Accelerated Regimens of Adjuvant Radiotherapy in the Treatment of Breast Cancer

Abstract

Treatment of breast cancer (BC) is a complex multidisciplinary problem. Often, radiation therapy is an obligatory component of treatment of breast cancer patients. Numerous large randomized trials have proved the efficacy of adjuvant radiotherapy in both the standard fractionation regimen in a single focal dose of 2 Gy to a total focal dose of 50 Gy for 25 fractions and in modes of hypofractionation using radiation exposure at a larger daily dose with a reduction in the total treatment time. The presented review summarizes the data of the largest studies on the modes of hypofractionation of postoperative radiotherapy for breast cancer. Most of the studies comparing the standard mode of fractionation of postoperative radiotherapy with the modes of hypofractionation showed comparable results for the main oncological parameters with similar tolerability, frequency of complications and good cosmetic results. It also shows the economic feasibility of applying accelerated regimes in everyday practice. Despite the fact that radiotherapy in the mode of hypofractionation has already become the standard of treatment and is recommended for use by the largest European and American cancer associations, indications for its conduct, the criteria for selection in the studies and the range of recommended single focal doses differ. The obtained results do not give an opportunity to confidently judge the advantage of one or another regime. It is necessary to determine the factors of a favorable and unfavorable prognosis, to clarify the indications for the use of various radiotherapy techniques. Therefore, questions about the optimal mode of hypo-fractionation of adjuvant radiotherapy, the timing of its initiation and the criteria for selecting patients for this type of therapy as part of the comprehensive treatment of breast cancer have not yet been fully resolved. Also open is the choice of optimal single and total doses of radiation, its combination with drug therapy.

Value Analysis of Neoadjuvant Radiotherapy for Breast Cancer after Modified Radical Mastectomy Based on Data Mining

“…For patients treated with endocrine therapy, menopausal status should be considered in the selection of drugs. Molecular targeted therapy must be clarified with HER2 gene testing results [ 15 ]. While informing patients of possible complications, attention should be paid to supportive therapy, treatment of complications, psychotherapy, and rehabilitation training so that patients can obtain the best treatment outcome.…”

“…In the early screening of breast cancer, the clinical intelligence system gives the location and localization of mass lesions and calcified lesions through the analysis of image data. The computer is used to improve the efficiency of medical film reading, reduce the rate of diagnostic failure and misdiagnosis, and provide quantitative image interpretation reports to help doctors and patients better understand the condition [ 15 ].…”

Radiation-Induced Damage to the Cardiovascular System After Radiation Therapy in Women With Breast Cancer

“…According to the operational information of the National Cancer Register of Ukraine, the specific weight of patients with stages I-II of breast cancer among patients first diagnosed in life in 2018 was 74.2 % [5]. Despite modern achievements of drug therapy, improvement of surgical methods, radiation thera py remains an important component of a multidis ciplinary approach in the treatment of this pathol ogy and for many patients is an integral component of breast cancer treatment in the postoperative period, both after breast conserving operations and after radical mastectomies [6][7][8][9][10][11][12]. However at the same time, an important problem is delayed post radiation pathology of the heart, which worsens the quality of life and increases the risk of cardiac mor tality 10 or more years after radiation therapy (RT).…”

“…За даними оперативної інформації націо нального канцер реєстру України, питома вага хво рих на РМЗ І-ІІ стадії серед пацієнтів з числа із вперше виявленим у житті діагнозом в 2018 р. стано вила 74,2 % [5]. Незважаючи на сучасні досягнення медикаментозної терапії, вдосконалення хірургічних методів, променева терапія залишається важливим компонентом мультидисциплінарного підходу в лікуванні даної патології і у багатьох пацієнтів є не від'ємним компонентом лікування РМЗ в післяопе раційний період, як після органозберігаючих опера тивних втручань, так і після радикальних мастек томій [6][7][8][9][10][11][12]. Але при цьому важливою проблемою постає віддалена післяпроменева патологія серця, яка погіршує якість життя і підвищує ризик серцевої смертності через 10 і більше років після ПТ.…”