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Chicheł A, Burchardt W, Chyrek AJ, Bielęda G. Thermal Boost Combined with Interstitial Brachytherapy in Early Breast Cancer Conserving Therapy—Initial Group Long-Term Clinical Results and Late Toxicity. J Pers Med 2022; 12:jpm12091382. [PMID: 36143167 PMCID: PMC9504368 DOI: 10.3390/jpm12091382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
(1) In breast-conserving therapy (BCT), adjuvant radiation, including tumor bed boost, is mandatory. Safely delivered thermal boost (TB) based on radio-sensitizing interstitial microwave hyperthermia (MWHT) preceding standard high-dose-rate (HDR) brachytherapy (BT) boost has the potential for local control (LC) improvement. The study is to report the long-term results regarding LC, disease-free survival (DFS), overall survival (OS), toxicity, and cosmetic outcome (CO) of HDR-BT boost ± MWHT for early breast cancer (BC) patients treated with BCT. (2) In the years 2006 and 2007, 57 diverse stages and risk (IA-IIIA) BC patients were treated with BCT ± adjuvant chemotherapy followed by 42.5–50.0 Gy whole breast irradiation (WBI) and 10 Gy HDR-BT boost. Overall, 25 patients (group A; 43.9%) had a BT boost, and 32 (group B; 56.1%) had an additional pre-BT single session of interstitial MWHT on a tumor bed. Long-term LC, DFS, OS, CO, and late toxicity were evaluated. (3) Median follow-up was 94.8 months (range 1.1–185.5). LC was 55/57, or 96.5% (1 LR in each group). DFS was 48/57, or 84.2% (4 failures in group A, 5 in B). OS was 46/57, or 80.7% (6 deaths in group A, 5 in B). CO was excellent in 60%, good in 36%, and satisfactory in 4% (A), and in 53.1%, 34.4%, and 9.4% (B), respectively. One poor outcome was noted (B). Late toxicity as tumor bed hardening occurred in 19/57, or 33.3% of patients (9 in A, 10 in B). In one patient, grade 2 telangiectasia occurred (group A). All differences were statistically insignificant. (4) HDR-BT boost ± TB was feasible, well-tolerated, and highly locally effective. LC, DFS, and OS were equally distributed between the groups. Pre-BT MWHT did not increase rare late toxicity.
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Affiliation(s)
- Adam Chicheł
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
- Correspondence: ; Tel.: +48-618-850-818 or +48-600-687-369
| | - Wojciech Burchardt
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
| | - Artur J. Chyrek
- Department of Brachytherapy, Greater Poland Cancer Center, 61-866 Poznan, Poland
| | - Grzegorz Bielęda
- Department of Electroradiology, Poznan University of Medical Sciences, 61-866 Poznan, Poland
- Department of Medical Physics, Greater Poland Cancer Center, 61-866 Poznan, Poland
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Jones BM, Green S. Modern radiation techniques in early stage breast cancer for the breast radiologist. Clin Imaging 2021; 80:19-25. [PMID: 34224950 DOI: 10.1016/j.clinimag.2021.06.035] [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: 03/23/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023]
Abstract
Partial breast irradiation (PBI) and ultra-hypofractionated whole breast irradiation (uWBI) are contemporary alternatives to conventional and standard hypofractionated whole breast irradiation (WBI), which shorten treatment from 3 to 6 weeks to 1-2 weeks for select patients. PBI and accelerated PBI (APBI) can be delivered with external beam radiation (3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT)), intraoperative radiation (IORT), or brachytherapy. These new radiation techniques offer the advantage of convenience and lower cost, which ultimately improves access to care. Globally, the COVID 19 pandemic has accelerated APBI/PBI and ultra-hypofractionated regimens into routine practice for carefully selected patients. Recent long-term data from randomized controlled trials (RCTs) have demonstrated these techniques are safe and effective in suitable patients demonstrating equivalent or improved local recurrence, acute/late toxicity, and cosmesis. PBI and APBI should be limited to low risk unifocal invasive ductal carcinoma and ductal carcinoma in situ with tumor size < 2 cm, clear margins (≥2 mm), ER+, and negative nodes. Based on the results from UK Fast-Forward and UK FAST ultra-hypofractionated breast radiation can be safely employed for early stage node negative patients, but is not yet considered an international standard of care. In this review, authors will appraise recent data for these shorter course radiation treatment regimens, as well as, considerations for breast radiologists including surveillance imaging and radiographic findings.
