiya
- Department of General Surgery, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ankita Gupta
- Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arun Singh Oinam
- Department of Radiation Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Cozzi S, Augugliaro M, Ciammella P, Botti A, Trojani V, Najafi M, Blandino G, Ruggieri MP, Giaccherini L, Alì E, Iori F, Sardaro A, Finocchi Ghersi S, Deantonio L, Gutierrez Miguelez C, Iotti C, Bardoscia L. The Role of Interstitial Brachytherapy for Breast Cancer Treatment: An Overview of Indications, Applications, and Technical Notes. Cancers (Basel) 2022; 14:cancers14102564. [PMID: 35626168 PMCID: PMC9139312 DOI: 10.3390/cancers14102564] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Breast cancer is the most common cancer in the female population. Adjuvant radiotherapy has become increasingly important as conservative treatment. Muticatheter interstitial brachytherapy is a type of radiation technique wherein the radioactive sources are directly implanted into or close to the target tissue and may be considered an extremely precise, versatile, and variable radiation technique. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy, with particular focus on the implant description, limits, and advantages of the technique. Abstract Breast cancer represents the second leading cause of cancer-related death in the female population, despite continuing advances in treatment options that have significantly accelerated in recent years. Conservative treatments have radically changed the concept of healing, also focusing on the psychological aspect of oncological treatments. In this scenario, radiotherapy plays a key role. Brachytherapy is an extremely versatile radiation technique that can be used in various settings for breast cancer treatment. Although it is invasive, technically complex, and requires a long learning curve, the dosimetric advantages and sparing of organs at risk are unequivocal. Literature data support muticatheter interstitial brachytherapy as the only method with strong scientific evidence to perform partial breast irradiation and reirradiation after previous conservative surgery and external beam radiotherapy, with longer follow-up than new, emerging radiation techniques, whose effectiveness is proven by over 20 years of experience. The aim of our work is to provide a comprehensive view of the use of interstitial brachytherapy to perform breast lumpectomy boost, breast-conserving accelerated partial breast irradiation, and salvage reirradiation for ipsilateral breast recurrence, with particular focus on the implant description, limits, and advantages of the technique.
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Affiliation(s)
- Salvatore Cozzi
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
- Correspondence: ; Tel.: +39-329-731-7608
| | - Matteo Augugliaro
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Patrizia Ciammella
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Andrea Botti
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Valeria Trojani
- Medical Physics Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.B.); (V.T.)
| | - Masoumeh Najafi
- Department of Radiation Oncology, Shohadaye Haft-e-Tir Hospital, Iran University of Medical Science, Teheran 1997667665, Iran;
| | - Gladys Blandino
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Maria Paola Ruggieri
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lucia Giaccherini
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Emanuele Alì
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Federico Iori
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Sebastiano Finocchi Ghersi
- Radiation Oncolgy Unit, AOU Sant’Andrea, Facoltà di Medicina e Psicologia, Università La Sapienza, 00185 Rome, Italy;
| | - Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, 6500 Lugano, Switzerland;
| | - Cristina Gutierrez Miguelez
- Brachytherapy Unit, Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, L’Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Cinzia Iotti
- Radiation Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.A.); (P.C.); (G.B.); (M.P.R.); (L.G.); (E.A.); (F.I.); (C.I.)
| | - Lilia Bardoscia
- Radiation Oncology Unit, S. Luca Hospital, Healthcare Company Tuscany Nord Ovest, 55100 Lucca, Italy;
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Thermal Boost to Breast Tumor Bed—New Technique Description, Treatment Application and Example Clinical Results. Life (Basel) 2022; 12:life12040512. [PMID: 35455003 PMCID: PMC9032001 DOI: 10.3390/life12040512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Current breast-conserving therapy for breast cancer consists of a combination of many consecutive treatment modalities. The most crucial goal of postoperative treatment is to eradicate potentially relapse-forming residual cancerous cells within the tumor bed. To achieve this, the HDR brachytherapy boost standardly added to external beam radiotherapy was enhanced with an initial thermal boost. This study presents an original thermal boost technique developed in the clinic. (2) A detailed point-by-point description of thermal boost application is presented. Data on proper patient selection, microwave thermal boost planning, and interstitial hyperthermia treatment delivery are supported by relevant figures and schemes. (3) Out of 1134 breast cancer patients who were administered HDR brachytherapy boost in the tumor bed, 262 were also pre-heated interstitially without unexpected complications. The results are supported by two example cases of hyperthermia planning and delivery. (4) Additional breast cancer interstitial thermal boost preceding HDR brachytherapy boost as a part of combined treatment in a unique postoperative setting was feasible, well-tolerated, completed in a reasonable amount of time, and reproducible. A commercially available interstitial hyperthermia system fit and worked well with standard interstitial brachytherapy equipment.
