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Habatsch M, Schneider M, Requardt M, Doussin S. Movement assessment of breast and organ-at-risks using free-breathing, self-gating 4D magnetic resonance imaging workflow for breast cancer radiation therapy. Phys Imaging Radiat Oncol 2022; 22:111-114. [PMID: 35619641 PMCID: PMC9127201 DOI: 10.1016/j.phro.2022.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
Motion management is essential in treatment planning of radiotherapy for breast cancer. This study assessed the movement of organs-at-risk and the breast using 4D magnetic resonance imaging (MRI). A self-gating respiration-resolved radial 3D gradient echo sequence was used. Five healthy volunteers were imaged at 1.5 T during free-breathing in supine position making use of a breast board. Median distances between heart and chest wall in axial views were 2.4 cm (range: 1.5 cm) and 3.0 cm (range: 1.7 cm) for end-of-exhale and end-of-inhale. 4D-MRI allowed organ delineation and might be a promising addition to novel RT planning for breast cancer patients.
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Schmitt M, Eber J, Antoni D, Noel G. Should the management of radiation therapy for breast cancer be standardized? Results of a survey on current French practices in breast radiotherapy. Rep Pract Oncol Radiother 2021; 26:814-826. [PMID: 34760316 DOI: 10.5603/rpor.a2021.0102] [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: 05/14/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Breast cancer is the most frequent cancer in women in France. Its management has evolved considerably in recent years with a focus on reducing iatrogenic toxicity. The radiotherapy indications are validated in multidisciplinary consultation meetings; however, questions remain outstanding, particularly regarding hypofractionated radiotherapy, partial breast irradiation, and irradiation of the internal mammary chain and axillary lymph node area. Materials and methods An online survey was sent to 47 heads of radiotherapy departments in France. The survey consisted of 22 questions concerning indications for irradiation of the supraclavicular, internal mammary and axillary lymph node areas; irradiation techniques and modalities; prescribed doses; and fractionation. Results Twenty-four out of 47 centers responded (response rate of 51%). This survey demonstrated a wide variation in the prescribed dose regimen, monoisocentric radiotherapy, and indications of irradiation of the lymph node areas. Conclusion This survey provides insight into the current radiotherapy practice for breast cancer in France. It shows the need to standardize practices.
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Affiliation(s)
- Martin Schmitt
- Radiotherapy Department, Institut du Cancer, Strasbourg, Europe, France
| | - Jordan Eber
- Radiotherapy Department, Institut du Cancer, Strasbourg, Europe, France
| | - Delphine Antoni
- Radiotherapy Department, Institut du Cancer, Strasbourg, Europe, France
| | - Georges Noel
- Radiotherapy Department, Institut du Cancer, Strasbourg, Europe, France
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Duane FK, Kerr A, Wang Z, Darby SC, Ntentas G, Aznar MC, Taylor CW. Exposure of the oesophagus in breast cancer radiotherapy: A systematic review of oesophagus doses published 2010-2020. Radiother Oncol 2021; 164:261-267. [PMID: 34626725 DOI: 10.1016/j.radonc.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Breast cancer radiotherapy can increase the risk of subsequent primary oesophageal cancer, with risk increasing according to oesophagus radiation dose. We describe oesophagus exposure from modern breast cancer regimens and discuss the risks of oesophageal cancer for women irradiated recently. MATERIALS AND METHODS A systematic review was undertaken of oesophagus doses from breast cancer radiotherapy regimens published during 2010-2020. Mean and maximum oesophagus doses were described for different target regions irradiated and different radiotherapy techniques. RESULTS In 112 published regimens from 18 countries, oesophagus doses varied with target region. For partial breast irradiation, average mean oesophagus dose was 0.2 Gy (range 0.1-0.4) in four regimens; maximum dose was not reported. For breast or chest wall radiotherapy, average oesophagus doses were mean 1.8 Gy (range 0.1-10.4) in 24 regimens and maximum 6.7 Gy (range 0.4-14.3) in seven regimens. For radiotherapy including a nodal region, average oesophagus doses were higher: mean 11.4 Gy (range <0.1-29.3) in 61 regimens and maximum 34.4 Gy (range 3.4-51.3) in 55 regimens. Average mean oesophagus doses were >10 Gy for intensity modulated nodal radiotherapy, but lower for other node techniques. CONCLUSIONS Mean oesophagus doses from partial breast and breast/chest wall regimens were usually less than 2 Gy, hence radiation-risks will be very small. However, for radiotherapy including lymph nodes, average mean oesophagus dose of 11.4 Gy may nearly double oesophageal cancer risk. Consideration of oesophageal exposure during nodal radiotherapy planning may reduce the risks of radiation-related oesophageal cancer for women irradiated today.
