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Brunt AM, Haviland JS, Wheatley DA, Sydenham MA, Bloomfield DJ, Chan C, Cleator S, Coles CE, Donovan E, Fleming H, Glynn D, Goodman A, Griffin S, Hopwood P, Kirby AM, Kirwan CC, Nabi Z, Patel J, Sawyer E, Somaiah N, Syndikus I, Venables K, Yarnold JR, Bliss JM. One versus three weeks hypofractionated whole breast radiotherapy for early breast cancer treatment: the FAST-Forward phase III RCT. Health Technol Assess 2023; 27:1-176. [PMID: 37991196 PMCID: PMC11017153 DOI: 10.3310/wwbf1044] [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] [Indexed: 11/23/2023] Open
Abstract
Background FAST-Forward aimed to identify a 5-fraction schedule of adjuvant radiotherapy delivered in 1 week that was non-inferior in terms of local cancer control and as safe as the standard 15-fraction regimen after primary surgery for early breast cancer. Published acute toxicity and 5-year results are presented here with other aspects of the trial. Design Multicentre phase III non-inferiority trial. Patients with invasive carcinoma of the breast (pT1-3pN0-1M0) after breast conservation surgery or mastectomy randomised (1 : 1 : 1) to 40 Gy in 15 fractions (3 weeks), 27 Gy or 26 Gy in 5 fractions (1 week) whole breast/chest wall (Main Trial). Primary endpoint was ipsilateral breast tumour relapse; assuming 2% 5-year incidence for 40 Gy, non-inferiority pre-defined as < 1.6% excess for 5-fraction schedules (critical hazard ratio = 1.81). Normal tissue effects were assessed independently by clinicians, patients and photographs. Sub-studies Two acute skin toxicity sub-studies were undertaken to confirm safety of the test schedules. Primary endpoint was proportion of patients with grade ≥ 3 acute breast skin toxicity at any time from the start of radiotherapy to 4 weeks after completion. Nodal Sub-Study patients had breast/chest wall plus axillary radiotherapy testing the same three schedules, reduced to the 40 and 26 Gy groups on amendment, with the primary endpoint of 5-year patient-reported arm/hand swelling. Limitations A sequential hypofractionated or simultaneous integrated boost has not been studied. Participants Ninety-seven UK centres recruited 4096 patients (1361:40 Gy, 1367:27 Gy, 1368:26 Gy) into the Main Trial from November 2011 to June 2014. The Nodal Sub-Study recruited an additional 469 patients from 50 UK centres. One hundred and ninety and 162 Main Trial patients were included in the acute toxicity sub-studies. Results Acute toxicity sub-studies evaluable patients: (1) acute grade 3 Radiation Therapy Oncology Group toxicity reported in 40 Gy/15 fractions 6/44 (13.6%); 27 Gy/5 fractions 5/51 (9.8%); 26 Gy/5 fractions 3/52 (5.8%). (2) Grade 3 common toxicity criteria for adverse effects toxicity reported for one patient. At 71-month median follow-up in the Main Trial, 79 ipsilateral breast tumour relapse events (40 Gy: 31, 27 Gy: 27, 26 Gy: 21); hazard ratios (95% confidence interval) versus 40 Gy were 27 Gy: 0.86 (0.51 to 1.44), 26 Gy: 0.67 (0.38 to 1.16). With 2.1% (1.4 to 3.1) 5-year incidence ipsilateral breast tumour relapse after 40 Gy, estimated absolute differences versus 40 Gy (non-inferiority test) were -0.3% (-1.0-0.9) for 27 Gy (p = 0.0022) and -0.7% (-1.3-0.3) for 26 Gy (p = 0.00019). Five-year prevalence of any clinician-assessed moderate/marked breast normal tissue effects was 40 Gy: 98/986 (9.9%), 27 Gy: 155/1005 (15.4%), 26 Gy: 121/1020 (11.9%). Across all clinician assessments from 1 to 5 years, odds ratios versus 40 Gy were 1.55 (1.32 to 1.83; p < 0.0001) for 27 Gy and 1.12 (0.94-1.34; p = 0.20) for 26 Gy. Patient and photographic assessments showed higher normal tissue effects risk for 27 Gy versus 40 Gy but not for 26 Gy. Nodal Sub-Study reported no arm/hand swelling in 80% and 77% in 40 Gy and 26 Gy at baseline, and 73% and 76% at 24 months. The prevalence of moderate/marked arm/hand swelling at 24 months was 10% versus 7% for 40 Gy compared with 26 Gy. Interpretation Five-year local tumour incidence and normal tissue effects prevalence show 26 Gy in 5 fractions in 1 week is a safe and effective alternative to 40 Gy in 15 fractions for patients prescribed adjuvant local radiotherapy after primary surgery for early-stage breast cancer. Future work Ten-year Main Trial follow-up is essential. Inclusion in hypofractionation meta-analysis ongoing. A future hypofractionated boost trial is strongly supported. Trial registration FAST-Forward was sponsored by The Institute of Cancer Research and was registered as ISRCTN19906132. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 09/01/47) and is published in full in Health Technology Assessment; Vol. 27, No. 25. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Adrian Murray Brunt
- School of Medicine, University of Keele and University Hospitals of North Midlands, Staffordshire, UK
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Joanne S Haviland
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Duncan A Wheatley
- Department of Oncology, Royal Cornwall Hospital NHS Trust, Truro, UK
| | - Mark A Sydenham
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - David J Bloomfield