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Salvestrini V, Mariotti M, Banini M, Becherini C, Visani L, Scotti V, Desideri I, Livi L, Meattini I. Is there a worthwhile value in personalizing radiation therapy for breast cancer patients? Time for a new paradigm in the older adult population. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1897463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit – Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Matteo Mariotti
- 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
| | - Marco Banini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit – Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Carlotta Becherini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit – Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luca Visani
- Radiation Oncology Unit – Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit – Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit – Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy
- Radiation Oncology Unit – Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - 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
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10
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Oses G, Cases C, Valduvieco I, Farrús B, Alonso I, Caparrós X, Mases J, Muñoz-Guglielmetti D, Biete A, Castro C, Escudero E, Molina M, Herreros A, Saez J, Mollà M. Chronic toxicity and long-term outcome in intraoperative electron radiotherapy as boost followed by whole-breast irradiation. Clin Transl Oncol 2021; 23:1593-1600. [PMID: 33534078 DOI: 10.1007/s12094-021-02555-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The administration of a dose boost to the tumor bed after breast-conserving surgery has proven to reduce local recurrence. Intra-operative electron radiotherapy (IOERT) offers an alternative method to deliver a boost with several advantages, such as direct visualization of the tumor bed, less inter- and intrafraction motion and a reduction in the number of medical appointments. The objective of our study is to assess chronic toxicity and long-term outcome for our patients after IOERT boost. MATERIAL AND METHODS Forty-six patients treated at our institution between July 2013 and June 2020 with IOERT boost during Breast-Conserving Surgery and consecutive whole breast irradiation were prospectively analyzed. A 10-12 Gy boost was prescribed to 42 patients and 4 patients received a 20 Gy boost. An analysis for overall survival, local relapse and distant progression was performed. Acute and chronic toxicity was assessed by CTCAE 4.0. RESULTS The median age was 64.5 years (40-90). The median follow-up was 62 months (4-86). We had no local recurrences but 2 patients (4.3%) presented a distant recurrence. Mean pathological tumor size was 16 mm (6-52). 84.8% (39) of the patients had invasive ductal carcinoma. 52.2% (24) presented histological grade II. 52.2% (24) were Luminal A like, 21.7% (10) Luminal B like, 13% (6) HER2 positive, 13% (6) triple negative. No Grade 3-4 chronic toxicity was observed. Grade 1-2 fibrosis was evidenced in 13% (6) of the patients, 4.3% (2) patients presented fat necrosis, 6.5% (3) presented seroma, 4.3% (2) had localized pain, 2.2% (1) presented localized hematoma and 2.2% (1) presented localized edema. CONCLUSIONS IOERT boost in breast cancer treatment during BCS is a safe option with low chronic toxicity. The recurrence rates are comparable to published data and emphasize that IOERT as boost is an effective treatment.
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Affiliation(s)
- G Oses
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain.
| | - C Cases
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - I Valduvieco
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - B Farrús
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - I Alonso
- Department of Gynecology Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - X Caparrós
- Department of Gynecology Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - J Mases
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - D Muñoz-Guglielmetti
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - A Biete
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain.,Department of Clinical Foundations, University of Barcelona, Barcelona, Spain
| | - C Castro
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - E Escudero
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - M Molina
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - A Herreros
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain.,Department of Clinical Foundations, University of Barcelona, Barcelona, Spain
| | - J Saez
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - M Mollà
- Department of Radiation Oncology, Hospital Clínic of Barcelona, Barcelona, Spain.,Department of Clinical Foundations, University of Barcelona, Barcelona, Spain
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11
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Biological dose summation of external beam radiotherapy for the whole breast and image-guided high-dose-rate interstitial brachytherapy boost in early-stage breast cancer. J Contemp Brachytherapy 2020; 12:462-469. [PMID: 33299435 PMCID: PMC7701920 DOI: 10.5114/jcb.2020.100379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/25/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To develop an alternative method for summing biologically effective doses of external beam radiotherapy (EBRT) with interstitial high-dose-rate (HDR) brachytherapy (BT) boost in breast cancer. The total doses using EBRT boost were compared with BT boost using our method. Material and methods Twenty-four EBRT plus interstitial HDR-BT plans were selected, and additional plans using EBRT boost were created. The prescribed dose was 2.67/40.05 Gy to whole breast and 4.75/14.25 Gy BT or 2.67/10.7 Gy EBRT to planning target volume (PTV) boost. EBRT and BT computed tomography (CT) were registered twice, including fitting the target volumes and using the lung, and the most exposed volume of critical organs in BT were identified on EBRT CT images. The minimal dose of these from EBRT was summed with their BT dose, and these EQD2 doses were compared using BT vs. EBRT boost. This method was compared with uniform dose conception (UDC). Results D90 of PTV boost was significantly higher with BT than with EBRT boost: 67.1 Gy vs. 56.7 Gy, p = 0.0001. There was no significant difference in the dose of non-target and contralateral breast using BT and EBRT boost. D1 to skin, lung, and D0.1 to heart were 58.6 Gy vs. 66.7 Gy (p = 0.0025), 32.6 Gy vs. 50.6 Gy (p = 0.0002), and 52.2 Gy vs. 58.1 Gy (p = 0.0009), respectively, while D0.1 to ribs was 44.3 Gy vs. 37.7 Gy (p = 0.0062). UDC overestimated D1 (lung) by 54% (p = 0.0001) and D1 (ribs) by 28% (p = 0.0003). Conclusions Based on our biological dose summation method, the total dose of PTV in the breast is higher using BT boost than with EBRT. BT boost yields lower skin, lung, and heart doses, but higher dose to ribs. UDC overestimates lung and ribs doses.
