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Pérez-Echagüen S, Sanz-Freire CJ, Guinot-Rodríguez JL, Gutiérrez-Miguélez C, Samper-Ots P, González-Pérez V, Villafranca-Iturre E, Modolell I, Pellejero-Pellejero S, Cambeiro-Vázquez M, Ossola-Lentati G. Consensus statement from the Spanish Brachytherapy Group (GEB) on accelerated partial breast irradiation using multicatheter interstitial brachytherapy. Rep Pract Oncol Radiother 2020; 25:832-839. [DOI: 10.1016/j.rpor.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
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Forster T, Köhler CVK, Debus J, Hörner-Rieber J. Accelerated Partial Breast Irradiation: A New Standard of Care? Breast Care (Basel) 2020; 15:136-147. [PMID: 32398982 DOI: 10.1159/000506254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/29/2020] [Indexed: 01/19/2023] Open
Abstract
Background Breast-conserving therapy including lumpectomy and adjuvant whole breast irradiation (WBI) has become the standard therapy for early-stage breast cancer (EBC). Without WBI, the recurrence rate is significantly increased. However, when selecting patients at a low a priori risk of local recurrence only a small breast-cancer-specific mortality benefit, but no overall survival improvement, was detected for WBI. As most recurrences occur close to the lumpectomy cavity, accelerated partial breast irradiation (APBI) delivered exclusively to a limited volume of tissue around the initial lumpectomy site, has gained increased attention and is now discussed as an alternative to WBI for selected EBC patients. Summary Numerous techniques for APBI (interstitial brachytherapy, external beam-based APBI, intraoperative radiotherapy, MR-guided radiotherapy) allow treatment delivery in a shorter period of time, and radiation oncologists expect to further reduce side effects by using these new techniques, with improvements in cosmetics and quality of life. In this review, we aim to describe the existing evidence for the feasibility and effectiveness of different APBI techniques used in modern radiotherapy. Key Messages APBI has provided outcomes similar to WBI combined with potentially reduced toxicity. While appropriate patient selection persists to be crucial for acceptable recurrence rates, the precise definition of patients suitable for APBI remains a matter of discussion. As long-term data are often still lacking, special attention should be paid to late side effects and long-term outcomes. Decision-making on appropriate treatment techniques should take into account not only local control rates, but also the impact on the patient's quality of life.
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Affiliation(s)
- Tobias Forster
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | | | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), partner site Heidelberg, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Iijima K, Okamoto H, Takahashi K, Aikawa A, Wakita A, Nakamura S, Nishioka S, Harada K, Notake R, Sugawara A, Yoshimura R, Kunieda E, Itami J. Inter-fractional variations in the dosimetric parameters of accelerated partial breast irradiation using a strut-adjusted volume implant. JOURNAL OF RADIATION RESEARCH 2020; 61:123-133. [PMID: 31665490 PMCID: PMC7022137 DOI: 10.1093/jrr/rrz061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/23/2019] [Accepted: 04/29/2019] [Indexed: 06/10/2023]
Abstract
The aim of the study was to evaluate inter-fractional dosimetric variations for high-dose rate breast brachytherapy using a strut-adjusted volume implant (SAVI). For the nine patients included, dosimetric constraints for treatment were as follows: for the planning target volume for evaluation (PTV_Eval), the volume receiving 90, 150 and 200% of the prescribed dose (V90%,150%,200%) should be >90%, ≤50 cm3 and ≤20 cm3, respectively; the dose covering 1 cm3 (D1cc) of the organs at risk should be ≤110% of the prescribed dose; and the air volume should be ≤10% of PTV_Eval. Differences in V90%,150%,200%, D1cc and air volume ($\Delta V$ and $\Delta D$) as inter-fractional dosimetric variations and SAVI displacements were measured with pretreatment and planning computed tomography (CT) images. Inter-fractional dosimetric variations were analyzed for correlations with the SAVI displacements. The patients were divided into two groups based on the distance of the SAVI from the surface skin to assess the relationship between the insertion position of the SAVI and dosimetric parameters. The median ΔV90%,150%,200% for the PTV_Eval in all patients was -0.3%, 0.2 cm3 and 0.2 cm3, respectively. The median (range) ΔD1cc for the chest wall and surface skin was -0.8% (-18.9 to 9.4%) and 0.3% (-7.6 to 5.3%), respectively. SAVI displacement did not correlate with inter-fractional dosimetric variations. In conclusion, the dose constraints were satisfied in most cases. However, there were inter-fractional dosimetric changes due to SAVI displacement.
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Affiliation(s)
- Kotaro Iijima
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Ako Aikawa
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Akihisa Wakita
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Satoshi Nakamura
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Shie Nishioka
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
| | - Ken Harada
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Ryoichi Notake
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Bunkyo-ku, Ushima 1-5-45, Tokyo, 113-8510, Japan
| | - Akimoto Sugawara
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, Bunkyo-ku, Ushima 1-5-45, Tokyo, 113-8510, Japan
| | - Etsuo Kunieda
- Department of Radiation Oncology, Tokai University, School of Medicine, Isehara Shimokasuya 143, Kanagawa, 259-1193, Japan
| | - Jun Itami
- Department of Medical Physics, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tsukiji 5-1-1, Tokyo, 104-0045, Japan
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Franco P, Iorio GC, Bartoncini S, Airoldi M, De Sanctis C, Castellano I, Ricardi U. De-escalation of breast radiotherapy after conserving surgery in low-risk early breast cancer patients. Med Oncol 2018; 35:62. [PMID: 29616366 DOI: 10.1007/s12032-018-1121-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/30/2018] [Indexed: 12/12/2022]
Abstract
The reduction in the burden related to treatment is becoming more and more important in modern oncology. Radiation therapy is a mainstay option in the postoperative setting for early breast cancer patients after breast-conserving surgery. Nowadays, different options are available to de-escalate radiotherapy in this scenario such as the use of hypofractionated whole-breast radiation, the selective delivery of the boost dose to the lumpectomy cavity, the introduction of accelerated partial breast irradiation and the omission of treatment in appropriately selected patients with low-risk features. We herein provide a review article on this topic.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Giuseppe Carlo Iorio
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
| | - Sara Bartoncini
- Department of Oncology, Radiation Oncology, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Mario Airoldi
- Department of Medical Sciences, Pathology Unit, University of Turin, Turin, Italy
| | - Corrado De Sanctis
- Department of Gynecology and Obstetrics, Breast Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Isabella Castellano
- Department of Oncology, Medical Oncology 2, AOU Città della Salute e della Scienza, Turin, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Via Genova 3, 10126, Turin, Italy
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Zhen X, Zhao B, Wang Z, Timmerman R, Spangler A, Kim N, Rahimi A, Gu X. Comprehensive target geometric errors and margin assessment in stereotactic partial breast irradiation. Radiat Oncol 2017; 12:151. [PMID: 28893302 PMCID: PMC5594509 DOI: 10.1186/s13014-017-0889-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/06/2017] [Indexed: 11/09/2022] Open
Abstract
Background Recently developed stereotactic partial breast irradiation (S-PBI) allows delivery of a high biologically potent dose to the target while sparing adjacent critical organs and normal tissue. With S-PBI tumoricidal doses, accurate and precise dose delivery is critical to achieve high treatment quality. This study is to investigate both rigid and non-rigid components of target geometric error and their corresponding margins in S-PBI and identify correlated clinical factors. Methods Forty-three early-stage breast cancer patients with implanted gold fiducial markers were enrolled in the study. Fiducial positions recorded on the orthogonal kV images on a Cyberknife system during treatment were used to estimate intra-fraction errors and composite errors (including intra-fraction errors and residual errors after patient setup). Both rigid and non-rigid components of intra-fraction and composite errors were analyzed and used to estimate rigid and non-rigid margins, respectively. Univariate and multivariate linear regressions were conducted to evaluate correlations between clinical factors and errors. Results For the study group, the intra-fraction rigid and non-rigid errors are 2.0 ± 0.6 mm and 0.3 ± 0.2 mm, respectively. The composite rigid and non-rigid errors are 2.3 ± 0.5 mm and 1.3 ± 0.8 mm, respectively. The rigid margins in the left-right, anterior-posterior, and superior-inferior directions are estimated as 2.1, 2.4, and 2.3 mm, respectively. The estimated non-rigid margin, assumed to be isotropic, is 1.7 mm. The outer breast quadrants are more susceptible to composite errors occurrence than the inner breast quadrants. The target to chest wall distance is the clinical factor correlated with target geometric errors. Conclusions This is the first comprehensive analysis of breast target geometric rigid and non-rigid errors in S-PBI. Upon the estimation, the non-rigid margin is comparable to rigid margin, and therefore should be included in planning target volume as it cannot be accounted for by the Cyberknife system. Treatment margins selection also need to consider the impact of relevant clinical factor. Electronic supplementary material The online version of this article (10.1186/s13014-017-0889-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xin Zhen
