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Yee C, Lam E, Gallant F, Karam I, Czarnota G, Soliman H, Wong G, Drost L, Vesprini D, Rakovitch E, Wronski M, Leung E, Szumacher E, Carothers K, Pon K, Gonzales G, Easton L, Lewis D, Zhang L, Chow E. A Feasibility Study of Mepitel Film for the Prevention of Breast Radiation Dermatitis in a Canadian Center. Pract Radiat Oncol 2020; 11:e36-e45. [PMID: 32949772 DOI: 10.1016/j.prro.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Severe radiation dermatitis (RD) is distressing and may have adverse long-term effects including fibrosis and telangiectasia. Treatment interruptions due to severe RD may increase the risk of recurrence. Two randomized trials of Mepitel film demonstrated efficacy in preventing severe RD in breast cancer, but this product has not been widely adopted in North America. We aimed to assess the feasibility and efficacy of Mepitel film for prevention of breast RD at a Canadian center. METHODS AND MATERIALS Patients were stratified based on breast size and receipt of postmastectomy radiation therapy. The primary outcome was RD grade using the Common Terminology Criteria for Adverse Events. Secondary outcomes included moist desquamation, patient- and clinician-reported symptoms of skin toxicity, and cosmetic outcomes. RESULTS Thirty patients receiving external beam radiation therapy to the breast or chest wall were enrolled. Two patients (6.7%) discontinued use of the Mepitel film before completing radiation therapy. No patients developed grade 3 RD or higher. Five patients (17.9%) developed grade 2 RD: 3 (10.7%) had moist desquamation, and 2 (7.1%) had brisk erythema without moist desquamation. CONCLUSIONS Mepitel film completely prevented grade 3 RD. Rates of moist desquamation and grade 2 RD were lower with Mepitel film than in studies using aqueous cream, but unlike previous trials of Mepitel film we did not achieve complete prevention of moist desquamation. Further research is needed to confirm the efficacy of Mepitel film versus standard prophylaxis for RD and identify the patients who will benefit the most from the film.
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Affiliation(s)
- Caitlin Yee
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lam
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Francois Gallant
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Czarnota
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Hany Soliman
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Gina Wong
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Leah Drost
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Danny Vesprini
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Eileen Rakovitch
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Matt Wronski
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Eric Leung
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Ewa Szumacher
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Carothers
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Kucy Pon
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Glen Gonzales
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Linda Easton
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Donna Lewis
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Liying Zhang
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
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Gulstene S, Raziee H. Radiation Boost After Adjuvant Whole Breast Radiotherapy: Does Evidence Support Practice for Close Margin and Altered Fractionation? Front Oncol 2020; 10:772. [PMID: 32670865 PMCID: PMC7332558 DOI: 10.3389/fonc.2020.00772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/21/2020] [Indexed: 12/03/2022] Open
Abstract
Adding a boost to whole breast radiation (WBI) following breast-conserving surgery (BCS) may help improve local control, but it increases the total cost of treatment and may worsen cosmetic outcomes. Therefore, it is reserved for patients whose potential benefit outweighs the risks; however, current evidence is insufficient to support comprehensive and consistent guidance on how to identify these patients, leading to a potential for significant variations in practice. The use of a boost in the setting of close margins and hypofractionated radiotherapy represents two important areas where consensus guidelines, patterns of practice, and current evidence do not seem to converge. Close margins were previously routinely re-excised, but this is no longer felt to be necessary. Because of this recent practice change, good long-term data on the local recurrence risk of close margins with or without a boost is lacking. As for hypofractionation, although there is guidance recommending that the decision to add a boost be independent from the whole-breast fractionation schedule, it appears that patterns-of-practice data may show underutilization of a boost when hypofractionation is used. The use of a boost in these two common clinical scenarios represents important areas of future study for the optimization of adjuvant breast radiation.
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Affiliation(s)
- Stephanie Gulstene
- Department of Radiation Oncology, University of Western Ontario, London, ON, Canada
| | - Hamid Raziee
- Department of Radiation Oncology, BC Cancer Surrey, University of British Columbia, Vancouver, BC, Canada
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Koulis TA, Phan T, Olivotto IA. Hypofractionated whole breast radiotherapy: current perspectives. BREAST CANCER-TARGETS AND THERAPY 2015; 7:363-70. [PMID: 26604820 PMCID: PMC4629948 DOI: 10.2147/bctt.s81710] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Adjuvant radiotherapy (RT) is an important part of breast cancer management but the dose and fractionation schedules used are variable. A total of 50 Gy in 25 daily fractions delivered over 5 weeks is often considered the “standard” adjuvant RT prescription. Hypofractionated regimes such as 42.5 Gy in 16 daily fractions or 40 Gy in 15 daily fractions following breast-conserving surgery have proven to be equally effective and achieve similar or better cosmetic and normal tissue outcomes for both invasive and in situ diseases and when treating the regional nodes. Hypofractionation is more convenient for patients and less costly. However, certain patients at higher risk of RT late effects may benefit from a less intense, even more extended fractionation schedule. This review describes the indications for whole breast hypofractionated adjuvant RT for patients with breast cancer following breast-conserving surgery and proposes that hypofractionation should be the new “standard” for adjuvant breast cancer RT.
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Affiliation(s)
- Theodora A Koulis
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Tien Phan
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Ivo A Olivotto
- Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
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