1
|
|
2
|
Mills MN, Russo NW, Fahey M, Nanda RH, Raiker S, Jastrzebski J, Stout LL, Wilson JP, Altoos TA, Allen KG, Blumencranz PW, Diaz R. Increased Risk for Ipsilateral Breast Tumor Recurrence in Invasive Lobular Carcinoma after Accelerated Partial Breast Irradiation Brachytherapy. Oncologist 2021; 26:e1931-e1938. [PMID: 34516030 DOI: 10.1002/onco.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/06/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The suitability criteria for accelerated partial breast irradiation (APBI) from the American Brachytherapy Society (ABS), American Society for Radiation Oncology (ASTRO), and The Groupe Européende Curiethérapie European SocieTy for Radiotherapy & Oncology (GEC-ESTRO) have significant differences. MATERIALS AND METHODS This is a single institution retrospective review of 946 consecutive patients with invasive breast cancer who underwent lumpectomy and APBI intracavitary brachytherapy from 2003 to 2018. Overall survival (OS), breast cancer-specific survival (BCSS), relapse-free survival (RFS), and ipsilateral breast tumor recurrence (IBTR) were estimated with Kaplan-Meier method. RESULTS Median follow-up time was 60.2 months. Median age was 68 years (46-94 years). The majority of patients had estrogen receptor (ER)-positive disease (94%). There were 821 (87%) cases of invasive ductal carcinoma and 68 cases (7%) of invasive lobular carcinoma (ILC). The 5-year OS, BCSS, RFS, and IBTR were 93%, 99%, 90%, and 1.5%, respectively. Upon univariate analysis, ILC (hazard ratio [HR], 4.6; p = .008) and lack of nodal evaluation (HR, 6.9; p = .01) were risk factors for IBTR. The 10-year IBTR was 2.5% for IDC and 14% for ILC. While the ABS and ASTRO criteria could not predict IBTR, the GEC-ESTRO intermediate risk group was associated with inferior IBTR (p = .04) when compared to both low risk and high risk groups. None of the suitability criteria was able to predict RFS. CONCLUSION These results show that APBI is an effective treatment for patients with invasive breast cancer. Expansion of the current eligibility criteria should be considered, although prospective validation is needed. Caution is required when considering APBI for patients with ILC. IMPLICATIONS FOR PRACTICE In a large retrospective review of 946 patients with early breast cancer treated with partial mastectomy and accelerated partial breast irradiation (APBI) intracavitary brachytherapy, this study demonstrates durable local control. Patients deemed unsuitable or high risk by the American Brachytherapy Society, American Society for Radiation Oncology, and European Society for Radiotherapy and Oncology guidelines were not at increased risk for ipsilateral breast tumor recurrence (IBTR), suggesting that expansion of the current criteria should be considered. Importantly, however, these results demonstrate that caution should be taken when considering APBI for patients with invasive lobular carcinoma, as these patients had relatively high risk for IBTR (10-year IBTR, 14%).
Collapse
Affiliation(s)
- Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Nicholas W Russo
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Matthew Fahey
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ronica H Nanda
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | | | | | - Jason P Wilson
- Comprehensive Breast Cancer Center of Tampa Bay, Morton Plant Hospital, Clearwater, Florida, USA
| | | | - Kathleen G Allen
- Comprehensive Breast Cancer Center of Tampa Bay, Morton Plant Hospital, Clearwater, Florida, USA
| | - Peter W Blumencranz
- Comprehensive Breast Cancer Center of Tampa Bay, Morton Plant Hospital, Clearwater, Florida, USA
| | - Roberto Diaz
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| |
Collapse
|
3
|
Petroni G, Buqué A, Yamazaki T, Bloy N, Liberto MD, Chen-Kiang S, Formenti SC, Galluzzi L. Radiotherapy Delivered before CDK4/6 Inhibitors Mediates Superior Therapeutic Effects in ER + Breast Cancer. Clin Cancer Res 2021; 27:1855-1863. [PMID: 33495311 DOI: 10.1158/1078-0432.ccr-20-3871] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/14/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Recent preclinical data suggest that cyclin-dependent kinase 4/6 (CDK4/6) inhibition may be harnessed to sensitize estrogen receptor-positive (ER+) breast cancer to radiotherapy. However, these findings were obtained in human ER+ breast cancer cell lines exposed to subclinical doses