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12
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Brachytherapy in Breast Cancer. Pract Radiat Oncol 2020. [DOI: 10.1007/978-981-15-0073-2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Jacobs DHM, Horeweg N, Straver M, Roeloffzen EMA, Speijer G, Merkus J, van der Sijp J, Mast ME, Fisscher U, Petoukhova AL, Zwanenburg AG, Marijnen CAM, Koper PCM. Health-related quality of life of breast cancer patients after accelerated partial breast irradiation using intraoperative or external beam radiotherapy technique. Breast 2019; 46:32-39. [PMID: 31075670 DOI: 10.1016/j.breast.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/13/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare health-related quality of life (HRQL) in elderly breast cancer patients between two types of Accelerated Partial Breast Irradiation: intraoperative radiotherapy (IORT) and external beam APBI (EB-APBI). METHODS Between 2011 and 2016 women ≥60 years undergoing breast conserving therapy for early stage breast cancer were included in a prospective multi-centre cohort study. Patients were treated with electron IORT (1 × 23.3 Gy) or photon EB-APBI (10 × 3.85 Gy daily). HRQL was measured by the EORTC-QLQ C30 and BR23 questionnaires before surgery and at several time points until 1 year. RESULTS HRQoL data was available of 204 IORT and 158 EB-APBI patients. In longitudinal analyses emotional functioning and future perspective were significantly, but not clinically relevantly, worse in IORT-treated patients, and improved significantly during follow-up in both groups. All other aspects of HRQL slightly worsened after treatment and recovered within 3 months with an improvement until 1 year. Cross-sectional analysis showed that postoperatively fatigue and role functioning were significantly worse in IORT patients compared to EB-APBI patients who were not yet irradiated, but the difference was not clinically relevant. At other timepoints there were no significant differences. Multivariable analysis at 1 year identified comorbidity and systemic therapy as risk factors for a worse global health score (GHS). CONCLUSIONS EB-APBI and IORT were well tolerated. Despite a temporary deterioration after treatment, all HRQL scales recovered within 3 months resulting in no clinically relevant differences until 1 year between groups nor compared to baseline levels.
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Affiliation(s)
- D H M Jacobs
- Department of Radiation Oncology, Haaglanden Medical Centre, The Hague, the Netherlands; Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands.