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.,Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Bo Zhao
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Zhuoyu Wang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 805 Sherbrooke Street West, Montreal, Quebec, H3A 0G4, Canada
| | - Robert Timmerman
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Ann Spangler
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nathan Kim
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Asal Rahimi
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Xuejun Gu
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
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Meattini I, Saieva C, Miccinesi G, Desideri I, Francolini G, Scotti V, Marrazzo L, Pallotta S, Meacci F, Muntoni C, Bendinelli B, Sanchez LJ, Bernini M, Orzalesi L, Nori J, Bianchi S, Livi L. Accelerated partial breast irradiation using intensity modulated radiotherapy versus whole breast irradiation: Health-related quality of life final analysis from the Florence phase 3 trial. Eur J Cancer 2017; 76:17-26. [DOI: 10.1016/j.ejca.2017.01.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/07/2016] [Accepted: 01/24/2017] [Indexed: 11/24/2022]
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Strut-based accelerated partial breast irradiation: Report of treatment results for 250 consecutive patients at 5 years from a multicenter retrospective study. Brachytherapy 2016; 15:780-787. [DOI: 10.1016/j.brachy.2016.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 12/13/2022]
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Comparative dosimetric findings using accelerated partial breast irradiation across five catheter subtypes. Radiat Oncol 2015; 10:160. [PMID: 26227388 PMCID: PMC4521502 DOI: 10.1186/s13014-015-0468-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/17/2015] [Indexed: 11/16/2022] Open
Abstract
Purpose Accelerated partial breast irradiation (APBI) with balloon and strut adjusted volume implants (SAVI) show promising results with excellent tumor control and minimal toxicity. Knowing the factors that contribute to a high skin dose, rib dose, and D95 coverage may reduce toxicity, improve tumor control, and help properly predict patient outcomes following APBI. Methods and materials A retrospective analysis of 594 patients treated with brachytherapy based APBI at a single institution from May 2008 to September 2014 was grouped by applicator subtype. Patients were treated to a total of 34 Gy (3.4 Gy x 10 fractions over 5 days delivered BID) targeting a planning target volume (PTV) 1.0 cm beyond the lumpectomy cavity using a high dose rate source. Results SAVI devices had the lowest statistically significant values of DmaxSkin (81.00 ± 29.83), highest values of D90 (101.50 ± 3.66), and D95 (96.09 ± 4.55). SAVI-mini devices had the lowest statistically significant values of DmaxRib (77.66 ± 32.92) and smallest V150 (18.01 ± 3.39). Multi-lumen balloons were able to obtain the smallest V200 (5.89 ± 2.21). Strut-based applicators were more likely to achieve a DmaxSkin and a DmaxRib less than or equal to 100 %. The effect of PTV on V150 showed a strong positive relationship (p < .001). PTV and DmaxSkin showed a weak negative relationship in multi-lumen applicators (p = .016) and SAVI-mini devices (p < .001). PTV and DmaxRib showed a weak negative relationship in multi-lumen applicators (p = .009), SAVI devices (p < .001), and SAVI-mini devices (p < .001). Conclusion PTV volume is strongly correlated with V150 in all devices and V200 in strut based devices. Larger PTV volumes result in greater V150 and V200, which could help predict potential risks for hotspots and resulting toxicities in these devices. PTV volume is also weakly negatively correlated with max skin dose and max rib dose, meaning that as the PTV volumes increase one can expect slightly smaller max skin and rib doses. Strut based applicators are significantly more effective in keeping skin and rib dose constraints under 125 and 100 % when compared to any balloon based applicator.
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Proton partial breast irradiation in the supine position: Treatment description and reproducibility of a multibeam technique. Pract Radiat Oncol 2015; 5:e283-90. [DOI: 10.1016/j.prro.2015.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 12/02/2014] [Accepted: 01/29/2015] [Indexed: 11/22/2022]
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Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer 2015; 51:451-463. [PMID: 25605582 DOI: 10.1016/j.ejca.2014.12.013] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/13/2014] [Accepted: 12/22/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) has been introduced as an alternative treatment method for selected patients with early stage breast cancer (BC). Intensity-modulated radiotherapy (IMRT) has the theoretical advantage of a further increase in dose conformity compared with three-dimensional techniques, with more normal tissue sparing. The aim of this randomised trial is to compare the local recurrence and survival of APBI using the IMRT technique after breast-conserving surgery to conventional whole-breast irradiation (WBI) in early stage BC. METHODS This study was performed at the University of Florence (Florence, Italy). Women aged more than 40years affected by early BC, with a maximum pathological tumour size of 25mm, were randomly assigned in a 1:1 ratio to receive either WBI or APBI using IMRT. Patients in the APBI arm received a total dose of 30 Gy to the tumour bed in five daily fractions. The WBI arm received 50Gy in 25 fractions, followed by a boost on the tumour bed of 10Gy in five fractions. The primary end-point was occurrence of ipsilateral breast tumour recurrences (IBTRs); the main analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT02104895. FINDINGS A total of 520 patients were randomised (260 to external WBI and 260 to APBI with IMRT) between March 2005 and June 2013. At a median follow-up of 5.0 years (Interquartile Range (IQR) 3.4-7.0), the IBTR rate was 1.5% (three cases) in the APBI group (95% confidence interval (CI) 0.1-3.0) and in the WBI group (three cases; 95% CI 0.0-2.8). No significant difference emerged between the two groups (log rank test p=0.86). We identified seven deaths in the WBI group and only one in the APBI group (p=0.057). The 5-year overall survival was 96.6% for the WBI group and 99.4% for the APBI group. The APBI group presented significantly better results considering acute (p=0.0001), late (p=0.004), and cosmetic outcome (p=0.045). INTERPRETATION To our knowledge, this is the first randomised study using the IMRT technique for APBI delivery. No significant difference in terms of IBTR and overall survival was observed between the two arms. APBI displayed a significantly better toxicity profile.
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11
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Comparison of radiation dose to the left anterior descending artery by whole and partial breast irradiation in breast cancer patients. J Contemp Brachytherapy 2015; 7:23-8. [PMID: 25829933 PMCID: PMC4371057 DOI: 10.5114/jcb.2014.47891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 10/05/2014] [Accepted: 12/08/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose Breast conserving surgery (BCS) followed by whole breast irradiation (WBI) is the standard of care for breast cancer patients. However, there is a risk of coronary events with WBI therapy. In this study, we compared the radiation dose in the left anterior descending artery (LAD) in patients receiving partial breast irradiation (PBI) with WBI. Material and methods We evaluated consecutive patients who underwent adjuvant radiotherapy after BCS between October 2008 and July 2014. Whole breast irradiation patients received 50 Gy in fractions of 2 Gy to the entire breast. Partial breast irradiation was performed using multicatheter brachytherapy at a dose of 32 Gy in eight fractions. The mean and maximal cumulative doses to LAD were calculated. The radiotherapeutic biologically effective dose of PBI was adjusted to WBI, and radiation techniques were compared. Results Of 379 consecutive patients with 383 lesions receiving radiotherapy (151 WBI and 232 PBI lesions), 82 WBI and 100 PBI patients were analyzed. In WBI patients, the mean and maximal cumulative doses for left-sided breast cancer (2.13 ± 0.11 and 8.19 ± 1.21 Gy, respectively) were significantly higher than those for right-sided (0.37 ± 0.02 and 0.56 ± 0.03 Gy, respectively; p < 0.0001). In PBI patients with left-sided breast cancer, the doses for tumors in inner quadrants or central location (2.54 ± 0.21 and 4.43 ± 0.38 Gy, respectively) were significantly elevated compared to outer quadrants (1.02 ± 0.17 and 2.10 ± 0.29 Gy, respectively; p < 0.0001). After the adjustment, the doses in PBI patients were significantly reduced in patients with tumors only in outer quadrants (1.12 ± 0.20 and 2.43 ± 0.37 Gy, respectively; p = 0.0001). Conclusions Tumor control and dose to LAD should be considered during treatment since PBI may reduce the risk of coronary artery disease especially in patients with lateral tumors in the left breast.
