Breast conserving therapy versus mastectomy for stage I–II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial

Litière, Saskia; Werutsky, Gustavo; Fentiman, Ian S.; Rutgers, Emiel J. T.; Christiaens, Marie-Rose; Limbergen, Erik; Baaijens, Margreet H.A.; Bogaerts, Jan; Bartelink, Harry

doi:10.1016/s1470-2045(12)70042-6

Cited by 465 publications

(309 citation statements)

References 25 publications

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“…Radiotherapy is an integral component of breast conserving therapy, which has been shown to have equivalent survival compared to mastectomy [1,2]. Long term side effects after radiotherapy for breast cancer, include cardiac toxicities [3], radiation fibrosis and second primary cancers [4,5].…”

Section: Introductionmentioning

confidence: 99%

The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning

Dundas

Pogson

Batumalai

et al. 2018

Practical Radiation Oncology

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The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiotherapy planning, Practical Radiation Oncology (2017Oncology ( ), doi: 10.1016Oncology ( /j.prro.2017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT Title:The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiotherapy planning. Short Title:CT/MRI Supine/Prone Breast RadiotherapyAuthor Details: Conflict of Interest Statement:The authors report a grant (no. APP1033237) from Cancer Australia and the National Breast Cancer Foundation during the conduct of this study. Dr. Pogson reports grants from University of Wollongong, during the conduct of the study.Word Count: 3642 A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT Abstract:Purpose: To evaluate the impact of MRI vs CT derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiotherapy. Methods and Materials:Four WB radiotherapy plans were generated for 28 patients, where PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6MV tangential IMRT technique was used, with plans designated as ideal, acceptable or non-compliant. Dose metrics for PTVs and OARs were compared to analyse any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone).Results: With respect to imaging modality 2/11 WB_PTV dose metrics (V90% and V110%) displayed statistically significant differences, however these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan vs a non-compliant plan were higher for the supine position compared to the prone position (p=0.026). The minimum distance between the seroma cavity (SC)_PTV and the chest-wall was increased with prone positioning, (p<0.001, supine and prone values 1.1 mm and 8.7 mm respectively). Heart volume was greater in the supine position (p=0.005). Heart doses were lower in the supine position than prone (p<0.01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone respectively). Mean lung doses met ideal dose constraints in both positions, however best spared in the prone position. The contra-lateral breast D1cc showed significantly lower doses in the supine position, (p<0.001, 4.64 Gy vs 9.51 Gy). Conclusions:Planning with PTVs generated from MRI data showed no clinically significant differences to planning with PTVs generated from CT with respect to PTV and OAR doses. Prone positioning within this study r...

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Section: Introductionmentioning

confidence: 99%

The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning

Dundas

Pogson

Batumalai

et al. 2018

Practical Radiation Oncology

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“…Breast conserving therapy, consisting of lumpectomy followed by 6 to 7 weeks of whole breast irradiation (WBI), has been shown in multiple randomized trials to produce equivalent clinical outcomes compared to mastectomy, as well as reduced breast cancer mortality when compared to lumpectomy alone [1,2,3,4]. However, the protracted nature of treatment can pose financial and logistical hardships on patients and medical systems [5,6,7].…”

Section: Purposementioning

confidence: 99%

Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow

Shah¹,

Wobb²,

Manyam³

et al. 2016

jcb

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Accelerated partial breast irradiation (APBI) represents an evolving technique that is a standard of care option in appropriately selected woman following breast conserving surgery. While multiple techniques now exist to deliver APBI, interstitial brachytherapy represents the technique used in several randomized trials (National Institute of Oncology, GEC-ESTRO). More recently, many centers have adopted applicator-based brachytherapy to deliver APBI due to the technical complexities of interstitial brachytherapy. The purpose of this article is to review methods to evaluate and select patients for APBI, as well as to define potential workflow mechanisms that allow for the safe and effective delivery of APBI. Multiple consensus statements have been developed to guide clinicians on determining appropriate candidates for APBI. However, recent studies have demonstrated that these guidelines fail to stratify patients according to the risk of local recurrence, and updated guidelines are expected in the years to come. Critical elements of workflow to ensure safe and effective delivery of APBI include a multidisciplinary approach and evaluation, optimization of target coverage and adherence to normal tissue guideline constraints, and proper quality assurance methods.J PurposeBreast conserving therapy, consisting of lumpectomy followed by 6 to 7 weeks of whole breast irradiation (WBI), has been shown in multiple randomized trials to produce equivalent clinical outcomes compared to mastectomy, as well as reduced breast cancer mortality when compared to lumpectomy alone [1,2,3,4]. However, the protracted nature of treatment can pose financial and logistical hardships on patients and medical systems [5,6,7]. Therefore, there has been increased interest in developing shorter treatment courses without compromising treatment efficacy, in particular local control. One such technique is accelerated partial breast irradiation (APBI), which covers the area surrounding the lumpectomy cavity with a margin and typically is completed in one week or less [8]. Multiple studies have compared APBI with WBI and have found equivalent rates of local control and thus, APBI has emerged as a viable, safe treatment option for properly selected patients with early stage breast cancer [9,10,11,12,13]. As interest in and the utilization APBI grows, a standardized approach to treatment and workflow is necessary for many groups. The purpose of this review is to provide clinicians with a guide on patient selection and treatment workflow for patients undergoing brachytherapy-based APBI. Discussion Patient selectionSociety-specific guidelines have utilized a combination of data from patients treated with APBI, data from patients treated with WBI including patterns of failure, and expert opinion to define appropriateness criteria for the utilization of APBI off-protocol (Table 1) [14,15,16,17]. The ASTRO consensus statement, published in 2009, is one of the most commonly utilized guidelines and uses clinical and pathologic features that stratify ...

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“…I 2005 viste imidlertid en metaanalyse resultater som indikerte høyere dødelighet hos kvinner som fikk brystbevarende kirurgi og stråle-behandling enn hos dem som fikk utført mastektomi (8). Nylig publiserte resultater fra en multisenterstudie med 22 års oppføl-ging bestrider imidlertid dette -forfatterne konkluderer med at behandlingsregimer med brystbevarende kirurgi og mastektomi er sidestilt med henblikk på overlevelse og dødelighet (9). En stor registerstudie fra USA viser til og med at mastektomi gir lavere overlevelse enn brystbevarende kirurgi (10).…”

Section: Materiale Og Metodeunclassified

“…Én mulig årsak er metaanalysen utført av Early Breast Cancer Trialists' Collaborative Group, som antydet økt forekomst av lokalt residiv og høyere dødelighet etter brystbevarende kirurgi med påfølgende strålebehandling (8). Funnene er i strid med resultater fra andre studier og er omdiskutert (6,7,9,(17)(18)(19). Nye studier viser at den tilsynelatende overdødeligheten etter brystbevarende kirurgi ikke er reell (9) og at mastektomi muligens har dårligst resultater (10).…”

Section: Lk-63unclassified

Brystkreftkirurgi i Norge 1986 – 2009

Hofvind¹,

Schlichting²,

Ursin³

et al. 2013

Tidsskriftet

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Breast conserving therapy versus mastectomy for stage I–II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial

Cited by 465 publications

References 25 publications

The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning

The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning

Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow

Brystkreftkirurgi i Norge 1986 – 2009

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