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Dzhugashvili M, Veldeman L, Kirby AM. The role of the radiation therapy breast boost in the 2020s. Breast 2023; 69:299-305. [PMID: 36958070 PMCID: PMC10068257 DOI: 10.1016/j.breast.2023.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
Given that most local relapses of breast cancer occur proximal to the original location of the primary, the delivery of additional radiation dose to breast tissue that contained the original primary cancer (known as a "boost") has been a standard of care for some decades. In the context of falling relapse rates, however, it is an appropriate time to re-evaluate the role of the boost. This article reviews the evolution of the radiotherapy boost in breast cancer, discussing who to boost and how to boost in the 2020s, and arguing that, in both cases, less is more.
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Affiliation(s)
| | - L Veldeman
- Ghent University/Ghent University Hospital, Ghent, Belgium.
| | - A M Kirby
- Royal Marsden Hospital NHS Foundation Trust & Institute of Cancer Research, UK.
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Li H, Wang H, Chen F, Gao L, Zhou Y, Zhou Z, Huang J, Xu L. Detection of axillary lymph node metastasis in breast cancer using dual-layer spectral computed tomography. Front Oncol 2022; 12:967655. [PMID: 36300099 PMCID: PMC9589258 DOI: 10.3389/fonc.2022.967655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/19/2022] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To investigate the value of contrast-enhanced dual-layer spectral computed tomography (DLCT) in the detection of axillary lymph node (ALN) metastasis in breast cancer. MATERIALS AND METHODS In this prospective study, 31 females with breast cancer underwent contrast-enhanced DLCT from August 2019 to June 2020. All ALNs were confirmed by postoperative histology. Spectral quantitative parameters, including λ HU (in Hounsfield units per kiloelectron-volt), nIC (normalized iodine concentration), and Zeff (Z-effective value) in both arterial and delay phases, were calculated and contrasted between metastatic and nonmetastatic ALNs using the McNemar test. Discriminating performance from metastatic and nonmetastatic ALNs was analyzed using receiver operating characteristic curves. RESULTS In total, 132 ALNs (52 metastatic and 80 nonmetastatic) were successfully matched between surgical labels and preoperative labels on DLCT images. All spectral quantitative parameters (λHu , nIC, and Zeff) derived from both arterial and delayed phases were greater in metastatic ALNs than in nonmetastatic SLNs (all p < 0.001). Logistic regression analyses showed that λHu in the delayed phase was the best single parameter for the detection of metastatic ALNs on a per-lymph node basis, with an area under the curve of 0.93, accuracy of 86.4% (114/132), sensitivity of 92.3% (48/52), and specificity of 87.5% (70/80). CONCLUSION The spectral quantitative parameters derived from contrast-enhanced DLCT, such as λHu , can be applied for the preoperative detection of ALN metastasis in breast cancer.
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Affiliation(s)
- Huijun Li
- Department of Medical Imaging, School of Medicine, Yangtze University, Jingzhou, China
| | - Huan Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fangfang Chen
- Department of Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Gao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yurong Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhou Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinbai Huang
- Department of Medical Imaging, School of Medicine, Yangtze University, Jingzhou, China
- Department of Positron Emission Tomography/Computed Tomography (PET/CT) Center, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Liying Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Duzenli C, Koulis T, Menna T, Carpentier E, Arora T, Coope R, Gill B, Lim P, Aquino-Parsons C, Nichol A, Singer J, Ingledew PA, Grahame S, Chan EK. Reduction in Doses to Organs at Risk and Normal Tissue During Breast Radiation Therapy With a Carbon-Fiber Adjustable Reusable Accessory. Pract Radiat Oncol 2021; 11:470-479. [PMID: 34303034 DOI: 10.1016/j.prro.2021.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/05/2021] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the breast, remove the inframammary fold, and reduce dose to organs at risk for whole breast radiation therapy in the supine position. METHODS AND MATERIALS Thirty patients with inframammary folds ≥1 cm or lateral ptosis in supine treatment position were planned with standard positioning and with a carbon-fiber Adjustable Reusable Accessory (CARA) breast support. Twenty patients received whole breast with or without regional nodal irradiation with 42.5 Gy in 16 fractions or 50 Gy in 25 fractions using CARA. Median body mass index was 32 in this study. RESULTS CARA removed all inframammary folds and reduced V20Gyipsilateral lung, V105%breast, and V50% body, without compromising target coverage. Median (range) V20Gyipsilateral lung for whole breast radiation therapy was 12.3% (1.4%-28.7%) with standard of care versus 10.9% (1.2%-17.3%) with CARA (Wilcoxon P = .005). Median V105% breast was 8.0% (0.0%-29%) with standard of care versus 4.0% (0.0%-23%) with CARA (P = .006) and median V50% body was 3056 mL (1476-5285 mL) versus 2780 mL (1415-5123 mL) with CARA (P = .001). CARA was compatible with deep inspiration breath hold and achieved median V25Gyheart = 0.1% (range 0%-1.9%) for all patients with left breast cancer. Skin reactions with CARA were consistent with historical data and daily variation in treatment setup was consistent with standard supine positioning. CONCLUSIONS CARA can reduce V105%breast, lung and normal tissue dose, and remove the inframammary fold for breast patients with large or pendulous breasts and high body mass index treated in the supine position, without compromising target coverage. CARA will undergo further study in a randomized controlled trial.
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Affiliation(s)
- Cheryl Duzenli
- Department of Medical Physics, BC Cancer, Vancouver, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada.
| | - Theodora Koulis
- Department of Radiation Oncology, BC Cancer, Kelowna, Canada
| | - Tara Menna
- Department of Radiation Therapy, BC Cancer, Vancouver, Canada
| | - Emilie Carpentier
- Department of Medical Physics, BC Cancer, Vancouver, Canada; Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Tania Arora
- Department of Radiation Therapy, BC Cancer, Vancouver, Canada
| | - Robin Coope
- BC Cancer Genome Sciences Centre, Vancouver, Canada
| | - Bradford Gill
- Department of Medical Physics, BC Cancer, Vancouver, Canada
| | - Peter Lim
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Christina Aquino-Parsons
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Alan Nichol
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Joel Singer
- University of British Columbia, School of Population and Public Health, Vancouver, Canada
| | - Paris-Anne Ingledew
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada; University of British Columbia, Department of Surgery, Division of Radiation Oncology and Developmental Radiotherapeutics, Vancouver, Canada
| | - Sheri Grahame
- Department of Radiation Therapy, BC Cancer, Vancouver, Canada
| | - Elisa K Chan
- Department of Radiation Oncology, BC Cancer, Vancouver, Canada
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