APBI Versus Ultra-APBI in the Elderly With Low-Risk Breast Cancer: A Comparative Analysis of Oncological Outcome and Late Toxicity

Hannoun‐Lévi, Jean‐Michel; Montagné, Lucile; Sumodhee, S.; Schiappa, Renaud; Boulahssass, Rabia; Gautier, Mathieu; Gal, Jocelyn; Chand, Marie-Eve

doi:10.1016/j.ijrobp.2021.03.052

Cited by 16 publications

(4 citation statements)

References 39 publications

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“…Equivalence of accelerated partial breast radiation delivered by external beam has been demonstrated in several clinical trials and endorsed for women with tumors with favorable biology, and together with ultra-hypofractionation, may be an attractive option in resource-restricted regions. Investigations for further de-intensifying radiation schedules using ultra-accelerated partial breast radiation as a single fraction are being planned to be tested against accelerated partial breast radiation + endocrine therapy [199,200].…”

Section: Discussionmentioning

confidence: 99%

Recent Advances in Optimizing Radiation Therapy Decisions in Early Invasive Breast Cancer

Riaz

Jeen

Whelan

et al. 2023

Cancers

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Adjuvant whole breast irradiation after breast-conserving surgery is a well-established treatment standard for early invasive breast cancer. Screening, early diagnosis, refinement in surgical techniques, the knowledge of new and specific molecular prognostic factors, and now the standard use of more effective neo/adjuvant systemic therapies have proven instrumental in reducing the rates of locoregional relapses. This underscores the need for reliably identifying women with such low-risk disease burdens in whom elimination of radiation from the treatment plan would not compromise oncological safety. This review summarizes the current evidence for radiation de-intensification strategies and details ongoing prospective clinical trials investigating the omission of adjuvant whole breast irradiation in molecularly defined low-risk breast cancers and related evidence supporting the potential for radiation de-escalation in HER2+ and triple-negative clinical subtypes. Furthermore, we discuss the current evidence for the de-escalation of regional nodal irradiation after neoadjuvant chemotherapy. Finally, we also detail the current knowledge of the clinical value of stromal tumor-infiltrating lymphocytes and liquid-based biomarkers as prognostic factors for locoregional relapse.

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Section: Discussionmentioning

confidence: 99%

Recent Advances in Optimizing Radiation Therapy Decisions in Early Invasive Breast Cancer

Riaz

Jeen

Whelan

et al. 2023

Cancers

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“…Single-fraction high-dose brachytherapy dose delivered ranged between 16 and 21 Gy. Median ages of patients treated ranged from 64 to 77 years, and included patients with early-stage breast cancer [18][19][20][21][22][23][24].…”

Section: Breastmentioning

confidence: 99%

Single-fraction high-dose-rate brachytherapy: a scoping review on outcomes and toxicities for all disease sites

Kazemi¹,

Nadarajan²,

Kamrava³

2022

jcb

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Purpose: Brachytherapy is well positioned to safely deliver highly conformal single-fraction doses of radiation, which can lower costs and improve efficiency. Traditionally, high-dose-rate brachytherapy (HDR-BT) has been delivered over multiple treatments. A scoping literature review was conducted to better understand the available literature on single-fraction HDR-BT for all disease sites.Material and methods: According to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, PubMed database was queried from 1994-2021 using the following search terms: 'brachytherapy', 'highdose-rate', and 'single-fraction'. A total of 53 studies met our exclusion criteria.Results: Liver had the highest number of studies, with a total of 618 patients treated with doses ranging from 8 to 25 Gy. Median follow-up ranged from 11-33 months. Local control (LC) rates ranged from 37% to 98%. G3 acute/late toxicities or higher were reported in 3 patients. Prostate cancer included a total of 1,474 patients treated with doses ranging from 19 to 21 Gy. Median follow-up ranged from 20 to 72 months. Prostate specific antigen (PSA) control outcomes after definitive treatment ranged from 65% to 94%, and salvage treatments from 5% to 84%. G3 acute/late toxicities or higher ranged from 0 to 6%. Breast cancer included a total of 268 patients treated with doses ranging from 16 to 20 Gy. Median follow-up ranged from 24 to 72 months. LC rates were 100%. G3 acute toxicities or higher ranged from 0 to 6%. Regarding other cancers, conclusions were limited given the small number of patients within each respective site.Conclusions: Currently used regimens appear safe, but efficacy vary by different disease sites. Outcomes are more promising for breast and liver, while are less encouraging for prostate. Additional prospective evaluation of single-fraction HDR-BT regimens are warranted.