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Mellon EA, Sreeraman R, Gebhardt BJ, Mierzejewski A, Correa CR. Impact of radiation treatment parameters and adjuvant systemic therapy on cosmetic outcomes after accelerated partial breast irradiation using 3-dimensional conformal radiation therapy technique. Pract Radiat Oncol 2014; 4:e159-e166. [DOI: 10.1016/j.prro.2013.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 08/02/2013] [Accepted: 08/05/2013] [Indexed: 01/23/2023]
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Russo AL, Taghian AG. Fat necrosis of the breast in the accelerated partial breast irradiation era: the need for a universal grading system. Breast Cancer Res Treat 2014; 140:1-11. [PMID: 23797180 DOI: 10.1007/s10549-013-2611-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/11/2013] [Indexed: 12/01/2022]
Abstract
Fat necrosis of the breast is increasingly reported and used as a trial endpoint in the treatment of breast cancer with accelerated partial breast irradiation (APBI). Yet, there is no universal toxicity scoring system within the latest version of the Common Terminology Criteria for Adverse Events (CTCAE v4.0). This requires investigators to adopt their own scoring system or improperly use those that exist, and limits accurate reporting of this entity. Fat necrosis of the breast also creates diagnostic uncertainty among clinicians and concern of recurrence among patients. In this review, we address the question of increasing incidence of fat necrosis through the comparison of recent APBI trials and literature. The pathogenesis, symptoms, clinical and radiologic diagnosis, clinical predictors of developing fat necrosis, management and follow-up are also discussed.Lastly, we propose a simplified and universal scoring system for the reporting of fat necrosis.
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Qiu JJ, Chang Z, Horton JK, Wu QRJ, Yoo S, Yin FF. Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI). Med Dosim 2014; 39:152-8. [PMID: 24480375 DOI: 10.1016/j.meddos.2013.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 11/18/2022]
Abstract
The purpose is to dosimetrically compare the following 3 delivery techniques: 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated arc therapy (IMRT), and volumetric-modulated arc therapy (V-MAT) in the treatment of accelerated partial-breast irradiation (APBI). Overall, 16 patients with T1/2N0 breast cancer were treated with 3D-CRT (multiple, noncoplanar photon fields) on the RTOG 0413 partial-breast trial. These cases were subsequently replanned using static gantry IMRT and V-MAT technology to understand dosimetric differences among these 3 techniques. Several dosimetric parameters were used in plan quality evaluation, including dose conformity index (CI) and dose-volume histogram analysis of normal tissue coverage. Quality assurance studies including gamma analysis were performed to compare the measured and calculated dose distributions. The IMRT and V-MAT plans gave more conformal target dose distributions than the 3D-CRT plans (p < 0.05 in CI). The volume of ipsilateral breast receiving 5 and 10Gy was significantly less using the V-MAT technique than with either 3D-CRT or IMRT (p < 0.05). The maximum lung dose and the ipsilateral lung volume receiving 10 (V10) or 20Gy (V20) were significantly less with both V-MAT and IMRT (p < 0.05). The IMRT technique was superior to 3D-CRT and V-MAT of low dose distributions in ipsilateral lung (p < 0.05 in V5 and D5). The total mean monitor units (MUs) for V-MAT (621.0 ± 111.9) were 12.2% less than those for 3D-CRT (707.3 ± 130.9) and 46.5% less than those for IMRT (1161.4 ± 315.6) (p < 0.05). The average machine delivery time was 1.5 ± 0.2 minutes for the V-MAT plans, 7.0 ± 1.6 minutes for the 3D-CRT plans, and 11.5 ± 1.9 minutes for the IMRT plans, demonstrating much less delivery time for V-MAT. Based on this preliminary study, V-MAT and IMRT techniques offer improved dose conformity as compared with 3D-CRT techniques without increasing dose to the ipsilateral lung. In terms of MU and delivery time, V-MAT is significantly more efficient for APBI than for conventional 3D-CRT and static-beam IMRT.
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Affiliation(s)
- Jian-Jian Qiu
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zheng Chang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Janet K Horton
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Qing-Rong Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Sua Yoo
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC.
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Macdonald SM, Taghian AG. Partial–breast irradiation: towards a replacement for whole–breast irradiation? Expert Rev Anticancer Ther 2014; 7:123-34. [PMID: 17288524 DOI: 10.1586/14737140.7.2.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Largely thanks to all of the investigators and patients who have participated in randomized breast-conservation trials, many women facing a diagnosis of breast cancer today can conserve their breast with the help of adjuvant radiation therapy. A standard course of radiation consists of 5-7 weeks of daily radiation treatments delivered to the whole breast. The success of this treatment has led investigators to attempt to determine whether the same control can be achieved while decreasing the volume of breast tissue irradiated, thus allowing treatment to be delivered in a shorter period of time. This approach could alleviate time and logistical problems faced by patients during their course of treatment as well as improving overall cost-effectiveness. It can also allow complete avoidance of the adjacent heart and lung tissue in the radiation treatment portal. Partial-breast irradiation (the delivery of radiation to the resection cavity, plus a safety margin) delivered in just hours or days, is currently under investigation. Although relatively new, its use is growing rapidly and many institutional and cooperative group trials are quickly enlisting patients, while physicians are gaining experience in a variety of partial-breast irradiation techniques.
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Affiliation(s)
- Shannon M Macdonald
- Harvard Medical School, Massachusetts General Hospital, Department of Radiation Oncology, Boston, MA 02114, USA.
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16
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Abstract
MammoSite is a novel brachytherapy applicator for breast irradiation as a component of breast conservation therapy in the management of early stage breast carcinoma. Early stage breast cancer accounts for over two-thirds of newly diagnosed cases. Breast conservation therapy is an option for most women for local therapy. The standard treatment of partial mastectomy and whole-breast irradiation is being challenged. Physicians and patients are searching for alternatives to a 6- to 7-week course of external beam radiation therapy. The direct application of radioactive materials (brachytherapy) in this setting has been employed for over 10 years. MammoSite has been developed as an easier, more quality assured applicator to allow broader acceptance and wider availability of partial breast irradiation techniques. The background leading to the device will be examined, current clinical results will be reviewed and alternative technologies will be discussed.
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Affiliation(s)
- Martin Keisch
- Mount Sinai Medical Center, Department of Radiation Oncology, Miami Beach, FL 33140, USA.
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Wong S, Chor H, Moorthy S, Ong C, Phan T, Lu J. Human epidermal keratinocytes death and expression of protein markers of apoptosis after ionizing radiation exposure. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2013. [DOI: 10.14319/ijcto.0102.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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18
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Fentiman I. Getting the right balance in treatment of ductal carcinoma in situ (DCIS). INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2013. [DOI: 10.14319/ijcto.0102.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Accelerated partial breast irradiation for breast cancer: a meta-analysis. Transl Oncol 2013; 6:619-27. [PMID: 24466364 DOI: 10.1593/tlo.13580] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/26/2013] [Accepted: 11/05/2013] [Indexed: 12/31/2022] Open
Abstract
To evaluate the long-term effect of breast conservation with accelerated partial breast irradiation (APBI) for early-stage breast cancer, PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, and China Journal Full-text Database were searched to identify relevant original published trials. Randomized controlled trials in any language comparing APBI with whole-breast radiotherapy in patients with early-stage breast cancer were included. RevMan 5 software was used for statistical analysis. Four trials involving 919 patients were included. The rate of 5- and 7-year excellent/good cosmetic results was significant {odds ratio (OR) = 2.09 [95% confidence interval (CI) = 1.21-3.62]} between two groups. The 5- and 8-year overall survival had no significant difference [OR = 1.76 (95% CI = 0.67-4.62) and OR = 0.86 (95% CI = 0.44-1.66)]. The 10-year overall survival had significant differences [OR = 0.56 (95% CI = 0.35-0.91)]. There were no differences in the 5-year local recurrence (LR)-free survival [OR = 0.65 (95% CI = 0.18-2.34)], cancer-specific survival [OR = 1.67 (95% CI = 0.39-7.12)], disease-free survival [OR = 0.84 (95% CI = 0.38-1.84)], LR [OR = 1.36 (95% CI = 0.46-3.99)], the rate of contralateral breast cancer [OR = 2.82 (95% CI = 0.73-10.89)], and distant metastasis [OR = 0.71 (95% CI = 0.22-2.31)]. APBI significantly improved the rate of excellent/good cosmetic results anywhere in the breast, shortened the treatment time, alleviated the pain, and improved the quality of life. Future large-scale, high-quality, and double-blind trials are needed.