of CDK4/6 inhibitors with limited attention to treatment schedule. We investigated the activity of radiotherapy combined with the prototypic CDK4/6 inhibitor palbociclib placing emphasis on therapeutic schedule. EXPERIMENTAL DESIGN We combined radiotherapy and palbociclib in various doses and therapeutic schedules in human and mouse models of ER+ and ER-negative (ER-) breast cancer, including an immunocompetent mouse model that recapitulates key features of human luminal B breast cancer in women. We assessed proliferation, cell death, cell-cycle control, and clonogenic survival in vitro, as well as tumor growth, overall survival, and metastatic dissemination in vivo. RESULTS Radiotherapy and palbociclib employed as standalone agents had partial cytostatic effects in vitro, correlating with suboptimal tumor control in vivo. However, while palbociclib delivered before focal radiotherapy provided minimal benefits as compared with either treatment alone, delivering focal radiotherapy before palbociclib mediated superior therapeutic effects, even in the absence of p53. Such superiority manifested in vitro with enhanced cytostasis and loss of clonogenic potential, as well as in vivo with improved local and systemic tumor control. CONCLUSIONS Our preclinical findings demonstrate that radiotherapy delivered before CDK4/6 inhibitors mediates superior antineoplastic effects compared with alternative treatment schedules, calling into question the design of clinical trials administering CDK4/6 inhibitors before radiotherapy in women with ER+ breast cancer.
Collapse
Affiliation(s)
- Giulia Petroni
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York
| | - Aitziber Buqué
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York
| | - Takahiro Yamazaki
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York
| | - Norma Bloy
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York
| | | | - Selina Chen-Kiang
- Department of Pathology, Weill Cornell Medical College, New York, New York.,Graduate Program of Immunology and Microbial Pathogenesis, Weill Cornell Medical College, New York, New York.,Sandra and Edward Meyer Cancer Center, New York, New York
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York.,Sandra and Edward Meyer Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, New York. .,Sandra and Edward Meyer Cancer Center, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, New York, New York
| |
Collapse
|
4
|
Anjomani Z, Hilts M, Batchelar D, Crook J. A reliable skin toxicity predictor in permanent breast seed implant brachytherapy. Brachytherapy 2020; 19:685-693. [PMID: 32739213 DOI: 10.1016/j.brachy.2020.06.006] [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: 04/15/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To establish skin dose-outcome relationships using a reliable metric in permanent breast seed implant (PBSI). METHODS Sixty-seven consecutive patients who underwent PBSI at our institution were included. Skin doses were calculated using two skin dose indices: maximum point dose to the skin surface, Dmax, and D0.2cc for a 2-mm internal skin rind (a surrogate to the dose to 1 cm2 area of skin) from CT-based postoperative treatment plans. Toxicity data were extracted from patients' charts and photographs. The associations between skin dose and skin toxicity were investigated using the analysis of variance, and the predictive performance of skin dose measures was evaluated using receiver operating characteristic curves. RESULTS For acute reactions, 49.3% of patients had Grade 1, 4.5% Grade 2, and 1.5% Grade 3 toxicity. For telangiectasia at 3 years, very minor and minimally apparent telangiectasia was observed in 25% of patients. Moderate but asymptomatic telangiectasia was observed in 9.1% of cases. Both metrics were significantly associated with the occurrence of acute toxicity and telangiectasia at 3 years (p < 0.01). The predictive values for Dmax and D0.2cc were 0.779 and 0.763, respectively, (p < 0.0001) for acute skin toxicity and 0.786 and 0.810 for telangiectasia (p < 0.0002). Extreme dose outliers (up to 878 Gy) and a high variability were observed for Dmax but not for D0.2cc, illustrating the superior reliability of D0.2cc. CONCLUSION D0.2cc, as an alternate skin dose measure to Dmax, is a robust metric for measuring skin dose that is simple to calculate, yet is clinically relevant and not prone to inaccuracies inherent to point dose measurement.
