Radiation-induced lung injury after concurrent neoadjuvant chemoradiotherapy for locally advanced breast cancer

Evaluation of abches and volumetric modulated arc therapy under deep inspiration breath-hold technique for patients with left-sided breast cancer: A retrospective observational study

Radiotherapy after breast-conserving surgery or mastectomy has clinical benefits including reducing local recurrence and improving overall survival. Deep inspiration breath-hold (DIBH) technique using the Abches system is an easy and practical method to reduce radiation dose to the heart and lungs. This retrospective study was proposed to investigate the dosimetric difference between Abches system and free breathing technique in treating left-sided breast cancer.Eligible patients underwent computed tomography (CT) scans to acquire both free breathing (FB) and DIBH technique data using the Abches. For each patient, both FB and DIBH image sets were planned based on the volumetric modulated arc therapy (VMAT). Radiation dose to the heart, ipsilateral lung, and contralateral lung was compared between the Abches system and FB.No significant differences in the planning target volume (PTV) (674.58 vs 665.88 cm, P = .29), mean dose (52.28 vs 52.03 Gy, P = .13), and volume received at the prescribed dose (Vpd) (94.66% vs 93.92%, P = .32) of PTV were observed between the FB and DIBH plans. Significant differences were found in mean heart (6.71 Gy vs 4.21 Gy, P < .001), heart V5 (22.73% vs 14.39%, P = .002), heart V20 (10.96% vs. 5.62%, P < .001), mean left lung (11.51 vs 10.07 Gy, P = .01), left lung V20 (22.88% vs 19.53%, P = .02), left lung V30 (18.58 vs 15.27%, P = .005), and mean right lung dose (.89 vs 72 Gy, P = .03).This is the first report on reduced mean left lung, mean right lung dose, and V20 of left lung using VMAT and Abches. The combination of Abches and VMAT can practically and efficiently reduce extraradiation doses to the heart and lungs.

Phase I study of concurrent and consolidation cisplatin and docetaxel chemotherapy with thoracic radiotherapy in non-small cell lung cancer

Background

We designed a phase i study of concurrent chemoradiotherapy (ccrt) with docetaxel (D) and cisplatin (C), followed by consolidation dc, for unresectable stage iii non-small cell lung cancer (nsclc).

Methods

Patients with histologically proven and unresectable stage iii nsclc were eligible. During ccrt, C was given every 3 weeks (75 mg/m²) and D given weekly. The starting dose of D was 20 mg/m², escalated in cohorts of 3 to define the maximum tolerated dose (mtd). Radiotherapy was prescribed to a dose of 60 Gy in 30 fractions. This was followed by 2 cycles of consolidation dc, which were dose escalated if ccrt was tolerated.

Results

Twenty-six patients were enrolled, with 1 excluded following evidence of metastatic disease. Nineteen patients completed both phases of treatment. There were 7 grade 3 events during ccrt (5 esophagitis, 2 nausea), and 8 grade 3 events during consolidation (2 neutropenia, 2 leukopenia, 1 esophagitis, 2 nausea, and 1 pneumonitis). Three patients had grade 4 neutropenia. No patients died due to toxicities. The mtd of concurrent weekly D was 20 mg/m². Consolidation D and C were each dose escalated to 75 mg/m² in 8 patients. The median overall survival (os) and progression-free survival (pfs) of all patients were 33.6 months and 17.2 months, respectively, with median follow-up of 26.6 months (range 0.43-110.8).

Conclusions

The use of docetaxel 20 mg/m² weekly and cisplatin 75 mg/m² every 3 weeks concurrent with thoracic radiotherapy, followed by consolidation docetaxel and cisplatin, both given at 75 mg/m² every 3 weeks, appears to be safe in this phase i trial.

Randomized controlled trial of late-course concurrent versus sequential chemoradiotherapy after mastectomy and axillary surgery in locally advanced breast cancer

BACKGROUND

Concurrent chemoradiotherapy could increase the local control rate in patients with high recurrence risk after breast-conserving surgery, but the effect of concurrent chemoradiotherapy after mastectomy and axillary dissection is not clear. The aim of the study was to compare the effects of late-course concurrent chemoradiotherapy (CCRT) versus sequential therapy (SCRT) after mastectomy and axillary surgery in locally advanced breast cancer.

METHODS

This was a randomized controlled trial of 155 patients with stage pT3-4p N1-3c M0 or pAnyT pN2-3c M0 breast cancer undergoing 5-fluorouracil+epirubicin+cyclophosphamide followed by docetaxel (FEC-D) chemotherapy after mastectomy and axillary dissection. Patients were randomized to the CCRT group (intensity-modulated radiation therapy was performed concurrently with docetaxel) or to the SCRT group (radiotherapy after chemotherapy). Recurrences, adverse reactions, and short-term effects were observed.

RESULTS

All the patients completed the planned therapy. The median follow-up was 39 (range, 16-62) months. Compared with SCRT, the 3-year local-regional recurrence-free survival (LRFS) in the CCRT group was improved (81.8% vs 92.3%, P = .046). There was no significant difference in 3-year disease-free survival (DFS) and overall survival (OS). In the pT3-4 pN1-3 cM0 subgroup, the 3-year local recurrence-free survival and DFS were significantly improved in the CCRT group (69.4% vs 88.2%, P = .036; and 41.7% vs 72.6%, P = .049, respectively). No significant difference was observed adverse reactions between the 2 groups.

