Accelerated partial breast irradiation: advances and controversies

Akhtari, Mani; Teh, Bin S.

doi:10.1186/s40880-016-0095-1

Cited by 13 publications

(12 citation statements)

References 41 publications

(38 reference statements)

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“…One of the limitations of our study is the use of 'classic' external beam radiotherapy. Though it is still commonly in use, the forefront in radiotherapy is shorter treatment protocols, intra-surgical radiation and others ( 23 ). Also, it needs to be considered that the intention of the paper was not to provide information on disease-free survival even though the number of patients was fair, but to show the necessity of marking the tumor bed with clips in order to make radiotherapy more precise.…”

Section: Discussionmentioning

confidence: 99%

To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer

Ebner

Gregorio

Rempen

et al. 2017

J Turkish German Gynecol Assoc

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Objective:Planning of breast radiation for patients with breast conserving surgery often relies on clinical markers such as scars. Lately, surgical clips have been used to identify the tumor location. The purpose of this study was to evaluate the geographic miss index (GMI) and the normal tissue index (NTI) for the electron boost in breast cancer treatment plans with and without surgical clips.Material and Methods:A retrospective descriptive study of 110 consecutive post-surgical patients who underwent breast-conserving treatment in early breast cancer, in which the clinical treatment field with the radiologic (clipped) field were compared and GMI/NTI for the electron boost were calculated respectively.Results:The average clinical field was 100 mm (range, 100-120 mm) and the clipped field was 90 mm (range, 80-100 mm). The average GMI was 11.3% (range, 0-44%), and the average NTI was 27.5% (range, 0-54%). The GMI and NTI were reduced through the use of intra-surgically placed clips.Conclusion:The impact of local tumor control on the survival of patients with breast cancer is also influenced by the precision of radiotherapy. Additionally, patients demand an appealing cosmetic result. This makes “clinical” markers such as scars unreliable for radiotherapy planning. A simple way of identifying the tissue at risk is by intra-surgical clipping of the tumor bed. Our results show that the use of surgical clips can reduce the diameter of the radiotherapy field and increase the accuracy of radiotherapy planning. With the placement of surgical clips, more tissue at risk is included in the radiotherapy field. Less normal tissue receives radiotherapy with the use of surgical clips.

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Section: Discussionmentioning

confidence: 99%

To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer

Ebner

Gregorio

Rempen

et al. 2017

J Turkish German Gynecol Assoc

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“…A retrospective study found that patients treated with this method had higher rate of mastectomy, when compared to patients treated with the WBI (17). Other studies have noted the increased rates of complications, such as fatt y necrosis and rib fractures (5).…”

Section: Efficacy and Side Effects Of Pbimentioning

confidence: 98%

“…In the case of the whole breast irradiation (WBI) the side eff ects involve the entire breast, as opposed to the partial breast irradiation (PBI), in which the target volume is much smaller. Further rationale for PBI off ers the data that as much as 68% of ipsilateral recurrences occur within 3 cm radius around the tumor bed (5). This, in addition to the fact that the smaller treatment volume allows for the application of higher total radiation dose, this enabling even further shortening of the RT course, has prompted the idea of PBI.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiotherapy of breast cancer - is partial breast irradiation sufficient?

Mikulandra

Beketić-Orešković

2019

lib oncol

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Partial breast irradiation is a relatively novel approach in adjuvant breast cancer radiotherapy. It involves administration of irradiation to a part of the breast, as opposed to the standard practice of irradiation of the whole breast. This method allows delivery of higher radiation dose to smaller volumes, and in shorter period of time. It can be delivered via standard linear accelerators, brachytherapy, or via mobile accelerator units which allow the delivery of a single dose of radiation to the tumor bed intraoperatively. However, the use of partial breast irradiation in standard clinical practice is still controversial. The level of evidence that supports its equality to the whole breast irradiation remains limited. While the results of some prospective randomized trials indicate its applicability in certain, highly selected patients, longer follow-up of patients is necessary to draw defi nitive conclusions.

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“…This type of radiation can be delivered using several techniques: (I) interstitial brachytherapy (high dose rate, pulsed dose rate, permanent implants); (II) brachytherapy using the balloons (Mammosite ® , Contura ® ); (III) hybrid brachytherapy devices [strut-adjusted volume implant (SAVI) applicator]; (IV) external beam radiotherapy (3D, IMRT, VMAT); or (V) intraoperative radiotherapy with electrons or X-rays, (detailed below). A review of these techniques and associated controversies has been reported elsewhere (66,67). © Gland Surgery.…”

Section: Apbimentioning

confidence: 99%

Evolution of radiotherapy techniques in breast conservation treatment

Boyages

Baker

2018

Gland Surg

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Radiation therapy (RT) is an important component of breast cancer treatment that reduces local recurrence and improves survival after breast conservation. Breast conservation rates have increased significantly since the late 1980s and techniques have improved with greater awareness of the impact of radiation on the heart. An overview of randomized controlled trials of breast conservation using standard whole breast irradiation, whole breast hypofractionation, accelerated partial breast irradiation (APBI) and intraoperative radiation are reviewed. Selection criteria for breast conservation and the utility of adding a boost dose to the primary tumor site are reviewed. Modern dose constraints are documented and 10 different radiation techniques from the 1980s through to modern volumetric modulated arc therapy (VMAT) are compared for a patient where the breast and internal mammary nodes are treated. A radiation boost reduces the risk of a recurrence for most, but not all patients. Short courses of RT over 3-4 weeks are generally as effective as longer courses. Short-term follow-up of trials of APBI show promise for selected good prognosis subgroups. The role of intraoperative radiation remains controversial. In the last 30 years, there have been significant advances in radiation techniques. Modern radiotherapy equipment and techniques will reduce complications and improve survival rates.

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Accelerated partial breast irradiation: advances and controversies

Cited by 13 publications

References 41 publications

To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer

To clip or not to clip the breast tumor bed? A retrospective look at the geographic miss index and normal tissue index of 110 patients with breast cancer

Adjuvant radiotherapy of breast cancer - is partial breast irradiation sufficient?

Evolution of radiotherapy techniques in breast conservation treatment

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