- Sussex Cancer Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Charlie Chan
- Women's Health Clinic, Nuffield Health Cheltenham Hospital, Cheltenham, UK
| | - Suzy Cleator
- Department of Oncology, Imperial Healthcare NHS Trust, London, UK
| | | | - Ellen Donovan
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK
| | - Helen Fleming
- Clinical and Translational Radiotherapy Research Group, National Cancer Research Institute, London, UK
| | - David Glynn
- Centre for Health Economics, University of York, York, UK
| | | | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | - Penelope Hopwood
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Anna M Kirby
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Cliona C Kirwan
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Zohal Nabi
- RTQQA, Mount Vernon Cancer Centre, Middlesex, UK
| | - Jaymini Patel
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Elinor Sawyer
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Navita Somaiah
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Isabel Syndikus
- Clatterbridge Cancer Centre, Clatterbridge Hospital NHS Trust, Cheshire, UK
| | | | - John R Yarnold
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, Sutton, UK and Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Judith M Bliss
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
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2
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Best J, Starkey T, Chatterjee A, Fackrell D, Pettit L, Srihari N, Tween H, Olsson-Brown A, Cheng V, Hughes DJ, Lee AJX, Purshouse K, Arnold R, Uk Coronavirus Cancer Monitoring Project Team, Sivakumar S, Cazier JB, Lee LYW. Coronavirus Disease 2019: the Pivotal Role of UK Clinical Oncology and the UK Coronavirus Cancer Monitoring Project. Clin Oncol (R Coll Radiol) 2021; 33:e50-e53. [PMID: 32593552 PMCID: PMC7274595 DOI: 10.1016/j.clon.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Affiliation(s)
- J Best
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - T Starkey
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - A Chatterjee
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - D Fackrell
- Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - L Pettit
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - H Tween
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - V Cheng
- Leeds Cancer Centre, Bexley Wing, St James's University Hospital, Leeds, UK
| | - D J Hughes
- Department of Cancer Imaging, Division of Cancer Studies, Guy's Campus, King's College London, London, UK
| | - A J X Lee
- University College London, UCL Cancer Institute, London, UK
| | - K Purshouse
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - R Arnold
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - S Sivakumar
- Department of Oncology, University of Oxford, Oxford, UK
| | - J-B Cazier
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - L Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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3
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Radiotherapy challenges in COVID era. BIOMEDICAL ENGINEERING TOOLS FOR MANAGEMENT FOR PATIENTS WITH COVID-19 2021. [PMCID: PMC8192315 DOI: 10.1016/b978-0-12-824473-9.00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pandemic caused by the new coronavirus (SARS-CoV-2) associated with a disease named COVID-19 by the World Health Organization that began in late 2019 in Wuhan city has become a global public health problem. Only 2 months later, the new virus affected most countries of the world, the consequence being an overload of health systems, especially Intensive Care Units. Considered a category of patients at high risk of developing severe forms of the disease, cancer patients can develop a severe form of the disease, complicated by acute respiratory distress syndrome requiring mechanical ventilation. Radiotherapy, as a treatment included in the multidisciplinary management of cancer for both curative and palliative purposes, is also affected by the COVID-19 pandemic. COVID-19-positive or -suspected patients are a special category for which the decision to postpone treatment should be made based on the particularities of tumor biology and the radiobiological effect of a gap in radiation fractions delivery. Emergencies including spinal cord compressions, tumor bleeding, and brain metastases not responsive to corticosteroid treatment, should be considered a priority but the palliative treatment should be limited from one single fraction to maximum five fractions for spinal cord compression and whole brain radiotherapy. Radiotherapy for brain metastases does not bring a benefit in terms of overall survival for patients with life expectancy of days or weeks and dexamethasone treatment is the correct choice in this situation. In all settings, the approach of radiotherapy treatment must be adapted for both scenarios of an outbreak pandemic, when general measures of social distancing and protection by specific equipment of patients and radiotherapy staff are a priority, but also for a long period of coexistence with the virus with possible new “pandemic waves.”
