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Ott OJ, Stillkrieg W, Lambrecht U, Schweizer C, Lamrani A, Sauer TO, Strnad V, Bert C, Hack CC, Beckmann MW, Fietkau R. External-Beam-Accelerated Partial-Breast Irradiation Reduces Organ-at-Risk Doses Compared to Whole-Breast Irradiation after Breast-Conserving Surgery. Cancers (Basel) 2023; 15:3128. [PMID: 37370738 DOI: 10.3390/cancers15123128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/19/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
In order to evaluate organ-at-risk (OAR) doses in external-beam-accelerated partial-breast irradiation (APBI) compared to standard whole-breast irradiation (WBI) after breast-conserving surgery. Between 2011 and 2021, 170 patients with early breast cancer received APBI within a prospective institutional single-arm trial. The prescribed dose to the planning treatment volume was 38 Gy in 10 fractions on 10 consecutive working days. OAR doses for the contralateral breast, the ipsilateral, contralateral, and whole lung, the whole heart, left ventricle (LV), and the left anterior descending coronary artery (LAD), and for the spinal cord and the skin were assessed and compared to a control group with real-world data from 116 patients who underwent WBI. The trial was registered at the German Clinical Trials Registry, DRKS-ID: DRKS00004417. Compared to WBI, APBI led to reduced OAR doses for the contralateral breast (0.4 ± 0.6 vs. 0.8 ± 0.9 Gy, p = 0.000), the ipsilateral (4.3 ± 1.4 vs. 9.2 ± 2.5 Gy, p = 0.000) and whole mean lung dose (2.5 ± 0.8 vs. 4.9 ± 1.5 Gy, p = 0.000), the mean heart dose (1.6 ± 1.6 vs. 1.7 ± 1.4 Gy, p = 0.007), the LV V23 (0.1 ± 0.4 vs. 1.4 ± 2.6%, p < 0.001), the mean LAD dose (2.5 ± 3.4 vs. 4.8 ± 5.5 Gy, p < 0.001), the maximum spinal cord dose (1.5 ± 1.1 vs. 4.5 ± 5.7 Gy, p = 0.016), and the maximum skin dose (39.6 ± 1.8 vs. 49.1 ± 5.8 Gy, p = 0.000). APBI should be recommended to suitable patients to minimize the risk of secondary tumor induction and the incidence of consecutive major cardiac events.
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Affiliation(s)
- Oliver J Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Wilhelm Stillkrieg
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Ulrike Lambrecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Claudia Schweizer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Allison Lamrani
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Tim-Oliver Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
| | - Carolin C Hack
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
- Department of Gynecology and Obstetrics, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Matthias W Beckmann
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
- Department of Gynecology and Obstetrics, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, 91054 Erlangen, Germany
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Dose-Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An "All-in-One" Multicenter-Multidisciplinary Practical Summary. Curr Oncol 2022; 29:7021-7050. [PMID: 36290829 PMCID: PMC9600677 DOI: 10.3390/curroncol29100552] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature. MATERIAL AND METHODS A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin's lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence. RESULTS Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form. CONCLUSIONS A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations.
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Kouloulias V, Mosa E, Zygogianni A, Kypraiou E, Georgakopoulos J, Platoni K, Antypas C, Kyrgias G, Tolia M, Papadimitriou C, Psyrri A, Patatoukas G, Dilvoi M, Armpilia C, Theodorou K, Kalogeridi MA, Beli I, Kouvaris J, Kelekis N. A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer. Breast Care (Basel) 2016; 11:328-332. [PMID: 27920625 DOI: 10.1159/000449433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The aim of this analysis was a retrospective evaluation of the efficacy and toxicity of 2 hypofractionated irradiation schedules compared to conventional therapy in post-mastectomy patients. METHODS 3 irradiation schedules were analyzed: 48.30 Gy in 21 fractions (group A, n = 60), 42.56 Gy in 16 fractions (group B, n = 27) and 50 Gy in 25 fractions (group C, n = 30) of the front chest wall. All groups were also treated with a supraclavicular field, with 39.10 Gy in 17 fractions (group A), 37.24 Gy in 14 fractions (group B) or 45 Gy in 25 fractions (group C). RESULTS No local recurrences were noted in any group during 36 months of follow-up. Acute skin toxicity presented in all groups, with 58.3%, 70.4% and 60% of grade I; 35%, 25.9% and 40% of grade II; 6.7%, 3.7% and 0% of grade III being seen in groups A, B and C, respectively. Late skin toxicity was noted only as grade I in 16.7%, 25.9% and 26.7% of groups A, B and C, respectively. No significant difference was noted among all groups for either acute or late skin toxicity, or for radio-pneumonitis (chi2 test, p > 0.05). CONCLUSION All schedules were equally effective with equivalent toxicity. A prospective randomized study is needed to confirm our results.