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Impact of interfraction seroma collection on breast brachytherapy dosimetry - a mathematical model. J Contemp Brachytherapy 2013; 4:101-5. [PMID: 23349651 PMCID: PMC3552631 DOI: 10.5114/jcb.2012.29366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/04/2012] [Accepted: 05/03/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose Balloon brachytherapy is a widely accepted modality for delivery of accelerated partial breast irradiation (APBI). Our hypothesis was that inter-fraction seroma collection around the balloon surface would have an adverse effect on dosimetry of the target. Material and methods This is a dosimetric re-planning study using two volumetric models (30 cc and 45 cc) in a Contura® multi-lumen balloon (MLB) catheter. In a previously treated patient, two customized baseline plans were generated using multiple channels of the Contura® catheter prescribed to the Planning Target Volume Evaluation (PTV_Eval). Symmetric expansions of 1.0 mm (0-9 mm) increments around the balloon surface were performed to simulate a “Virtual Seroma” (VS) accumulation for both balloon volumes and plans were obtained for each expansion using Eclipse Brachyvision™. An analysis of these plans was then performed to evaluate the effect of seroma accumulation on dosimetric parameters of V100 and V90. Results 20 plans were generated and analyzed (10 plans for each balloon volume), representing VS of 6.0-66.0 cc. There was a commensurate decrease in the dose delivered to the PTV_Eval V100 and V90 (as defined by the original treatment plan) with increasing VS accumulation leading to a sub-optimal coverage of the PTV_Eval. For 30 cc MLB catheter, V100 decreased by 1.4% and V90 decreased by 0.9% for every 1 cc of VS. For 45cc MLB catheter, V100 decreased by 1.3% and V90 decreased by 1.15% for every 1.0 cc accumulation of VS. Conclusions Balloon catheter-tissue adherence ensures daily dose delivery to the planned PTV_Eval. Accumulation of seroma, hematoma or air between HDR fractions can significantly impact PTV_Eval dosimetry. Vacuum-port aspiration prior to delivery of each fraction, if available, should be considered to minimize the risk of geographic under dosing.
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Moghaddasi L, Bezak E, Marcu LG. Current challenges in clinical target volume definition: tumour margins and microscopic extensions. Acta Oncol 2012; 51:984-95. [PMID: 22998477 DOI: 10.3109/0284186x.2012.720381] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Determination of optimal clinical target volume (CTV) margins around gross tumour volume (GTV) for modern radiotherapy techniques, requiring more precise target definitions, is controversial and complex. Tumour localisation has been greatly improved using molecular imaging integrated with conventional imaging techniques. However, the exact incidence and extent of microscopic disease, to be encompassed by CTV, cannot be visualised by any techniques developed to date and remain uncertain. As a result, the CTV is generally determined by clinicians based on their experience and patients' histopathological data. In this article we review histopathological studies addressing the extent of subclinical disease and its possible correlation with tumour characteristics in various tumour sites. The data have been tabulated to facilitate a comparison between proposed margins by different investigations and with current margins generally accepted for each tumour site. It is concluded that there is a need for further studies to reach a consensus on the optimal CTV pertaining to each tumour site.
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Affiliation(s)
- Leyla Moghaddasi
- Department of Medical Physics, Royal Adelaide Hospital, South Australia, Australia.
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22
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Valente SA, Levine GM, Guerra LE, Silverstein MJ. Breast cancer recurrence after inadvertent malpositioning of a partial breast radiation catheter. Breast J 2012; 18:591-5. [PMID: 23009321 DOI: 10.1111/tbj.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Accelerated partial breast irradiation (APBI) is an alternative to receiving whole breast radiation in carefully selected patients. Because breast cancer local recurrence rates are low and follow-up has been short-term, the exact cause of recurrences after APBI has been difficult to evaluate. We report the first case of documented radiation balloon catheter malpositioning that resulted in local recurrence. Patients undergo CT imaging of the breast after radiation balloon catheter placement for radiotherapy treatment planning, which evaluates adequate conformance of the balloon to the surrounding breast parenchyma and confirms a >7 mm distance between the balloon surface and the skin surface. Although true local recurrences are rare in appropriately selected partial breast irradiation candidates, inadvertent malpositioning of the radiation treatment catheter can increase the risk. This case is presented to illustrate the importance of comparing CT radiation planning images, with treatment catheter in place, to the original diagnostic breast imaging studies to confirm proper catheter positioning (in addition to measuring balloon to skin distance and conformance) prior to initiating radiotherapy.
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Affiliation(s)
- Stephanie A Valente
- University of Southern California, Keck School of Medicine, Division of Breast and Soft Tissue Surgery, Los Angeles, CA 90033, USA.
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Feasibility of intraoperative radiation therapy for early breast cancer in Japan: a single-center pilot study and literature review. Breast Cancer 2012; 21:415-22. [DOI: 10.1007/s12282-012-0412-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
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Mukesh M, Harris E, Jena R, Evans P, Coles C. Relationship between irradiated breast volume and late normal tissue complications: a systematic review. Radiother Oncol 2012; 104:1-10. [PMID: 22682540 DOI: 10.1016/j.radonc.2012.04.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/29/2012] [Accepted: 04/30/2012] [Indexed: 12/25/2022]
Abstract
The concept of radiation dose-volume effect has been exploited in breast cancer as boost treatment for high risk patients and more recently in trials of Partial Breast Irradiation for low risk patients. However, there appears to be paucity of published data on the dose-volume effect of irradiation on breast tissue including the recently published report on Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC). This systematic review looks at the current literature for relationship between irradiated breast volume and normal tissue complications and introduces the concept of dose modulation.
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Affiliation(s)
- Mukesh Mukesh
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
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25
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Albuquerque K, Tell D, Lobo P, Millbrandt L, Mathews HL, Janusek LW. Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer. BMC Cancer 2012; 12:251. [PMID: 22708709 PMCID: PMC3542587 DOI: 10.1186/1471-2407-12-251] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 05/29/2012] [Indexed: 12/02/2022] Open
Abstract
Introduction This pilot study used a prospective longitudinal design to compare the effect of adjuvant whole breast radiation therapy (WBRT) versus partial breast radiation therapy (PBRT) on fatigue, perceived stress, quality of life and natural killer cell activity (NKCA) in women receiving radiation after breast cancer surgery. Methods Women (N = 30) with early-stage breast cancer received either PBRT, Mammosite brachytherapy at dose of 34 Gy 10 fractions/5 days, (N = 15) or WBRT, 3-D conformal techniques at dose of 50 Gy +10 Gy Boost/30 fractions, (N = 15). Treatment was determined by the attending oncologist after discussion with the patient and the choice was based on tumor stage and clinical need. Women were assessed prior to initiation of radiation therapy and twice after completion of radiation therapy. At each assessment, blood was obtained for determination of NKCA and the following instruments were administered: Perceived Stress Scale (PSS), Functional Assessment of Cancer Therapy-Fatigue (FACT-F), and Functional Assessment of Cancer Therapy-General (FACT-G). Hierarchical linear modeling (HLM) was used to evaluate group differences in initial outcomes and change in outcomes over time. Results Fatigue (FACT-F) levels, which were similar prior to radiation therapy, demonstrated a significant difference in trajectory. Women who received PBRT reported progressively lower fatigue; conversely fatigue worsened over time for women who received WBRT. No difference in perceived stress was observed between women who received PBRT or WBRT. Both groups of women reported similar levels of quality of life (FACT-G) prior to initiation of radiation therapy. However, HLM analysis revealed significant group differences in the trajectory of quality of life, such that women receiving PBRT exhibited a linear increase in quality of life over time after completion of radiation therapy; whereas women receiving WBRT showed a decreasing trajectory. NKCA was also similar between therapy groups but additional post hoc analysis revealed that better quality of life significantly predicted higher NKCA regardless of therapy. Conclusions Compared to WBRT, PBRT results in more rapid recovery from cancer-related fatigue with improved restoration of quality of life after radiation therapy. Additionally, better quality of life predicts higher NKCA against tumor targets, emphasizing the importance of fostering quality of life for women undergoing adjuvant radiation therapy.
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Affiliation(s)
- Kevin Albuquerque
- Department of Radiation Oncology, Loyola University Health System, Maywood, IL, USA.
