Dosimetry and Toxicity Outcomes in Patients Treated with Hypofractionated Regional Nodal Irradiation for Breast Cancer: What is the Best Dose-Volume Limit to Minimize Risks of Radiation Pneumonitis?

Schad, Michael D.; Richman, Adam H.; Diego, Emilia; McAuliffe, Priscilla F.; Johnson, R. R.; Steiman, Jennifer; Vargo, John A.; Beriwal, Sushil

doi:10.1016/j.prro.2022.10.007

Cited by 1 publication

(2 citation statements)

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“…Finally, the studies in the presented meta-analysis uniformly utilized conventional fractionation. There is increasing data suggesting the safety of transitioning to hypofractionation, but it remains unclear how incorporation of IMNI might impact heart and lung doses in the context of hypofractionation and alter these results 25–27 …”

Section: Discussionmentioning

confidence: 99%

“…There is increasing data suggesting the safety of transitioning to hypofractionation, but it remains unclear how incorporation of IMNI might impact heart and lung doses in the context of hypofractionation and alter these results. [25][26][27] There are important limitations beyond those aforementioned. The presented data do not include any individual patient level data.…”

Section: Toxicitymentioning

confidence: 99%

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Treatment of Internal Mammary Nodes is Associated With Improved Overall Survival in Breast Cancer

Shaikh,

Mulherkar,

Khasawneh

et al. 2023

American Journal of Clinical Oncology

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Introduction: The role of internal mammary nodal irradiation (IMNI) as a component of regional nodal radiotherapy is a controversial issue in breast radiation oncology with conflicting results presented in recent landmark trials. We thus created a meta-analysis of available data to better ascertain the potential benefit of IMNI. We hypothesize that with the increased power available within a meta-analysis, IMNI will prove to improve overall survival (OS) in breast cancer. Methods: Literature search was conducted for prospective studies comparing IMNI to no IMNI. Primary endpoint was OS and secondary endpoints included local recurrence, regional recurrence, disease-free survival (DFS), breast cancer mortality (BCM), distant metastasis-free survival (DMFS), grade 2+ skin toxicity, cardiac events, and pneumonitis events. Subgroup analyses were performed for tumor location (medial/central vs. lateral), and nodal status (pN+ vs. pN0). Fixed-effect model was used if there was no heterogeneity, random-effects model otherwise. Results: Four studies with a total of 5258 patients (IMNI: n=2592; control: n=2666) were included in the study. Pooled results showed IMNI significantly improved OS for all-comers (hazard ratio [HR]=0.89; 95% CI 0.81-0.97; P=0.008), as well as subgroups of pN+ with medial/central tumor location (HR=0.84; 95% CI 0.73-0.96; P=0.01) and pN+ with lateral tumor location (HR=0.87; 95% CI 0.77-0.99; P=0.04). There was no significant difference in OS for subgroups of pN0 and medial/central tumor location. There was no difference in local recurrence, but regional recurrence was significantly improved (P=0.04). Endpoints of DFS (HR 0.91, 95% CI 0.84-0.99 P=0.03), BCM (HR 0.87, 95% CI 0.77-0.98, P=0.03), and DMFS (HR=0.87; 95% CI, 0.78-0.98; P=0.02) were all improved with IMNI. Grade 2+ skin toxicity, cardiac events and pneumonitis events were not significantly different between patient in the IMNI and no IMNI groups. Conclusion: Inclusion of IMN irradiation improves OS, DFS, BCM, and DMFS in breast cancer. Largest effect on OS was noted in the subgroup of patients with pN+ and medial/central tumor location.

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Section: Discussionmentioning

confidence: 99%

Section: Toxicitymentioning

confidence: 99%