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Affiliation(s)
- Frances K Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland.
| | - Amanda Kerr
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhe Wang
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sarah C Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, UK
| | - Marianne C Aznar
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Carolyn W Taylor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kaidar-Person O, Dahn HM, Nichol AM, Boersma LJ, de Ruysscher D, Meattini I, Pignol JP, Aristei C, Belkacemi Y, Benjamin D, Bese N, Coles CE, Franco P, Ho AY, Hol S, Jagsi R, Kirby AM, Marrazzo L, Marta GN, Moran MS, Nissen HD, Strnad V, Zissiadis Y, Poortmans PM, Offersen BV. A Delphi study and International Consensus Recommendations: The use of bolus in the setting of postmastectomy radiation therapy for early breast cancer. Radiother Oncol 2021; 164:115-121. [PMID: 34563607 DOI: 10.1016/j.radonc.2021.09.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/01/2023]
Abstract
Bolus serves as a tissue equivalent material that shifts the 95-100% isodose line towards the skin and subcutaneous tissue. The need for bolus for all breast cancer patients planned for postmastectomy radiation therapy (PMRT) has been questioned. The work was initiated by the faculty of the European SocieTy for Radiotherapy & Oncology (ESTRO) breast cancer courses and represents a multidisciplinary international breast cancer expert collaboration to optimize PMRT. Due to the lack of randomised trials evaluating the benefits of bolus, we designed a stepwise project to evaluate the existing evidence about the use of bolus in the setting of PMRT to achieve an international consensus for the indications of bolus in PMRT, based on the Delphi method.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, at Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; GROW-School for Oncology and Developmental Biology (Maastro), Maastricht University, Maastricht, The Netherlands.
| | - Hannah M Dahn
- Department of Radiation Oncology, Dalhousie University, Halifax, Canada
| | - Alan M Nichol
- Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, Canada
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dirk de Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence; Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi; Florence, Italy
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, University of Paris-Est (UPEC), Creteil, France, INSERM Unit 955, Creteil, France
| | - Dori Benjamin
- Department of Physics, Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Nuran Bese
- Acibadem Mehmet Ali Aydinlar University, Research Institute of Senology Istanbul, Turkey
| | | | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont and Department of Radiation Oncology, University Hospital "Maggiore della Carità,", Novara, Italy
| | - Alice Y Ho
- Harvard Medical School, Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Sandra Hol
- Instituut Verbeeten, Tilburg, The Netherlands
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Anna M Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Livia Marrazzo
- Medical Physics Unit, Careggi University Hospital, Florence, Italy
| | - Gustavo N Marta
- Department of Radiation Oncology - Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Vratislav Strnad
- Dept. of Radiation Oncology, University Hospital Erlangen, Germany
| | | | | | - Birgitte V Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Brown E, Dundas K, Surjan Y, Miller D, Lim K, Boxer M, Ahern V, Papadatos G, Batumalai V, Harvey J, Lee D, Delaney GP, Holloway L. The effect of imaging modality (magnetic resonance imaging vs. computed tomography) and patient position (supine vs. prone) on target and organ at risk doses in partial breast irradiation. J Med Radiat Sci 2021; 68:157-166. [PMID: 33283982 PMCID: PMC8168067 DOI: 10.1002/jmrs.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Conventionally computed tomography (CT) has been used to delineate target volumes in radiotherapy; however, magnetic resonance imaging (MRI) is being continually integrated into clinical practice; therefore, the investigation into targets derived from MRI is warranted. The purpose of this study was to evaluate the impact of imaging modality (MRI vs. CT) and patient positioning (supine vs. prone) on planning target volumes (PTVs) and organs at risk (OARs) for partial breast irradiation (PBI). METHODS A retrospective data set, of 35 patients, was accessed where each patient had undergone MRI and CT imaging for tangential whole breast radiotherapy in both the supine and prone position. PTVs were defined from seroma cavity (SC) volumes delineated on each respective image, resulting in 4 PTVs per patient. PBI plans were generated with 6MV external beam radiotherapy (EBRT) using the TROG 06.02 protocol guidelines. A prescription of 38.5Gy in 10 fractions was used for all cases. The impact analysis of imaging modality and patient positioning included dose to PTVs, and OARs based on agreed criteria. Statistical analysis was conducted though Mann-Whitey U, Fisher's exact and chi-squared testing (P < 0.005). RESULTS