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Chua VH, Chua JH, Aniceto CJ, Antonio JA, Harina MDH, Martinez KC. DCIS: When is accelerated partial breast irradiation an option? A meta-analysis on outcomes and eligibility. Am J Surg 2023; 225:871-877. [PMID: 36914530 DOI: 10.1016/j.amjsurg.2023.03.004] [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: 11/12/2022] [Revised: 02/06/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND The natural history of DCIS may not be progression to invasive breast cancer (IBC). Accelerated partial breast irradiation (APBI) has emerged as an alternative to whole breast radiotherapy (WBRT). The purpose of this study was to assess the impact of APBI on DCIS patients. MATERIALS AND METHODS Eligible studies from 2012 to 2022 were identified in PubMed, Cochrane Library, ClinicalTrials, and ICTRP. A meta-analysis was done comparing recurrence rates, breast-related mortality rates, and adverse events of APBI versus WBRT. A subgroup analysis of 2017 ASTRO Guidelines "Suitable" and "Unsuitable" groups was performed. Forest plots and quantitative analysis were done. RESULTS Six studies were eligible (3 on APBI versus WBRT, 3 on APBI suitability). All had a low risk of bias and publication bias. The cumulative incidence was the following for APBI and WBRT respectively: IBTR was 5.7% and 6.3% with odds ratio of 1.09, 95% CI [0.84, 1.42], mortality rate was 4.9% and 5.05%, and adverse events was 48.87% and 69.63%. All had no statistical significance between groups. Adverse events were found to favor the APBI arm. Recurrence rate was significantly less in the Suitable group with an odds ratio 2.69, 95% CI [1.56, 4.67], favoring it over the Unsuitable group. CONCLUSION APBI was comparable to WBRT in terms of recurrence rate, breast cancer-related mortality rate, and adverse events. APBI was not inferior to WBRT and showed better safety in terms of skin toxicity. Patients classified as suitable for APBI had significantly lesser recurrence rate.
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Affiliation(s)
- Vannesza Hendricke Chua
- Department of Medical Education and Research, Chinese General Hospital and Medical Center, Philippines.
| | - Joyce Hazel Chua
- Department of Surgery, Chinese General Hospital and Medical Center, Philippines
| | - Celina Joyce Aniceto
- Department of Medical Education and Research, Chinese General Hospital and Medical Center, Philippines
| | - Jane April Antonio
- Department of Medical Education and Research, Chinese General Hospital and Medical Center, Philippines
| | - Ma Dara Hannah Harina
- Department of Medical Education and Research, Chinese General Hospital and Medical Center, Philippines
| | - Karen Claire Martinez
- Department of Medical Education and Research, Chinese General Hospital and Medical Center, Philippines
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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%).
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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
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Five-year results of accelerated partial breast irradiation: A single-institution retrospective review of 289 cases. Brachytherapy 2021; 20:807-817. [PMID: 33810984 DOI: 10.1016/j.brachy.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of the study was to describe our institutional experience with accelerated partial breast irradiation (APBI) using multicatheter brachytherapy with high-dose-rate. We report 5-year survival outcomes, cosmesis, and treatment-related toxicity. METHODS AND MATERIALS This included a retrospective review of patients who underwent breast-conserving surgery followed by APBI at our institution from 2004 to 2017. RESULTS A total of 289 patients were evaluated. Median followup was 72 months. Median age was 70 years. APBI was the only primary treatment in 86.2% of cases with early-stage breast cancer and a second conservative treatment in 13.8%. The implant was performed postoperatively in 213 patients (73.7%) and intraoperatively in 76 (26.3%). The most common radiation schemes were 10 fractions of 3.4 Gy and eight fractions of 4 Gy. Elderly or frail patients (10%) received a single 16 Gy dose. Of the 289 patients, 215 met Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology criteria for APBI; in this group, late side effects included Grade 2 (G2) fibrosis (14.8%), skin discoloration at the catheter points (8.8%), and telangiectasia (0.5%). The cosmetic result was considered excellent or good in 88.3% of cases. Five-year local control, disease-free, cancer-specific, and overall survival rates were 98.9%, 96.7%, 99.1%, and 95.6%, respectively. CONCLUSIONS Local control and survival outcomes at 5 years of followup in this group of well-selected patients were excellent, with low rates of treatment-related toxicity. These findings confirm the safety and effectiveness of APBI, even in elderly and frail patients. These results provide further support for the clinical use of APBI in suitable patients.
