Interim Cosmetic and Toxicity Results From RAPID: A Randomized Trial of Accelerated Partial Breast Irradiation Using Three-Dimensional Conformal External Beam Radiation Therapy

Olivotto, Ivo A.; Whelan, Timothy J.; Parpia, Sameer; Kim, Do-Hoon; Berrang, Tanya; Truong, Pauline T.; Kong, Iwa; Cochrane, Brandy; Nichol, Alan; Roy, Isabelle; Germain, Isabelle; Akra, Mohamed; Reed, Melanie; Fyles, Anthony; Trotter, Theresa; Perera, Francisco; Beckham, Wayne; Levine, Mark; Julian, Jim A.

doi:10.1200/jco.2013.50.5511

Cited by 352 publications

(234 citation statements)

References 31 publications

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“…4 In each trial, roughly 90% or more of enrolled patients had T1, N0 and hormone-sensitive disease. Data from other large randomized phase 3 trials evaluating APBI, including the National Surgical Adjuvant Breast and Bowel Project B39/Radiation Therapy Oncology Group (RTOG) 0413 trial 5 and Randomized Trial of Accelerated Partial Breast Irradiation trials, 6 are pending.…”

Section: Resultsmentioning

confidence: 99%

“…Most important, the Randomized Trial of Accelerated Partial Breast Irradiation trial randomized 2135 patients to WBI or 3D-CRT APBI. 6 Although the IBTR risk has not yet been reported, cosmetic outcome, as assessed separately by patients, nurses, and physician panels, was consistently worse at 3 and 5 years in patients randomized to 3D-CRT APBI. 15 In contrast, the University Florence phase 3 trial reported that IMRT APBI resulted in improved physician-rated cosmetic outcome compared with WBI.…”

Section: Comment On External Beam Apbimentioning

confidence: 93%

See 1 more Smart Citation

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Correa

Harris

Leonardi

et al. 2017

Practical Radiation Oncology

518

342

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Section: Resultsmentioning

confidence: 99%

Section: Comment On External Beam Apbimentioning

confidence: 93%

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Correa

Harris

Leonardi

et al. 2017

Practical Radiation Oncology

518

342

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“…Twenty-one percent of patients treated with APBR using IMRT, 38.5 Gy in 3.85 Gy fractions twice daily, at the University of Michigan developed unacceptable adverse cosmesis, leading to early closure of the trial [23]. Excellent or good cosmesis was reported in 73%-82% of patients treated with APBR using 3D-CRT with various fractionation schedule [19,22,24,25].…”

Section: Discussionmentioning

confidence: 99%

A Novel Schedule of Accelerated Partial Breast Radiation Using Intensity Modulated Radiation Therapy in Elderly Patients: Survival and Toxicity Analysis of a Prospective Clinical Trial

Sayan

Wilson

Nelson

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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“…Some initial reports have showed acceptable cosmesis with external beam photon ABPI [50][51][52]. However, a multicenter randomized trial demonstrated increased rates of adverse cosmesis with external beam photon APBI compared with whole breast irradiation [53]. The APBI dose-fractionation regimen in that study remains the most commonly employed regimen in North America.…”

Section: Clinical Applications For Pbt In Breast Cancermentioning

confidence: 96%

Proton Therapy for Breast Cancer: Progress & Pitfalls

Corbin

Mutter

2018

Breast Cancer Manag.

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Practice points• Proton therapy is under investigation for early stage and locally advanced breast cancer.• Due to unique physical properties, proton therapy reduces the dose to the heart, lungs, skin, muscle, and bone and is therefore hypothesized to reduce side effects from treatment.• Proton therapy may also enable improved target coverage in some breast cancer patients.• Due to its highly conformal nature, proton therapy requires careful attention to target volume delineation and implementation of strategies to mitigate uncertainties in setup and delivery.• Proton therapy for breast cancer is rapidly evolving with improvements in techniques for treatment delivery and optimizing of dose and fractionation schedules.• Research is ongoing to determine whether proton therapy improves treatment outcomes and quality of life compared with conventional photon techniques.As the number of patients cured from breast cancer increases with improvements in multidisciplinary care, emphasis on reducing late toxicities of treatment has increased, in order to improve long-term quality of life. Proton beam therapy (PBT) is a form of radiotherapy that uses particles with unique physical properties that enable treatment delivery with minimal dose deposition beyond the treatment target. Therefore, PBT has emerged as an exciting radiotherapy modality for breast cancer due to the ability to minimize exposure to the heart, lungs, muscle, and bone. Herein, we review the rationale for PBT in breast cancer, potential clinical applications, and the available clinical data supporting its use. We also address some of the technical and logistical challenges and areas of ongoing research that will ultimately establish the role for PBT for breast cancer in the years ahead.First draft submitted: 5 January 2018; Accepted for publication: 13 March 2018; Published online: 13 April 2018Keywords: breast cancer • cardiotoxicity • heart • particle therapy • pencil-beam scanning • proton therapy • radiation therapyBreast cancer accounts for 30% of new cancer diagnoses in women [1]. Although breast cancer remains the second leading cause of cancer death among women, advances in detection and treatment have resulted in improved outcomes, with 5-year expected survival of 90% [1]. Radiation therapy (RT) is indicated in the management of the majority of women with breast cancer [2]. For early stage breast cancer, breast irradiation following lumpectomy is an essential component of breast conserving therapy, lowering the risk of recurrence and improving breast cancer specific survival [3,4]. Recently published clinical trials also support the oncologic value of regional nodal irradiation (RNI) in some women with high risk node negative or axillary nodal metastases [5,6]. In addition, women with locally advanced breast cancer benefit from RT to the chest wall and regional lymph nodes, delivered in the post mastectomy setting [7]. While RT is widely utilized and improves breast cancer treatment outcomes, RT is also associated with late effects including cardi...

show abstract

Interim Cosmetic and Toxicity Results From RAPID: A Randomized Trial of Accelerated Partial Breast Irradiation Using Three-Dimensional Conformal External Beam Radiation Therapy

Abstract: 3D-CRT APBI increased rates of adverse cosmesis and late radiation toxicity compared with standard WBI. Clinicians and patients are cautioned against the use of 3D-CRT APBI outside the context of a controlled trial.

Cited by 352 publications

References 31 publications

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

Accelerated Partial Breast Irradiation: Executive summary for the update of an ASTRO Evidence-Based Consensus Statement

A Novel Schedule of Accelerated Partial Breast Radiation Using Intensity Modulated Radiation Therapy in Elderly Patients: Survival and Toxicity Analysis of a Prospective Clinical Trial

Proton Therapy for Breast Cancer: Progress & Pitfalls

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