Implementation of image-guided intensity-modulated accelerated partial breast irradiation

Mészáros, Norbert; Major, Tibor; Stelczer, Gábor; Zaka, Zoltán; Mózsa, Emőke; Pukancsik, Dávid; Takácsi‐Nagy, Zoltán; Fodor, János; Polgár, Csaba

doi:10.1007/s00066-016-1074-9

Cited by 13 publications

(18 citation statements)

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“…To minimalize the treatment schedule from 3 to 7 weeks to 1 week or less is another advantage of APBI. These pathological findings and the clinical eagerness to abbreviate the course of breast radiotherapy and decrease the toxicity of normal tissues led to the investigation of efficacy and safety of APBI in prospective clinical trials [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. In these early studies, the inappropriate patient selection criteria, quality control, and target definition led to very high (25-37%) local relapse rates after 6-8 years [8,9].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Mészáros

Smanykó

Major

et al. 2020

Pathol. Oncol. Res.

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To report the implementation, dosimetric results of and early experiences with stereotactic accelerated partial breast irradiation (SAPBI) following breast conserving surgery (BCS) for postmenopausal low-risk St I-II invasive breast cancer (IBC) patients. Between November 2018 and August 2019, 27 patients were registered in our phase II prospective study. SAPBI was performed with Cyber-Knife (CK) M6 machine, in 4 daily fractions of 6.25 Gy to a total dose of 25 Gy. Respiratory movements were followed with implanted gold markers and Synchrony system. Corrections for patient displacement and respiratory movement during treatment were performed with the robotic arm. Early side effects, cosmetic results, and dosimetric parameters were assessed. The average volume of the surgical cavity, clinical target volume (CTV), and planning target volume (PTV_EVAL) were 8.1 cm 3 (range: 1.75-27.3 cm 3), 55.3 cm 3 (range: 26.2-103.5 cm 3), and 75.7 cm 3 (range: 40-135.4 cm 3), respectively. The mean value of the PTV_eval/whole breast volume ratio was 0.09 (range: 0.04-0.19). No grade 2 or worst acute side-effect was detected. Grade 1 (G1) erythema occurred in 6 (22.2%) patients, while G1 oedema was reported by 3 (11.1%) cases. G1 pain was observed in 1 (3.4%) patient. Cosmetic result were excellent in 17 (62.9%) and good in 10 (37.1%) patients. SAPBI with CK is a suitable and practicable technique for the delivery of APBI after BCS for low-risk, St. I-II. IBC. Our early findings are encouraging, CK-SAPBI performed with four daily fractions is convenient and perfectly tolerated by the patients.

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Section: Introductionmentioning

confidence: 99%

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Mészáros

Smanykó

Major

et al. 2020

Pathol. Oncol. Res.

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“…Patients may benefit in terms of lower mean whole heart doses with moderate HF using 3D-CRT and the accelerated partial breast irradiation technique (APBI) with an external beam or interstitial brahcytherapy. 64 , 65 , 66 , 67 Meszaros et al . demonstrated the reproducibility of image-guidance intensity modulated APBI and feasibility in terms of acute toxicity and the cosmetic outcome with a median follow up of 3.2 years.…”

Section: Resultsmentioning

confidence: 99%

“…demonstrated the reproducibility of image-guidance intensity modulated APBI and feasibility in terms of acute toxicity and the cosmetic outcome with a median follow up of 3.2 years. In a study, 55 % of the patients had cup size C and 21 % cup size ≥ D. 67 Investigators emphasised the necessity of image guidance prior to each radiation fraction to reduce the CTV to PTV margins. 67 …”

Section: Resultsmentioning

confidence: 99%

“…In a study, 55 % of the patients had cup size C and 21 % cup size ≥ D. 67 Investigators emphasised the necessity of image guidance prior to each radiation fraction to reduce the CTV to PTV margins. 67 …”