Twenty-four patients were eligible for imaging analysis. However, positioning analysis could only be investigated on 19 of these data sets. No statistically significant difference was found in OAR doses based on imaging modality. Supine patient position resulted in lower contralateral breast dose (0.10Gy ± 0.35 vs. 0.33Gy ± 0.78, p = 0.011). Prone positioning resulted in a lower dose to ipsilateral lung volumes (10.85Gy ± 11.37 vs. 3.41Gy ± 3.93, P = <0.001). CONCLUSIONS PBI plans with PTVs derived from MRI exhibited no clinically significant differences when compared to plans created from CT in relation to plan compliance and OAR dose. Patient position requires careful consideration regardless of imaging modality chosen. Although there was no proven superiority of MRI derived target volumes, it indicates that MRI could be considered for PBI target delineation.
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Affiliation(s)
- Emily Brown
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
| | - Kylie Dundas
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Yolanda Surjan
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
| | - Daniela Miller
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
| | - Karen Lim
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Miriam Boxer
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Verity Ahern
- Crown Princess Mary Cancer CentreWestmead HospitalSydneyNSWAustralia
- Westmead Clinical SchoolUniversity of SydneySydneyNSWAustralia
| | - George Papadatos
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - Jennifer Harvey
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
- Princess Alexandra HospitalBrisbaneQLDAustralia
| | - Debra Lee
- Medical Radiation Science (MRS)School of Health SciencesThe University of NewcastleCallaghanNSWAustralia
| | - Geoff P. Delaney
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
- School of MedicineUniversity of Western SydneySydneyNSWAustralia
| | - Lois Holloway
- Liverpool and Macarthur Cancer Therapy CentersLiverpoolNSWAustralia
- Ingham Institute for Applied Medical ResearchLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
- Centre for Medical Radiation PhysicsFaculty of Engineering and Information SciencesUniversity of WollongongWollongongNSWAustralia
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Kairn T, Crowe SB. Application of retrospective data analysis to clinical protocol design: can the potential benefits of breath-hold techniques for breast radiotherapy be assessed without testing on patients? AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:227-233. [DOI: 10.1007/s13246-019-00725-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/12/2019] [Indexed: 12/25/2022]
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The Assisi Think Tank Meeting and Survey of post MAstectomy Radiation Therapy after breast reconstruction: The ATTM-SMART report. Eur J Surg Oncol 2018; 44:436-443. [DOI: 10.1016/j.ejso.2018.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/11/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022] Open
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Kahán Z, Rárosi F, Gaál S, Cserháti A, Boda K, Darázs B, Kószó R, Lakosi F, Gulybán Á, Coucke PA, Varga Z. A simple clinical method for predicting the benefit of prone vs. supine positioning in reducing heart exposure during left breast radiotherapy. Radiother Oncol 2018; 126:487-492. [DOI: 10.1016/j.radonc.2017.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 12/25/2022]
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Influence of body habitus on dose parameters of nodal levels III to IV irradiation for breast cancer: comparison of 3 techniques. Med Dosim 2017; 43:328-333. [PMID: 29223303 DOI: 10.1016/j.meddos.2017.11.002] [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: 04/09/2017] [Revised: 08/25/2017] [Accepted: 11/06/2017] [Indexed: 11/22/2022]
Abstract
This study aimed to investigate the effect of body habitus on supraclavicular (SC) dose-volume histogram (DVH) parameters among breast cancer patients according to 3 different techniques. Three SC irradiation plans were generated for 24 postoperative breast cancer patients: (1) direct antero-posterior field only (1fieldP), with dose prescribed to a 3-cm depth; (2) 3-cm depth plan (3cmP) using an antero-posterior field plus a posterior boost with the dose prescription defined to 3 cm; and (3) optimized plan (OptP) similar to 3cmP, with dose prescribed depending on the anatomy. The OptP plans had the least variation in DVH parameters with body habitus; 3cmP plans were the most varied. Conformity index among normal weight patients were 0.73, 0.78, and 0.87 (p = 0.02) and 0.61, 0.6, and 0.82 among overweight-obese patients for 1fieldP, 3cmP, and OptP, respectively (p < 0.001). V95% of the planning target volume among normal weight patients were 72.63%, 78.03%, and 87.18% for 1fieldP, 3cmP, and OptP, respectively (p = 0.02). The corresponding values among overweight-obese patients were 60.5%, 59.62%, and 81.62%, respectively (p = 0.001). Fixed depth dose prescriptions caused greater SC under dose than plans optimized according to patient's anatomy.
