Accelerated partial breast irradiation using 3D conformal radiotherapy: Toxicity and cosmetic outcome

Gatti, Marco; Ponzone, Riccardo; Bresciani, S.; Panaia, Rocco; Kubatzki, Franziska; Virgilio, Maria Rosaria Di; Salatino, A.; Baiotto, Barbara; Montemurro, Filippo; Stasi, M.; Gabriele, P.

doi:10.1016/j.breast.2013.07.042

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…Prior trials of external beam APBI assessing cosmetic subdomains have used varying scales and evaluated different subdomains, making comparisons across studies difficult. These included the use of RTOG, 19,39 CTCAE, 14,22,[40][41][42][43] and European Organization for Research and Treatment of Cancer 44 scales, as well as the use of a Multi-Skin-Center MC-750-B2 probe to objectively assess fibrosis in 1 study. 18 In a phase 2 trial of 158 patients at the University of Kentucky assessing once weekly 30 Gy/5 fractions (later amended to 28.5Gy/5 fractions) WBI, a similar 9 parameter Breast Cancer Treatment Outcome Scale subdomain scale was used, and they reported volume loss (28%), retraction (18%), and scarring (18%) as being the subdomains most frequently affecting cosmesis.…”

Section: Discussionmentioning

confidence: 99%

“…Other trials of external beam APBI have similarly reported low rates of CTCAE grade 1þ hyperpigmentation (3%-18%). 40,41,43,44 Although 9 distinct cosmetic subdomains were assessed in this trial, some subdomain scores may not be reliable via digital photography alone without physical examination correlation. When evaluating the Fleiss k scores at all time points, all subdomains reached significance except for telangiectasia.…”

Section: Discussionmentioning

confidence: 99%

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Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer

Rahimi

Morgan

Kim

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer

Rahimi

Morgan

Kim

et al. 2021

International Journal of Radiation Oncology*Biology*Physics

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“…APBI with 3D-CRT is noninvasive and linear accelerator based, delivered with modern techniques, and may be less costly. Different studies have reported outcomes with APBI, [7][8][9][10][11][12][13] and few have reported unfavorable outcomes for cosmesis. [16][17][18][19] This study was designed to compare APBI with WBI after BCS in women with breast cancer.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Toxicity and Cosmetic Outcomes After Accelerated Partial Breast Irradiation or Whole Breast Irradiation Using 3-Dimensional Conformal External Beam Radiation Therapy

Yadav

Loganathan

Sharma

et al. 2020

Advances in Radiation Oncology

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To compare rates of acute and late skin toxicities and cosmetic outcomes after accelerated partial breast irradiation (APBI) or whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy in women with breast cancer after breast conservation surgery (BCS). Methods and Materials: Women >35 years of age with invasive or noninvasive breast cancer 4 cm treated by BCS were randomized to 3D-CRT APBI (34 Gy/10 fractions/5 days) or WBI (40 Gy/16 fractions/3 weeks AE boost irradiation). The primary outcome was ipsilateral breast tumor recurrence. Important secondary outcomes were skin toxicities using Radiation Therapy Oncology Group scores, Late Effects Normal Tissue Task Force and Subjective, Objective, Management, Analytic scales, and adverse cosmetic outcome. This interim analysis focuses on the secondary endpoints of radiation toxicities and cosmesis. Patient and tumor characteristics and rates of adverse cosmetic outcomes and skin toxicities were compared using Fisher exact tests. All statistical tests were 2 sided, with P < .05 considered statistically significant. Results: Between June 2011 and December 2015, 133 women with breast cancer were randomized to 3D-CRT APBI or WBI. Patient and tumor characteristics were balanced between the 2 arms. Median follow-up was 60 months (range, 12-93 months). Grade 4 late toxicity was not seen in either of the treatment arms, and grade 3 toxicity was very low for each endpoint assessed in both the groups. The rates of grade !2 acute dermatitis were 8% and 15%, respectively, for APBI and WBI (P Z .18). Rates of grade !1 late radiation toxicities were higher in the WBI arm compared with the APBI arm for breast shrinkage (P Z .008), pigmentation (P Z .028), fibrosis (P Z .040), induration (P Z .048), and edema (P Z .33). Adverse cosmesis at last follow-up was significantly higher in patients treated with WBI: 33% compared with 6% with APBI (P < .001). Conclusions: In women with breast cancer after BCS, APBI was associated with better cosmetic outcome and fewer late radiation toxicities than WBI.