| | - N Horeweg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Straver
- Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | - E M A Roeloffzen
- Department of Radiation Oncology, Isala, Zwolle, the Netherlands
| | - G Speijer
- Department of Radiation Oncology, Haga Hospital, The Hague, the Netherlands
| | - J Merkus
- Department of Surgery, Haga Hospital, The Hague, the Netherlands
| | - J van der Sijp
- Department of Surgery, Haaglanden Medical Centre, The Hague, the Netherlands
| | - M E Mast
- Department of Radiation Oncology, Haaglanden Medical Centre, The Hague, the Netherlands
| | - U Fisscher
- Department of Radiation Oncology, Haaglanden Medical Centre, The Hague, the Netherlands
| | - A L Petoukhova
- Department of Radiation Oncology, Haaglanden Medical Centre, The Hague, the Netherlands
| | - A G Zwanenburg
- Department of Radiation Oncology, Isala, Zwolle, the Netherlands
| | - C A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - P C M Koper
- Department of Radiation Oncology, Haaglanden Medical Centre, The Hague, the Netherlands
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14
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Breast: Hungarian Experience and European Trend. Brachytherapy 2019. [DOI: 10.1007/978-981-13-0490-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Imboden S, Knabben L, Mueller MD, Günthert AR, Lössl K. Bone in the breast? Long term toxicity 21 years after interstitial brachytherapy as a boost. Rep Pract Oncol Radiother 2018; 23:337-340. [PMID: 30127673 DOI: 10.1016/j.rpor.2018.06.002] [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: 10/20/2017] [Revised: 03/02/2018] [Accepted: 06/23/2018] [Indexed: 11/17/2022] Open
Abstract
An 81-year-old patient developed an exulcerous tumor in her left breast 21 years after breast cancer treatment with lumpectomy and adjuvant radiotherapy. At the time of the initial treatment 21 years ago, whole breast irradiation was performed with a prescribed dose of 48 Gy and a maximal dose of 69 Gy. In addition, the patient received a 14.7 Gy boost with multicatheter brachytherapy as partial breast irradiation. In general, fat necrosis after radiotherapy, surgery or trauma is a minor problem for patients, but can lead to diagnostic difficulties. The incidence varies: the literature indicates that it occurs in up to 34% of cases. The direct pathogenesis is not clear; it can be due to high radiation dose to the breast, dosimetric inhomogeneities or surgical complications (seromas and inflammation). The tumor in the case described here, occurring more than two decades after the primary treatment, is a rarity in this extent and is an unusual clinical, radiological, and histological finding. It provides a good example of the need for an individualized approach to treatment.
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Affiliation(s)
- Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
| | - Andreas R Günthert
- Department of Obstetrics and Gynecology, Cantonal Hospital, Lucerne, Switzerland
| | - Kristina Lössl
- Department of Radiooncology, University Hospital of Berne and University of Berne, 3010 Berne, Switzerland
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16
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Kauer-Dorner D, Berger D. The Role of Brachytherapy in the Treatment of Breast Cancer. Breast Care (Basel) 2018; 13:157-161. [PMID: 30069174 DOI: 10.1159/000489638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy plays an important part in the management of breast cancer. Especially after breast-conserving surgery, external whole breast irradiation, occasionally with an additional local boost, is an integral part of breast conservation. Besides external radiation techniques, brachytherapy (BT) has long been among the treatment options, especially with regard to local boost application. With the emerging implementation of accelerated partial breast irradiation (APBI), BT in general and interstitial multi-catheter BT in particular, are gaining an increasing role in the management of a selected group of early breast cancer patients. APBI is an approach to reduce the irradiated area to the former tumor bed rather than treating the whole breast tissue in patients with a low baseline local recurrence risk. After a variety of phase I-III clinical studies, it is clearly evident that APBI will play a role in the treatment of this selected patient group. In this review, we focus on the clinical development and different available techniques of breast BT and provide a preview of prospects for its use.
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Affiliation(s)
| | - Daniel Berger
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
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17
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Transition from Paris dosimetry system to 3D image-guided planning in interstitial breast brachytherapy. J Contemp Brachytherapy 2016; 7:479-84. [PMID: 26816505 PMCID: PMC4716128 DOI: 10.5114/jcb.2015.56492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate our first experience with 3D image-guided breast brachytherapy and to compare dose distribution parameters between Paris dosimetry system (PDS) and image-based plans. MATERIAL AND METHODS First 49 breast cancer patients treated with 3D high-dose-rate interstitial brachytherapy as a boost were selected for the study. Every patient underwent computed tomography, and the planning target volume (PTV) and organs at risk (OAR) were outlined. Two treatment plans were created for every patient. First, based on a Paris dosimetry system (PDS), and the second one, imaged-based plan with graphical optimization (OPT). The reference isodose in PDS implants was 85%, whereas in OPT plans the isodose was chosen to obtain proper target coverage. Dose and volume parameters (D90, D100, V90, V100), doses at OARs, total reference air kerma (TRAK), and quality assurance parameters: dose nonuniformity ratio (DNR), dose homogeneity index (DHI), and conformity index (COIN) were used for a comparison of both plans. RESULTS The mean number of catheters was 7 but the mean for 20 first patients was 5 and almost 9 for the next 29 patients. The mean value of prescribed isodose for OPT plans was 73%. The mean D90 was 88.2% and 105.8%, the D100 was 59.8% and 75.7%, the VPTV90 was 88.6% and 98.1%, the VPTV100 was 79.9% and 98.9%, and the TRAK was 0.00375 Gym(-1) and 0.00439 Gym(-1) for the PDS and OPT plans, respectively. The mean DNR was 0.29 and 0.42, the DHI was 0.71 and 0.58, and the COIN was 0.68 and 0.76, respectively. CONCLUSIONS The target coverage in image-guided plans (OPT) was significantly higher than in PDS plans but the dose homogeneity was worse. Also, the value of TRAK increased because of change of prescribing isodose. The learning curve slightly affected our results.