Collapse
Affiliation(s)
- Zahra Anjomani
- Department of Medical Physics, BC Cancer, Kelowna, BC, Canada.
| | - Michelle Hilts
- Department of Medical Physics, BC Cancer, Kelowna, BC, Canada
| | | | - Juanita Crook
- Department of Radiation Oncology, BC Cancer, Kelowna, BC, Canada
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Jethwa KR, Park SS, Gonuguntla K, Wick SM, Vallow LA, Deufel CL, Whitaker TJ, Furutani KM, Ruddy KJ, Corbin KS, Hieken TJ, Mutter RW. Three-Fraction Intracavitary Accelerated Partial Breast Brachytherapy: Early Provider and Patient-Reported Outcomes of a Novel Regimen. Int J Radiat Oncol Biol Phys 2018; 104:75-82. [PMID: 30583041 DOI: 10.1016/j.ijrobp.2018.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE To report early adverse events and patient-reported outcomes (PROs) of 3-fraction intracavitary catheter-based partial breast brachytherapy (ICBB). MATERIALS AND METHODS Eligible women ≥50 years of age with ≤2.5-cm, lymph node-negative invasive or in situ breast cancer underwent breast-conserving surgery and placement of a brachytherapy applicator. ICBB was initiated on the second weekday after surgery and prescribed to 21 Gy in 3 once-daily fractions. Common Terminology Criteria for Adverse Events, version 4.0; 10-point linear analog scale assessment; the PRO version of the Common Terminology Criteria for Adverse Events; and the Harvard Breast Cosmesis Scale were used for provider and patient-reported assessments. RESULTS Seventy-three women were treated for invasive (79%) or in situ (21%) breast cancer. The median time to completion of surgery and radiation therapy was 6 days. After 14-months median follow-up, 2 patients (3%) had developed breast infections that resolved with oral antibiotics. There was no other treatment-associated adverse event grade ≥2. The grade 1 seroma rate at 3 months was 20%, which dropped to 8% at 12 months; no events required intervention. At 12 months, 91% of patients reported an overall quality of life score as ≥8 of 10, and patient-reported cosmesis was good or excellent in 95%. All patients are alive without relapse at the last follow-up. CONCLUSIONS Three-fraction ICBB is associated with low rates of early provider and patient- reported adverse events and compares favorably with early outcomes of more protracted ICBB regimens, including twice-daily (3.4 Gy × 10) fractionation studied in the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39. Further investigation is warranted.
Collapse
Affiliation(s)
- Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Stephanie M Wick
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Keith M Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kathryn J Ruddy
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
7
|
Zhang Y, Mutter RW, Park SS, Hieken TJ, Yan ES, Corbin KS, Brinkmann DH, Pafundi DH. Carbon Fiducial Image Guidance Increases the Accuracy of Lumpectomy Cavity Localization in Radiation Therapy for Breast Cancer. Pract Radiat Oncol 2018; 9:e14-e21. [PMID: 30287358 DOI: 10.1016/j.prro.2018.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/16/2018] [Accepted: 09/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated the feasibility and accuracy of using carbon fiducials to localize the lumpectomy cavity with 2-dimensional kV imaging for early stage breast cancer radiation therapy. METHODS AND MATERIALS Carbon fiducials were placed intraoperatively in the periphery of the lumpectomy cavity. Nine patients received whole breast irradiation with a boost, and 2 patients received 3-dimensional conformal partial breast irradiation. A total of 89 fractions were assessed for setup errors relative to a predefined gold standard, cone beam computed tomography (CBCT) match to the lumpectomy cavity, using the following 4 setup methods: (1) Align skin tattoos with lasers; (2) match bone with 2-dimensional-2-dimensional (2D/2D) kV onboard imaging (OBI); (3) match the whole breast with CBCT; and (4) match carbon fiducials with 2D/2D kV OBI. The margin for the planning target volume (PTV) was calculated by 2 standard deviations of the setup errors, and compared among the 4 setup methods. Setup errors for patients treated with free breathing and patients with deep inspiration breath hold were also compared. RESULTS The carbon fiducials were sufficiently visible on OBI for matching and introduced minimal artifacts. Of the 4 alignment methods, 2D/2D OBI match to fiducials resulted in the smallest setup errors. The PTV margin was 12 mm for aligning skin tattoos using lasers, 9.2 mm for matching bone on OBI, 6.5 mm for matching breast on CBCT, and 3.5 mm for matching fiducials on 2D/2D OBI. Compared with free breathing, deep inspiration breath hold generally reduced the standard deviations of the setup errors, but further investigation would be needed. CONCLUSIONS Matching to carbon fiducials increased the localization accuracy to the lumpectomy cavity. This reduces residual setup error and PTV margins, facilitating tissue sparing without diminishing treatment efficacy.