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Dundas K, Pogson EM, Batumalai V, Delaney GP, Boxer MM, Yap ML, Ahern V, Chan C, David S, Dimigen M, Harvey JA, Koh ES, Lim K, Papadatos G, Lazarus E, Descellar J, Metcalfe P, Holloway L. The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning. Pract Radiat Oncol 2017; 8:e87-e97. [PMID: 28993138 DOI: 10.1016/j.prro.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of magnetic resonance imaging (MRI) versus computed tomography (CT)-derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiation therapy. METHODS AND MATERIALS Four WB radiation therapy plans were generated for 28 patients in which PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6-MV tangential intensity modulated radiation therapy technique was used, with plans designated as ideal, acceptable, or noncompliant. Dose metrics for PTVs and organs at risk were compared to analyze any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone). RESULTS With respect to imaging modality 2/11 whole breast planning target volume (WB_PTV) dose metrics (percentage of PTV receiving 90% and 110% of prescribed dose) displayed statistically significant differences; however, these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan versus a noncompliant plan were higher for the supine position compared with the prone position (P = .026). The minimum distance between the seroma cavity planning target volume (SC_PTV) and the chest wall was increased with prone positioning (P < .001, supine and prone values 1.1 mm and 8.7 mm, respectively). Heart volume was greater in the supine position (P = .005). Heart doses were lower in the supine position than prone (P < .01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone, respectively). Mean lung doses met ideal dose constraints in both positions, but were best spared in the prone position. The contralateral breast maximum dose to 1cc (D1cc) showed significantly lower doses in the supine position (P < .001, 4.64 Gy vs 9.51 Gy). CONCLUSIONS Planning with PTVs generated from MRI data showed no clinically significant differences from planning with PTVs generated from CT with respect to PTV and doses to organs at risk. Prone positioning within this study reduced mean lung dose and whole heart volumes but increased mean heart and contralateral breast doses compared with supine.
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Affiliation(s)
- Kylie Dundas
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia.
| | - Elise M Pogson
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Miriam M Boxer
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; School of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Verity Ahern
- Crown Princess Mary Cancer Care Centre, Westmead Hospital, NSW, Australia
| | - Christine Chan
- Department of Radiology, Liverpool Hospital, NSW, Australia
| | - Steven David
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Marion Dimigen
- Department of Radiology, Liverpool Hospital, NSW, Australia
| | - Jennifer A Harvey
- School of Medicine, University of Queensland, QLD, Australia; Princess Alexandra Hospital, QLD, Australia
| | - Eng-Siew Koh
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Lim
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - George Papadatos
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia
| | | | - Joseph Descellar
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia
| | - Lois Holloway