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Mouawad M, Lailey O, Poulsen P, O'Neil M, Brackstone M, Lock M, Yaremko B, Shmuilovich O, Kornecki A, Ben Nachum I, Muscedere G, Lynn K, Karnas S, Prato FS, Thompson RT, Gaede S. Intrafraction motion monitoring to determine PTV margins in early stage breast cancer patients receiving neoadjuvant partial breast SABR. Radiother Oncol 2021; 158:276-284. [PMID: 33636230 DOI: 10.1016/j.radonc.2021.02.021] [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: 01/09/2021] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE To quantify intra-fraction tumor motion using imageguidance and implanted fiducial markers to determine if a 5 mm planning-target-volume (PTV) margin is sufficient for early stage breast cancer patients receiving neoadjuvant stereotactic ablative radiotherapy (SABR). MATERIALS AND METHODS A HydroMark© (Mammotome) fiducial was implanted at the time of biopsy adjacent to the tumor. Sixty-one patients with 62 tumours were treated prone using a 5 mm PTV margin. Motion was quantified using two methods (separate patient groups): 1) difference in 3D fiducial position pre- and post-treatment cone-beam CTs (CBCTs) in 18 patients receiving 21 Gy/1fraction (fx); 2) acquiring 2D triggered-kVimages to quantify 3D intra-fraction motion using a 2D-to-3D estimation method for 44 tumours receiving 21 Gy/1fx (n = 22) or 30 Gy/3fx (n = 22). For 2), motion was quantified by calculating the magnitude of intra-fraction positional deviation from the pretreatment CBCT. PTV margins were derived using van Herkian analysis. RESULTS The average ± standard deviation magnitude of motion across patients was 1.3 ± 1.15 mm Left/Right (L/R), 1.0 ± 0.9 mm Inferiorly/Superiorly (I/S), and 1.8 ± 1.5 mm Anteriorly/Posteriorly (A/P). 85/105 (81%) treatment fractions had dominant anterior motion. 6/62patients (9.7%) had mean intra-fraction motion during any fraction > 5 mm in any direction, with 4 in the anterior direction. Estimated PTV margins for single and three-fx patients in the L/R, I/S, and A/P directions were 6.0x4.1x5.9 mm and 4.5x2.9x4.3 mm, respectively. CONCLUSION Our results suggest that a 5 mm PTV margin is sufficient for the I/S and A/P directions if a lateral kV image is acquired immediately before treatment. For the L/R direction, either further immobilization or a larger margin is required.
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Affiliation(s)
- Matthew Mouawad
- Medical Biophysics, Western University, London, Canada; London Health Sciences Centre, London, Canada.
| | - Owen Lailey
- London Health Sciences Centre, London, Canada
| | - Per Poulsen
- Danish Center for Particle Therapy and Department of Oncology, Aarhus University Hospital, Denmark.
| | | | - Muriel Brackstone
- Medical Biophysics, Western University, London, Canada; London Health Sciences Centre, London, Canada; Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada.
| | - Michael Lock
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Brian Yaremko
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Olga Shmuilovich
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada; Department of Medical Imaging, Western University, London, Canada.
| | - Anat Kornecki
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada; Department of Medical Imaging, Western University, London, Canada.
| | - Ilanit Ben Nachum
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada; Department of Medical Imaging, Western University, London, Canada.
| | - Giulio Muscedere
- Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada; Department of Medical Imaging, Western University, London, Canada.
| | - Kalan Lynn
- London Health Sciences Centre, London, Canada; Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada.
| | | | - Frank S Prato
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada; St. Joseph's Health Care, London, Canada; Department of Medical Imaging, Western University, London, Canada.
| | - R Terry Thompson
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada.
| | - Stewart Gaede
- Medical Biophysics, Western University, London, Canada; London Health Sciences Centre, London, Canada; Lawson Health Research Institute, London, Canada; Department of Oncology, Western University, London, Canada.