Collapse
Affiliation(s)
- Yan Zhang
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth S Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Deanna H Pafundi
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
8
|
Michael J, Morton D, Batchelar D, Hilts M, Crook J, Fenster A. Development of a 3D ultrasound guidance system for permanent breast seed implantation. Med Phys 2018; 45:3481-3495. [PMID: 29791029 DOI: 10.1002/mp.12990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/20/2018] [Accepted: 04/22/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Permanent breast seed implantation (PBSI) is a promising radiotherapy technique for early-stage breast cancer, completed in a single visit by permanently implanting 103 Pd seeds using needles inserted through a template and guided by two-dimensional (2D) ultrasound (US). However, operator dependence has been highlighted as a limitation of this procedure. Consequently, we propose and have developed an intraoperative guidance system using three-dimensional (3D) US and an instrumented mechanical arm to provide intraoperative 3D imaging and needle template tracking. METHODS A mechatronic 3D US scanner reconstructs a 3D image from 150 2D images. A tracked mechanical arm mounted to the scanner locates four fiducial points on the template, registering the template to the 3D image. 3D reconstruction was validated for linear and volumetric measurement accuracy using phantoms of known geometry. In vivo breast US image quality was evaluated in a healthy volunteer. The encoded arm was calibrated and validated using a jig with divots at known locations relative to the scanner and the scanner registered to the 3D US image using intersecting strings in a fluid-filled test jig. Template registration accuracy was assessed using a machined test jig. Tracking accuracy was assessed in a liquid medium by comparing tracked and imaged needle tip positions. Finally, the system was used to guide a mock procedure in a patient-specific phantom and micro-CT imaging used to evaluate its accuracy. RESULTS Geometric validation showed median distances within ±1.1% of expected values and volumetric validation showed differences of ≤4.1%. Tracking arm point measurements showed an average error of 0.43 mm and 3D US volume registration showed target registration error ≤0.9 mm. Mean template registration accuracy in each axis of translation/rotation was ≤1.3 mm/1.0°. Mean needle-targeting error was 2.5 mm and 1.6° for needle tips and trajectories, respectively. Mean needle tip and angular errors of the phantom procedure were 2.1 mm and 2.6°. Modeled seed displacement of the phantom procedure showed mean error of 2.6 mm and a maximum of 3.8 mm. CONCLUSIONS A 3D US guidance system for PBSI has been developed. Benchtop performance and image quality in volunteer scans are satisfactory. A phantom PBSI procedure was successfully delivered using the system with maximum seed error within dosimetric benchmarks (<5 mm). Translation of the device into the clinic is forthcoming.
Collapse
Affiliation(s)
- Justin Michael
- Robarts Research Institute, The University of Western Ontario, London, Ontario, N6A 5B7, Canada
- Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario, N6A 5B7, Canada
| | - Daniel Morton
- Department of Medical Physics, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, British Columbia, V1Y 5L3, Canada
- Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, V8P 5C2, Canada
| | - Deidre Batchelar
- Department of Medical Physics, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, British Columbia, V1Y 5L3, Canada
| | - Michelle Hilts
- Department of Medical Physics, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, British Columbia, V1Y 5L3, Canada
- Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, V8P 5C2, Canada
| | - Juanita Crook
- Department of Radiation Oncology, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, British Columbia, V1Y 5L3, Canada
| | - Aaron Fenster
- Robarts Research Institute, The University of Western Ontario, London, Ontario, N6A 5B7, Canada
- Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario, N6A 5B7, Canada
- Departments of Medical Biophysics and Medical Imaging, The University of Western Ontario, London, Ontario, N6A 5B7, Canada
| |
Collapse
|
9
|