- Centre for Medical Radiation Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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Coles CE, Griffin CL, Kirby AM, Titley J, Agrawal RK, Alhasso A, Bhattacharya IS, Brunt AM, Ciurlionis L, Chan C, Donovan EM, Emson MA, Harnett AN, Haviland JS, Hopwood P, Jefford ML, Kaggwa R, Sawyer EJ, Syndikus I, Tsang YM, Wheatley DA, Wilcox M, Yarnold JR, Bliss JM. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet 2017; 390:1048-1060. [PMID: 28779963 PMCID: PMC5594247 DOI: 10.1016/s0140-6736(17)31145-5] [Citation(s) in RCA: 384] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/08/2017] [Accepted: 04/13/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Local cancer relapse risk after breast conservation surgery followed by radiotherapy has fallen sharply in many countries, and is influenced by patient age and clinicopathological factors. We hypothesise that partial-breast radiotherapy restricted to the vicinity of the original tumour in women at lower than average risk of local relapse will improve the balance of beneficial versus adverse effects compared with whole-breast radiotherapy. METHODS IMPORT LOW is a multicentre, randomised, controlled, phase 3, non-inferiority trial done in 30 radiotherapy centres in the UK. Women aged 50 years or older who had undergone breast-conserving surgery for unifocal invasive ductal adenocarcinoma of grade 1-3, with a tumour size of 3 cm or less (pT1-2), none to three positive axillary nodes (pN0-1), and minimum microscopic margins of non-cancerous tissue of 2 mm or more, were recruited. Patients were randomly assigned (1:1:1) to receive 40 Gy whole-breast radiotherapy (control), 36 Gy whole-breast radiotherapy and 40 Gy to the partial breast (reduced-dose group), or 40 Gy to the partial breast only (partial-breast group) in 15 daily treatment fractions. Computer-generated random permuted blocks (mixed sizes of six and nine) were used to assign patients to groups, stratifying patients by radiotherapy treatment centre. Patients and clinicians were not masked to treatment allocation. Field-in-field intensity-modulated radiotherapy was delivered using standard tangential beams that were simply reduced in length for the partial-breast group. The primary endpoint was ipsilateral local relapse (80% power to exclude a 2·5% increase [non-inferiority margin] at 5 years for each experimental group; non-inferiority was shown if the upper limit of the two-sided 95% CI for the local relapse hazard ratio [HR] was less than 2·03), analysed by intention to treat. Safety analyses were done in all patients for whom data was available (ie, a modified intention-to-treat population). This study is registered in the ISRCTN registry, number ISRCTN12852634. FINDINGS Between May 3, 2007, and Oct 5, 2010, 2018 women were recruited. Two women withdrew consent for use of their data in the analysis. 674 patients were analysed in the whole-breast radiotherapy (control) group, 673 in the reduced-dose group, and 669 in the partial-breast group. Median follow-up was 72·2 months (IQR 61·7-83·2), and 5-year estimates of local relapse cumulative incidence were 1·1% (95% CI 0·5-2·3) of patients in the control group, 0·2% (0·02-1·2) in the reduced-dose group, and 0·5% (0·2-1·4) in the partial-breast group. Estimated 5-year absolute differences in local relapse compared with the control group were -0·73% (-0·99 to 0·22) for the reduced-dose and -0·38% (-0·84 to 0·90) for the partial-breast groups. Non-inferiority can be claimed for both reduced-dose and partial-breast radiotherapy, and was confirmed by the test against the critical HR being more than 2·03 (p=0·003 for the reduced-dose group and p=0·016 for the partial-breast group, compared with the whole-breast radiotherapy group). Photographic, patient, and clinical assessments recorded similar adverse effects after reduced-dose or partial-breast radiotherapy, including two patient domains achieving statistically significantly lower adverse effects (change in breast appearance [p=0·007 for partial-breast] and breast harder or firmer [p=0·002 for reduced-dose and p<0·0001 for partial-breast]) compared with whole-breast radiotherapy. INTERPRETATION We showed non-inferiority of partial-breast and reduced-dose radiotherapy compared with the standard whole-breast radiotherapy in terms of local relapse in a cohort of patients with early breast cancer, and equivalent or fewer late normal-tissue adverse effects were seen. This simple radiotherapy technique is implementable in radiotherapy centres worldwide. FUNDING Cancer Research UK.