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“…Entre as técnicas disponíveis para a IPM, há a própria radioterapia conformacional (Gatti et al, 2013;Goyal et al, 2013;Mózsa et al, 2014;Olivotto et al, 2013), a braquiterapia (Aristei et al, 2017;Hepel et al, 2014;Major et al, 2016;Ott et al, 2016;Polgár et al, 2017;Shah et al, 2018;Strnad et al, 2016) e a radioterapia intraoperatória com elétrons (IOeRT) (Veronesi et al, 2013). A radioterapia intraoperatória com fótons (IOpRT), também descrita na literatura, é, neste momento, de utilização desaconselhada.…”

Section: Introductionunclassified

Radioterapia intraoperatória com elétrons no tratamento do câncer de mama inicial – revisão bibliográfica e análise econômica

Santos¹

2019

JBES

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RESUMOObjetivos: Comparar os resultados de controle local e sobrevida global e fazer uma análise econômica comparativa da radioterapia intraoperatória com elétrons (IOeRT) para o tratamento da neo plasia de mama inicial, em comparação à radioterapia conformacional de toda a mama (RT 3D). Métodos: Foi feita revisão sistemática da literatura e, posteriormente, considerando-se os resultados comparáveis de eficácia, análise de minimização de custos, comparando as técnicas mencionadas anteriormente. Resultados: Foi incluído um estudo randomizado. Observou-se pequeno aumento do número de falhas locais em cinco anos (4,4 vs. 0,4%), sem alteração, porém, na sobrevida global. Quando se restringiu o estudo às mulheres com tumores de até 2,0 cm de diâmetro, grau I ou II, com axila negativa ou com até três linfonodos comprometidos e com tumores não classificados como triplos-negativos, chegou-se a um nível comparável de controle local (1,5% de recidivas em cinco anos), sem diferenças significativas no tocante aos efeitos secundários ao tratamento. Em análise econômica posterior, optou-se, então, pelo estudo de minimização de custos, sob a perspectiva das operadoras de saúde do sistema de saúde privado brasileiro, tendo como base os custos dos procedimentos descritos na Classificação Brasileira Hierarquizada de Procedimentos Médicos (CBHPM), 5ª edição. Nesta análise, observou-se que a aplicação da IOeRT implica uma economia de recursos da ordem de 51,5% por tratamento. Conclusão: Conclui-se que a IOeRT é opção que leva à economia de recursos quando utilizada no tratamento de mulheres com câncer de mama inicial, sob a perspectiva das operadoras de saúde do Brasil, quando observados os critérios de inclusão descritos previamente. ABSTRACTObjectives: To compare local control and overall survival and perform an economic analysis between intraoperative electron beam radiation therapy (IOeRT) and conformal radiotherapy, directed to the whole breast (RT 3D), for the treatment of early breast cancer. Methods: A systematic review of the literature was performed, with the inclusion of 1 controlled randomized study, comparing IOeRT with standard treatment -RT 3D, in early breast cancer. Posteriorly, due to comparable results between the studied techniques, a cost-minimization analysis was executed. Results: There was a small increase in the number of local failures, in 5 years (4.4 vs. 0.4%), but with no changes in overall survival. When the analysis was restricted to women with tumors up to 2.0 cm, grades I or II, with negative axilla or with up to 3 compromised lymph nodes and with tumors not classified as triple-negative, a comparable level of local control was reached (1.5% over 5 years), without significant differences in treatment side effects. In the following economic analysis, a cost minimization study was chosen, once both treatments were equivalent, considering local control and overall survival. The perspective was that of the Brazilian private healthcare system, based on the costs of the procedures according to the Brazilia...

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Accelerated partial breast irradiation using 3D conformal radiotherapy: Toxicity and cosmetic outcome

Abstract: APBI using 3D-CRT is technically feasible with very low acute and late toxicity. Long-term results are needed to assess its efficacy in reducing the incidence of breast relapse.

Cited by 5 publications

References 23 publications

Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer

Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer

Comparison of Toxicity and Cosmetic Outcomes After Accelerated Partial Breast Irradiation or Whole Breast Irradiation Using 3-Dimensional Conformal External Beam Radiation Therapy

Radioterapia intraoperatória com elétrons no tratamento do câncer de mama inicial – revisão bibliográfica e análise econômica

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