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Budrukkar A, Telkhade T, Wadasadawala T, Shet T, Upreti RR, Jalali R, Badwe R, Gupta S, Sarin R. A comparison of long-term clinical outcomes of accelerated partial breast irradiation using interstitial brachytherapy as per GEC-ESTRO, ASTRO, updated ASTRO, and ABS guidelines. Brachytherapy 2021; 19:337-347. [PMID: 32359677 DOI: 10.1016/j.brachy.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of this study is to evaluate long-term clinical outcomes of women treated with accelerated partial breast irradiation (APBI) using multicatheter interstitial brachytherapy (MIB-APBI) with risk groups defined by Groupe Européen de Curie-thérapie and the European Society for Radiotherapy & Oncology (GEC-ESTRO), American Society for Radiation Oncology (ASTRO), updated ASTRO, and American Brachytherapy Society (ABS) guidelines and to elucidate the most appropriate guideline that could differentiate outcomes among its risk groups. METHODS AND MATERIALS Two hundred forty women underwent MIB-APBI during July 2000 to March 2013. Comparisons of long-term clinical outcomes (local control [LC], disease-free survival [DFS], cause-specific survival [CSS], and overall survival [OAS]) stratified by the risk groups proposed by the aforementioned patient selection guidelines were carried out on a prospectively maintained database. RESULTS At a median follow-up of 114 months, 10-year LC, DFS, and OAS were 90%, 81%, and 83.5%, respectively, for the entire group. There was no statistically significant difference in the LC rates for risk groups by ESTRO, ASTRO, updated ASTRO and ABS guidelines. The 10-year DFS and OAS for GEC-ESTRO low-, intermediate-, and high-risk group was 75%, 88%, and 60% (p = 0.02) and 86%, 93%, and 62% (p = 0.001), respectively. Ten-year DFS and OAS in the ABS 2018-acceptable and ABS 2018-unacceptable group were 78% and 67% (p = 0.01) and 88% and 69% (p = 0.001), respectively. No significant difference in any of the outcomes was observed with risk groups suggested by ASTRO or updated ASTRO consensus guidelines. CONCLUSIONS None of the current patient selection guidelines for APBI could differentiate LC (main APBI endpoint) among its risk groups, whereas GEC-ESTRO and ABS guideline could differentiate DFS and OAS.
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Affiliation(s)
- Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India.
| | - Tejshri Telkhade
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Ritu Raj Upreti
- Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Rajendra Badwe
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
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Patterns of Recurrence Among Higher-Risk Patients Receiving Daily External Beam Accelerated Partial-Breast Irradiation to 40 Gy in 10 Fractions. Adv Radiat Oncol 2019; 5:27-33. [PMID: 32051887 PMCID: PMC7004933 DOI: 10.1016/j.adro.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose The 2016 American Society for Radiation Oncology consensus guidelines for the use of accelerated partial-breast irradiation (APBI) define “suitable,” “cautionary,” and “unsuitable” populations for this adjuvant breast radiation therapy technique. We sought to determine whether patients in the cautionary group exhibited adverse outcomes after APBI compared with their suitable counterparts. Methods and Materials We identified 252 consecutively treated patients from a single institution with in situ or early-stage invasive breast cancer who underwent APBI between 2008 and 2017. Treatment technique was uniform throughout the population, consisting of 3-dimensional conformal radiation therapy to 40 Gy administered in 10 daily fractions. Results One hundred seventy-eight patients (70%) were classified as suitable, 69 (27%) as cautionary, and 5 (2.0%) as unsuitable. Because unsuitable patients were few and had no recurrences, they were excluded from analysis. At a median follow-up time of 3.9 years, 97.2% of patients were free of recurrence. Four patients (1.5% overall; 3 suitable and 1 cautionary) experienced ipsilateral in-breast recurrences, and 1 cautionary patient developed an ipsilateral regional recurrence in an axillary lymph node. There was no significant difference in the rate of ipsilateral breast recurrence (2.4% vs 1.0%) between cautionary and suitable groups. Conclusions Local recurrences are rare among guideline-defined cautionary patients with in situ or invasive breast cancer treated with APBI delivered via daily 3-dimensional conformal radiation therapy to 40 Gy. At a median follow-up of 3.9 years, no significant differences in local control were noted between cautionary and suitable patient groups. Further study is needed to characterize long-term disease outcomes among various risk groups.