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Budrukkar A, Jagtap V, Kembhavi S, Munshi A, Jalali R, Seth T, Parmar V, Raj Upreti R, Badwe R, Sarin R. Fat necrosis in women with early-stage breast cancer treated with accelerated partial breast irradiation (APBI) using interstitial brachytherapy. Radiother Oncol 2012; 103:161-5. [DOI: 10.1016/j.radonc.2011.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 11/22/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Ferraro DJ, Garsa AA, DeWees TA, Margenthaler JA, Naughton M, Aft R, Gillanders WE, Eberlein T, Matesa MA, Zoberi I. Comparison of accelerated partial breast irradiation via multicatheter interstitial brachytherapy versus whole breast radiation. Radiat Oncol 2012; 7:53. [PMID: 22458887 PMCID: PMC3359280 DOI: 10.1186/1748-717x-7-53] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 03/29/2012] [Indexed: 11/10/2022] Open
Abstract
Background Brachytherapy as adjuvant treatment for early-stage breast cancer has become widely available and offers patients an expedited treatment schedule. Given this, many women are electing to undergo brachytherapy in lieu of standard fractionation radiotherapy. We compare outcomes between patients treated with accelerated partial breast irradiation (APBI) via multicatheter interstitial brachytherapy versus patients who were also eligible for and offered APBI but who chose whole breast radiation (WBI). Methods Patients treated from December 2002 through May 2007 were reviewed. Selection criteria included patients with pTis-T2N0 disease, ≤ 3 cm unifocal tumors, and negative margins who underwent breast conservation surgery. Local control (LC), cause-specific (CSS) and overall survival (OS) were analyzed. Results 202 patients were identified in the APBI cohort and 94 patients in the WBI cohort. Median follow-up for both groups exceeded 60 months. LC was 97.0% for the APBI cohort and 96.2% for the WBI cohort at 5 years (ns). Classification by 2010 ASTRO APBI consensus statement categories did not predict worse outcomes. Conclusion APBI via multicatheter interstitial brachytherapy provides similar local failure rates compared to WBI at 5 years for properly selected patients. Excellent results were seen despite the high fraction of younger patients (< 60 years old) and patients with DCIS.
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Affiliation(s)
- Daniel J Ferraro
- Department of Radiation Oncology and Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO 63110, USA
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Kumar R, Sharma SC, Kapoor R, Singh R, Bhardawaj A. Dosimetric evaluation of 3Dconformal acceleratedpartial-breast irradiation vs. whole-breast irradiation: A comparative study. Int J Appl Basic Med Res 2012; 2:52-7. [PMID: 23776810 PMCID: PMC3657992 DOI: 10.4103/2229-516x.96810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Conventional early breast cancer treatment consists of lumpectomy followed by whole-breast irradiation (WBI) therapy. Accelerated partial-breast irradiation (APBI) is also an approach to post-lumpectomy radiation for early breast cancer. Aim: The purpose of this study is to compare two different external-beam APBI techniques using three-dimensional (3D) conformal radiation therapy (3DCRT), with conventional whole-breast irradiation based on the radiation conformity index, dose homogeneity index, and dose to organs at risk. Materials and Methods: WBI treatment plans were compared with two different 3DCRT APBI plans for each of 15 patients (8 with right sided lesions, 7 with left sided lesions). The first APBI plan (APBI 1) used two small coplanar fields conformed to the planning target volume (PTV) using multileaf collimators (MLCs) and wedges, while the other APBI plan (APBI 2) used three non-coplanar fields conformed to the PTV using MLCs and wedges. Results: Both the APBI techniques improved the conformity index significantly over whole-breast tangents while maintaining dose homogeneity and not causing significant increase in dose to organs at risk. Conclusion: Both the 3DCRT APBI techniques are technically feasible and dosimetrically appealing,with better target coverage and relative sparing of normal critical organs
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Affiliation(s)
- Ritesh Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
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Vermeulen S, Cotrutz C, Morris A, Meier R, Buchanan C, Dawson P, Porter B. Accelerated Partial Breast Irradiation: Using the CyberKnife as the Radiation Delivery Platform in the Treatment of Early Breast Cancer. Front Oncol 2011; 1:43. [PMID: 22649764 PMCID: PMC3355980 DOI: 10.3389/fonc.2011.00043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 10/24/2011] [Indexed: 12/27/2022] Open
Abstract
We evaluate the CyberKnife (Accuray Incorporated, Sunnyvale, CA, USA) for non-invasive delivery of accelerated partial breast irradiation (APBI) in early breast cancer patients. Between 6/2009 and 5/2011, nine patients were treated with CyberKnife APBI. Normal tissue constraints were imposed as outlined in the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 (NSABP/RTOG) Protocol (Vicini and White, 2007). Patients received a total dose of 30 Gy in five fractions (group 1, n = 2) or 34 Gy in 10 fractions (group 2, n = 7) delivered to the planning treatment volume (PTV) defined as the clinical target volume (CTV) +2 mm. The CTV was defined as either the lumpectomy cavity plus 10 mm (n = 2) or 15 mm (n = 7). The cavity was defined by a T2-weighted non-contrast breast MRI fused to a planning non-contrast thoracic CT. The CyberKnife Synchrony system tracked gold fiducials sutured into the cavity wall during lumpectomy. Treatments started 4-5 weeks after lumpectomy. The mean PTV was 100 cm(3) (range, 92-108 cm(3)) and 105 cm(3) (range, 49-241 cm(3)) and the mean PTV isodose prescription line was 70% for groups 1 and 2, respectively. The mean percent of whole breast reference volume receiving 100 and 50% of the dose (V(100) and V(50)) for group 1 was 11% (range, 8-13%) and 23% (range, 16-30%) and for group 2 was 11% (range, 7-14%) and 26% (range, 21-35.0%), respectively. At a median 7 months follow-up (range, 4-26 months), no acute toxicities were seen. Acute cosmetic outcomes were excellent or good in all patients; for those patients with more than 12 months follow-up the late cosmesis outcomes were excellent or good. In conclusion, the lack of observable acute side effects and current excellent/good cosmetic outcomes is promising. We believe this suggests the CyberKnife is a suitable non-invasive radiation platform for delivering APBI with achievable normal tissue constraints.
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Affiliation(s)
- Sandra Vermeulen
- Swedish Radiosurgery Center, Swedish Medical CenterSeattle, WA, USA
| | - Cristian Cotrutz
- Swedish Radiosurgery Center, Swedish Medical CenterSeattle, WA, USA
| | - Astrid Morris
- Swedish Cancer Center, Swedish Medical CenterSeattle, WA, USA
| | - Robert Meier
- Swedish Radiosurgery Center, Swedish Medical CenterSeattle, WA, USA
| | - Claire Buchanan
- Swedish Cancer Center, Swedish Medical CenterSeattle, WA, USA
| | - Patricia Dawson
- Swedish Cancer Center, Swedish Medical CenterSeattle, WA, USA
| | - Bruce Porter
- Swedish First Hill Diagnostic Imaging Center, Swedish Medical CenterSeattle, WA, USA
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Ravi A, Keller BM, Pignol JP. A comparison of postimplant dosimetry for 103
Pd versus 131
Cs seeds on a retrospective series of PBSI patients. Med Phys 2011; 38:6046-52. [DOI: 10.1118/1.3651633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Phase I/II study of intraoperative radiotherapy for early breast cancer in Japan. Breast Cancer 2011; 19:353-9. [PMID: 21779813 DOI: 10.1007/s12282-011-0294-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 06/27/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Intraoperative radiotherapy (IORT) is under evaluation in breast-conserving surgery. We have begun our study with the first step being a phase I-II study. This study was designed to identify the recommended dose and to test the feasibility of and tolerance to IORT in Japanese patients (UMIN000000918). METHODS A phase I study was designed using a scheme of dose escalation from 19 to 20 to 21 Gy. We designed the phase II study to use the recommended dose. The primary endpoint was early toxicity. Secondary endpoints were efficacy for a long period and late toxicity. Inclusion criteria included the following: (1) T < 2.5 cm, (2) age >50 years, (3) surgical margin >1 cm, (4) intraoperative pathologically free margins, and (5) sentinel node negative. Partial resection was performed with at least a 1 cm margin around the tumor. Radiation was delivered directly to the mammary gland with the use of a Mobetron(®). The toxicity was evaluated with the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. RESULTS Nine patients were enrolled for the phase I study. All patients tolerated and we therefore recommend 21 Gy. The following 23 patients were enrolled in a phase II study and received 21 Gy. After a median follow-up of 26.0 months, their toxicities within 3 months included deep connective tissue fibrosis (G1 23/26, G2 2/26), hematoma (G1 9/26), infection in the musculoskeletal soft tissue (G1 4/26), and soft tissue necrosis (G2 3/26). There have been no local recurrences. CONCLUSIONS The first group of Japanese female patients treated with IORT showed very good tolerability in the phase I/II study.
