Mild Lung Restriction in Breast Cancer Patients After Hypofractionated and Conventional Radiation Therapy: A 3-Year Follow-Up

Verbanck, Sylvia; Hanon, Shane; Schuermans, Daniël; Parijs, Hilde Van; Vinh-Hung, Vincent; Miedema, Geertje; Verellen, Dirk; Storme, Guy; Fontaine, Christel; Lamote, Jan; Ridder, Mark De; Vincken, Walter

doi:10.1016/j.ijrobp.2016.02.008

Cited by 21 publications

(18 citation statements)

References 26 publications

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“…That set of weights, which we call "penalty type 1," was chosen to represent the authors' practice for breast cancer when considered as low risk. The motivation stems from the legacy of studies that investigated the impact of breast radiotherapy on mortality [4][5][6][7][8][9][10][11][12][13]. A set of ordinal priorities was established assigning heart > lungs > CTV tumor bed > contralateral breast > CTV ipsilateral breast, which were then converted to the numerical weights.…”

Section: Methodsmentioning

confidence: 99%

“…Yet, despite a 67% reduction in local recurrence rates, the survival benefit for those patients treated with postoperative radiotherapy has been disproportionately modest [4]. There has been concern that local control is offset by an increased risk of heart, vascular, and lung toxicity [5][6][7][8][9][10][11][12][13][14]. For decades, one of the major challenges facing radiation oncologists has been to reduce the risk of toxicity without decreasing the chances of cancer control and survival [10].…”

Section: Introductionmentioning

confidence: 99%

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Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

et al. 2021

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Purpose The advantage of prone setup compared with supine for left-breast radiotherapy is controversial. We evaluate the dosimetric gain of prone setup and aim to identify predictors of the gain. Methods Left-sided breast cancer patients who had dual computed tomography (CT) planning in prone free breathing (FB) and supine deep inspiration breath-hold (DiBH) were retrospectively identified. Radiation doses to heart, lungs, breasts, and tumor bed were evaluated using the recently developed mean absolute dose deviation (MADD). MADD measures how widely the dose delivered to a structure deviates from a reference dose specified for the structure. A penalty score was computed for every treatment plan as a weighted sum of the MADDs normalized to the breast prescribed dose. Changes in penalty scores when switching from supine to prone were assessed by paired t-tests and by the number of patients with a reduction of the penalty score (i.e., gain). Robust linear regression and fractional polynomials were used to correlate patients’ characteristics and their respective penalty scores. Results Among 116 patients identified with dual CT planning, the prone setup, compared with supine, was associated with a dosimetric gain in 72 (62.1%, 95% CI: 52.6–70.9%). The most significant predictors of a gain with the prone setup were the breast depth prone/supine ratio (>1.6), breast depth difference (>31 mm), prone breast depth (>77 mm), and breast volume (>282 mL). Conclusion Prone compared with supine DiBH was associated with a dosimetric gain in 62.1% of our left-sided breast cancer patients. High pendulousness and moderately large breast predicted for the gain.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

et al. 2021

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“…Medical imaging was not implemented for lack of funding. Functional assessment was implemented under the form of five parallel modules: 1) echocardiographic evaluation under cardiologist guidance [ 13 ]; 2) pulmonary function test managed by the pneumology department [ 11 ]; 3) shoulder-arm physical evaluation managed by the physiotherapy unit [ 14 ]; 4) oncologist’s recording of clinical toxicities using the Late Effects Normal Tissues - Subjective, Objective, Management, Analytic (LENT-SOMA), and the Radiation Therapy Oncology Group (RTOG) scores [ 15 ]; and 5) patient-reported outcomes (PRO) as will be detailed in the next section. Analyses of the echocardiography, pulmonary function, physical evaluation, and clinician’s assessed toxicities limited to five-years curated data are on-going.…”