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18
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Breast Brachytherapy: Interstitial Breast Brachytherapy. Brachytherapy 2016. [DOI: 10.1007/978-3-319-26791-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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The use of an interstitial boost in the conservative treatment of breast cancer: how to perform it routinely in a radiotherapy department. J Contemp Brachytherapy 2014; 6:397-403. [PMID: 25834585 PMCID: PMC4300358 DOI: 10.5114/jcb.2014.46757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/26/2014] [Accepted: 10/22/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose To demonstrate the utility of a boost with interstitial brachytherapy (BT) in breast-conserving therapy (BCT) by doing a thorough review of the literature and describing in detail our technique for delivering this boost. Material and methods Our department has been delivering the boost with interstitial BT since 1989, in most cases with rigid needles and a theoretical dosimetry. In the early years, we used low-dose-rate (LDR) with iridium-192 wires. The dose administered was 15 Gy if there were no risk factors for local relapse or 20-25 Gy in the presence of risk factors. The risk factors considered were the presence of a close margin (less than 10 mm) and an extensive intraductal component (more than 25%). After 2002, we switched to high-dose-rate (HDR); using the linear quadratic model we changed the low dose to 3 fractions of 4.5 Gy in the case of no risk factors for local relapse or to 3 fractions of 5 Gy in the presence of risk factors. Results In 79 consecutive boost patients treated in our department between 2010 and 2011, with a median follow-up of 46 months, the local control rate was 97.47%. With respect to cosmesis, fibrosis occurred in 17 cases (21.5%) and hyperpigmentation in 26 cases (32.9%). Our hospital's results are comparable in terms of local control and cosmesis to those of other authors. Conclusions This educational article describes our department's boost technique with rigid needles and comments briefly on our results using this technique in a group of consecutively treated patients in our department. A review of the literature and the published results on local control and cosmesis is also described.
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20
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Lasota J, Kabacińska R, Makarewicz R. Dose estimation for different skin models in interstitial breast brachytherapy. J Contemp Brachytherapy 2014; 6:200-7. [PMID: 25097562 PMCID: PMC4105640 DOI: 10.5114/jcb.2014.43167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 03/16/2014] [Accepted: 06/26/2014] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Skin is a major organ at risk in breast-conserving therapy (BCT). The American Brachytherapy Society (ABS) recommendations require monitoring of maximum dose received, however, there is no unambiguous way of skin contouring provided. The purpose of this study was to compare the doses received by the skin in different models. MATERIAL AND METHODS Standard treatment plans of 20 patients who underwent interstitial breast brachytherapy were analyzed. Every patient had a new treatment plan prepared according to Paris system and had skin contoured in three different ways. The first model, Skin 2 mm, corresponds to the dermatological breast skin thickness and is reaching 2 mm into an external patient contour. It was rejected in a further analysis, because of distinct discontinuities in contouring. The second model, Skin 4 mm, replaced Skin 2 mm, and is reaching 2 mm inside and 2 mm outside of the External contour. The third model, Skin EXT, is created on the External contour and it expands 4 mm outside. Doses received by the most exposed 0.1 cc, 1 cc, 2 cc, and the maximum doses for Skin 4 mm and Skin EXT were compared. RESULTS Mean, median, maximum, and standard deviation of percentage dose difference between Skin EXT and Skin 4 mm for the most exposed 0.1 cc (D0.1cc) of skin were 18.01%, 17.20%, 27.84%, and 4.01%, respectively. All differences were statistically significant (p < 0.05). CONCLUSIONS Monitoring of doses received by skin is necessary to avoid complications and obtain a satisfactory cosmetic effect. It is difficult to assess the compatibility of treatment plans with recommendations, while there is no unambiguous way of skin contouring. Especially, if a mean difference of doses between two models of skin contouring is 18% for the most exposed 0.1 cc and can reach almost 28% in some cases. Differences of this magnitude can result in skin complications during BCT.