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Yashar CM, Scanderbeg D, Kuske R, Wallace A, Zannis V, Blair S, Grade E, Swenson VH, Quiet C. Initial Clinical Experience With the Strut-Adjusted Volume Implant (SAVI) Breast Brachytherapy Device for Accelerated Partial-Breast Irradiation (APBI): First 100 Patients With More Than 1 Year of Follow-Up. Int J Radiat Oncol Biol Phys 2011; 80:765-70. [DOI: 10.1016/j.ijrobp.2010.02.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 01/08/2010] [Accepted: 02/20/2010] [Indexed: 10/19/2022]
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Breast Preservation in Patients with Local Recurrence After Breast-Conserving Therapy. CURRENT BREAST CANCER REPORTS 2011. [DOI: 10.1007/s12609-011-0042-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lin R, Tripuraneni P. Radiation therapy in early-stage invasive breast cancer. Indian J Surg Oncol 2011; 2:101-11. [PMID: 22693401 DOI: 10.1007/s13193-011-0048-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 01/06/2010] [Indexed: 10/18/2022] Open
Abstract
The treatment of breast cancer involves a multi-disciplinary approach with radiation therapy playing a key role. Breast-conserving surgery has been an option for women with early-stage breast cancer for over two decades now. Multiple randomized trials now have demonstrated the efficacy of breast-conserving surgery followed by radiation therapy. With the advancements in breast imaging and the successful campaign for early detection of breast cancer, more women today are found to have early-stage small breast cancers. Patient factors (breast size, tumor location, history of prior radiation therapy, preexisting conditions such as collagen vascular disease, age, having prosthetically augmented breasts), pathological factors (margin status, tumor size, presence of extensive intraductal component requiring multiple surgical excisions), as well as patient preference are all taken into consideration prior to surgical management of breast cancer. Whole-breast fractionated radiation therapy between 5 and 7 weeks is considered as the standard of care treatment following breast-conserving surgery. However, new radiation treatment strategies have been developed in recent years to provide alternatives to the conventional 5-7 week whole-breast radiation therapy for some patients. Accelerated partial breast radiation therapy (APBI) was introduced because the frequency of breast recurrences outside of the surgical cavity has been shown to be low. This technique allows treatments to be delivered quicker (usually 1 week, twice daily) to a limited volume. Often times, this treatment involves the use of a brachytherapy applicator to be placed into the surgical cavity following breast-conserving surgery. Accelerated hypofractionated whole-breast irradiation may be another faster way to deliver radiation therapy following breast-conserving surgery. This journal article reviews the role of radiation therapy in women with early-stage breast cancer addressing patient selection in breast-conserving therapy, a review of pertinent trials in breast-conserving therapy, as well as the different treatment techniques available to women following breast-conserving surgery.
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Affiliation(s)
- Ray Lin
- Department of Radiation Oncology, Scripps Clinic and Scripps Green Hospital, La Jolla, CA USA
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Dooley WC, Algan O, Dowlatshahi K, Francescatti D, Tito E, Beatty JD, Lerner AG, Ballard B, Boolbol SK. Surgical perspectives from a prospective, nonrandomized, multicenter study of breast conserving surgery and adjuvant electronic brachytherapy for the treatment of breast cancer. World J Surg Oncol 2011; 9:30. [PMID: 21385371 PMCID: PMC3065420 DOI: 10.1186/1477-7819-9-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 03/07/2011] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Accelerated partial breast irradiation (APBI) may be used to deliver radiation to the tumor bed post-lumpectomy in eligible patients with breast cancer. Patient and tumor characteristics as well as the lumpectomy technique can influence patient eligibility for APBI. This report describes a lumpectomy procedure and examines patient, tumor, and surgical characteristics from a prospective, multicenter study of electronic brachytherapy. METHODS The study enrolled 65 patients of age 45-84 years with ductal carcinoma or ductal carcinoma in situ, and 44 patients, who met the inclusion and exclusion criteria, were treated with APBI using the Axxent® electronic brachytherapy system following lumpectomy. The prescription dose was 34 Gy in 10 fractions over 5 days. RESULTS The lumpectomy technique as described herein varied by site and patient characteristics. The balloon applicator was implanted by the surgeon (91%) or a radiation oncologist (9%) during or up to 61 days post-lumpectomy (mean 22 days). A lateral approach was most commonly used (59%) for insertion of the applicator followed by an incision site approach in 27% of cases, a medial approach in 5%, and an inferior approach in 7%. A trocar was used during applicator insertion in 27% of cases. Local anesthetic, sedation, both or neither were administered in 45%, 2%, 41% and 11% of cases, respectively, during applicator placement. The prescription dose was delivered in 42 of 44 treated patients. CONCLUSIONS Early stage breast cancer can be treated with breast conserving surgery and APBI using electronic brachytherapy. Treatment was well tolerated, and these early outcomes were similar to the early outcomes with iridium-based balloon brachytherapy.
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MESH Headings
- Aged
- Aged, 80 and over
- Brachytherapy/methods
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Prospective Studies
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Affiliation(s)
- William C Dooley
- University of Oklahoma Health Sciences Center, 825 NE 10th Street Suite 4500, Oklahoma City, OK 73104, USA
| | - Ozer Algan
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 825 North East 10th Street Suite 1430, Oklahoma City, OK 73104, USA
| | - Kambiz Dowlatshahi
- Rush University Medical Center, 60 E Delaware Place Suite 1400, Chicago, IL 60611, USA
| | - Darius Francescatti
- Rush University Medical Center, 1725 West Harrison Street Suite 810, Chicago, IL 60612, USA
| | - Elizabeth Tito
- Rhode Island Hospital, Providence, RI 02903, USA
- Enterprise Surgical, 91 Washington St Unit 302, Taunton, MA 02780, USA
| | - J David Beatty
- Swedish Cancer Institute, Comprehensive Breast Center, Swedish Medical Center, 1600 East Jefferson St. Suite 305, Seattle, WA 98122, USA
| | - Art G Lerner
- Dickstein Cancer Center, White Plains Hospital, White Plains, 4 Longview Ave, NY 10601, USA
| | - Betsy Ballard
- Holy Cross Medical Center, 2101 Medical Parks Drive Suite 304, Silver Spring, MD 20902, USA
| | - Susan K Boolbol
- Beth Israel Medical Center, 10 Union Square East, New York City, NY 10003, USA
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Gurdalli S, Kuske RR, Quiet CA, Ozer M. Dosimetric performance of Strut-Adjusted Volume Implant: A new single-entry multicatheter breast brachytherapy applicator. Brachytherapy 2011; 10:128-35. [DOI: 10.1016/j.brachy.2010.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/26/2010] [Accepted: 03/31/2010] [Indexed: 12/31/2022]
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Dooley WC, Wurzer JC, Megahy M, Schreiber G, Roy T, Proulx G, Laduzinsky S, Lane S, Dalzell J, Dowlatshahi K, Simmons D, Thropay JP, Ahuja H, Beitsch P, Holt RW, Lee CA. Electronic brachytherapy as adjuvant therapy for early stage breast cancer: a retrospective analysis. Onco Targets Ther 2011; 4:13-20. [PMID: 21552411 PMCID: PMC3084303 DOI: 10.2147/ott.s15297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This multicenter, retrospective study evaluated treatment and clinical outcomes of patients with early stage breast cancer who received adjuvant high-dose rate (HDR) electronic brachytherapy (EBT) treatment post-lumpectomy using the Axxent(®) EBT system. Dosimetric data from the EBT treatment plans were compared with those based on iridium-192 HDR brachytherapy. MATERIAL AND METHODS Medical records of 63 patients with early stage breast cancer (Tis, T1a, T1b, T1c, and T2) who were treated post-lumpectomy with EBT alone or in combination with external beam radiation therapy were reviewed. The prescribed EBT dose was 34 Gy (10 fractions over 5 days, 3.4 Gy each) to 1 cm from the balloon surface. Dosimetry data from 12 patients were compared with these of treatment plans using an iridium-192 source prepared for the same 12 patients. RESULTS The majority of patients (90.5%) were older than 50 years and had one or more risk factors for breast cancer (80.6%). Tumor sizes were 0.1 cm to 3.5 cm (mean 1.3 cm). Median follow-up was 7 months (1 to 18 months) post-EBT. Balloon applicators were implanted 0 to 85 days (mean 13.4 days) post-lumpectomy/re-excision. The most common adverse events were erythema, rash dermatitis, and pain or breast tenderness. No recurrences were reported. Dosimetric analyses demonstrated comparable target coverage, increased high-dose regions, and a significantly reduced dose to the ipsilateral breast and lungs as well as the heart with EBT as compared with the iridium-192 treatment plans. CONCLUSION This retrospective, multicenter study showed that postsurgical adjuvant radiation therapy for early stage breast cancer can be administered using the EBT system with similar toxicity outcomes to those reported with iridium-192 brachytherapy. EBT offers a convenient, portable, nonisotope alternative to HDR brachytherapy using iridium-192.