Soror T, Kovács G, Seibold N, Melchert C, Baumann K, Wenzel E, Stojanovic-Rundic S. Cosmetic changes following surgery and accelerated partial breast irradiation using HDR interstitial brachytherapy : Evaluation by a multidisciplinary/multigender committee. Strahlenther Onkol 2017; 193:367-374. [PMID: 28044202 DOI: 10.1007/s00066-016-1093-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/29/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with early-stage breast cancer can benefit from adjuvant accelerated partial breast irradiation (APBI) following breast-conserving surgery (BCS). This work reports on cosmetic results following APBI using multicatheter high-dose-rate interstitial brachytherapy (HDR-IBT). PATIENTS AND METHODS Between 2006 and 2014, 114 patients received adjuvant APBI using multicatheter HDR-IBT. For each patient, two photographs were analyzed: the first was taken after surgery (baseline image) and the second at the last follow-up visit. Cosmesis was assessed by a multigender multidisciplinary team using the Harvard Breast Cosmesis Scale. Dose-volume histogram (DVH) parameters and the observed cosmetic results were investigated for potential correlations. RESULTS The median follow-up period was 3.5 years (range 0.6-8.5 years). The final cosmetic scores were 30% excellent, 52% good, 14.5% fair, and 3.5% poor. Comparing the baseline and follow-up photographs, 59.6% of patients had the same score, 36% had a better final score, and 4.4% had a worse final score. Only lower target dose nonuniformity ratio (DNR) values (0.3 vs. 0.26; p = 0.009) were significantly associated with improved cosmetic outcome vs. same/worse cosmesis. CONCLUSION APBI using multicatheter HDR-IBT adjuvant to BCS results in favorable final cosmesis. Deterioration in breast cosmesis occurs in less than 5% of patients. The final breast cosmetic outcome in patients treated with BCS and APBI using multicatheter HDR-IBT is influenced primarily by the cosmetic result of the surgery. A lower DNR value is significantly associated with a better cosmetic outcome.
Collapse
Affiliation(s)
- Tamer Soror
- Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany.
- National Cancer Institute (NCI), Radiation Oncology Department, Cairo University, Cairo, Egypt.
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Nina Seibold
- Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Corinna Melchert
- Interdisciplinary Brachytherapy Unit, University of Luebeck/UKSH-CL, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Kristin Baumann
- Clinic for Gynecology and Obstetrics, University of Luebeck/UKSH-CL, Luebeck, Germany
| | - Eike Wenzel
- Clinic for Plastic Surgery, University of Luebeck/UKSH-CL, Luebeck, Germany
| | - Suzana Stojanovic-Rundic
- Institute for Oncology and Radiology (IORS), Medical School University of Belgrade, Belgrade, Serbia
| |
Collapse
|
10
|
Zur M, Shai A, Leviov M, Bitterman A, Shiloni E, Ben Yosef R, Steiner M. Short-term complications of intra-operative radiotherapy for early breast cancer. J Surg Oncol 2016; 113:370-3. [DOI: 10.1002/jso.24157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Maoz Zur
- Department of Oncology; Lin and Carmel Lady Davis Medical Centers; Haifa Israel
| | - Ayelet Shai
- Department of Oncology; Galilee Medical Center; Nahariyya Israel
- Faculty of Medicine; Bar-Ilan University; Zefat Israel
| | - Michelle Leviov
- Department of Oncology; Lin and Carmel Lady Davis Medical Centers; Haifa Israel
| | - Arie Bitterman
- Department of Surgery A; Carmel Lady Davis Medical Center; Haifa Israel
| | - Eitan Shiloni
- Department of Surgery B; Carmel Lady Davis Medical Center; Haifa Israel
- Bruce Rappaport Faculty of Medicine; Technion Israel Institute of Technology; Haifa Israel
| | - Rahamim Ben Yosef
- Bruce Rappaport Faculty of Medicine; Technion Israel Institute of Technology; Haifa Israel
- Radiotherapy Unit; Oncology Institute; Rambam Health Care Campus; Haifa Israel
| | - Mariana Steiner
- Department of Oncology; Lin and Carmel Lady Davis Medical Centers; Haifa Israel
| |
Collapse
|
11
|
Tiberi D, Hijal T, Yassa M. [Current status of hypofractionated external beam radiotherapy for early-stage breast cancer]. Cancer Radiother 2015; 19:426-30. [PMID: 26278987 DOI: 10.1016/j.canrad.2015.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/05/2015] [Indexed: 01/15/2023]
Abstract
The benefits of adjuvant radiotherapy following lumpectomy for early-stage breast cancer are well established. The most widely used method consists of roughly twenty-five fractions of whole-breast irradiation. In recent years, there has been a growing trend towards hypofractionated external beam radiotherapy regimens. Many of these techniques have been shown to be equivalent in terms of tumor control and cosmetic results while minimizing inconvenience and costs both to the patient and health care system. Here, we present the various hypofractionation modalities, patient selection criteria, consensus guideline recommendations and a look at future indications.
