Accelerated partial breast irradiation for elderly women with early breast cancer: A compromise between whole breast irradiation and omission of radiotherapy

Sumodhee, S.; Levy, Johan; Chamorey, Emmanuel; Kee, D. Lam Cham; Chand, Marie-Eve; Gautier, Mathieu; Peyrottes, Isabelle; Barranger, Emmanuel; Hannoun‐Lévi, Jean‐Michel

doi:10.1016/j.brachy.2017.06.006

Cited by 20 publications

(14 citation statements)

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“…survival rate with or without adjuvant WBI (24). Our results suggested that the 10-year mastectomy-free survival rate observed after APBI was 97.4% vs. 96.3% after WBI ( p 5 1) and 92.7% without irradiation ( p 5 0.27), leading to consider APBI, at least, as effective as WBI, but without the burden of 4e6 treatment weeks (25). Currently, APBI based on HDR MIB delivers a total dose ranged from 30.1 to 34 Gy, in 7e10 fractions twice daily, during 4e5 consecutive days (7,26).…”

Section: Discussionmentioning

confidence: 70%

Accelerated partial breast irradiation in the elderly: 5-Year results of the single fraction elderly breast irradiation (SiFEBI) phase I/II trial

et al. 2020

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PURPOSE: To evaluate the clinical outcomes of a very-accelerated partial breast irradiation (vAP-BI) in the elderly based on a single fraction of multicatheter interstitial high-dose rate brachytherapy (MIB). Mature results with a median follow-up of 5 years. METHODS AND MATERIALS: From November 2012 to September 2014, 26 patients (pts) ($70) with early breast cancer were enrolled in a prospective phase II trial (NCT01727011). After lumpectomy, intraoperative catheter implant was performed for postoperative APBI (single fraction 16 Gy). Surveillance was performed twice a year after APBI. Oncologic outcome (local [LRFS], metastasis-free survival, cancer-specific survival, and overall survival [OS]) as well as late toxicity and cosmetic outcome were investigated. RESULTS: Median age was 77 years [69e89]. After a median follow-up of 63 months [60e68], 5-year LRFS, metastasis-free survival, cancer-specific survival, and overall survival rates were 100%, 95.5%, 100%, and 88.5%, respectively. Late toxicity was observed in 5 pts (19.2%) with a total of five events: 3 pts G1 (60%); and 2 pts G2 (40%). The observed late side effects were breast pain in 1 pt (G2 cytosteatonecrosis with occasional acetaminophen consumption), hypopigmentation (puncture site) in 2 pts (G1) and breast fibrosis in 2 pts (G1: 1 pt; G2: 1 pt). Cosmetic evaluation was excellent for 21 pts (81%) and good for 2 pts (19%). CONCLUSION: For elderly with early breast cancer, a vAPBI using a single fraction of postoperative MIB (16 Gy) provides excellent oncologic results, mainly in terms of local control and cancer death. Late toxicity and cosmetic profile are acceptable.

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Section: Discussionmentioning

confidence: 70%

Accelerated partial breast irradiation in the elderly: 5-Year results of the single fraction elderly breast irradiation (SiFEBI) phase I/II trial

et al. 2020

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“…Treatment decisions in elderly cancer patients need to focus not only on local control and overall survival but primarily on quality of life. Sumodhee et al [45 ]and Genebes et al [46] demonstrated in their studies that MIB can perfectly apply sufficient local irradiation with maximum preservation of OAR in a very short treatment period with excellent local control and low acute and chronic side effects. This could be an ideal alternative for elderly breast cancer patients, representing a compromise between omitting radiotherapy and a whole course of WBI.…”

Section: Role Of Brachytherapy In Accelerated Partial Breast Irradiationmentioning

confidence: 99%

The Role of Brachytherapy in the Treatment of Breast Cancer

Kauer-Dorner

Berger

2018

Breast Care

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Radiotherapy plays an important part in the management of breast cancer. Especially after breast-conserving surgery, external whole breast irradiation, occasionally with an additional local boost, is an integral part of breast conservation. Besides external radiation techniques, brachytherapy (BT) has long been among the treatment options, especially with regard to local boost application. With the emerging implementation of accelerated partial breast irradiation (APBI), BT in general and interstitial multi-catheter BT in particular, are gaining an increasing role in the management of a selected group of early breast cancer patients. APBI is an approach to reduce the irradiated area to the former tumor bed rather than treating the whole breast tissue in patients with a low baseline local recurrence risk. After a variety of phase I-III clinical studies, it is clearly evident that APBI will play a role in the treatment of this selected patient group. In this review, we focus on the clinical development and different available techniques of breast BT and provide a preview of prospects for its use.

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“…Only one study is randomized [36], two studies are phase II [37,38], and 4 studies are retrospective investigations [39][40][41][42]. Following the defined selection criteria, only data from the APBI treatments in elderly patients were extracted and considered for the analysis.…”

Section: Resultsmentioning

confidence: 99%

Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion

Tagliaferri

Lancellotta

Colloca

et al. 2020

Journal of Oncology

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Introduction. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. Material and Method. A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results. Seven papers fulfilled the eligibility criteria. The number of evaluated patients was 405 and the median age was 77.7 years. The disease-free survival (DFS) range was 96.1%–100%, the grade 3-4 toxicity range was 0%–6.6%, the cancer-specific survival (CSS) range was 97.9%–100%, and the overall survival (OS) range was 87%–100%. All studies reported excellent/good cosmetic results in a range of 74% to 99%. Conclusion. Accelerated partial breast irradiation (APBI) results in a safe and effective substitute for the adjuvant external beam radiotherapy in selected elderly early-stage breast cancer patients. Based on the relatively low toxicity, APBI should be advised in selected patients with life expectancies larger than 5–10 years.

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Accelerated partial breast irradiation for elderly women with early breast cancer: A compromise between whole breast irradiation and omission of radiotherapy

Cited by 20 publications

References 34 publications

Accelerated partial breast irradiation in the elderly: 5-Year results of the single fraction elderly breast irradiation (SiFEBI) phase I/II trial

Accelerated partial breast irradiation in the elderly: 5-Year results of the single fraction elderly breast irradiation (SiFEBI) phase I/II trial

The Role of Brachytherapy in the Treatment of Breast Cancer

Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion

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