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4
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Elghazawy H, Bakkach J, Zaghloul MS, Abusanad A, Hussein MM, Alorabi M, eldin NB, Helal T, Zaghloul TM, Venkatesulu BP, Elghazaly H, Al-Sukhun S. Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic. Future Oncol 2020; 16:2551-2567. [PMID: 32715776 PMCID: PMC7386379 DOI: 10.2217/fon-2020-0574] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.
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Affiliation(s)
- Hagar Elghazawy
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Joaira Bakkach
- Biomedical Genomics & Oncogenetics Research Laboratory. Faculty of Sciences and Techniques of Tangier. Abdel Malek Essaadi University, Tangier 90000, Morocco
| | - Mohamed S Zaghloul
- Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo 12622, Egypt
| | - Atlal Abusanad
- Department of Medicine, Oncology Division, King Abdulaziz University, Jeddah 23221, Saudi Arabia
| | - Mariam Mohamed Hussein
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Mohamed Alorabi
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Nermean Bahie eldin
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Thanaa Helal
- Department of Pathology, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Tarek M Zaghloul
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo 12622, Egypt
| | | | - Hesham Elghazaly
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Sana Al-Sukhun
- Al-Hyatt Oncology Center, Faculty of medicine, Jordan University, Amman 11183, Jordan
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5
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Martin M, Guerrero‐Zotano A, Montero Á, Jara C, Filipovich E, Rojo F, Moreno F, García‐Sáenz JÁ, Alés JE, Chacón JI, Cruz J, Gimenez J, Cruz‐Merino L, Algara M, Santisteban M, Tarruella SL. GEICAM Guidelines for the Management of Patients with Breast Cancer During the COVID-19 Pandemic in Spain. Oncologist 2020; 25:e1339-e1345. [PMID: 32652782 PMCID: PMC7405405 DOI: 10.1634/theoncologist.2020-0363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
Breast cancer (BC) is the most common cancer in women in Spain. During the COVID-19 pandemic caused by the SARS-CoV-2 virus, patients with BC still require timely treatment and follow-up; however, hospitals are overwhelmed with infected patients and, if exposed, patients with BC are at higher risk for infection and serious complications if infected. Thus, health care providers need to evaluate each BC treatment and in-hospital visit to minimize pandemic-associated risks while maintaining adequate treatment efficacy. Here we present a set of guidelines regarding available options for BC patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the lack of evidence about COVID-19 infection, these recommendations are mainly based on expert opinion, medical organizations' and societies' recommendations, and some published evidence. We consider this a useful tool to facilitate medical decision making in this health crisis situation we are facing. IMPLICATIONS FOR PRACTICE: This work presents a set of guidelines regarding available options for breast cancer (BC) patient management and treatment by BC subtype in the context of the COVID-19 pandemic. Owing to the suddenness of this health crisis, specialists have to make decisions with little evidence at hand. Thus, these expert guidelines may be a useful tool to facilitate medical decision making in the context of a worldwide pandemic with no resources to spare.