Section: Methodsmentioning

confidence: 99%

“…Previous reports of the trial have shown that tomotherapy improved the homogeneity of the dose to targets, decreased the dose to the heart and ipsilateral lung, and reduced the pooled all-grades lung-heart toxicity [ 10 ]. Subsequent analyses of the trial’s data established that lung function declined during the initial 3 months more markedly in the conventional radiotherapy arm and continued to decline thereafter [ 11 ]. Thus, at the very least, the trial already showed that lung toxicity is detectable early on and is affected by the choice of radiation technique.…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary-related patient-reported outcomes in a randomized clinical trial of radiation therapy for breast cancer

et al. 2021

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Background Long-term prospective patient-reported outcomes (PRO) after breast cancer adjuvant radiotherapy is scarce. TomoBreast compared conventional radiotherapy (CR) with tomotherapy (TT), on the hypothesis that TT might reduce lung-heart toxicity. Methods Among 123 women consenting to participate, 64 were randomized to CR, 59 to TT. CR delivered 50 Gy in 25 fractions/5 weeks to breast/chest wall and regional nodes if node-positive, with a sequential boost (16 Gy/8 fractions/1.6 weeks) after lumpectomy. TT delivered 42 Gy/15 fractions/3 weeks to breast/chest wall and regional nodes if node-positive, 51 Gy simultaneous-integrated-boost in patients with lumpectomy. PRO were assessed using the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30. PRO scores were converted into a symptom-free scale, 100 indicating a fully symptom-free score, 0 indicating total loss of freedom from symptom. Changes of PRO over time were analyzed using the linear mixed-effect model. Survival analysis computed time to > 10% PRO-deterioration. A post-hoc cardiorespiratory outcome was defined as deterioration in any of dyspnea, fatigue, physical functioning, or pain. Results At 10.4 years median follow-up, patients returned on average 9 questionnaires/patient, providing a total of 1139 PRO records. Item completeness was 96.6%. Missingness did not differ between the randomization arms. The PRO at baseline were below the nominal 100% symptom-free score, notably the mean fatigue-free score was 64.8% vs. 69.6%, pain-free was 75.4% vs. 75.3%, and dyspnea-free was 84.8% vs. 88.5%, in the TT vs. CR arm, respectively, although the differences were not significant. By mixed-effect modeling on early ≤2 years assessment, all three scores deteriorated, significantly for fatigue, P ≤ 0.01, without effect of randomization arm. By modeling on late assessment beyond 2 years, TT versus CR was not significantly associated with changes of fatigue-free or pain-free scores but was associated with a significant 8.9% improvement of freedom from dyspnea, P = 0.035. By survival analysis of the time to PRO deterioration, TT improved 10-year survival free of cardiorespiratory deterioration from 66.9% with CR to 84.5% with TT, P = 0.029. Conclusion Modern radiation therapy can significantly improve long-term PRO. Trial registration Trial registration number ClinicalTrials.govNCT00459628, April 12, 2007 prospectively.

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“…Reassuringly, the START trials’ data showed very low rates of ischemic heart disease and lung fibrosis (<2%) [ 28 ]. Even though reported rate may be higher when using modern diagnostic instruments due to increased detection of subclinical heart or lung disease, patients currently rarely develop cardiac or pulmonary toxicity symptoms that require medical intervention [ [31] , [32] , [33] ].…”

Section: Clinical Applicability Of Moderate Hypofractionationmentioning

confidence: 99%

The use of moderately hypofractionated post-operative radiation therapy for breast cancer in clinical practice: A critical review

Marta

Coles

Kaidar‐Person

et al. 2020

Critical Reviews in Oncology/Hematology

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Highlights Moderately hypofractionated radiation therapy (mHF-RT) for breast cancer patients is applied very variably in clinical practice worldwide. mHF-RT to the breast, chest wall (with or without breast reconstruction), and regional lymph nodes is a safe and effective alternative to conventionally fractionated regimens. The use of mHF-RT can help during health crises like the COVID-19 pandemic, to compensate the potential backlog of patients whose radiation therapy was delayed.

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Mild Lung Restriction in Breast Cancer Patients After Hypofractionated and Conventional Radiation Therapy: A 3-Year Follow-Up

Cited by 21 publications

References 26 publications

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis

Cardiopulmonary-related patient-reported outcomes in a randomized clinical trial of radiation therapy for breast cancer

The use of moderately hypofractionated post-operative radiation therapy for breast cancer in clinical practice: A critical review

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