Section: Resultsmentioning

confidence: 99%

“… 66 , 92 A higher APBI-PTV/breast volume ratio most probably contributes to adverse acute and poor final cosmetic results. 67 Further clinical trials with longer follow-ups are needed in partial breast radiotherapy, especially in large-breasted woman, to confirm the clinical relevance.…”

Section: Discussionmentioning

confidence: 99%

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Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Ratoša

Jenko

Oblak

2018

Radiology and Oncology

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BackgroundBreast radiotherapy is an established adjuvant treatment after breast conserving surgery. One of the important individual factors affecting the final cosmetic outcome after radiation is breast size. The purpose of this review is to summarise the clinical toxicity profile of adjuvant radiotherapy in women with breasts of various sizes, and to evaluate the treatment planning studies comparing target coverage and dose to thoracic organs at risk in relation to breast size.ConclusionsInhomogeneity and excessive radiation dose (hot spots) in the planning of target volume as well as large volume of the breast per se, all contribute to a higher rate of acute adverse events and suboptimal final cosmetic outcome in adjuvant breast cancer radiotherapy, regardless of the fractionation schedule. Improved homogeneity leads to a lower rate of ≥ grade 2 toxicity and can be achieved with three-dimensional conformal or modulated radiotherapy techniques. There may be an association between body habitus (higher body mass index, bigger breast size, pendulous breast, and large chest wall separation) and a higher mean dose to the ipsilateral lung and whole heart. A combination of the technical innovations (i.e. the breath-hold technique, prone position with or without holding breath, lateral decubitus position, and thermoplastic bra), dose prescription (i.e. moderate hypofractionation), and irradiated volume (i.e. partial breast irradiation) should be tailored to every single patient in clinical practice to mitigate the risk of radiation adverse effects.

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Accelerated partial breast irradiation with 3-dimensional conformal and image-guided intensity-modulated radiotherapy following breast conserving surgery – 7-Year results of a phase II trial

et al. 2020

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Purpose To present the 7-year results of accelerated partial breast irradiation (APBI) using three-dimensional conformal (3D-CRT) and image-guided intensity-modulated radiotherapy (IG-IMRT) following breast-conserving surgery (BCS). Patients and methods Between 2006 and 2014, 104 patients were treated with APBI given by means of 3D-CRT using 3–5 non-coplanar, isocentric wedged fields, or IG-IMRT using kV-CBCT. The total dose of APBI was 36.9 Gy (9 × 4.1 Gy) using twice-a-day fractionation. Survival results, side effects and cosmetic results were assessed. Results At a median follow-up of 90 months three (2.9%) local recurrences, one (0.9%) regional recurrence and two (1.9%) distant metastases were observed. The 7-year local (LRFS), recurrence free survival was 98.9%. The 7-year disease-free (DFS), metastases free (MFS) and overall survival (OS) was 94.8%, 97.9% and 94.8%, respectively. Late side effects included G1 skin toxicity in 15 (14.4%), G1, G2, and G3 fibrosis in 26 (25%), 3 (2.9%) and 1 (0.9%) patients respectively. Asymptomatic (G1) fat necrosis occurred in 10 (9.6%) patients. No ≥ G2 or higher late side effects occurred with IMRT. The rate of excellent/good and fair/poor cosmetic results was 93.2% and 6.8%, respectively. Conclusion 7-year results of APBI with 3D-CRT and IG-IMRT are encouraging. Toxicity profile and local tumor control are comparable to other series using multicatheter interstitial brachytherapy. Therefore, these external beam APBI techniques are valid alternatives to whole breast irradiation and brachytherapy based APBI.

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Implementation of image-guided intensity-modulated accelerated partial breast irradiation

Cited by 13 publications

References 40 publications

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Implementation of Stereotactic Accelerated Partial Breast Irradiation Using Cyber-Knife – Technical Considerations and Early Experiences of a Phase II Clinical Study

Breast size impact on adjuvant radiotherapy adverse effects and dose parameters in treatment planning

Accelerated partial breast irradiation with 3-dimensional conformal and image-guided intensity-modulated radiotherapy following breast conserving surgery – 7-Year results of a phase II trial

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