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Affiliation(s)
- Brianna M Jones
- Icahn School of Medicine at Mount Sinai, United States of America.
| | - Sheryl Green
- Icahn School of Medicine at Mount Sinai, United States of America.
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3
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Mammographic Changes in Hypofractionated Radiotherapy. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2018-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Wallace AS, Tchatalbachev V, Nelson J, Wang Z, Dale P, Biedermann GB. Long term radiographic findings of breast brachytherapy: Implications of surgical volume. J Surg Oncol 2017; 116:203-207. [PMID: 28445590 PMCID: PMC9744260 DOI: 10.1002/jso.24646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Little is known about long-term radiographic findings after treatment with accelerated partial breast irradiation (APBI). METHODS Univariate and multivariate analysis of factors leading to formation and resolution of seroma were performed in patients treated with lumpectomy and APBI. RESULTS Post-treatment images of 129 patients were reviewed by one radiologist. Median surgical excision volume was 108.9 cc (range 20.5-681.9). Primary mode of imaging was mammogram. Median time from end of RT to first and last surveillance image was 6 and 54 months, respectively. Median number of images was 7 (range 3-12). Seroma was identified in 98 (76%) patients, with median maximum diameter of 3.9 cm. Forty (41%) patients experienced resolution of seroma, at a median time of 29 months (range 6-74). On univariate analysis, surgical excision volume was associated with seroma formation, and tumor stage and margin re-excision were significant on univariate and multivariate analysis. No factors were associated with seroma resolution. CONCLUSION Seroma formation after APBI resolves around 2.5 years for many patients, but persists for others possibly due to primary tumor and surgical excision volumes. With revised criteria on the definition of positive margins, smaller volumes may lead to decreased risk of seroma formation for future patients.
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Affiliation(s)
- Audrey S. Wallace
- University of Missouri School of Medicine, Columbia,Department of Radiation Oncology, University of Alabama Birmingham
| | | | - Jay Nelson
- University of Missouri School of Medicine, Columbia
| | - Zhenyu Wang
- Department of Radiology, University of Missouri, Columbia
| | - Paul Dale
- Division of Surgical Oncology, Navicent Healthcare & Mercer University School of Medicine
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Holmes DR, Zimmerman R. Intraoperative radiotherapy: Patient selection, management, and follow-up. J Surg Oncol 2017; 116:824-830. [PMID: 28715150 DOI: 10.1002/jso.24734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 01/19/2023]
Abstract
Intraoperative partial breast radiotherapy is an alternative or an adjunct to fractionated whole breast irradiation for the administration of adjuvant radiotherapy in breast cancer following breast conserving surgery. Establishing intraoperative radiotherapy as a therapeutic modality requires a multidisciplinary approach to patient selection, workup, surgery, radiation protocols, chemotherapy, and patient follow up. In this article, we review the published evidence for best clinical practice, as a guide to the introduction of intraoperative radiotherapy for breast cancer treatment.