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“…Tampoco se reportaron diferencias en toxicidad, ni en resultado estético entre las cohortes (p=0,677 y p=0,98). A pesar de las limitaciones de este análisis retrospectivo comparativo, los autores apuestan que la estrategia de fracción única en población seleccionada es factible y ofrece resultados de control oncológico y toxicidad alentadores (205). Bajo esta línea de investigación, dos esquemas de dosis única han sido publicados.…”

Section: Resultados Oncológicos Del Programa Mitbiand4f-ambiunclassified

“…En esta línea de investigación, el grupo liderado por Hannoun-Lévi et al ha comparado retrospectivamente su experiencia con fraccionamiento convencional frente a la fracción única en un grupo muy seleccionado de pacientes. Con un seguimiento mediano de 6 años, no se han observado diferencias ni en los resultados oncológicos reportados, ni en la toxicidad crónica, ni en el resultado estético entre las cohortes (205). Futuros ensayos clínicos prospectivos deberán ser desarrollados para evaluar la eficacia clínica de esquemas ultra-acelerados en pacientes correctamente seleccionadas.…”

Section: Líneas Futuras De Trabajounclassified

Estudio de factibilidad, seguridad y eficacia de la irradiación ultra-acelerada de mínimo volumen empleando técnica de braquiterapia perioperatoria en cáncer precoz de mama

Gimeno¹

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Estudio de factibilidad, seguridad y eficacia de la irradiación ultra-acelerada de mínimo volumen empleando técnica de braquiterapia perioperatoria en cáncer precoz de mama.MARTA GIMENO MORALES PAMPLONA, 2021. CLASIFICACIÓN HISTOLÓGICALa clasificación histológica o anatomo-patológica está basada en el tipo de célula y su disposición arquitectural. Una reciente actualización de la OMS del año 2019 (5) reclasifica los diferentes tipos histológicos del cáncer de mama de origen epitelial, tal y como se muestra en la tabla 1: Tabla 1: Clasificación histológica OMS 2019. Carcinoma ductal in situ (CDIS) Carcinoma intraductal, no infiltrante, NOS. -CDIS de bajo grado nuclear. -DCIS de grado nuclear intermedio. -DCIS de alto grado nuclear. Carcinoma de mama invasivo Carcinoma ductal infiltrante, NOS. (CDI) Carcinoma oncocítico. Carcinoma "lipid-rich". Carcinoma "glycogen-rich". Carcinoma sebáceo. Carcinoma lobulillar, NOS. Carcinoma tubular. Carcinoma cribiforme, NOS. Adenocarcinoma mucinoso. Cistoadenocarcinoma mucinoso, NOS Carcinoma micropapilar invasivo. Adenocarcinoma apocrino. Carcinoma metaplásico, NOS.Para el CDIS, tanto el nuevo compendio de la OMS como el colegio de patólogos americanos (CAP) recomiendan el uso de la morfología citonuclear para la graduación (6). De manera que, a través de la evaluación nuclear (pleomorfismo, el tamaño, la orientacion, la presencia o ausencia de cromatina, nucleolos y mitosis), se establecen tres categorías: bajo grado, grado intermedio y alto grado. Además, la presencia o ausencia de necrosis, clasificada como central ("comedo") o focal, debe ser descrita en el informe de anatomía patológica.Para los CDI, el grado histológico se evalúa con la clasificación de Nottingham (7,8) como referencia semi-cuantitativa de la estructura morfológica. Mediante la evaluación de tres características (la diferenciación tubular, el pleomorfismo nuclear y el número de mitosis) que son puntuadas con una escala numérica de 1 a 3, se obtienen tres categorías:

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APBI Versus Ultra-APBI in the Elderly With Low-Risk Breast Cancer: A Comparative Analysis of Oncological Outcome and Late Toxicity

Cited by 16 publications

References 39 publications

Recent Advances in Optimizing Radiation Therapy Decisions in Early Invasive Breast Cancer

Recent Advances in Optimizing Radiation Therapy Decisions in Early Invasive Breast Cancer

Single-fraction high-dose-rate brachytherapy: a scoping review on outcomes and toxicities for all disease sites

Estudio de factibilidad, seguridad y eficacia de la irradiación ultra-acelerada de mínimo volumen empleando técnica de braquiterapia perioperatoria en cáncer precoz de mama

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