CONCLUSION

LRFS of patients with locally advanced invasive breast cancer after mastectomy and axillary surgery was better with CCRT than with SCRT and with similar profiles of adverse reactions. The DFS of patients staged pT3-4 pN1-3 cM0 was also improved.

Intratumorally Injected 177Lu-Labeled Gold Nanoparticles: Gold Nanoseed Brachytherapy with Application for Neoadjuvant Treatment of Locally Advanced Breast Cancer

Improvements in the treatment of locally advanced breast cancer (LABC) are needed. Our objective was to study a radiation nanomedicine (gold nanoseeds) composed of 30-nm gold nanoparticles (AuNP) modified with polyethyleneglycol (PEG) chains linked to DOTA for complexing the β-particle emitter (177)Lu and to panitumumab for targeting epidermal growth factor receptors (EGFR) ((177)Lu-T-AuNP) as a novel neoadjuvant brachytherapy for LABC. Nontargeted gold nanoseeds ((177)Lu-NT-AuNP) were constructed without panitumumab for comparison.

METHODS

(177)Lu-T-AuNP or (177)Lu-NT-AuNP was injected intratumorally in CD-1 athymic mice bearing subcutaneous EGFR-positive MDA-MB-468 human breast cancer tumors. Biodistribution and small-animal SPECT/CT imaging studies were performed to evaluate tumor and normal organ localization. A short-term (15 d) study was conducted to select the most effective amount of (177)Lu-T-AuNP or (177)Lu-NT-AuNP for treatment with long-term observation (90-120 d). Normal organ toxicities were assessed by monitoring body weight, blood cell counts, and serum alanine aminotransferase and creatinine. Radiation-absorbed doses in the tumor and normal organs were estimated by Monte Carlo N-Particle version 5.0 modeling.

RESULTS

Tumor radioactivity concentrations were high at 1 h after injection (>300-400 percentage injected dose per gram [%ID/g]) but decreased by 2-3-fold at 48 h after injection. Normal organ uptake was low (<0.5 %ID/g) except for the liver and spleen (<3 %ID/g), increasing by 2-5-fold at 48 h after injection. Treatment with 4.5 MBq (6 × 10(11) AuNP) of (177)Lu-T-AuNP or (177)Lu-NT-AuNP arrested tumor growth over 90 d without normal organ toxicity, whereas tumors continued to grow in mice treated with unlabeled T-AuNP or (177)Lu-labeled PEG polymer not linked to AuNP. Survival was prolonged up to 120 d in mice treated with (177)Lu-T-AuNP or (177)Lu-NT-AuNP. Radiation-absorbed doses to the tumor were 30 and 22 Gy for (177)Lu-T-AuNP and (177)Lu-NT-AuNP, respectively. Some tumor regions received high radiation doses (250-1,300 Gy). Normal organ doses were low (0.04-0.6 Gy).

CONCLUSION

Gold nanoseeds injected intratumorally were highly effective for inhibiting the growth of breast cancer tumors in CD-1 athymic mice and caused no normal organ toxicity. These results are promising for their application for neoadjuvant brachytherapy of LABC. Because EGFR targeting was not required, the approach is broadly applicable to LABC with different phenotypes.

Response to: "Current definition of locally advanced breast cancer"

Locally advanced breast cancer (labc) represents an advanced stage of heterogenous breast cancers that continues to invoke great interest. [...]

A new method to validate thoracic CT-CT deformable image registration using auto-segmented 3D anatomical landmarks

BACKGROUND

Deformable image registrations are prone to errors in aligning reliable anatomically features. Consequently, identification of registration inaccuracies is important. Particularly thoracic three-dimensional (3D) computed tomography (CT)-CT image registration is challenging due to lack of contrast in lung tissue. This study aims for validation of thoracic CT-CT image registration using auto-segmented anatomically landmarks.

MATERIAL AND METHODS

Five lymphoma patients were CT scanned three times within a period of 18 months, with the initial CT defined as the reference scan. For each patient the two successive CT scans were registered to the reference CT using three different image registration algorithms (Demons, B-spline and Affine). The image registrations were evaluated using auto-segmented anatomical landmarks (bronchial branch points) and Dice Similarity Coefficients (DSC). Deviation of corresponding bronchial landmarks were used to quantify inaccuracies in respect of both misalignment and geometric location within lungs.

RESULTS

The median bronchial branch point deviations were 1.6, 1.1 and 4.2 (mm) for the three tested algorithms (Demons, B-spline and Affine). The maximum deviations (> 15 mm) were found within both Demons and B-spline image registrations. In the upper part of the lungs the median deviation of 1.7 (mm) was significantly different (p < 0.02) relative to the median deviations of 2.0 (mm), found in the middle and lower parts of the lungs. The DSC revealed similar registration discrepancies among the three tested algorithms, with DSC values of 0.96, 0.97 and 0.91, for respectively Demons, B-spline and the Affine algorithms.

CONCLUSION

Bronchial branch points were found useful to validate thoracic CT-CT image registration. Bronchial branch points identified local registration errors > 15 mm in both Demons and B-spline deformable algorithms.