Collapse
Affiliation(s)
- D Tiberi
- Département de radio-oncologie, hôpital Maisonneuve-Rosemont, centre affilié à l'université de Montréal, 5415, boulevard de l'Assomption, Montréal, QC H1T 2M4, Canada
| | - T Hijal
- Département de radio-oncologie, centre universitaire de santé McGill, 1001 boulevard Décarie, Montréal, H4A 3J1, Canada
| | - M Yassa
- Département de radio-oncologie, hôpital Maisonneuve-Rosemont, centre affilié à l'université de Montréal, 5415, boulevard de l'Assomption, Montréal, QC H1T 2M4, Canada.
| |
Collapse
|
12
|
Accelerated partial breast irradiation through brachytherapy for ductal carcinoma in situ: factors influencing utilization and risks of second breast tumors. Breast Cancer Res Treat 2015; 151:199-208. [PMID: 25893591 DOI: 10.1007/s10549-015-3389-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/11/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to examine influencing factors and outcomes of accelerated partial breast irradiation through brachytherapy (APBIb) versus whole breast irradiation (WBI) for ductal carcinoma in situ (DCIS). From the Surveillance Epidemiology and End Results program of the US National Cancer Institute, we identified 40,749 women who were diagnosed with first primary DCIS between 2002 and 2011 and treated with breast-conserving surgery and radiotherapy. A multi-level logistic regression analysis was performed to estimate odds ratios of APBIb use. Hazard ratios (HRs) of developing ipsilateral breast tumors (IBTs) and contralateral breast tumors (CBTs) were analyzed in 1962 patients with APBIb and 7203 propensity score-matched patients with WBI, using Cox proportional hazards regression. Overall, 2212 (4.5 %) of 40,749 women (the whole cohort) received APBIb. Factors associated with the increased use of APBIb included older age, non-Hispanic white race/ethnicity, smaller tumor size, hormone receptor positivity, comedo subtypes, and urban residence. During the 46-month follow-up, 74 (0.8 %) and 131 (1.4 %) of 9165 propensity score-matched patients developed IBTs and CBTs, respectively. Compared with WBI, APBIb was associated with a significantly increased risk of IBTs (HR 1.74; 95 % CI 1.06-2.85) but not CBTs (OR 0.91; 95 % CI 0.59-1.41). This population-based study suggests that APBIb use for DCIS was influenced by patient and tumor characteristics as well as urbanization of residence. We observed a moderately increased IBT risk associated with APBIb versus WBI, suggesting that APBIb should be used with caution for DCIS before data from randomized controlled trials with long-term follow-ups are available.
Collapse
|
13
|
Spano JP, Azria D, Gonçalves A. Patients' satisfaction in early breast cancer treatment: Change in treatment over time and impact of HER2-targeted therapy. Crit Rev Oncol Hematol 2015; 94:270-8. [PMID: 25682223 DOI: 10.1016/j.critrevonc.2015.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022] Open
Abstract
Although breast cancer remains a major cause of cancer death, its related death rate has dropped in the last years through early tumor detection and better available treatments. With the development of innovative techniques and new molecules as well as new routes of administration, local treatment and adjuvant therapy of early breast cancer have evolved, from mutilating, time-consuming and/or painful procedures to breast-conservative ones, sparing healthy tissues, reducing the total dose of treatment and the treatment time which in turn reduce the occurrence and severity of toxicity. In parallel with these improvements leading to an increase in survival rate, patients' health-related quality of life has become a major concern. This review aims at describing the evolution of early breast cancer treatment, and its impact on patients' quality of life, convenience, and satisfaction, including a special insight into emerging human epidermal growth factor receptor 2 (HER2)-targeted therapy.