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Affiliation(s)
- Miguel Martin
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Departamento de Medicina, Universidad ComplutenseMadridSpain
- Centro de Investigación Biomedica en Red de Oncologia, CIBERONC‐ISCIIISpain
| | | | - Ángel Montero
- Radiation Oncology, Hospital HM SanchinarroMadridSpain
| | - Carlos Jara
- Medical Oncology, Universidad Rey Juan Carlos, Hospital Fundación AlcorcónMadridSpain
| | | | - Federico Rojo
- Centro de Investigación Biomedica en Red de Oncologia, CIBERONC‐ISCIIISpain
- Pathology, Hospital Fundación Jimenez Díaz de MadridMadridSpain
| | - Fernando Moreno
- Medical Oncology, Hospital Universitario Clínico San Carlos de MadridMadridSpain
| | - Jose Ángel García‐Sáenz
- Centro de Investigación Biomedica en Red de Oncologia, CIBERONC‐ISCIIISpain
- Medical Oncology, Hospital Universitario Clínico San Carlos de MadridMadridSpain
| | | | | | - Josefina Cruz
- Medical Oncology, Hospital Universitario de CanariasTenerifeSpain
| | - Julia Gimenez
- Surgery, Instituto Valenciano de OncologíaValenciaSpain
| | - Luis Cruz‐Merino
- Medical Oncology, Hospital Virgen de Macarena de SevillaSevilleSpain
| | - Manel Algara
- Radiation Oncology, Hospital del Mar de BarcelonaBarcelonaSpain
| | | | - Sara López Tarruella
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Departamento de Medicina, Universidad ComplutenseMadridSpain
- Centro de Investigación Biomedica en Red de Oncologia, CIBERONC‐ISCIIISpain
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6
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Coles CE, Aristei C, Bliss J, Boersma L, Brunt AM, Chatterjee S, Hanna G, Jagsi R, Kaidar Person O, Kirby A, Mjaaland I, Meattini I, Luis AM, Marta GN, Offersen B, Poortmans P, Rivera S. International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:279-281. [PMID: 32241520 PMCID: PMC7270774 DOI: 10.1016/j.clon.2020.03.006] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- C E Coles
- Oncology Department, University of Cambridge, UK.
| | - C Aristei
- University of Perugia, Italy; Perugia General Hospital Sant'Andrea delle Fratte, Italy
| | - J Bliss
- The Institute of Cancer Research Clinical Trials and Statistics Unit, London, UK
| | - L Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A M Brunt
- University Hospitals of North Midlands & Keele University, Stoke-on-Trent, UK
| | | | - G Hanna
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - R Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, USA
| | - O Kaidar Person
- Breast Radiation Unit, Sheba Tel Ha'shomer, Ramat Gan, Israel
| | - A Kirby
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, UK
| | - I Mjaaland
- Department of Hematology and Oncology, Stavanger University Hospital, Norway
| | - I Meattini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - A M Luis
- University Hospital HM Sanchinarro, Madrid, Spain
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Division of Radiation Oncology, Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - B Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - P Poortmans
- Paris Sciences et Lettres University, Paris, France
| | - S Rivera
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Molecular Radiotherapy and Innovative Therapeutics, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
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7
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Meattini I, Franco P, Belgioia L, Boldrini L, Botticella A, De Santis MC, Marvaso G, Montesi G, Parisi S, Triggiani L, Lambertini M, Livi L. Radiation therapy during the coronavirus disease 2019 (covid-19) pandemic in Italy: a view of the nation's young oncologists. ESMO Open 2020; 5:S2059-7029(20)30077-6. [PMID: 32295769 PMCID: PMC7199912 DOI: 10.1136/esmoopen-2020-000779] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy .,Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | | | - Liliana Belgioia
- Health Science Department (DISSAL), University of Genoa, Genova, Italy.,Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Roma, Italy
| | - Angela Botticella
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Villejuif, France
| | | | - Giulia Marvaso
- Division of Radiation Oncology, IEO - European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giampaolo Montesi
- Radiation Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Silvana Parisi
- Radiation Oncology Unit - Department of Biomedical, Dental Science, and Morphological and Funcitional Images, University of Messina, Messina, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Brescia, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy.,Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
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8
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Curigliano G, Cardoso MJ, Poortmans P, Gentilini O, Pravettoni G, Mazzocco K, Houssami N, Pagani O, Senkus E, Cardoso F. Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic. Breast 2020; 52:8-16. [PMID: 32334323 PMCID: PMC7162626 DOI: 10.1016/j.breast.2020.04.006] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 01/14/2023] Open
Abstract
The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) associated disease (COVID-19) outbreak seriously challenges globally all health care systems and professionals. Expert projections estimate that despite social distancing and lockdown being practiced, we have yet to feel the full impact of COVID-19. In this manuscript we provide guidance to prepare for the impact of COVID-19 pandemic on breast cancer patients and advise on how to triage, prioritize and organize diagnostic procedures, surgical, radiation and medical treatments.
