Accelerated Treatment of Breast Cancer

Vicini, Frank A.; Baglan, Kathy; Kestin, Larry L.; Mitchell, C.; Chen, Peter Y.; Frazier, Robert C.; Edmundson, Greg; Goldstein, Neal S.; Benitez, Pamela; Huang, Ran; Martínez, Álvaro

doi:10.1200/jco.2001.19.7.1993

Cited by 206 publications

(33 citation statements)

References 41 publications

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“…The widely varied biological characteristics of patients with breast cancer, evidenced in clinical, pathological, cellular, and molecular studies, are sufficient to explain the diversity of treatments recommended over the past two decades [12]. Recent years have seen the introduction of changes from conventional radiotherapy at 5 × 1.8 to 2.0 Gy per week to more aggressive schedules such as unconventional protocols [13] or radiochemotherapy [11]. The gradually increasing success of cancer treatments has led to longer patient survival.…”

Section: Introductionmentioning

confidence: 99%

Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes

et al. 2005

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Introduction Radiotherapy outcomes might be further improved by a greater understanding of the individual variations in normal tissue reactions that determine tolerance. Most published studies on radiation toxicity have been performed retrospectively. Our prospective study was launched in 1996 to measure the in vitro radiosensitivity of peripheral blood lymphocytes before treatment with radical radiotherapy in patients with breast cancer, and to assess the early and the late radiation skin side effects in the same group of patients. We prospectively recruited consecutive breast cancer patients receiving radiation therapy after breast surgery. To evaluate whether early and late side effects of radiotherapy can be predicted by the assay, a study was conducted of the association between the results of in vitro radiosensitivity tests and acute and late adverse radiation effects.

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Section: Introductionmentioning

confidence: 99%

Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes

et al. 2005

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“…New data and the newest treatments available indicate the need to re-think our general approach to endocrine therapy and endocrine prevention (Howell et al 2001). This is of particular interest today because the results of new combined therapies, including chemotherapy, endocrine therapy and radiotherapy modalities, have also been reported (Crump et al 1997, Brain et al 1999, Zambetti et al 1999, Tan et al 2001, Vicini et al 2001.…”

Section: Mechanism and Tolerability Of Hormone Therapies In Breast Camentioning

confidence: 99%

“…Because 5 weeks of whole-breast radiotherapy results in one of the most significant impediments to the widespread use of breast-conserving techniques, acceleration of treatment by confining radiotherapy to the tumour bed has recently been explored. The result of the accelerated treatments using an interstitial implant to deliver radiation to the tumour bed alone over 4-5 days seemed to produce 5-year results equivalent to those achieved with conventional treatment (Vicini et al 2001). In Vicini et al (2001), selection criteria were highly restrictive and follow-up was relatively short.…”

Section: The Objectives Of Combined Therapymentioning

confidence: 99%

“…The result of the accelerated treatments using an interstitial implant to deliver radiation to the tumour bed alone over 4-5 days seemed to produce 5-year results equivalent to those achieved with conventional treatment (Vicini et al 2001). In Vicini et al (2001), selection criteria were highly restrictive and follow-up was relatively short. Extended follow-up will therefore be required to determine the long-term efficacy of this treatment approach.…”

Section: The Objectives Of Combined Therapymentioning

confidence: 99%

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Interactions between radiotherapy and endocrine therapy in breast cancer.

Moral

L√≥pez²,

N√∫√±ez³

et al. 2002

Endocrine-Related Cancer

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Whenever radiation therapy is given with curative intent there is the risk of serious damage to normal tissue. This risk increases with the dose of radiation, as does the probability of local tumour control. In the attempt to cure, the doses reach a level that inevitably causes some undesirable adverse effects, ranging from undetectable, or minimal, to unacceptably severe. Over the last few years, a number of reports have suggested that the prediction of normal tissue response after radiotherapy may be achieved by assays on samples withdrawn from the patients prior to treatment, although recent reports have described mixed results. The ability to predict tumour response to anti-hormones in patients with breast cancer has important implications with regard to treatment. Recent discoveries promise to provide individualized treatment options. However, there are no data to support that, used jointly, the combination of radiotherapy and hormone therapy may achieve an enhancement of breast cancer tumour response. Nowadays, development in cancer therapy is increasingly arising out of studies in basic science; its implementation in the hands of clinicians is improving the management of patients with cancer. In addition, as the biological aspects of irradiation and hormonal therapy offer an explanation, at least in part, for the outcome observed in patients with breast cancer after therapy, we have focused this review on trying to analyse the most relevant experimental research about the relative roles of radiotherapy and hormonal therapy, the corresponding side-effects and, taking into account recent advances, future areas of research that we consider of major importance in the field.

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“…As an alternative to conventional WB-EBRT, partial breast irradiation (PBI) using intra-operative radiotherapy (IORT) or other modalities such as MammoSite, brachytherapy, high-conformal EBRT have been recently proposed [7–11] and are currently under clinical evaluation. As yet, there is no firmly established standardised IORT dose for PBI in early breast cancer.…”

Section: Introductionmentioning

confidence: 99%

ecancermedicalscience

Paganelli

Cicco

Ferrari

et al.

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Background:Breast conserving surgery (BCS) plus external beam radiotherapy (EBRT) is considered the standard treatment for early breast cancer. We have investigated the possibility of irradiating the residual gland, using an innovative nuclear medicine approach named IART® (Intra-operative Avidination for Radionuclide Therapy).Aim:The objective of this study was to determine the optimal dose of avidin with a fixed activity (3.7 GBq) of 90Y-biotin, in order to provide a boost of 20 Gy, followed by EBRT to the whole breast (WB) at the reduced dose of 40 Gy. Local and systemic toxicity, patient’s quality of life, including the cosmetic results after the combined treatment with IART® and EBRT, were assessed.Methods:After tumour excision, the surgeon injected native avidin diluted in 30 ml of saline solution into and around the tumour bed (see video). Patients received one of three avidin dose levels: 50 mg (10 pts), 100 mg (15 pts) and 150 mg (10 pts). Between 12 to 24 h after surgery, 3.7 GBq 90Y-biotin spiked with 185 MBq 111In-biotin was administered intravenously (i.v.). Whole body scans and SPECT images were performed up to 30 h post-injection for dosimetric purposes. WB-EBRT was administered four weeks after the IART® boost. Local toxicity and quality of life were evaluated.Results:Thirty-five patients were evaluated. No side effects were observed after avidin administration and 90Y-biotin infusion. An avidin dose level of 100 mg resulted the most appropriate in order to deliver the required radiation dose (19.5 ± 4.0 Gy) to the surgical bed. At the end of IART®, no local toxicity occurred and the overall cosmetic result was good. The tolerance to the reduced EBRT was also good. The highest grade of transient local toxicity was G3, which occurred in 3/32 pts following the completion of WB-EBRT. The combination of IART®+EBRT was well accepted by the patients, without any changes to their quality of life.Conclusions:These preliminary results support the hypothesis that IART® may represent a valid approach to accelerated WB irradiation after BCS. We hope that this nuclear medicine technique will contribute to a better management of breast cancer patients.

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Accelerated Treatment of Breast Cancer

Cited by 206 publications

References 41 publications

Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes

Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes

Interactions between radiotherapy and endocrine therapy in breast cancer.

ecancermedicalscience

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