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Song D, Zhang H, Ren C, Zhan N, Xie L, Xie W. Accelerated partial breast irradiation: Current evidence and future developments. CANCER INNOVATION 2024; 3:e106. [PMID: 38948534 PMCID: PMC11212331 DOI: 10.1002/cai2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/15/2023] [Accepted: 10/11/2023] [Indexed: 07/02/2024]
Abstract
Whole breast irradiation after breast-conserving surgery for early breast cancer has become one of the standard treatment modes for breast cancer and yields the same effect as radical surgery. Accelerated partial breast irradiation (APBI) as a substitute for whole breast irradiation for patients with early breast cancer is a hot spot in clinical research. APBI is characterised by simple high-dose local irradiation of the tumour bed in a short time, thus improving convenience for patients and saving costs. The implementation methods of APBI mainly include brachytherapy, external beam radiation therapy, and intraoperative radiotherapy. This review provides an overview of the clinical effects and adverse reactions of the main technologies of APBI and discusses the prospects for the future development of APBI.
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Affiliation(s)
- Dandan Song
- Department of Radiation Oncology, Xiang'an Hospital of Xiamen University, Cancer Research Center, School of MedicineXiamen UniversityXiang'anXiamenChina
| | - Honghong Zhang
- Department of Radiation Oncology, Xiang'an Hospital of Xiamen University, Cancer Research Center, School of MedicineXiamen UniversityXiang'anXiamenChina
| | - Chengbo Ren
- Department of Radiation OncologyThe First Affiliated Hospital of Hebei North UniversityZhangjiakouHebeiChina
| | - Ning Zhan
- Department of Radiation Oncology, Xiang'an Hospital of Xiamen University, Cancer Research Center, School of MedicineXiamen UniversityXiang'anXiamenChina
| | - Liangxi Xie
- Department of Radiation Oncology, Xiang'an Hospital of Xiamen University, Cancer Research Center, School of MedicineXiamen UniversityXiang'anXiamenChina
| | - Wenjia Xie
- Department of Radiation Oncology, Xiang'an Hospital of Xiamen University, Cancer Research Center, School of MedicineXiamen UniversityXiang'anXiamenChina
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Meattini I, Kim K, Livi L. Accelerated Partial Breast Irradiation: Florence Phase 3 Trial Experience and Future Perspectives. Am J Clin Oncol 2023; 46:10-15. [PMID: 36472353 DOI: 10.1097/coc.0000000000000968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accelerated partial breast irradiation Florence phase 3 trial is a single-center study comparing intensity-modulated based accelerated partial breast irradiation (PBI, 30 Gy in 5 fractions) and whole breast irradiation (50 Gy in 25 fractions) followed by a tumor bed boost (10 Gy in 5 fractions). This easy-to-deliver PBI approach showed excellent long-term disease control with favorable safety and cosmetic outcome profiles. A plateau has been probably reached concerning the reduction of the number of fractions in the postoperative PBI setting. A 5-fraction schedule is the standard regimen and probably the appropriate compromise in terms of efficacy, safety, and quality of life, also considering the negative results of most intraoperative single-fraction PBI trials. A new frontier is now open on the potential benefit of preoperative PBI delivery, although concerns remain on the optimal dose, fractionation, and technique. Hereby we report the accelerated PBI Florence phase 3 trial experience and future perspectives.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Kyubo Kim
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- Department of Radiation Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio," University of Florence
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Rahimi A, Simmons A, Kim DN, Leitch M, Haas J, Gu X, Ahn C, Gao A, Spangler A, Morgan HE, Goudreau S, Seiler S, Farr D, Wooldridge R, Haley B, Bahrami S, Neufeld S, Mendez C, Alluri P, Rao R, Timmerman RD. Preliminary Results of Multi-Institutional Phase 1 Dose Escalation Trial Using Single-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2021; 112:663-670. [PMID: 34710523 DOI: 10.1016/j.ijrobp.2021.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE We report on our early experience of our prospective multicenter phase 1 dose- escalation study of single-fraction stereotactic partial breast irradiation (S-PBI) for early stage breast cancer after partial mastectomy using a robotic stereotactic radiation system. METHODS AND MATERIALS Thirty women with in situ or invasive breast cancer stage 0, I, or II with tumor size <3 cm treated with lumpectomy were enrolled in this phase 1 single-fraction S-PBI dose-escalation trial. Women received either 22.5, 26.5, or 30 Gy in a single fraction using a robotic stereotactic radiation system. The primary outcome was to reach tumoricidal dose of 30 Gy in a single fraction to the lumpectomy cavity without exceeding the maximum tolerated dose. Secondary outcomes were to determine dose-limiting toxicity and cosmesis. Tertiary goals were ipsilateral breast recurrence rate, distant disease-free interval, recurrence-free survival, and overall survival. RESULTS From June 2016 to January 2021, 11, 8, and 10 patients were treated to doses of 22.5, 26.5, or 30 Gy in a single fraction, respectively, with median follow-up being 47.9, 25.1, and 16.2 months. No patients experienced acute (<90 days) grade 3 or higher treatment-related toxicity, and maximum tolerated dose was not reached. There were 2 delayed grade 3 toxicities. Four patients (13.8%) developed fat necrosis across all 3 cohorts, which compares favorably with results from other PBI trials. No dose cohort had a statistically significant cosmetic detriment from baseline to 12 months or 24 months follow-up by patient- or physician-reported global cosmetic scores. There were no reports of disease recurrence. CONCLUSIONS This phase 1 trial demonstrates that S-PBI can be used to safely escalate dose to 30 Gy in a single fraction with low toxicity and without detriment in cosmesis relative to baseline.
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Affiliation(s)
- Asal Rahimi
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas.
| | - Ambrosia Simmons
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | - D Nathan Kim
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | - Marilyn Leitch
- Departments of Radiation Surgery, University Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Haas
- Perlmutter Cancer Center at NYU Langone Hospital, Long Island, New York
| | - Xuejun Gu
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | - Chul Ahn
- Departments of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ang Gao
- Departments of Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ann Spangler
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | - Howard E Morgan
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | - Sally Goudreau
- Departments of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen Seiler
- Departments of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Deborah Farr
- Departments of Radiation Surgery, University Texas Southwestern Medical Center, Dallas, Texas
| | - Rachel Wooldridge
- Departments of Radiation Surgery, University Texas Southwestern Medical Center, Dallas, Texas
| | - Barbara Haley
- Departments of Medical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shohreh Bahrami
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah Neufeld
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | | | - Prasanna Alluri
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
| | - Roshni Rao
- Columbia University Medical Center, Breast Surgery, New York City, New York
| | - Robert D Timmerman
- Departments of Radiation Oncology, University Texas Southwestern Medical Center, Dallas, Texas
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