Collapse
Affiliation(s)
- Jean-Philippe Spano
- Department of Medical Oncology, GHPS-CFX, APHP, IUC/UPMC, INSERM_UMRS1136, Paris, France.
| | - David Azria
- Department of Radiation Oncology, Institut du Cancer Montpellier - Val d'Aurelle (ICM), Montpellier, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Cancer Research Center of Marseille, Aix-Marseille University, Marseille, France
| |
Collapse
|
14
|
Intraoperative full-dose of partial breast irradiation with electrons delivered by standard linear accelerators for early breast cancer. Int J Breast Cancer 2015; 2014:568136. [PMID: 25587452 PMCID: PMC4281392 DOI: 10.1155/2014/568136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/25/2014] [Indexed: 02/01/2023] Open
Abstract
Purpose. To assess feasibility, efficacy, toxicity, and cosmetic results of intraoperative radiotherapy (IORT) with electrons delivered by standard linear accelerators (Linacs) during breast conserving surgeries for early infiltrating breast cancer (BC) treatment. Materials and Methods. A total of 152 patients with invasive ductal carcinoma (T ≤ 3.0 cm) at low risk for local relapses were treated. All had unicentric lesions by imaging methods and negative sentinel node. After a wide local excision, 21 Gy were delivered on the parenchyma target volume with electron beams. Local recurrences (LR), survival, toxicity, and cosmetic outcomes were analyzed. Results. The median age was 58.3 years (range 40–85); median follow-up was 50.7 months (range 12–101.5). There were 5 cases with LR, 2 cases with distant metastases, and 2 cases with deaths related to BC. The cumulative incidence rates of LR, distant metastases, and BC death were 3.2%, 1.5%, and 1.5%, respectively. Complications were rare, and the cosmetic results were excellent or good in most of the patients. Conclusions. IORT with electrons delivered by standard Linacs is feasible, efficient, and well tolerated and seems to be beneficial for selected patients with early infiltrating BC.
Collapse
|
15
|
Bloom M, Markovitz S, Silverman S, Yost C. Ten Trends Transforming Cancer Care and Their Effects on Space Planning for Academic Medical Centers. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 8:85-94. [DOI: 10.1177/1937586714565598] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This article aims to define the major trends currently affecting space needs for academic medical center (AMC) cancer centers. It will distinguish between the trends that promote the concentration of services with those that promote decentralization as well as identify opportunities for achieving greater effectiveness in cancer care space planning. Background: Changes in cancer care—higher survival rates, increased clinical trials, new technology, and changing practice models—increasingly fill hospitals’ and clinicians’ schedules and strain clinical space resources. Conflicts among these trends are concentrating some services and dispersing others. As a result, AMCs must expand and renovate intelligently to continue providing state-of-the-art, compassionate care. Conclusions: Although the typical AMC cancer center can expect to utilize more space than it would have 10 years ago, a deeper understanding of the cancer center enterprise can lead to opportunities for more effectively using available facility resources. Each AMC must determine for itself the appropriate balance of patient volume, clinical activity, and services between its main hospital campus and satellite branches. As well, space allocation should be flexible, as care trends, medical technology, and the provider’s own priorities shift over time. The goal isn’t necessarily more space—it’s better space.
Collapse
Affiliation(s)
- Mara Bloom
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | | | | |
Collapse
|
16
|
Vosooghi M, Firoozpour L, Rodaki A, Pordeli M, Safavi M, Ardestani SK, Dadgar A, Asadipour A, Moshafi MH, Foroumadi A. Design, synthesis, docking study and cytotoxic activity evaluation of some novel letrozole analogs. ACTA ACUST UNITED AC 2014; 22:83. [PMID: 25539909 PMCID: PMC4284924 DOI: 10.1186/s40199-014-0083-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/08/2014] [Indexed: 11/23/2022]
Abstract
Background Breast cancer is the most common type of female cancer. One class of hormonal therapy for breast cancer drugs -non steroidal aromatase inhibitors- are triazole analogues. In this work, some derivatives of these drugs was designed and synthesized. All synthesized compounds were evaluated for their cytotoxic activities on breast cancer cell lines (MDA-MB-231, T47D and MCF-7). Methods Our synthetic route for designed compounds started from 4-bromotolunitrile which was reacted with 1H-1,2,4-triazole to afford 4-(4-cyanobenzyl)-1,2,4-triazole. The reaction of later compound with aromatic aldehydes led to formation of the designed compounds. Eleven novel derivatives 1a-k were tested for their cytotoxic activities on three human breast cancer cell lines. Results Among the synthesized compound, 4-[2-(3-chlorophenyl)-1-(1H-1,2,4-triazol-1-yl)ethenyl]benzonitrile (1c) showed the highest activity against MCF-7 and MDA-MB-231 cell lines and 4-[2-(4-methoxyphenyl)-1-(1H-1,2,4-triazol-1-yl)ethenyl]benzonitrile (1 h) exhibited highest activity against T47D cell line. According to cytotoxic activities results, compound 4-[2-(4-dimethylamino)-1-(1H-1,2,4-triazol-1-yl)ethenyl]benzonitrile (1 k) showed comparative activity against T47D and MDA-MB-231 cell lines with compound (1 h) and our reference drug Etoposide. Conclusion In the process of anti-cancer drug discovery, to find new potential anti-breast cancer agents, we designed and synthesized a novel series of letrozole analogs. Cytotoxicity evaluation revealed that compounds (1c) and (1 k) were the most potent compounds with comparative activity with Etoposide. The results revealed that π-π interactions are responsible for the enzyme inhibitions of compounds (1 c) and (1 k).