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Affiliation(s)
- Judyta Lasota
- Department of Medical Physics, Oncology Center, Bydgoszcz, Poland
- Chair and Clinic of Oncology and Brachytherapy, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Renata Kabacińska
- Department of Medical Physics, Oncology Center, Bydgoszcz, Poland
- Chair and Clinic of Oncology and Brachytherapy, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Roman Makarewicz
- Chair and Clinic of Oncology and Brachytherapy, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
- Brachytherapy Department, Oncology Center, Bydgoszcz, Poland
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21
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Brachytherapy in breast cancer: an effective alternative. MENOPAUSE REVIEW 2014; 13:48-55. [PMID: 26327829 PMCID: PMC4520341 DOI: 10.5114/pm.2014.41090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 02/19/2014] [Accepted: 02/19/2014] [Indexed: 11/17/2022]
Abstract
Breast conserving surgery (BCS) with following external beam radiation therapy (EBRT) of the conserved breast has become widely accepted in the last decades for the treatment of early invasive breast cancer. The standard technique of EBRT after BCS is to treat the whole breast up to a total dose of 42.5 to 50 Gy. An additional dose is given to treated volume as a boost to a portion of the breast. In the early stage of breast cancer, research has shown that the area requiring radiation treatment to prevent the cancer from local recurrence is the breast tissue that surrounds the area where the initial cancer was removed. Accelerated partial breast irradiation (APBI) is an approach that treats only the lumpectomy bed plus a 1-2 cm margin rather than the whole breast and as a result allows accelerated delivery of the radiation dose in four to five days. There has been a growing interest for APBI and various approaches have been developed under phase I-III clinical studies; these include multicatheter interstitial brachytherapy, balloon catheter brachytherapy, conformal external beam radiation therapy (3D-EBRT) and intra-operative radiation therapy (IORT). Balloon-based brachytherapy approaches include MammoSite, Axxent electronic brachytherapy, Contura, hybrid brachytherapy devices. Another indication for breast brachytherapy is reirradiation of local recurrence after mastectomy. Published results of brachytherapy are very promising. We discuss the current status, indications, and technical aspects of breast cancer brachytherapy.
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22
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Marcos S, Montero A, Capuz B, Martinez-Ollero J, Hernanz R, Fernández E, Polo A, Ramos A. HDR-plesiotherapy for the treatment of anogenital extramammary Paget's disease. Rep Pract Oncol Radiother 2012; 17:163-7. [PMID: 24377019 DOI: 10.1016/j.rpor.2012.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 01/07/2012] [Accepted: 03/10/2012] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Extramammary Paget disease (EMPD) is a rare condition that most commonly affects the anogenital region in the elderly. It may be associated with an underlying invasive carcinoma. Surgical excision is nowadays considered a standard treatment for extramammary Paget's disease, although this approach might not be suitable for all patients. Good rates of local control and cosmetic outcome have been achieved by using high-dose-rate (HDR) plesiotherapy in the treatment of skin tumors arising in different locations. MATERIAL AND METHODS We present the results observed in a patient with EMPD treated by HDR plesiotherapy with a custom-made mold up to a final dose of 54 Gy in 12 fractions of 450 cGy over 4 weeks. RESULTS After a follow-up of 18 months, the patient is alive and without evidence of local or distant relapse. Acute toxicity was acceptable and cosmetic result was considered as excellent. CONCLUSION This technique represents an attractive alternative for those patients who are not candidates for surgical procedures because of unacceptable risk of disfigurements or functional impairment, medical contraindications or patient preference.