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Chin C, Hirji S, Onishi M, Ha R, Taback B, Horowitz DP, Connolly EP. A Single-Institution Experience in the Preoperative Selection of DCIS Patients for IORT using the ASTRO Consensus Guidelines. Adv Radiat Oncol 2019; 4:253-260. [PMID: 31011670 PMCID: PMC6460097 DOI: 10.1016/j.adro.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/07/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose Intraoperative radiation therapy (IORT) as a form of accelerated partial breast irradiation (APBI) is controversial given the limited evidence to support its efficacy. However, it remains an attractive option for low-risk patients with ductal carcinoma in situ (DCIS), who derive a small absolute benefit in local control with standard whole breast irradiation (WBI). We examine how the American Society for Therapeutic Radiation Oncology (ASTRO) APBI consensus guidelines (CG) may be applied to the preoperative selection of patients with DCIS for IORT and determine treatment outcomes by CG group. Methods and Materials We identified patients with biopsy-proven pure DCIS enrolled in an institutional prospective registry IORT database using the Zeiss Intrabeam® device between September 2013 and February 2017. Based on available preoperative clinicopathologic information, patients were deemed suitable, cautionary, or unsuitable for IORT according to the ASTRO CG. Change in CG group based on final pathologic diagnosis was determined, and additional therapy was recommended for unsuitable patients. Outcome in terms of ipsilateral breast tumor recurrence was determined. Results A total of 61 DCIS lesions in 60 patients were treated with IORT. Preoperatively, 21 patients (35%) were suitable and 36 (59%) were cautionary. Four (6%) were unsuitable because of lesion size but declined WBI. Final pathologic diagnosis changed the CG grouping of 10 patients (16%) because of either occult high-grade disease in 2 (3%) or close/positive margins in 8 (13%). Ultimately 12 patients total were considered unsuitable, of whom 8 (66%) accepted additional WBI after IORT. At a median follow-up of 2.2 years, ipsilateral breast tumor recurrence was identified among 2 suitable, 1 cautionary, and no unsuitable patients. Conclusion Further investigation is necessary to refine selection of patients with DCIS who may be optimally treated with IORT alone. High acceptance of additional therapy among unsuitable patients resulted in excellent outcomes. The use of biomarkers in addition to traditional clinical and pathologic factors may help to better select patients for IORT.
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Affiliation(s)
- Christine Chin
- Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Sitara Hirji
- Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Maika Onishi
- Medical Oncology, Sutter Health Network, Palo Alto Foundation Medical Group, Sunnyvale, California
| | - Richard Ha
- Department of Radiology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Bret Taback
- Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - David P. Horowitz
- Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Eileen P. Connolly
- Department of Radiation Oncology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
- Corresponding author. Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th St, CHONY North B-Level, Room 11, New York, NY 10032.
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Mouawad M, Biernaski H, Brackstone M, Lock M, Yaremko B, Sexton T, Yu E, Dinniwell RE, Lynn K, Hajdok G, Prato FS, Thompson RT, Gelman N, Gaede S. Reducing the dose of gadolinium-based contrast agents for DCE-MRI guided SBRT: The effects on inter and intra observer variability for preoperative target volume delineation in early stage breast cancer patients. Radiother Oncol 2019; 131:60-65. [PMID: 30773188 DOI: 10.1016/j.radonc.2018.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/26/2018] [Accepted: 11/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to determine the effects of reducing the dose of contrast agent (CA) in a DCE-MRI scan on inter- and intra-observer variability in the context of MRI-guided target volume delineation for stereotactic body radiation therapy of early stage breast cancer patients. This is in hopes of reducing risks to patients due to findings of residual CA in brain and bone. MATERIALS AND METHODS Twenty-three patients receiving neoadjuvant radiation therapy were enrolled. Five observers delineated the gross target volume (GTV) using DCE-MRI for guidance. 14/23 patients received the full clinical dose of CA and 9/23 received half. Clinical target volumes (CTV) were created through a 0.5 cm uniform expansion. Several metrics were used to quantify the inter and intra-observer reliability including differences in delineation volume and the reliability coefficient. RESULTS There were no significant differences in the volume, though half contrast patients had a lower median for both the GTV and CTV (difference of 0.26 cm3 and 1.27 cm3, respectively). All indicated a high degree of agreement between and within observers for both dose groups. However, the full dose group had a greater inter-observer variability, most likely due to the full CA causing more pronounced enhancement in the periphery. CONCLUSIONS Reducing the dose of contrast agent did not significantly alter inter- or intra-observer variability. These results have prompted our centre to reduce the dose of gadolinium in all patients enrolled in the SIGNAL trial.