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Affiliation(s)
- William C Dooley
- Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
- Correspondence: William C Dooley, The G Rainey Williams Chair of Surgical Oncology, University of Oklahoma, Health Sciences Center, Oklahoma City, OK 73104, USA, Tel +1 405 271 7867, Fax +1 405 271 4443, Email
| | | | | | | | - Tapan Roy
- Cape Girardeau Cancer Center, Cape Girardeau, MO, USA
| | | | | | | | | | | | | | - John P Thropay
- Beverly Oncology and Imaging Center, Montebello, CA, USA
| | | | | | | | - Charles A Lee
- Gulf Coast Cancer Treatment Center, Panama City, FL, USA
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Li S, Goins B, Phillips WT, Saenz M, Otto PM, Bao A. Post-lumpectomy intracavitary retention and lymph node targeting of (⁹⁹m)Tc-encapsulated liposomes in nude rats with breast cancer xenograft. Breast Cancer Res Treat 2010; 130:97-107. [PMID: 21181436 DOI: 10.1007/s10549-010-1309-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 12/10/2010] [Indexed: 01/27/2023]
Abstract
Liposomes are recognized drug delivery systems with tumor-targeting capability. In addition, therapeutic or diagnostic radionuclides can be efficiently loaded into liposomes. This study investigated the feasibility of utilizing radiotherapeutic liposomes as a new post-lumpectomy radiotherapy for early-stage breast cancer by determining the locoregional retention and systemic distribution of liposomes radiolabeled with technetium-99m ((⁹⁹m)Tc) in an orthotopic MDA-MB-231 breast cancer xenograft nude rat model. To test this new brachytherapy approach, a positive surgical margin lumpectomy model was set up by surgically removing the xenograft and deliberately leaving a small tumor remnant in the surgical cavity. Neutral, anionic, and cationic surface-charged fluorescent liposomes of 100 and 400 nm diameter were manufactured and labeled with (⁹⁹m)Tc-BMEDA. Locoregional retention and systemic distribution of (⁹⁹m)Tc-liposomes injected into the post-lumpectomy cavity were determined using non-invasive nuclear imaging, ex vivo tissue gamma counting and fluorescent stereomicroscopic imaging. The results indicated that (⁹⁹)Tc-liposomes were effectively retained in the surgical cavity (average retention was 55.7 ± 24.2% of injected dose for all rats at 44 h post-injection) and also accumulated in the tumor remnant (66.9 ± 100.4%/g for all rats). The majority of cleared (⁹⁹m)Tc was metabolized quickly and excreted into feces and urine, exerting low radiation burden on vital organs. In certain animals (⁹⁹m)Tc-liposomes significantly accumulated in the peripheral lymph nodes, especially 100 nm liposomes with anionic surface charge. The results suggest that post-lumpectomy intracavitary administration of therapeutic radionuclides delivered by 100-nm anionic liposome carrier is a potential therapy for the simultaneous treatment of the surgical cavity and the draining lymph nodes of early-stage breast cancer.
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Affiliation(s)
- Shihong Li
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229-3900, USA
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James ML, Lehman M, Hider PN, Jeffery M, Hickey BE, Francis DP. Fraction size in radiation treatment for breast conservation in early breast cancer. Cochrane Database Syst Rev 2010:CD003860. [PMID: 21069678 DOI: 10.1002/14651858.cd003860.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Shortening the duration of radiation therapy would benefit women with early breast cancer treated with breast conserving surgery. It may also improve access to radiation therapy by improving efficiency in radiation oncology departments globally. This can only happen if the shorter treatment is as effective and safe as conventional radiation therapy. This is an updated version of the original Cochrane Review published in Issue 3, 2008. OBJECTIVES To determine the effect of altered radiation fraction size on outcomes for women with early breast cancer who have undergone breast conserving surgery. SEARCH STRATEGY We searched the Cochrane Breast Cancer Group Specialised Register, MEDLINE, EMBASE and the WHO ICTRP search portal to June 2009, reference lists of articles and relevant conference proceedings. We applied no language constraints. SELECTION CRITERIA Randomised controlled trials of unconventional versus conventional fractionation in women with early breast cancer who had undergone breast conserving surgery. DATA COLLECTION AND ANALYSIS The authors performed data extraction independently, with disagreements resolved by discussion. We sought missing data from trial authors. MAIN RESULTS Four trials reported on 7095 women. The women were highly selected: tumours were node negative and 89.8% were smaller than 3 cm. Where the breast size was known, 87% had small or medium breasts. The studies were of low to medium quality. Unconventional fractionation (delivering radiation therapy in larger amounts each day but over fewer days than with conventional fractionation) did not affect: (1) local recurrence risk ratio (RR) 0.97 (95% CI 0.76 to 1.22, P = 0.78), (2) breast appearance RR 1.17 (95% CI 0.98 to 1.39, P = 0.09), (3) survival at five years RR 0.89 (95% CI 0.77 to 1.04, P = 0.16). Acute skin toxicity was decreased with unconventional fractionation: RR 0.21 (95% CI 0.07 to 0.64, P = 0.007). AUTHORS' CONCLUSIONS Two new studies have been published since the last version of the review, altering our conclusions. We have evidence from four low to medium quality randomised trials that using unconventional fractionation regimens (greater than 2 Gy per fraction) does not affect local recurrence, is associated with decreased acute toxicity and does not seem to affect breast appearance or late toxicity for selected women treated with breast conserving therapy. These are mostly women with node negative tumours smaller than 3 cm and negative pathological margins. Long-term follow up (> 5 years) is available for a small proportion of the patients randomised. Longer follow up is required for a more complete assessment of the effect of altered fractionation.
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Affiliation(s)
- Melissa L James
- Oncology Service, Private Bag 4710, Christchurch Hospital, Christchurch, New Zealand
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40
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Mammary fat necrosis following radiotherapy in the conservative management of localized breast cancer: Does it matter? Radiother Oncol 2010; 97:92-4. [DOI: 10.1016/j.radonc.2010.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 02/17/2010] [Accepted: 02/23/2010] [Indexed: 11/23/2022]
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Experience with an electronic brachytherapy technique for intracavitary accelerated partial breast irradiation. Am J Clin Oncol 2010; 33:327-35. [PMID: 20375833 DOI: 10.1097/coc.0b013e3181d79d9e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Phase IV study evaluated the safety and device performance of an electronic brachytherapy system (Axxent Electronic Brachytherapy System) as adjuvant therapy for early-stage breast cancer. METHODS Patients were > or =50 years of age and had completely resected invasive ductal carcinoma or ductal carcinoma in situ (<2.0 cm), with N0 M0 and negative microscopic margins of > or =1 mm. The balloon applicator was placed in a closed cavity with a balloon surface to skin distance of > or =7 mm. The prescribed dose was 3.4 Gy/fraction prescribed to 1 cm beyond the balloon surface twice daily (BID) for 10 fractions. RESULTS Of 65 patients consented, 21 (32%) were not eligible for treatment, and 44 (68%) were treated, with 6-months follow-up in 43 and 1-year follow-up in 36. The prescribed radiation treatment was successfully delivered in 42/44 (95.4%) patients; one was unsuccessful due to a controller issue and the other declined the final fraction following a balloon deflation. Side effects were as anticipated and generally manageable. Four CTCAE v3 grade 3 toxicities were reported: blistering (1), breast tenderness (1), and moist desquamation (2); all have resolved. The most common grade 2 toxicity was erythema. There were no device-related serious adverse events. CONCLUSIONS Early experience demonstrates that the electronic brachytherapy system performed as expected. Electronic brachytherapy has similar acute toxicity profiles to other high dose rate approaches for accelerated partial breast irradiation and offers the convenience of having the treatment in an unshielded room.