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Affiliation(s)
- Soraya Marcos
- Department of Radiation Oncology, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - Angel Montero
- Department of Radiation Oncology, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - Belén Capuz
- Department of Radiation Oncology, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | | | - Raúl Hernanz
- Department of Radiation Oncology, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - Eva Fernández
- Department of Radiation Oncology, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - Alfredo Polo
- Department of Radiation Oncology, Universitary Hospital Ramón y Cajal, Madrid, Spain
| | - Alfredo Ramos
- Department of Radiation Oncology, Universitary Hospital Ramón y Cajal, Madrid, Spain
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23
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Algara M, Arenas M, De Las Peñas Eloisa Bayo D, Muñoz J, Carceller JA, Salinas J, Moreno F, Martínez F, González E, Montero A. Radiation techniques used in patients with breast cancer: Results of a survey in Spain. Rep Pract Oncol Radiother 2012; 17:122-8. [PMID: 24377012 DOI: 10.1016/j.rpor.2012.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 02/05/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022] Open
Abstract
AIM To evaluate the resources and techniques used in the irradiation of patients with breast cancer after lumpectomy or mastectomy and the status of implementation of new techniques and therapeutic schedules in our country. BACKGROUND The demand for cancer care has increased among the Spanish population, as long as cancer treatment innovations have proliferated. Radiation therapy in breast cancer has evolved exponentially in recent years with the implementation of three-dimensional conformal radiotherapy, intensity modulated radiotherapy, image guided radiotherapy and hypofractionation. MATERIAL AND METHODS An original survey questionnaire was sent to institutions participating in the SEOR-Mama group (GEORM). In total, the standards of practice in 969 patients with breast cancer after surgery were evaluated. RESULTS The response rate was 70% (28/40 centers). In 98.5% of cases 3D conformal treatment was used. All the institutions employed CT-based planning treatment. Boost was performed in 56.4% of patients: electrons in 59.8%, photons in 23.7% and HDR brachytherapy in 8.8%. Fractionation was standard in 93.1% of patients. Supine position was the most frequent. Only 3 centers used prone position. The common organs of risk delimited were: homolateral lung (80.8%) and heart (80.8%). In 84% histograms were used. An 80.8% of the centers used isocentric technique. In 62.5% asymmetric fields were employed. CTV was delimited in 46.2%, PTV in 65% and both in 38.5%. A 65% of the centers checked with portal films. IMRT and hypofractionation were used in 1% and in 5.5% respectively. CONCLUSION In most of centers, 3D conformal treatment and CT-based planning treatment were used. IMRT and hypofractionation are currently poorly implemented in Spain.
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Affiliation(s)
- Manuel Algara
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | | | | | - Julia Muñoz
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | | | - Juan Salinas
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | - Ferran Moreno
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
| | | | | | - Angel Montero
- Breast Cancer Radiation Oncology Spanish Group (GEORM), Spain
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Adamczyk M, Zwierzchowski G, Malicki J, Skowronek J. Evaluation of clinical benefits achievable by using different optimization algorithms during real-time prostate brachytherapy. Phys Med 2012; 29:111-6. [PMID: 22221470 DOI: 10.1016/j.ejmp.2011.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/09/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND AND PURPOSE High dose rate (HDR) brachytherapy is a clinically used procedure in prostate cancer treatment. The purpose of this study was to present the influence of using different optimization algorithms in 3D-CBRT planning on the treatment plan quality. MATERIALS AND METHODS Treatment plans were calculated for 15 patients--three plans for each patient using: geometrical optimization (GO), inverse optimization (IO) and blind inverse optimization (BIO). For each patient, PTV and OAR volumes, number of needles and geometry of the implant were set equal. Differences between dose distributions were tracked using: D90, V100, V200, Dmax (for prostate); D10, Dmax (for urethra); D10, V100, Dmax (for rectum). RESULTS The analysis of mean values of D90 and V100 in the prostate showed that inverse algorithms gave the best results (mean D90 was 12.1% for BIO and 9.3% for IO better than for GO, mean V100 was 8.2% for BIO and 6.3% for IO better than for GO). From a clinical point of view, GO diminished the doses in the PTV and urethra in all analyzed parameters. The lowest mean doses in the rectum were achieved for plans optimized with IO and BIO (mean D10: 61.2% for GO, 58.1% for IO, 58.0% for BIO; mean Dmax: 92.8% for GO, 85.1% for IO, 83.6% for BIO). CONCLUSIONS Application of the blind inverse optimization (BIO) algorithm led to clinically best dose parameters for PTV and the rectum. Use of geometrical optimization (GO) led to smaller doses in the urethra, which was however associated with a certain dose decrease also in PTV.
