1
|
Vakaet V, Deseyne P, Schoepen M, Stouthandel M, Post G, Speleers B, Van Greveling A, Monten C, Mareel M, Van Hulle H, Paelinck L, De Gersem W, De Neve W, Vandecasteele K, Veldeman L. Prone Breast and Lymph Node Irradiation in 5 or 15 Fractions: A Randomized 2 × 2 Design Comparing Dosimetry, Acute Toxicity, and Set-Up Errors. Pract Radiat Oncol 2022; 12:324-334. [PMID: 35717049 DOI: 10.1016/j.prro.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/20/2021] [Accepted: 01/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Prone whole breast irradiation results in lower dose to organs at risk compared with supine position, especially lung dose. However, the adoption of prone position for whole breast irradiation + lymph node irradiation remains limited and data on lymph node irradiation in 5 fractions are lacking. Although the study was ended prematurely for the primary endpoint (breast retraction at 2 years), we decided to report acute toxicity for prone and supine positions and 5 and 15 fractions. Additionally, dosimetry and set-up accuracy between prone and supine positions were evaluated. METHODS AND MATERIALS A randomized open-label factorial 2 × 2 design was used for an acute toxicity comparison between prone and supine positions and 5 and 15 fractions. The primary endpoint of the trial was breast retraction 2 years after treatment. In total, 57 patients were evaluated. Dosimetry and set-up errors were compared between prone and supine positions. All patients were positioned on either our in -house developed prone crawl breast couch or a Posirest-2 (Civco). RESULTS No difference in acute toxicity between prone and supine positions was found, but 5 fractions did result in a lower risk of desquamation (15% vs 41%; P = .04). Prone positioning resulted in lower mean ipsilateral lung dose (2.89 vs 4.89 Gy; P < .001), mean thyroid dose (3.42 vs 6.61 Gy; P = .004), and mean contralateral breast dose (0.41 vs 0.54 Gy; P = .007). No significant difference in mean heart dose (0.90 vs 1.07 Gy; P = .22) was found. Set-up accuracy was similar between both positions. CONCLUSIONS Unfortunately, the primary endpoint of the trial was not met due to premature closure of the trial. Acceleration in 5 fractions resulted in a lower risk of desquamation. Prone positioning did not influence acute toxicity or set-up accuracy, but did result in lower ipsilateral mean lung dose, thyroid dose, and contralateral breast dose.
Collapse
Affiliation(s)
- Vincent Vakaet
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Pieter Deseyne
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Max Schoepen
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium; Department of Industrial Systems Engineering and Product Design, Kortrijk, Belgium
| | - Michael Stouthandel
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Giselle Post
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Bruno Speleers
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | | | - Christel Monten
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Marcus Mareel
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Hans Van Hulle
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Werner De Gersem
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium
| | - Katrien Vandecasteele
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University Hospital, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
2
|
Benitez CM, Knox SJ. Harnessing genome-wide association studies to minimize adverse radiation-induced side effects. Radiat Oncol J 2020; 38:226-235. [PMID: 33233031 PMCID: PMC7785837 DOI: 10.3857/roj.2020.00556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2022] Open
Abstract
Radiotherapy is used as definitive treatment in approximately two-thirds of all cancers. However, like any treatment, radiation has significant acute and long-term side effects including secondary malignancies. Even when similar radiation parameters are used, 5%–10% of patients will experience adverse radiation side effects. Genomic susceptibility is thought to be responsible for approximately 40% of the clinical variability observed. In the era of precision medicine, the link between genetic susceptibility and radiation-induced side effects is further strengthening. Genome-wide association studies (GWAS) have begun to identify single-nucleotide polymorphisms (SNPs) attributed to overall and tissue-specific toxicity following radiation for treatment of breast cancer, prostate cancer, and other cancers. Here, we review the use of GWAS in identifying polymorphisms that are predictive of acute and long-term radiation-induced side effects with a focus on chest, pelvic, and head-and-neck irradiation. Integration of GWAS with “omic” data, patient characteristics, and clinical correlates into predictive models could decrease radiation-induced side effects while increasing therapeutic efficacy.
Collapse
Affiliation(s)
- Cecil M Benitez
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Susan J Knox
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
3
|
Objective Evaluation of Risk Factors for Radiation Dermatitis in Whole-Breast Irradiation Using the Spectrophotometric L*a*b Color-Space. Cancers (Basel) 2020; 12:cancers12092444. [PMID: 32872216 PMCID: PMC7563751 DOI: 10.3390/cancers12092444] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022] Open
Abstract
Simple Summary In this prospective study, radiation dermatitis severity of 142 Caucasian early breast cancer patients undergoing whole-breast irradiation was evaluated by physicians, the patients themselves and objective technical measurements. The primary aim and a substantial novelty of this study was to identify patient- and treatment-related risk factors for radiation dermatitis by using objective spectrophotometry: 24 patient or radiotherapy related parameters were evaluated as potential risk factors. Objective and significant risk factors for radiation dermatitis were the breast volume and the applied irradiation technique; a boost radiotherapy administration also showed a trend towards a slightly more severe radiation dermatitis. These results can help to identify those patients at increased risk of developing a severe radiation dermatitis, as susceptible patients may require special monitoring and timely treatment. Abstract Background: Radiation-induced dermatitis (RID) is frequent in breast cancer patients undergoing radiotherapy (RT). Spectrophotometry (SP) is an objective and reliable tool for assessing RID severity. Despite intensive research efforts during the past decades, no sustainable prophylactic and treatment strategies have been found. Estimation of new and reevaluation of established risk factors leading to severe RID is therefore of major importance. Methods: 142 early breast cancer patients underwent whole-breast irradiation following breast-conserving surgery. RID was evaluated by physician-assessed Common Terminology Criteria of Adverse Events (CTCAE v4.03). Spectrophotometers provided additional semi quantification of RID using the L*a*b color-space. A total of 24 patient- and treatment-related parameters as well as subjective patient-assessed symptoms were analyzed. Results: Values for a*max strongly correlated with the assessment of RID severity by physicians. Breast volume, initial darker skin, boost administration, and treatment technique were identified as risk factors for severe RID. RID severity positively correlated with the patients’ perception of pain, burning, and reduction of everyday activities. Conclusions: Physician-assessed RID gradings correlate with objective SP skin measurements. Treatment technique and high breast volumes were identified as objective and significant predictors of RID. Our data provide a solid benchmark for future studies on RID with objective SP.
Collapse
|
4
|
Van Hulle H, Vakaet V, Deckmyn K, Monten C, Paelinck L, Van Greveling A, Post G, Schoepen M, Fonteyne A, Speleers B, Deseyne P, Mareel M, De Neve W, Veldeman L. Two-year toxicity of hypofractionated breast cancer radiotherapy in five fractions. Acta Oncol 2020; 59:872-875. [PMID: 32285729 DOI: 10.1080/0284186x.2020.1747638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hans Van Hulle
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Vincent Vakaet
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Kathleen Deckmyn
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Chris Monten
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Giselle Post
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Max Schoepen
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Industrial Systems Engineering and Product Design, Kortrijk, Belgium
| | - Arthur Fonteyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Bruno Speleers
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Pieter Deseyne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Marc Mareel
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|