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Stick LB, Lorenzen EL, Yates ES, Anandadas C, Andersen K, Aristei C, Byrne O, Hol S, Jensen I, Kirby AM, Kirova YM, Marrazzo L, Matías-Pérez A, Nielsen MMB, Nissen HD, Oliveros S, Verhoeven K, Vikström J, Offersen BV. Selection criteria for early breast cancer patients in the DBCG proton trial - The randomised phase III trial strategy. Clin Transl Radiat Oncol 2021; 27:126-131. [PMID: 33659716 PMCID: PMC7892790 DOI: 10.1016/j.ctro.2021.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Adjuvant radiotherapy of internal mammary nodes (IMN) improves survival in high-risk early breast cancer patients but inevitably leads to more dose to heart and lung. Target coverage is often compromised to meet heart/lung dose constraints. We estimate heart and lung dose when target coverage is not compromised in consecutive patients. These estimates are used to guide the choice of selection criteria for the randomised Danish Breast Cancer Group (DBCG) Proton Trial. MATERIALS AND METHODS 179 breast cancer patients already treated with loco-regional IMN radiotherapy from 18 European departments were included. If the clinically delivered treatment plan did not comply with defined target coverage requirements, the plan was modified retrospectively until sufficient coverage was reached. The choice of selection criteria was based on the estimated number of eligible patients for different heart and lung dose thresholds in combination with proton therapy capacity limitations and dose-response relationships for heart and lung. RESULTS Median mean heart dose was 3.0 Gy (range, 1.1-8.2 Gy) for left-sided and 1.4 Gy (0.4-11.5 Gy) for right-sided treatment plans. Median V17Gy/V20Gy (hypofractionated/normofractionated plans) for ipsilateral lung was 31% (9-57%). The DBCG Radiotherapy Committee chose mean heart dose ≥ 4 Gy and/or lung V17Gy/V20Gy ≥ 37% as thresholds for inclusion in the randomised trial. Using these thresholds, we estimate that 22% of patients requiring loco-regional IMN radiotherapy will be eligible for the trial. CONCLUSION The patient selection criteria for the DBCG Proton Trial are mean heart dose ≥ 4 Gy and/or lung V17Gy/V20Gy ≥ 37%.
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Affiliation(s)
- Line Bjerregaard Stick
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Carmel Anandadas
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Karen Andersen
- Department of Radiotherapy, Herlev & Gentofte Hospital, Herlev, Denmark
| | - Cynthia Aristei
- Department of Medicine and Surgery, Radiation Oncology Section, University of Perugia & Perugia General Hospital, Perugia, Italy
| | - Orla Byrne
- Department of Medical Physics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sandra Hol
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands
| | - Ingelise Jensen
- Department of Medical Physics, Aalborg University Hospital, Aalborg, Denmark
| | - Anna M. Kirby
- Department of Radiotherapy, The Royal Marsden Hospital NHS Foundation Trust & Institute of Cancer Research, London, UK
| | | | - Livia Marrazzo
- Department of Medical Physics, Careggi University Hospital, Florence, Italy
| | | | | | | | - Sileida Oliveros
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karolien Verhoeven
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Johan Vikström
- Department of Radiotherapy, Stavanger University Hospital, Stavanger, Norway
| | - Birgitte Vrou Offersen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Experimental Clinical Oncology & Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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