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Affiliation(s)
- Marta Adamczyk
- Department of Medical Physics, Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
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Affiliation(s)
- Ferran Guedea
- Department of Radiation Oncology, Institut Català d'Oncologia, Gran vía s/n, Km 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
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Assessment of dose homogeneity in conformal interstitial breast brachytherapy with special respect to ICRU recommendations. J Contemp Brachytherapy 2011; 3:150-5. [PMID: 23346125 PMCID: PMC3551357 DOI: 10.5114/jcb.2011.24822] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/25/2011] [Accepted: 09/06/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose To present the results of dose homogeneity analysis for breast cancer patients treated with image-based conformal interstitial brachytherapy, and to investigate the usefulness of the ICRU recommendations. Material and methods Treatment plans of forty-nine patients who underwent partial breast irradiation with interstitial brachytherapy were analyzed. Quantitative parameters were used to characterize dose homogeneity. Dose non-uniformity ratio (DNR), dose homogeneity index (DHI), uniformity index (UI) and quality index (QI) were calculated. Furthermore, parameters recommended by the ICRU 58 such as minimum target dose (MTD), mean central dose (MCD), high dose volume, low dose volume and the spread between local minimum doses were determined. Correlations between the calculated homogeneity parameters and usefulness of the ICRU parameters in image-based brachytherapy were investigated. Results Catheters with mean number of 15 (range: 6-25) were implanted in median 4 (range: 3-6) planes. The volume of the PTV ranged from 15.5 cm3 to 176 cm3. The mean DNR was 0.32, the DHI 0.66, the UI 1.49 and the QI 1.94. Related to the prescribed dose, the MTD was 69% and the MCD 135%. The mean high dose volume was 8.1 cm3 (10%), while the low dose volume was 63.8 cm3 (96%). The spread between minimum doses in central plane ranged from −14% to +20%. Good correlation was found between the DNR and the DHI (R2=0.7874), and the DNR correlated well with the UI (R2=0.7615) also. No correlation was found between the ICRU parameters and any other volumetric parameters. Conclusions To characterize the dose uniformity in high-dose rate breast implants, DVH-related homogeneity parameters representing the full 3D dose distributions are mandatory to be used. In many respects the current recommendations of the ICRU Report 58 are already outdated, and it is well-timed to set up new recommendations, which are more feasible for image-guided conformal interstitial brachytherapy.
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Chicheł A, Skowronek J, Kanikowski M. Thermal boost combined with interstitial brachytherapy in breast conserving therapy - Assessment of early toxicity. Rep Pract Oncol Radiother 2011; 16:87-94. [PMID: 24376963 DOI: 10.1016/j.rpor.2011.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/11/2010] [Accepted: 02/21/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperthermia (HT) causes a direct damage to cancerous cells and/or sensitize them to radiotherapy with usually minimal injury to normal tissues. Adjuvant HT is probably one of the most effective radiation sensitizers known and works best when delivered simultaneously with radiation. In breast conserving therapy, irradiation has to minimize the risk of local relapse within the treated breast, especially in an area of a tumor bed. Brachytherapy boost reduces 5-year local recurrence rate to mean 5,5%, so there still some place for further improvement. The investigated therapeutic option is an adjuvant single session of local HT (thermal boost) preceding standard CT-based multicatheter interstitial HDR brachytherapy boost in order to increase the probability of local cure. AIM To report the short-term results in regard to early toxicity of high-dose-rate (HDR) brachytherapy (BT) boost with or without interstitial microwave hyperthermia (MV HT) for early breast cancer patients treated with breast conserving therapy (BCT). MATERIALS AND METHODS Between February 2006 and December 2007, 57 stage IA-IIIA breast cancer patients received a 10 Gy HDR BT boost after conservative surgery and 42.5-50 Gy whole breast irradiation (WBI) ± adjuvant chemotherapy. 32 patients (56.1%) were treated with additional pre-BT single session of interstitial MW HT to a tumor bed (multi-catheter technique). Reference temperature was 43 °C and therapeutic time (TT) was 1 h. Incidence, severity and duration of radiodermatitis, skin oedema and skin erythema in groups with (I) or without HT (II) were assessed, significant p-value ≤ 0.05. RESULTS Median follow-up was 40 months. Local control was 100% and distant metastasis free survival was 91.1%. HT sessions (median): reference temperature 42.2 °C, therapeutic time (TT) 61.4 min, total thermal dose 42 min and a gap between HT and BT 30 min. Radiodermatitis grades I and II occurred in 24 and 6 patients, respectively, differences between groups I and II were not significant. Skin oedema and erythema occurred in 48 (85.7%) and 36 (64.3%) cases, respectively, and were equally distributed between the groups. The incidence and duration of skin oedema differed between the subgroups treated with different fractionation protocols of WBI, p = 0.006. Skin oedema was present up to 12 months. No difference in pattern of oedema regression between groups I and II was observed, p = 0.933. CONCLUSION Additional thermal boost preceding standard HDR BT boost has a potential of further improvement in breast cancer local control in BCT. Pre-BT hyperthermia did not increase early toxicity in patients treated with BCT and was well tolerated. All side effects of combined treatment were transient and were present for up to 12 months. The increase in incidence of skin oedema was related to hypofractionated protocols of WBI. The study has to be randomized and continued on a larger group of breast cancer patients to verify the potential of local control improvement and to assess the profile of late toxicity.
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Affiliation(s)
- Adam Chicheł
- Department of Brachytherapy, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznań, Poland
| | - Janusz Skowronek
- Department of Brachytherapy, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznań, Poland
| | - Marek Kanikowski
- Department of Brachytherapy, Greater Poland Cancer Centre, Garbary 15, 61-866 Poznań, Poland
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