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Affiliation(s)
| | - Clare L Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Anna M Kirby
- Department of Radiotherapy and Imaging, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Jenny Titley
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Rajiv K Agrawal
- Department of Oncology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Abdulla Alhasso
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Adrian M Brunt
- Cancer Centre, University Hospitals of North Midlands and Keele University, Stoke-on-Trent, UK
| | - Laura Ciurlionis
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - Charlie Chan
- Department of Breast Surgery, Nuffield Health Cheltenham Hospital, Cheltenham, UK
| | - Ellen M Donovan
- Department of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Marie A Emson
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Adrian N Harnett
- Department of Oncology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Joanne S Haviland
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Penelope Hopwood
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - Ronald Kaggwa
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Elinor J Sawyer
- Department of Research Oncology, King's College London, London, UK
| | - Isabel Syndikus
- Cancer Centre, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - Yat M Tsang
- Department of Radiotherapy, Mount Vernon Cancer Centre Northwood, Northwood, UK
| | - Duncan A Wheatley
- Department of Oncology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | | | - John R Yarnold
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Judith M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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12
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Nguyen K, Mackenzie P, Allen A, Dreosti M, Morgia M, Zissiadis Y, Lamoury G, Windsor A. Breast interest group faculty of radiation oncology: Australian and New Zealand patterns of practice survey on breast radiotherapy. J Med Imaging Radiat Oncol 2016; 61:508-516. [PMID: 27987274 DOI: 10.1111/1754-9485.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This patterns of practice study was conducted on behalf of the RANZCR Breast Interest Group in order to document current radiotherapy practices for breast cancer in Australia and New Zealand. The survey identifies variations and highlights potential contentious aspects of radiotherapy management of breast cancer. METHODS A fifty-eight question survey was disseminated via the Survey Monkey digital platform to 388 Radiation Oncologists in Australia and New Zealand. RESULTS In total, 156 responses were received and collated. Areas of notable consensus among respondents included hypofractionation (77.3% of respondents would 'always' or 'sometimes' consider hypofractionation in the management of ductal carcinoma in-situ and 99.3% in early invasive breast cancer); margin status in early breast cancer (73.8% believe a clear inked margin is sufficient and does not require further surgery) and use of bolus in post-mastectomy radiotherapy (PMRT) (91.1% of participants use bolus in PMRT). Areas with a wider degree of variability amongst respondents included regional nodal irradiation and components of radiotherapy planning and delivery (examples include the technique used for delivery of boost and frequency of bolus application for PMRT). CONCLUSION The results of these patterns of practice survey informs radiation oncologists in Australia and New Zealand of the current clinical practices being implemented by their peers. The survey identifies areas of consensus and contention, the latter of which may lead to a development of research trials and/or educational activities to address these areas of uncertainty.
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Affiliation(s)
- Kimberley Nguyen
- Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia.,South Western Sydney Local Health District, Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Penny Mackenzie
- St George Hospital Cancer Care, St George Hospital, Kogarah, New South Wales, Australia
| | - Angela Allen
- Waikato Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand
| | - Marcus Dreosti
- Genesis Cancer Care: Adelaide Radiotherapy Centre, Adelaide, South Australia, Australia
| | - Marita Morgia
- Northern Sydney Cancer Centre Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Yvonne Zissiadis
- Genesis Cancer Care: Wembley Radiotherapy Centre, Wembley, Western Australia, Australia
| | - Gilian Lamoury
- Northern Sydney Cancer Centre Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Apsara Windsor
- Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia.,University of New South Wales, Randwick, New South Wales, Australia
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13
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The 2016 Assisi Think Tank Meeting on breast cancer: white paper. Breast Cancer Res Treat 2016; 160:211-221. [DOI: 10.1007/s10549-016-3998-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
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14
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Walker A, Metcalfe P, Liney G, Batumalai V, Dundas K, Glide‐Hurst C, Delaney GP, Boxer M, Yap ML, Dowling J, Rivest‐Henault D, Pogson E, Holloway L. MRI geometric distortion: Impact on tangential whole-breast IMRT. J Appl Clin Med Phys 2016; 17:7-19. [PMID: 28297426 PMCID: PMC5495026 DOI: 10.1120/jacmp.v17i5.6242] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 03/21/2016] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to determine the impact of magnetic resonance imaging (MRI) geometric distortions when using MRI for target delineation and planning for whole-breast, intensity-modulated radiotherapy (IMRT). Residual system distortions and combined systematic and patient-induced distortions are considered. This retrospective study investigated 18 patients who underwent whole-breast external beam radiotherapy, where both CT and MRIs were acquired for treatment planning. Distortion phantoms were imaged on two MRI systems, dedicated to radiotherapy planning (a wide, closed-bore 3T and an open-bore 1T). Patient scans were acquired on the 3T system. To simulate MRI-based planning, distortion maps representing residual system distortions were generated via deformable registration between phantom CT and MRIs. Patient CT images and structures were altered to match the residual system distortion measured by the phantoms on each scanner. The patient CTs were also registered to the corresponding patient MRI scans, to assess patient and residual system effects. Tangential IMRT plans were generated and optimized on each resulting CT dataset, then propagated to the original patient CT space. The resulting dose distributions were then evaluated with respect to the standard clinically acceptable DVH and visual assessment criteria. Maximum residual systematic distortion was measured to be 7.9 mm (95%<4.7mm) and 11.9 mm (95%<4.6mm) for the 3T and 1T scanners, respectively, which did not result in clinically unacceptable plans. Eight of the plans accounting for patient and systematic distortions were deemed clinically unacceptable when assessed on the original CT. For these plans, the mean difference in PTV V95 (volume receiving 95% prescription dose) was 0.13±2.51% and -0.73±1.93% for right- and left-sided patients, respectively. Residual system distortions alone had minimal impact on the dosimetry for the two scanners investigated. The combination of MRI systematic and patient-related distortions can result in unacceptable dosimetry for whole-breast IMRT, a potential issue when considering MRI-only radiotherapy treatment planning. PACS number(s): 87.61.-c, 87.57.cp, 87.57.nj, 87.55.D.