Collapse
Affiliation(s)
- Mohsen Vosooghi
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Loghman Firoozpour
- Drug Design and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abolfazl Rodaki
- Drug Design and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahboobeh Pordeli
- Institute of Biochemistry and Biophysics, University of Tehran, PO Box 13145-1384, Tehran, Iran.
| | - Maliheh Safavi
- Department of Biotechnology, Iranian Research Organization for Science and Technology, Tehran, Iran.
| | - Sussan K Ardestani
- Institute of Biochemistry and Biophysics, University of Tehran, PO Box 13145-1384, Tehran, Iran.
| | - Armin Dadgar
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ali Asadipour
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medicinal Sciences, Kerman, Iran.
| | - Mohammad Hassan Moshafi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medicinal Sciences, Kerman, Iran.
| | - Alireza Foroumadi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medicinal Sciences, Kerman, Iran. .,Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
17
|
Marta GN, Macedo CR, Carvalho HDA, Hanna SA, da Silva JLF, Riera R. Accelerated partial irradiation for breast cancer: systematic review and meta-analysis of 8653 women in eight randomized trials. Radiother Oncol 2014; 114:42-9. [PMID: 25480094 DOI: 10.1016/j.radonc.2014.11.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/04/2014] [Accepted: 11/04/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Accelerated partial breast irradiation (APBI) is the strategy that allows adjuvant treatment delivery in a shorter period of time in smaller volumes. This study was undertaken to assess the effectiveness and outcomes of APBI in breast cancer compared with whole-breast irradiation (WBI). MATERIAL AND METHODS Systematic review and meta-analysis of randomized controlled trials of WBI versus APBI. Two authors independently selected and assessed the studies regarding eligibility criteria. RESULTS Eight studies were selected. A total of 8653 patients were randomly assigned for WBI versus APBI. Six studies reported local recurrence outcomes. Two studies were matched in 5 years and only one study for different time of follow-up. Meta-analysis of two trials assessing 1407 participants showed significant difference in the WBI versus APBI group regarding the 5-year local recurrence rate (HR=4.54, 95% CI: 1.78-11.61, p=0.002). Significant difference in favor of WBI for different follow-up times was also found. No differences in nodal recurrence, systemic recurrence, overall survival and mortality rates were observed. CONCLUSIONS APBI is associated with higher local recurrence compared to WBI without compromising other clinical outcomes.
Collapse
Affiliation(s)
- Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil; Department of Radiation Oncology, Instituto do Câncer de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Brazil.
| | - Cristiane Rufino Macedo
- Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), Brazil.
| | - Heloisa de Andrade Carvalho
- Department of Radiation Oncology, Hospital Sírio-Libanês, Brazil; Department of Radiation Oncology, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
| | | | | | - Rachel Riera
- Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), Brazil.
| |
Collapse
|
18
|
Tsoutsou PG, Jeanneret Sozzi W, Ozsahin M, Delaloye JF, Bourhis J. Radiotherapy options after breast-conserving surgery: how can selection of patients be refined? J Clin Oncol 2013; 31:4570-1. [PMID: 24190122 DOI: 10.1200/jco.2013.52.8299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|