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Affiliation(s)
- Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS, Department of Early Drug Development, Italy; University of Milano, Milano, Italy.
| | - Maria Joao Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Portugal; Nova Medical School, Lisbon, Portugal
| | - Philip Poortmans
- Iridium Kankernetwerk, Department of Radiation Oncology, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - Oreste Gentilini
- Breast Surgery, San Raffaele University and Research Hospital, Milano, Italy
| | - Gabriella Pravettoni
- Istituto Europeo di Oncologia, IRCCS, Department of Early Drug Development, Italy; University of Milano, Milano, Italy
| | - Ketti Mazzocco
- Istituto Europeo di Oncologia, IRCCS, Department of Early Drug Development, Italy; University of Milano, Milano, Italy
| | - Nehmat Houssami
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Olivia Pagani
- Service Interdisciplinaire de Cancérologie, Hopital Riviera-Chablais, Rennaz, Vaud, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Portugal
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9
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Abstract
We are facing a pandemic that is going to affect a significant part of the population. At the end of April in the world there are about 3,000,000 cases, with 205,000 deaths and 860,000 patients recovered. The response to this pandemic has in many cases led to a significant change in the daily work of caring for cancer patients, the good results of which depend largely on time-adjusted protocols and multidisciplinary treatments. We present a review of local, surgical and radiotherapy treatment together with authors’ recommendations made from personal experience on ways to act in the diagnosis and surgical treatment of breast cancer during the COVID-19 pandemic. The multidisciplinary Breast Committees must continue to meet weekly in videoconference format. All surgical actions and irradiations must be carried out with maximum safety for both the patients and the participating teams. Hypofractionation in radiation therapy should be the standard treatment. Sometimes it is recommended to apply a primary systemic treatment or even a primary irradiation. Great coordination between the surgical and oncology teams, both medical and radiotherapeutic, is essential.
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10
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Mutter RW, Jethwa KR, Gonuguntla K, Remmes NB, Whitaker TJ, Hieken TJ, Ruddy KJ, McGee LA, Corbin KS, Park SS. 3 fraction pencil-beam scanning proton accelerated partial breast irradiation: early provider and patient reported outcomes of a novel regimen. Radiat Oncol 2019; 14:211. [PMID: 31752934 PMCID: PMC6873533 DOI: 10.1186/s13014-019-1417-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
Abstract
Background and purpose To report dosimetry and early adverse effects, aesthetic, and patient-reported outcomes of a prospective study of 3-fraction pencil-beam scanning (PBS) proton accelerated partial irradiation (APBI). Materials and methods Eligibility included women age ≥ 50 years with estrogen receptor positive (ER+), sentinel lymph node negative invasive or in-situ breast cancer measuring ≤2.5 cm. The prescription was 21.9 Gy (RBE 1.1) in 3 daily fractions to the post-operative tumor bed with a 1 cm expansion. Toxicities were collected using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, 10-point Linear Analog Scale Assessment, Patient-Reported Outcomes Version of the CTCAE, and the Harvard Breast Cosmesis Scale. Results Seventy-six women were treated between 2015 and 2017. The median breast volume receiving 50% of prescription or more was 28%. Median mean heart, mean ipsilateral lung, and maximum skin dose were 0 Gy, 0.1 Gy, and 20.6 Gy, respectively. With a median follow-up of 12 months, no treatment-related toxicity grade ≥ 2 has been observed. Most common grade 1 adverse events were dermatitis (68%) and skin hyperpigmentation (18%). At 12 months, the only persistent toxicities were one patient with grade 1 breast edema and one patient with a grade 1 seroma. 90% of patients reported quality of life as ≥7 out of 10 (0 indicating “as bad as it can be” and 10 indicating “as good as it can be”) and 98% of patients reported excellent or good cosmesis. Conclusion 3-fraction PBS proton APBI is well tolerated with low rates of physician and patient reported early adverse effects. Follow-up is ongoing to assess late toxicities and disease control outcomes. Further investigation of this novel adjuvant treatment strategy is warranted.
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Affiliation(s)
- Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Karthik Gonuguntla
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Nicholas B Remmes
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Thomas J Whitaker
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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