Long-term cosmesis and toxicity following 3-dimensional conformal radiation therapy in the delivery of accelerated partial breast irradiation

Cosmetic Outcomes of a Phase 1 Dose Escalation Study of 5-Fraction Stereotactic Partial Breast Irradiation for Early Stage Breast Cancer

“…14 Similar rates of CTCAE or RTOG grade 1þ telangiectasia (17%-20%) and fat necrosis (0%-11%) have been reported in smaller trials of external beam APBI with wide ranges of fibrosis rates (3%-85%). 22,[39][40][41]43 Taken together, digital photography review as shown in our trial is likely less sensitive for detection of telangiectasia, fibrosis, and fat necrosis, and detection would likely improve with the incorporation of clinical findings and/or objective measurements.…”

“…Prior trials of external beam APBI assessing cosmetic subdomains have used varying scales and evaluated different subdomains, making comparisons across studies difficult. These included the use of RTOG, 19,39 CTCAE, 14,22,[40][41][42][43] and European Organization for Research and Treatment of Cancer 44 scales, as well as the use of a Multi-Skin-Center MC-750-B2 probe to objectively assess fibrosis in 1 study. 18 In a phase 2 trial of 158 patients at the University of Kentucky assessing once weekly 30 Gy/5 fractions (later amended to 28.5Gy/5 fractions) WBI, a similar 9 parameter Breast Cancer Treatment Outcome Scale subdomain scale was used, and they reported volume loss (28%), retraction (18%), and scarring (18%) as being the subdomains most frequently affecting cosmesis.…”

“…Other trials of external beam APBI have similarly reported low rates of CTCAE grade 1þ hyperpigmentation (3%-18%). 40,41,43,44 Although 9 distinct cosmetic subdomains were assessed in this trial, some subdomain scores may not be reliable via digital photography alone without physical examination correlation. When evaluating the Fleiss k scores at all time points, all subdomains reached significance except for telangiectasia.…”

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

“…29,36,37 However, other clinical series of APBI delivered with 3D-CRT or IMRT reported acceptable cosmetic outcomes. 9,[38][39][40][41][42][43][44][45] These conflicting studies raise the hypothesis that subtle variations in planning techniques and/or dose constraints may substantially modify the therapeutic ratio of EBRT-based APBI. [46][47][48] In light of ongoing research, particularly the National Surgical Adjuvant Breast and Bowel Project B-39/RTOG 0413 trial, 5 which has yet to report cosmetic outcomes for patients treated with 3D-CRT APBI, the task force opted not to make a specific recommendation either for or against the use of EBRT-based APBI at this time.…”

Effect of Low Magnetic Field on Dose Distribution in the Partial-Breast Irradiation

“…Many studies have shown the long-and short-term effectiveness of EBRT. 10,11) Recently, a commercial MR-IGRT system (ViewRay Ⓡ , ViewRay Inc., Cleveland, OH, USA) has been implemented in the clinic as a EBRT machine. The ViewRay Ⓡ system consists of an on-board MR imaging system with 0.35 T low magnetic field and a radiation therapy system with tri Co-60 sources.…”