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Qiu JJ, Chang Z, Wu QJ, Yoo S, Horton J, Yin FF. Impact of Volumetric Modulated Arc Therapy Technique on Treatment With Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2010; 78:288-96. [PMID: 20444558 DOI: 10.1016/j.ijrobp.2009.10.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 10/30/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
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El Mongy M, El Hossieny H, Haggag F, Fathy R. Clinico-pathological study and treatment results of 1009 operable breast cancer cases: Experience of NCI Cairo University, Egypt. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10330-010-0614-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ko EC, Koprowski CD, Dickson-Witmer D, Penman E, Sorensen M, Hanlon AL, Sammons S, Farach A, Strasser J. Partial vs. whole breast irradiation in a community hospital: A retrospective cohort analysis of 200 patients. Brachytherapy 2010; 9:248-53. [DOI: 10.1016/j.brachy.2009.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 12/02/2009] [Accepted: 12/03/2009] [Indexed: 11/26/2022]
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Baltas D, Lymperopoulou G, Löffler E, Mavroidis P. A radiobiological investigation on dose and dose rate for permanent implant brachytherapy of breast using 125I or 103Pd sources. Med Phys 2010; 37:2572-86. [PMID: 20632569 DOI: 10.1118/1.3426027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 04/13/2010] [Accepted: 04/13/2010] [Indexed: 11/15/2023] Open
Abstract
PURPOSE The present report addresses the question of what could be the appropriate dose and dose rate for 125I and 103PD permanent seed implants for breast cancer as monotherapy for early stage breast cancer. This is addressed by employing a radiobiological methodology, which is based on the linear quadratic model, to identify a biologically effective dose (BED) to the prescription point of the brachytherapy implant, which would produce equivalent cell killing (or same cell survival) when compared to a specified external radiotherapy scheme. METHODS In the present analysis, the tumor and normal tissue BED ratios of brachytherapy and external radiotherapy are examined for different combinations of tumor proliferation constant (K), alpha/beta ratios, initial dose rate (R0), and reference external radiotherapy scheme (50 or 60 Gy in 2 Gy per fraction). The results of the radiobiological analysis are compared against other reports and clinical protocols in order to examine possible opportunities of improvement. RESULTS The analysis indicates that physical doses of approximately 100-110 Gy delivered with an initial dose rate of around 0.05 Gyh(-1) and 78-80 Gy delivered at 0.135 Gyh(-1) for 125I and 103Pd permanent implants, respectively, are equivalent to 50 Gy external beam radiotherapy (EBRT) in 2 Gy per fraction. Similarly, for physical doses of approximately 115-127 Gy delivered with an initia dose rate of around 0.059 Gyh(-1) and 92 Gy delivered at 0.157 Gyh(-1) for 125I and 103Pd, respectively, are equivalent to 60 Gy EBRT in 2 Gy per fraction. It is shown that the initial dose rate required to produce isoeffective tumor response with 50 or 60 Gy EBRT in 2 Gy per fraction increases as the repopulation factor K increases, even though repopulation is also considered in EBRT. Also, the initial dose rate increases as the value of the alpha/beta ratio decreases. The impact of the different alpha/beta ratios on the ratio of the tumor BEDs is significantly large for both the 125I and 103Pd implants with the deviation between the alpha/beta = 10.0 Gy ratios and those using the 4.0 and 3.5 Gy values ranging between 18% and 22% in most of the cases. CONCLUSIONS For the cases of 125I and 103Pd, the equivalent physical doses to 50 Gy EBRT in 2 Gy per fraction are associated with an overdosage of the involved normal tissue in the range of 4%-16% and an underdosage by 10%-15% for a BED for normal tissue, using an alpha/beta value of 3.0 Gy (BEDNT,3 Gy) of 100 Gy. These values are lower by 10%-20% than the published value of 124 Gy for 125I and by about 13% when compared to the published isoeffective dose of 90 Gy for 103Pd. Similarly, the equivalent physical doses to 60 Gy EBRT in 2 Gy per fraction are associated with an overdosage of the involved normal tissue by 10%-20% and an underdosage by 4%-10% for BEDNT,3 Gy of 110 Gy.
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Affiliation(s)
- Dimos Baltas
- Department of Medical Physics and Engineering, Strahlenklinik, Klinikum Offenbach GmbH, 63069 Offenbach, Germany.
| | | | | | - Panayiotis Mavroidis
- Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, S-17176 Stockholm, Sweden and Department of Medical Physics, Larissa University Hospital, 41110 Larissa, Greece
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Hannoun-Lévi JM, Hennequin C, Pommier P, Izar F, Thomas L, Le Scodan R, Lesaunier F, Nguyen T, Heymann S, Truc G, Peiffert D. Enquête nationale sur la curiethérapie dans le cancer du sein : état des lieux et perspectives en 2009. Cancer Radiother 2010; 14:176-82. [DOI: 10.1016/j.canrad.2010.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 11/19/2009] [Accepted: 01/19/2010] [Indexed: 11/26/2022]
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Abstract
The addition of whole-breast external beam radiotherapy (EBRT) to breast-conserving surgery results in a significant reduction in the risk of death due to breast cancer, but this may be offset by an increase in deaths from other causes and toxicity to surrounding organs. Because of this, and with a view to patterns of local recurrence, irradiation of the tumour bed has been explored in selected patients with early breast cancer using a variety of radiotherapeutic modalities. This review article explores the treatment options for partial breast irradiation and examines their role within the field of breast cancer treatment.
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Sola A. Revisión de la literatura sobre radioterapia en el cáncer de mama temprano. Medwave 2010. [DOI: 10.5867/medwave.2010.01.4331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Paganelli G, De Cicco C, Ferrari ME, McVie G, Pagani G, Leonardi MC, Cremonesi M, Ferrari A, Pacifici M, Di Dia A, Botta F, De Santis R, Galimberti V, Luini A, Orecchia R, Veronesi U. IART (Intra-Operative Avidination for Radionuclide Therapy) for accelerated radiotherapy in breast cancer patients. Technical aspects and preliminary results of a phase II study with 90Y-labelled biotin. Ecancermedicalscience 2010; 4:166. [PMID: 22276027 PMCID: PMC3234029 DOI: 10.3332/ecancer.2010.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Breast conserving surgery (BCS) plus external beam radiotherapy (EBRT) is considered the standard treatment for early breast cancer. We have investigated the possibility of irradiating the residual gland, using an innovative nuclear medicine approach named IART(®) (Intra-operative Avidination for Radionuclide Therapy). AIM The objective of this study was to determine the optimal dose of avidin with a fixed activity (3.7 GBq) of (90)Y-biotin, in order to provide a boost of 20 Gy, followed by EBRT to the whole breast (WB) at the reduced dose of 40 Gy. Local and systemic toxicity, patient's quality of life, including the cosmetic results after the combined treatment with IART(®) and EBRT, were assessed. METHODS After tumour excision, the surgeon injected native avidin diluted in 30 ml of saline solution into and around the tumour bed (see video). Patients received one of three avidin dose levels: 50 mg (10 pts), 100 mg (15 pts) and 150 mg (10 pts). Between 12 to 24 h after surgery, 3.7 GBq (90)Y-biotin spiked with 185 MBq (111)In-biotin was administered intravenously (i.v.). Whole body scans and SPECT images were performed up to 30 h post-injection for dosimetric purposes. WB-EBRT was administered four weeks after the IART(®) boost. Local toxicity and quality of life were evaluated. RESULTS Thirty-five patients were evaluated. No side effects were observed after avidin administration and (90)Y-biotin infusion. An avidin dose level of 100 mg resulted the most appropriate in order to deliver the required radiation dose (19.5 ± 4.0 Gy) to the surgical bed. At the end of IART(®), no local toxicity occurred and the overall cosmetic result was good. The tolerance to the reduced EBRT was also good. The highest grade of transient local toxicity was G3, which occurred in 3/32 pts following the completion of WB-EBRT. The combination of IART(®)+EBRT was well accepted by the patients, without any changes to their quality of life. CONCLUSIONS These preliminary results support the hypothesis that IART(®) may represent a valid approach to accelerated WB irradiation after BCS. We hope that this nuclear medicine technique will contribute to a better management of breast cancer patients.
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50
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Initial clinical experience with the Strut-Adjusted Volume Implant brachytherapy applicator for accelerated partial breast irradiation. Brachytherapy 2009; 8:367-72. [DOI: 10.1016/j.brachy.2009.03.190] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 03/24/2009] [Accepted: 03/26/2009] [Indexed: 01/15/2023]
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