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Affiliation(s)
| | | | - Muriel Brackstone
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada; London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Michael Lock
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Brian Yaremko
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Tracy Sexton
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Edward Yu
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Robert E Dinniwell
- London Health Sciences Centre, London, Canada; Department of Oncology, Western University, London, Canada.
| | - Kalan Lynn
- London Health Sciences Centre, London, Canada.
| | | | - Frank S Prato
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada.
| | - Robert Terry Thompson
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada.
| | - Neil Gelman
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada.
| | - Stewart Gaede
- Medical Biophysics, Western University, London, Canada; Lawson Health Research Institute, London, Canada; London Health Sciences Centre, London, Canada.
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Gabani P, Cyr AE, Zoberi JE, Ochoa LL, Matesa MA, Thomas MA, Garcia J, Margenthaler JA, Naughton MJ, Ma C, Sanati S, Zoberi I. Long-term outcomes of APBI via multicatheter interstitial HDR brachytherapy: Results of a prospective single-institutional registry. Brachytherapy 2018; 17:171-180. [DOI: 10.1016/j.brachy.2017.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
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10
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Shah S, Kyrillos A, Kuchta K, Habib H, Tobias M, Raghavan V, Shaikh A, Bloomer W, Pesce C, Yao K. A Single Institution Retrospective Comparison Study of Locoregional Recurrence After Accelerated Partial Breast Irradiation Using External Beam Fractionation Compared with Whole Breast Irradiation with 8 Years of Follow-Up. Ann Surg Oncol 2017; 24:2935-2942. [PMID: 28766205 DOI: 10.1245/s10434-017-5953-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) was developed to address disadvantages of overall treatment time and potentially unnecessary radiation associated with whole breast irradiation (WBI). We report updated results of our single institution study using an external beam APBI regimen with a median follow-up of 8 years. METHODS A total of 290 APBI patients with AJCC Stage 0-II breast cancer were compared with 290 WBI patients with matched tumor characteristics. Toxicities were scored based on the Common Terminology Criteria for Adverse Events (CTCAE v3.0). Cox regression models were used to predict likelihood of freedom from ipsilateral failure. RESULTS Median follow-up was 8 years in the APBI group and 7.5 years in the WBI group. In the APBI group, there were 18 (6.2%) ipsilateral breast tumor recurrence (IBTR), 13 (72%) had elsewhere failures (EF), and 5 (28%) had local failures (LF) with a median time to failure of 64.1 months. In the WBI group, there were three (1.0%) IBTR; one (33%) was an EF and two (67%) were LF with a median time to failure of 91 months. APBI was 4.6 times more likely (hazard ratio 4.57, 95% confidence interval 1.3-16.2, p = 0.02) to have an IBTR than WBI after adjusting for age, tumor size, histology, grade, and estrogen receptor status. Fatigue, erythema, and desquamation toxicities were significantly less in the APBI group then the WBI group. CONCLUSIONS IBTR rates were higher in external beam APBI group compared with WBI, but APBI had fewer toxicities. Clinicians must weigh the risks and benefits of APBI when making a recommendation for partial breast irradiation after lumpectomy.
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Affiliation(s)
- Shalin Shah
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Alexandra Kyrillos
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristine Kuchta
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Hussain Habib
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Megan Tobias
- Department of Radiation Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Vathsala Raghavan
- Department of Radiation Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Arif Shaikh
- Department of Radiation Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - William Bloomer
- Department of Radiation Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Catherine Pesce
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Katharine Yao
- Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
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