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Affiliation(s)
- Vassilis Kouloulias
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece; Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Eftychia Mosa
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Anna Zygogianni
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Efrosini Kypraiou
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - John Georgakopoulos
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Kalliopi Platoni
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Christos Antypas
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - George Kyrgias
- Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Maria Tolia
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece; Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Christos Papadimitriou
- Therapeutics Clinic, Alexandra Hospital, Medical School of Athens, Athens, Greece, Athens, Greece
| | - Amanda Psyrri
- Medical Oncology Unit, ATTIKON University Hospital, Athens, Greece
| | - George Patatoukas
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Maria Dilvoi
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - Christina Armpilia
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Kyriaki Theodorou
- Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Maria-Aggeliki Kalogeridi
- Radiotherapy Department, Medical School of Thessaly, University Hospital of Larisa, Larisa, Greece, Athens, Greece
| | - Ivelina Beli
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
| | - John Kouvaris
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, Athens, Greece, Athens, Greece
| | - Nikolaos Kelekis
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, Athens, Greece, Athens, Greece
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Kouloulias V, Zygogianni A, Kypraiou E, Georgakopoulos J, Thrapsanioti Z, Beli I, Mosa E, Psyrri A, Antypas C, Armbilia C, Tolia M, Platoni K, Papadimitriou C, Arkadopoulos N, Gennatas C, Zografos G, Kyrgias G, Dilvoi M, Patatoucas G, Kelekis N, Kouvaris J. Adjuvant chemotherapy and acute toxicity in hypofractionated radiotherapy for early breast cancer. World J Clin Cases 2014; 2:705-710. [PMID: 25405195 PMCID: PMC4233416 DOI: 10.12998/wjcc.v2.i11.705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/16/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the effect of chemotherapy to the acute toxicity of a hypofractionated radiotherapy (HFRT) schedule for breast cancer.
METHODS: We retrospectively analyzed 116 breast cancer patients with T1, 2N0Mx. The patients received 3-D conformal radiotherapy with a total physical dose of 50.54 Gy or 53.2 Gy in 19 or 20 fractions according to stage, over 23-24 d. The last three to four fractions were delivered as a sequential tumor boost. All patients were monitored for acute skin toxicity according to the European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group criteria. The maximum monitored value was taken as the final grading score. Multivariate analysis was performed for the contribution of age, chemotherapy and 19 vs 20 fractions to the radiation acute skin toxicity.
RESULTS: The acute radiation induced skin toxicity was as following: grade I 27.6%, grade II 7.8% and grade III 2.6%. No significant correlation was noted between toxicity grading and chemotherapy (P = 0.154, χ2 test). The mean values of acute toxicity score in terms of chemotherapy or not, were 0.64 and 0.46 respectively (P = 0.109, Mann Whitney test). No significant correlation was also noted between acute skin toxicity and radiotherapy fractions (P = 0.47, χ2 test). According to univariate analysis, only chemotherapy contributed significantly to the development of acute skin toxicity but with a critical value of P = 0.05. However, in multivariate analysis, chemotherapy lost its statistical significance. None of the patients during the 2-years of follow-up presented any locoregional relapse.
CONCLUSION: There is no clear evidence that chemotherapy has an impact to acute skin toxicity after an HFRT schedule. A randomized trial is needed for definite conclusions.
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