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Chirilă ME, Kraja F, Marta GN, Neves Junior WFP, de Arruda GV, Gouveia AG, Franco P, Poortmans P, Ratosa I. Organ-sparing techniques and dose-volume constrains used in breast cancer radiation therapy - Results from European and Latin American surveys. Clin Transl Radiat Oncol 2024; 46:100752. [PMID: 38425691 PMCID: PMC10900109 DOI: 10.1016/j.ctro.2024.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
Background Advances in local and systemic therapies have improved the outcomes of patients with breast cancer (BC), leading to a possible increased risk for postoperative radiation therapy (RT) late adverse events. The most adequate technologies and dose constraints for organs at risk (OAR) in BC RT have yet to be defined. Methods An online survey was distributed to radiation oncologists (ROs) practicing in Europe and Latin America including the Caribbean (LAC) through personal contacts, RO and BC professional groups' networks. Demographic data and clinical practice information were collected. Results The study included 585 responses from ROs practicing in 57 different countries. The most frequently contoured OAR by European and LAC participants were the whole heart (96.6 % and 97.7 %), the ipsilateral (84.3 % and 90.8 %), and contralateral lung (71.3 % and 77.4 %), whole lung (69.8 % and 72.9 %), and the contralateral breast (66.4 % and. 83.2 %). ESTRO guidelines were preferred in Europe (33.3 %) and the RTOG contouring guideline was the most popular in LAC (62.2 %), while some participants used both recommendations (13.2 % and 19.2 %). IMRT (68.6 % and 59.1 %) and VMAT (65.6 % and 60.2 %) were the preferred modalities used in heart sparing strategies, followed by deep inspiration breath-hold (DIBH) (54.8 % and 37.4 %) and partial breast irradiation (PBI) (41.6 % and 24.6 %). Only a small percentage of all ROs reported the dose-volume constraints for OAR used in routine clinical practice. A mean heart dose (Heart-Dmean) between 4 and 5 Gy was the most frequently reported parameter (17.2 % and 39.3 %). Conclusion The delineation approaches and sparing techniques for OAR in BC RT vary between ROs worldwide. The low response rate to the dose constraints subset of queries reflects the uncertainty surrounding this topic and supports the need for detailed consensus recommendations in the clinical practice.
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Affiliation(s)
- Monica-Emila Chirilă
- Radiation Oncology Department, Amethyst Radiotherapy Centre, Cluj-Napoca, Romania
- Department of Clinical Development, MVision AI, Helsinki, Finland
| | - Fatjona Kraja
- Surgery Department, Faculty of Medicine, University of Medicine Tirana, Albania
- Department of Oncology, University Hospital Centre Mother Teresa, Tirana, Albania
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
- Post-Graduation Program, Radiology and Oncology Department, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Wellington Furtado Pimenta Neves Junior
- Department of Radiation Oncology, Hospital Sirio Libanês, São Paulo, Brazil
- Post-Graduation Program, Radiology and Oncology Department, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Gustavo Viani de Arruda
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - André Guimarães Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Pierfrancesco Franco
- Department of Translational Sciences (DIMET), University of Eastern Piedmont, Novara, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Faculty of Medicine and Health Sciences, University of Antwerp, Iridium Netwerk, Wilrijk-Antwerp, Belgium
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Slovenia
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Starling MTM, Thibodeau S, de Sousa CFPM, Restini FCF, Viani GA, Gouveia AG, Mendez LC, Marta GN, Moraes FY. Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings. Cancers (Basel) 2024; 16:539. [PMID: 38339290 PMCID: PMC10854666 DOI: 10.3390/cancers16030539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care.
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Affiliation(s)
| | - Stephane Thibodeau
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
| | | | | | - Gustavo A. Viani
- Department of Medical Imagings, Ribeirão Preto Medical School, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto 14049-900, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Andre G. Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
- Division of Radiation Oncology, Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Lucas C. Mendez
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Gustavo Nader Marta
- Radiation Oncology Department, Hospital Sirio Libanês, Sao Paulo 01308-050, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
| | - Fabio Ynoe Moraes
- Division of Radiation Oncology, Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON K7L 3N6, Canada
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, Brazil
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