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Affiliation(s)
- Amy Walker
- Centre for Medical Radiation Physics, University of WollongongWollongongNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
| | - Peter Metcalfe
- Centre for Medical Radiation Physics, University of WollongongWollongongNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
| | - Gary Liney
- Centre for Medical Radiation Physics, University of WollongongWollongongNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
- Institute of Medical Physics, School of Physics, University of SydneySydneyNSWAustralia
| | - Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
- South Western Clinical School, University of New South WalesSydneyNSWAustralia
| | - Kylie Dundas
- Centre for Medical Radiation Physics, University of WollongongWollongongNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
| | - Carri Glide‐Hurst
- Department of Radiation OncologyHenry Ford Health SystemDetroitMIUSA
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- South Western Clinical School, University of New South WalesSydneyNSWAustralia
- Collaboration for Cancer Outcomes Research and Evaluation, Liverpool HospitalLiverpoolNSWAustralia
- School of Medicine, University of Western SydneySydneyNSWAustralia
| | - Miriam Boxer
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- South Western Clinical School, University of New South WalesSydneyNSWAustralia
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
- South Western Clinical School, University of New South WalesSydneyNSWAustralia
- Collaboration for Cancer Outcomes Research and Evaluation, Liverpool HospitalLiverpoolNSWAustralia
- School of Medicine, University of Western SydneySydneyNSWAustralia
| | - Jason Dowling
- Commonwealth Scientific and Industrial Research Organisation Computational Informatics, Australian E‐Health Research CentreBrisbaneAustralia
| | - David Rivest‐Henault
- Commonwealth Scientific and Industrial Research Organisation Computational Informatics, Australian E‐Health Research CentreBrisbaneAustralia
| | - Elise Pogson
- Centre for Medical Radiation Physics, University of WollongongWollongongNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
| | - Lois Holloway
- Centre for Medical Radiation Physics, University of WollongongWollongongNSWAustralia
- Liverpool and Macarthur Cancer Therapy CentresNSWAustralia
- Ingham Institute for Applied Medical Research, Liverpool HospitalSydneyNSWAustralia
- South Western Clinical School, University of New South WalesSydneyNSWAustralia
- Institute of Medical Physics, School of Physics, University of SydneySydneyNSWAustralia
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15
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Cooper BT, Li X, Shin SM, Modrek AS, Hsu HC, DeWyngaert JK, Jozsef G, Lymberis SC, Goldberg JD, Formenti SC. Preplanning prediction of the left anterior descending artery maximum dose based on patient, dosimetric, and treatment planning parameters. Adv Radiat Oncol 2016; 1:373-381. [PMID: 28740908 PMCID: PMC5514165 DOI: 10.1016/j.adro.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Maximum dose to the left anterior descending artery (LADmax) is an important physical constraint to reduce the risk of cardiovascular toxicity. We generated a simple algorithm to guide the positioning of the tangent fields to reliably maintain LADmax <10 Gy. METHODS AND MATERIALS Dosimetric plans from 146 consecutive women treated prone to the left breast enrolled in prospective protocols of accelerated whole breast radiation therapy, with a concomitant daily boost to the tumor bed (40.5 Gy/15 fraction to the whole breast and 48 Gy to the tumor bed), provided the training set for algorithm development. Scatter plots and correlation coefficients were used to describe the bivariate relationships between LADmax and several parameters: distance from the tumor cavity to the tangent field edge, cavity size, breast separation, field size, and distance from the tangent field. A logistic sigmoid curve was used to model the relationship of LADmax and the distance from the tangent field. Furthermore, we tested this prediction model on a validation data set of 53 consecutive similar patients. RESULTS A lack of linear relationships between LADmax and distance from cavity to LAD (-0.47), cavity size (-0.18), breast separation (-0.02), or field size (-0.28) was observed. In contrast, distance from the tangent field was highly negatively correlated to LADmax (-0.84) and was used in the models to predict LADmax. From a logistic sigmoid model we selected a cut-point of 2.46 mm (95% confidence interval, 2.19-2.74 mm) greater than which LADmax is <10 Gy (95% confidence interval, 9.30-10.72 Gy) and LADmean is <3.3 Gy. CONCLUSIONS Placing the edge of the tangents at least 2.5 mm from the closest point of the contoured LAD is likely to assure LADmax is <10 Gy and LADmean is <3.3 Gy in patients treated with prone accelerated breast radiation therapy.