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Affiliation(s)
- Dennis R Holmes
- The Margie Petersen Breast Center, John Wayne Cancer Institute at Providence St John's Health Center, Santa Monica, California
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Tian S, Paster LF, Kim S, Kirstein L, Haffty BG, Ferro A, Amorosa J, Goyal S. Comparison of Mammographic Changes Across Three Different Fractionation Schedules for Early-Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2016; 95:597-604. [PMID: 27034177 DOI: 10.1016/j.ijrobp.2016.01.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 12/09/2015] [Accepted: 01/28/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE As the use of hypofractionated breast radiation therapy (RT) increases, so will the need for long-term data on post-RT mammographic changes. The purpose of the present study was to longitudinally compare the incidence of common mammographic sequelae seen after breast conserving surgery and RT in patients treated with accelerated partial breast irradiation (APBI), hypofractionated whole breast irradiation (HWBI), and conventionally fractionated whole breast irradiation (WBI). METHODS AND MATERIALS Patients treated with either APBI or HWBI after breast conserving therapy and with ≥3 mammograms of the treated breast were identified. They were matched 1:1 by age ±5 years to patients treated with WBI. The mammograms were evaluated for common post-RT breast findings by a mammographer who was unaware of the treatment. The outcomes were analyzed using a cumulative logistic regression model; P<.05 indicated statistically significance. RESULTS Of 89 patients treated with RT from 2006 to 2011, 29 had received APBI, 30 had received HWBI, and 30 had received WBI. Their median age was 60 years (range 33-83). A total of 605 mammograms were evaluated, with a median follow-up of 48 months. The treatment technique did not affect the severity of architectural distortion when the groups were evaluated longitudinally. The likelihood of finding skin thickening decreased with increasing follow-up duration (odds ratio 0.6; P<.001) adjusted for fractionation schemes. No differences were seen with respect to changes in skin thickening, fluid collections, or calcifications among the treatment groups, after adjustment for the follow-up time. The clinical characteristics, including age, race, T stage, and chemotherapy use, were not linked to the likelihood of finding several mammographic phenomena over time. CONCLUSIONS Although specific post-treatment imaging findings evolved over time, RT fractionation did not alter the relative incidence or severity of architectural distortion, skin thickening, fluid collections, or calcifications. These findings will be useful to both radiologists and radiation oncologists when counseling patients regarding follow-up studies after RT.
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Affiliation(s)
- Sibo Tian
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Lina F Paster
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Sinae Kim
- Biometrics Division, Rutgers Cancer Institute of New Jersey, and Department of Biostatistics, Rutgers School of Public Health, Rutgers, New Jersey
| | - Laurie Kirstein
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Bruce G Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Adam Ferro
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Judith Amorosa
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey
| | - Sharad Goyal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, Rutgers, New Jersey.
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Jalaguier-Coudray A, Cohen M, Thomassin-Piana J, Houvenaeghel G, Villard-Mahjoub R, Tallet A, Minsat M, Resbeut M. Calcifications and tungsten deposits after breast-conserving surgery and intraoperative radiotherapy for breast cancer. Eur J Radiol 2015; 84:2521-5. [PMID: 26476824 DOI: 10.1016/j.ejrad.2015.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
Abstract
AIM To describe the presence of atypical calcifications on post-operative mammography after breast-conserving surgery (BCS) and intraoperative radiotherapy (IORT). MATERIALS AND METHODS We retrospectively include all patients followed after BCS and IORT for breast cancer (n=271). All follow-up mammograms at 6 months after surgery were retrospectively evaluated by two board-certified radiologists. The radiologists had to notify the presence or the absence of atypical calcifications. RESULTS Five patients had on follow-up mammography the presence of atypical calcifications. Two patients had a stereotactic breast biopsy. The pathologic examination showed the presence of small tungsten particles located in the breast parenchyma. CONCLUSION The presence of atypical calcifications after BCS and IORT, presenting as multiple, scattered, round calcifications, should be rated as BIRADS 2 and do not require biopsy. They corresponded on tungsten deposits.
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Affiliation(s)
| | - M Cohen
- Department of Gynecology, Institut Paoli-Calmettes, Marseille, France.
| | - J Thomassin-Piana
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France.
| | - G Houvenaeghel
- Department of Gynecology, Institut Paoli-Calmettes, Marseille, France; CRCM and Université Aix-Marseille (G.H.), Marseille, France.
| | - R Villard-Mahjoub
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France.
| | - A Tallet
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France.
| | - M Minsat
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France.
| | - M Resbeut
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France.
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Ibrahim NB, Anandan S, Hartman AL, McSweeney M, Chun J, McKee A, Yang R, Kim C. Radiographic Findings after Treatment with Balloon Brachytherapy Accelerated Partial Breast Irradiation. Radiographics 2015; 35:6-13. [DOI: 10.1148/rg.351140131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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