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Affiliation(s)
- Benjamin T Cooper
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Xiaochun Li
- Division of Biostatistics and Department of Population Health, New York University School of Medicine, New York, New York
| | - Samuel M Shin
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Aram S Modrek
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Howard C Hsu
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - J K DeWyngaert
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Gabor Jozsef
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Stella C Lymberis
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
| | - Judith D Goldberg
- Division of Biostatistics and Department of Population Health, New York University School of Medicine, New York, New York
| | - Silvia C Formenti
- Department of Radiation Oncology, New York University School of Medicine and Langone Medical Center, New York, New York
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16
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Hamilton DG, Bale R, Jones C, Fitzgerald E, Khor R, Knight K, Wasiak J. Impact of tumour bed boost integration on acute and late toxicity in patients with breast cancer: A systematic review. Breast 2016; 27:126-35. [PMID: 27113229 DOI: 10.1016/j.breast.2016.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/24/2016] [Accepted: 03/11/2016] [Indexed: 01/13/2023] Open
Abstract
The purpose of this systematic review was to summarise the evidence from studies investigating the integration of tumour bed boosts into whole breast irradiation for patients with Stage 0-III breast cancer, with a focus on its impact on acute and late toxicities. A comprehensive systematic electronic search through the Ovid MEDLINE, EMBASE and PubMed databases from January 2000 to January 2015 was conducted. Studies were considered eligible if they investigated the efficacy of hypo- or normofractionated whole breast irradiation with the inclusion of a daily concurrent boost. The primary outcomes of interest were the degree of observed acute and late toxicity following radiotherapy treatment. Methodological quality assessment was performed on all included studies using either the Newcastle-Ottawa Scale or a previously published investigator-derived quality instrument. The search identified 35 articles, of which 17 satisfied our eligibility criteria. Thirteen and eleven studies reported on acute and late toxicities respectively. Grade 3 acute skin toxicity ranged from 1 to 7% whilst moderate to severe fibrosis and telangiectasia were both limited to 9%. Reported toxicity profiles were comparable to historical data at similar time-points. Studies investigating the delivery of concurrent boosts with whole breast radiotherapy courses report safe short to medium-term toxicity profiles and cosmesis rates. Whilst the quality of evidence and length of follow-up supporting these findings is low, sufficient evidence has been generated to consider concurrent boost techniques as an alternative to conventional sequential techniques.
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Affiliation(s)
- Daniel George Hamilton
- Epworth Radiation Oncology Research Centre, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia; Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia.
| | | | - Claire Jones
- Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia
| | - Emma Fitzgerald
- Epworth Radiation Oncology, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia
| | - Richard Khor
- Austin Health, Austin Hospital, 145 Studley Road, Heidelberg VIC 3121, Australia
| | - Kellie Knight
- Department of Medical Imaging & Radiation Sciences, School of Biomedical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton VIC 3800, Australia
| | - Jason Wasiak
- Epworth Radiation Oncology Research Centre, Epworth Richmond, 32 Erin St, Richmond VIC 3121, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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